PMID- 35397873
OWN - NLM
STAT- MEDLINE
DCOM- 20220615
LR  - 20220615
IS  - 1531-5037 (Electronic)
IS  - 0022-3468 (Linking)
VI  - 57
IP  - 7
DP  - 2022 Jul
TI  - Optimizing skin antisepsis for neonatal surgery: A quality improvement 
      initiative.
PG  - 1235-1241
LID - S0022-3468(22)00200-7 [pii]
LID - 10.1016/j.jpedsurg.2022.02.027 [doi]
AB  - PURPOSE: Surgical site infections (SSIs) are a significant determinant of 
      morbidity in the Neonatal Intensive Care Unit (NICU). Chlorhexidine 
      gluconate/isopropyl alcohol (CHG-IPA) skin prep has demonstrated superiority over 
      Povidone-Iodine (PI) in preventing SSIs in adults, however FDA labeling 
      discourages CHG use in infants <2 months. This project aimed to i) create 
      evidence for safe CHG skin antisepsis in neonates; and ii) evaluate the safety 
      and effectiveness of CHG skin prep for neonatal surgery. METHODS: A literature 
      review was conducted to assess the safety and effectiveness of neonatal CHG skin 
      antisepsis. Following stakeholder engagement, a CHG surgical skin prep protocol 
      and validated neonatal skin integrity tool to assess prep-associated skin injury 
      were implemented in 50 consecutive, eligible neonates >/=1500 g and >/=34 weeks post 
      conceptual age undergoing abdominal or thoracic surgery. SSI rates were compared 
      to a matched, historical PI skin prep cohort. RESULTS: 2%CHG-70%IPA or 
      0.5%CHG-70%IPA were used based on gestational age cutoffs. None of the CHG 
      patients experienced adverse skin prep outcomes while 8% developed SSIs, compared 
      to 14% in the historical PI cohort. CONCLUSION: This project engaged NICU 
      stakeholders in quality improvement work and informed the implementation of a 
      safe and effective CHG skin prep protocol for neonatal surgery. LOE: IV.
CI  - Crown Copyright (c) 2022. Published by Elsevier Inc. All rights reserved.
FAU - Carr, Sophie
AU  - Carr S
AD  - Faculty of Medicine, University of British Columbia, Vancouver, Canada.
FAU - Gogal, Carmina
AU  - Gogal C
AD  - Clinical Care Analyst, Surgical Services and National Surgical Quality 
      Improvement Program, BC Children's Hospital, Vancouver, Canada.
FAU - Afshar, Kourosh
AU  - Afshar K
AD  - Department of Surgery, British Columbia Children's Hospital/Department of 
      Urologic Sciences, University of British Columbia, Vancouver, Canada.
FAU - Ting, Joseph
AU  - Ting J
AD  - Division of Neonatology, Department of Pediatrics, University of Alberta, 
      Edmonton, Canada.
FAU - Skarsgard, Erik
AU  - Skarsgard E
AD  - Department of Surgery, British Columbia Children's Hospital and the University of 
      British Columbia, Vancouver, Canada. Electronic address: eskarsgard@cw.bc.ca.
LA  - eng
PT  - Journal Article
PT  - Review
DEP - 20220313
PL  - United States
TA  - J Pediatr Surg
JT  - Journal of pediatric surgery
JID - 0052631
RN  - 0 (Anti-Infective Agents, Local)
RN  - 85H0HZU99M (Povidone-Iodine)
RN  - R4KO0DY52L (Chlorhexidine)
SB  - IM
MH  - Adult
MH  - *Anti-Infective Agents, Local/therapeutic use
MH  - Antisepsis/methods
MH  - Chlorhexidine/therapeutic use
MH  - Humans
MH  - Infant
MH  - Infant, Newborn
MH  - Povidone-Iodine/therapeutic use
MH  - Preoperative Care/methods
MH  - Quality Improvement
MH  - Skin
MH  - Surgical Wound Infection/prevention & control
OTO - NOTNLM
OT  - Chlorhexidine gluconate
OT  - Multidisciplinary quality improvement
OT  - Neonatal
OT  - Neonatal intensive care unit
OT  - Skin antisepsis
OT  - Surgical site infection
COIS- Declaration of Competing Interest The authors declare no competing interests.
EDAT- 2022/04/11 06:00
MHDA- 2022/06/16 06:00
CRDT- 2022/04/10 20:22
PHST- 2022/02/04 00:00 [received]
PHST- 2022/02/23 00:00 [accepted]
PHST- 2022/04/11 06:00 [pubmed]
PHST- 2022/06/16 06:00 [medline]
PHST- 2022/04/10 20:22 [entrez]
AID - S0022-3468(22)00200-7 [pii]
AID - 10.1016/j.jpedsurg.2022.02.027 [doi]
PST - ppublish
SO  - J Pediatr Surg. 2022 Jul;57(7):1235-1241. doi: 10.1016/j.jpedsurg.2022.02.027. 
      Epub 2022 Mar 13.