Effectiveness of Agent Disinfectant Prior to Intravenous Catheter Placement on Infection and Potential Adverse Effects Among Neonates: A Systematic Review
Abstract
Several disinfection agents have been proven to have controversial issues with neonates. These agents continue to be used to disinfect prior to the insertion of intravenous catheters, both peripheral and central venous catheters in neonatal care rooms. Objective to identify the effectiveness of disinfection agents used prior to intravenous catheter placement among neonates and the possible adverse events. A systematic review was conducted. Databases including Pubmed, Science Direct, Proquest, Ebscohost, Clinical Key Nursing, and Wiley were searched from inception to October 2024. The eligibility criteria were neonates who needed intravenous catheter placement (peripheral or central), with experimental research design, and articles written in English. The quality of studies was assessed depending on the study design. Our study is registered on PROSPERO number CRD42024618924. 1119 articles were found. After the screening processes, we finally included 7 articles. Disinfection agents frequently used in neonatal settings in the included studies were chlorhexidine (with varying concentrations), aqueous and alcohol-based, and povidone-iodine 10%. The disinfectant used prior to the insertion of the intravenous catheter was effective in reducing pathogen colonization on the skin and preventing bloodstream infection. Even so, there were some concerns regarding the adverse effects of the disinfectant agent used. The disinfection prior to invasive procedures in neonatal care is a debated topic. Despite this, inadequate disinfection poses more life-threatening due to the risk of bloodstream infection. Key factors to consider when choosing an appropriate topical agent disinfectant prior to intravenous catheter placement in neonates include gestational age, birth weight, and skin condition.
References
APSIC. (2015, March). APSIC Guide for Prevention of Central Line Associated Bloodstream Infections (CLABSI). Retrieved from https://apsic-apac.org/wp-content/uploads/2016/09/APSIC-CLABSI-guidelines-FINAL-20-Jan-2015.pdf
Beauman, S. S., & Swanson, A. (2006). Neonatal infusion therapy: Preventing complications and improving outcomes. Newborn and Infant Nursing Reviews, https://doi.org/10.1053/j.nainr.2006.09.001.
Bolormaa, E., Kang, C., Choe, Y. J., Heo, J. S., & Cho, H. (2023). Epidemiology of catheter-related bloodstream infections in neonatal intensive care units: A rapid systematic literature review. Korean J healthc assoc Infect Control Prev 28(1): 113-125, https://doi.org/10.14192/kjicp.2023.28.1.113.
CDC. (2024, Mar 19). Infection Control. Retrieved from Recommendations for Prevention and Control Infections in NICU Patients: CLABSI: Retrieved from https://www.cdc.gov/infection-control
CDC. (n.d.). Prevention of central line-associated bloodstream infections: Aseptic insertion and site selection. Retrieved from Centres for Diseases Coltrol and Prevention: https://www.cdc.gov/infection-control/media/pdfs/Strive-CLABSI103-508.pdf
Chapman, A., Aucott, S., Gilmore, M., Advani, S., Clarke, W., & Milstone, A. (2013). Absorption and tolerability of aqueous chlorhexidine gluconate used for skin antisepsis prior to catheter insertion in preterm neonates. Journal of Perinatology, doi: 10.1038/jp.2013.61.
Cho, H. J., & Cho, H.-K. (2019). Central line-associated bloodstream infections . Korean Journal Pediatric, 62(3), https://doi.org/10.3345/kjp.2018.07003.
Ciccia, M., Chakrokh, R., Molinazzi, D., Zanni, A., Farruggia, P., & Sandri, F. (2018). Skin antisepsis with 0.05% sodium hypochlorite before central venous catheter insertion in neonates: A 2-year single-center experience. American Journal of Infection Control, https://doi.org/10.1016/j/ajic.2017.08.012.
Clarke, P., Soe, A., Nichols, A., Harizaj, H., Webber, M. A., Linsell, L., . . . Health, P. T. (2023). 2% chlorhexidine gluconate aqueous versus 2% chlorhexidine gluconate in 70% isopropyl alcohol for skin disinfection prior to percutaneous central venous catheterisation: The ARCTIC randomised controlled feasibility trial. BMJ, doi: 10.1136/archdischild-2023-325871.
Donovan, E. F., Sparling, K., Lake, M. R., Narendran, V., Schibler, K., Haberman, B., . . . Meinzen-Derr, J. (2013). The investment case for preventing NICU-associated infections. American Journal of Perinatology, 30(3), doi:10.1055/s-0032-1322516.
Gardner, S. L. (2021). Merenstein & Gardner's Handbook of Neonatal Intensive Care, Ninth Edition. Elsevier.
Garland, J. S., Alex, C. P., Mueller, C. D., Otten, D., Shivpuri, C., Harris, M. C., . . . Maki, D. G. (2000). A randomized controlled trial comparing povidone-iodine to a chlorhexidine gluconate-impregnated dressing for prevention of central venous catheter infections in neonates. AAP, DOI: 10.15.42/peds.107.6.1431.
Garland, J. S., Alex, C., Uhing, M., Peterside, I., Rentz, A., & Harris, M. (2009). Pilot trial to compare tolerance of chlorhexidine gluconate to povidone-iodine antisepsis for central venous catheter placement in neonates. Journal of Perinatology, 808-813.
Garland, J. S., Buck, R. K., Maloney, P., Durkin, D. M., Toth-Llyod, S., Duffy, M., . . . Goldman, D. (1995). Comparison of 10% povidone iodine and 0,5% chlorhexidine gluconate for the prevention of peripheral intravenous catheter colonization in neonates: A prospective trial. Pediatr Infect Dis J, Vol. 14, no 6.
Helmi, M. A., Lai, N. M., Rostenberghe, H. V., Ayub, I., & Mading, E. (2023). Antiseptic solutions for skin preparation during central catheter insertion in neonates (Review). Cochrane Database of Systematic Reviews, DOI: 10.1002/14651858.CD013841.pub2.
Hewlett, A. L., & Rupp, M. E. (2012). New development in the intravascular catheter associated infections. Infect Dis Clin N Am 26 (2012) 1–11, doi:10.1016/j.idc.2011.09.002.
Jain, A., Deshpande, P., Yoon, E. W., Lee, K.-S., McGeer, A., & Shah, V. (2021). 2% aqueous vs alcohol-based chlorhexidine for skin antisepsis in VLBW neonates undergoing peripheral venipuncture: a non-inferiority trial. Journal of Perinatology, https://doi.org/10.1038/s41372-022-01337-1.
Janssen, L., Tostmann, A., Hopman, J., & KD, L. (2017). 0.2% chlorhexidine acetate as skin disinfectant prevents skin lesions in extremely preterm infants: a preliminary report. BMJ, http://dx.doi.org/10.1136/archdischild-2017-313150.
Johnson, J., Robinson, M., Rajput, U., Valvi, C., Kinikar, A., Parikh, T., . . . Manabe, Y. (2021). High burden of bloodstream infections associated with antimicrobial resistance and mortality in the neonatal intensive care unit in Pune, India. Clinical Infectious Diseases 73(2):271–80, DOI: 10.1093/cid/ciaa554.
Kalu, I. C., Curless, M. S., Ponnampalavanar, S., Milstone, A. M., & Kamar, A. A. (2023). Strategies to reduce hospital-associated bloodstream infections in a limited resource setting: Preventing Infections in neonates (PIN) collaborative. Antimicrobial Stewardship & Healthcare Epidemiology, 3, e144, 1–6, doi:10.1017/ash.2023.415.
Karen, B., & Steward, D. (2020). Chlorhexidine gluconate utilization for infection prevention in the NICU. Abstract. Advances in Neonatal Care, DOI: 10.1097/ANC.0000000000000658.
Kieran, E. A., O'Sullivan, A., Miletin, J., Twomey, A. R., Knowles, S. J., & O'Donnell, C. P. (2017). 2% chlorhexidine-70% isopropyl alcohol versus 10% povidone-iodine for insertion site cleaning before central line insertion in preterm infants: A randomised trial. BMJ, doi.10. 1136/archdischild-2016-312193.
Kucuker, H., Cakir, S. C., Koksal, N., Ozkan, H., Kocael, F., Dorum, B. A., . . . Hacimustafaoglu, M. (2023). A comparison of chlorhexidine and povidone-iodine solutions in neonatal intensive care units. Pediatrics International, DOI: 10.1111/ped.15552 .
MHRA. (2014, December 11). Chlorhexidine solutions: risk of chemical burn injury to skin in premature infants. Retrieved from GOV.UK: https://www.gov.uk/drug-safety-update/chlorhexidine-solutions-reminder-of-the-risk-of-chemical-burns-in-premature-infants
Myaneh, Z. T., Abdollahi, F., Harikandeie, S. S., & Kamipoor, Z. (2023). Chlorhexidine of povidone-iodine and alcohol: A pilot study for evaluating the incidence pf phlebitis in neonates. Journal of Neonatal Nursing, https://doi.org/10.16/j.jnn.2022.03.003.
NHSN. (2024, January). Central Line Insertion Practices (CLIP) Adherence Monitoring. Retrieved from https://www.cdc.gov/nhsn/PDFs/pscManual/5psc_CLIPcurrent.pdf
O'Grady, N. P., Alexander, M., Burns, L. A., Dellinger, E. P., Garland, J., Heard, S. O., . . . HICPAC. (2011). Summary of Recommendations from the Guidelines for the Prevention of Intravascular Catheter-Related Infections (2011). Retrieved from CDC Infection Control: https://www.cdc.gov/infection-control/hcp/intravascular-catheter-related-infections/summary-recommendations.html
Pengpis, P., Tangsathapornpong, A., Bunjoungmanee, P., & Prachukthum, S. (2020). Randomized controlled trial comparing efficacy and safety of 2% chlorhexidine gluconate in 70% alcohol versus 10% povidone iodine in performing neonatal blood culture. Thammasat Medical Journal , Vol. 20 No. 1 January - March 2020.
Prasanna, S., & Lakshmanan, R. (2016). Characteristics, Uses and Side effects of Chlorhexidine- A Review. IOSR Journal of Dental and Medical Sciences, 15(6), DOI: 10.9790/0853-1506035759 .
Sadowska-Krawczenko, I., Jankowska, A., & Kurylak, A. (2012). Healthcare-associated infections in a neonatal intensive care unit. Clinical research, DOI: 10.5114/aoms.2012.31412.
Sathiyamurthy, S., Banerjee, J., & Godambe, S. V. (2016). Antiseptic use in the neonatal intensive care unit - a dilemma in clinical practice: An evidence based review. World Journal of Clinical Pediatrics, DOI: 10.5409/wjcp.v5.i2.159.
Sharma, A., Kulkarni, S., Thukral, A., Sankar, M. J., Agarwal, R., Deodari, A., . . . Bajpal, M. (2021). Aqueous chlorhexidine 1% versus 2% for neonatal skin antisepsis: A randomised non-inferiority trial. BMJ, http:/dx.doi.org/10.1136/archdischild-2020-321174.
WHO. (2009, Januari 15). WHO guidelines on hand hygiene in health care. Retrieved from World Health Organization: https://www.who.int/publications/i/item/9789241597906
Xu, H., Zhu, M., Xu, S., & Bian, L. (2024). Improving central venous catheter care with chlorhexidine gluconate dressings: Evidence from a systematic review and Meta-analysis. Journal of Health, Population and Nutrition 43, 177, https://doi.org/10.1186/s41043-024-00672-7.
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