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  • Clinical Research Article
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Efficacy and safety of three antiseptics for neonatal skin disinfection: a cohort study

Pediatric Research volume 97, pages 1943–1950 (2025)Cite this article

Abstract

Background

The choice of the ideal antiseptic is not only based on its efficacy but also on safety and skin-friendliness. There are no standard recommendations regarding ideal skin preparation in neonates.

Methods

This was a prospective cohort study to evaluate the efficacy of 3 antiseptics[10% Povidone Iodine(PI), 70% isopropyl alcohol(AL), 2% chlorhexidine in 70% alcohol(CHG-IPA)] in disinfecting the skin before venipuncture in term neonates as assessed by logarithmic reduction in skin bacterial colony counts post-application. Secondary objectives were to assess the changes in skin condition. Measurements were done pre-, post-antiseptic and 6–24 h (for residual effect) later. Fifty neonates were enrolled in each group.

Results

All three antiseptics caused a significant reduction in bacterial load post-application, but maximal efficacy [2.6(2.2–2.8)log reduction] and, maximal residual effect at 6–24 h was seen with CHG-IPA [2.4(2.2–2.6)log reduction]. The logarithmic reduction in colony counts from pre-intervention to 6–24 h later remained significant for all three groups [(PI, p-0.039; CHG-IPA, p–0.00; AL, p – 0.01)]. After an initial alteration in hydration, and skin condition score, there was a return to baseline after 6–24 h.

Conclusion(s)

2% CHG-IPA had better efficacy than AL or PI for skin antisepsis in term neonates. There was no significant change in skin integrity in all three groups.

Impact

  • All three antiseptics [2% chlorhexidine gluconate in 70% isopropyl alcohol(CHG + IPA), 10% Povidone Iodine(PI), and 70% isopropyl alcohol(AL)] cause significant reduction in bacterial colony counts.

  • CHG + IPA has the maximum efficacy as assessed by log reduction of bacterial colony counts with optimal residual effect favouring its usage in term neonates. The least efficacy is seen with 70% isopropyl alcohol.

  • All three antiseptics are skin-friendly and do not affect the skin integrity.

  • Future studies addressing the clinical outcomes and safety in preterm populations with these commonly used antiseptics should be done.

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Fig. 1
Fig. 2: Comparison of log colony counts between the groups.

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Data availability

The data that support the findings of this study are available from the corresponding author, U.D, upon reasonable request.

References

  1. The human skin microbiome | Nature Reviews Microbiology. https://www.nature.com/articles/nrmicro.2017.157.

  2. Garegrat, R. A., Banait, N., Pareek, P., Gupta, R. & Suryawanshi, P. National survey of routine bathing and antisepsis practices in neonatal intensive care units of India. J. Neonatol. 35, 209–213 (2021).

    Article  Google Scholar 

  3. Sathiyamurthy, S., Banerjee, J. & Godambe, S. V. Antiseptic use in the neonatal intensive care unit - a dilemma in clinical practice: An evidence based review. World J. Clin. Pediatr. 5, 159–171 (2016).

    Article  PubMed  PubMed Central  Google Scholar 

  4. Linder, N. et al. Topical iodine-containing antiseptics and subclinical hypothyroidism in preterm infants. J. Pediatr. 131, 434–439 (1997).

    Article  CAS  PubMed  Google Scholar 

  5. Helmi, M. A. M., Lai, N. M., Rostenberghe, H. V., Ayub, I. & Mading, E. Antiseptic solutions for skin preparation during central catheter insertion in neonates. Cochrane Database Syst. Rev. https://doi.org/10.1002/14651858.CD013841.pub2 (2023).

  6. Oranges, T., Dini, V. & Romanelli, M. Skin physiology of the neonate and infant: clinical implications. Adv. Wound Care 4, 587–595 (2015).

    Article  Google Scholar 

  7. Lund, C. H. & Osborne, J. W. Validity and reliability of the neonatal skin condition score. J. Obstet. Gynecol. Neonatal. Nurs. JOGNN 33, 320–327 (2004).

    Article  PubMed  Google Scholar 

  8. MoistureMeterSC - Skin Surface Hydration Meter. Delfin Technologies https://delfintech.com/products/moisturemetersc/.

  9. Horimukai, K. et al. Application of moisturizer to neonates prevents development of atopic dermatitis. J. Allergy Clin. Immunol. 134, 824–830.e6 (2014).

    Article  PubMed  Google Scholar 

  10. Alanen, E., Nuutinen, J., Nicklén, K., Lahtinen, T. & Mönkkönen, J. Measurement of hydration in the stratum corneum with the MoistureMeter and comparison with the Corneometer. Ski. Res. Technol. 10, 32–37 (2004).

    Article  Google Scholar 

  11. Monteiro Rodrigues, L., Fluhr, J. W. & the EEMCO Group. EEMCO guidance for the in vivo assessment of biomechanical properties of the human skin and its annexes: revisiting instrumentation and test modes. Ski. Pharmacol. Physiol. 33, 44–60 (2019).

    Article  Google Scholar 

  12. Gustin, J. et al. Use of an emollient‐containing diaper and pH‐buffered wipe regimen restores skin pH and reduces residual enzymatic activity. Pediatr. Dermatol. 37, 626–631 (2020).

    Article  PubMed  PubMed Central  Google Scholar 

  13. Gustin, J. et al. Improving newborn skin health: Effects of diaper care regimens on skin pH and erythema. Pediatr. Dermatol. 38, 768–774 (2021).

    Article  PubMed  PubMed Central  Google Scholar 

  14. Visscher, M. O., Carr, A. N. & Narendran, V. Premature infant skin barrier maturation: status at full-term corrected age. J. Perinatol. 41, 232–239 (2021).

    Article  CAS  PubMed  Google Scholar 

  15. HI-99181 Skin pH Meter. Hanna Instruments Ltd https://www.hannainstruments.co.uk/ph-meters/1839-skin-ph-meter.

  16. Faul, F., Erdfelder, E., Buchner, A. & Lang, A.-G. Statistical power analyses using G*Power 3.1: tests for correlation and regression analyses. Behav. Res. Methods 41, 1149–1160 (2009).

    Article  PubMed  Google Scholar 

  17. McCord, H., Fieldhouse, E. & El-Naggar, W. Current practices of antiseptic use in Canadian neonatal intensive care units. Am. J. Perinatol. 36, 141–147 (2019).

    Article  PubMed  Google Scholar 

  18. Tamma, P. D., Aucott, S. W. & Milstone, A. M. Chlorhexidine use in the neonatal intensive care unit: results from a national survey. Infect. Control Hosp. Epidemiol. 31, 846–849 (2010).

    Article  PubMed  PubMed Central  Google Scholar 

  19. Taylor, J. E., McDonald, S. J. & Tan, K. A survey of central venous catheter practices in Australian and New Zealand tertiary neonatal units. Aust. Crit. Care 27, 36–42 (2014).

    Article  PubMed  Google Scholar 

  20. Fraser, C. et al. Variation in infection prevention practices for peripherally inserted central venous catheters: A survey of neonatal units in England and Wales. PloS ONE 13, e0204894 (2018).

    Article  PubMed  PubMed Central  Google Scholar 

  21. Agathos, E., Kantyka, C. & Clarke, P. State of skin antiseptic choices in UK neonatal intensive care units in 2023. Arch. Dis. Child. Fetal Neonatal Ed. fetalneonatal-2024-326858 https://doi.org/10.1136/archdischild-2024-326858 (2024).

  22. Shah, D. & Tracy, M. Skin antisepsis survey in Australia-New Zealand neonatal nurseries. J. Paediatr. Child Health 49, 601–602 (2013).

    Article  PubMed  Google Scholar 

  23. Bagheri, I., Fallah, B., Dadgari, A., Farahani, A. S. & Salmani, N. A literature review of selection of appropriate antiseptics when inserting intravenous catheters in premature infants: the challenge in neonatal intensive care unit. J. Clin. Neonatol. 9, 162 (2020).

    Article  Google Scholar 

  24. Malathi, I., Millar, M. R., Leeming, J. P., Hedges, A. & Marlow, N. Skin disinfection in preterm infants. Arch. Dis. Child. 69, 312–316 (1993).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Nuntnarumit, P. & Sangsuksawang, N. A randomized controlled trial of 1% aqueous chlorhexidine gluconate compared with 10% povidone-iodine for topical antiseptic in neonates: effects on blood culture contamination rates. Infect. Control Hosp. Epidemiol. 34, 430–432 (2013).

    Article  PubMed  Google Scholar 

  26. Garland, J. S. et al. 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. 14, 510–516 (1995).

    Article  CAS  PubMed  Google Scholar 

  27. Reichel, M., Heisig, P., Kohlmann, T. & Kampf, G. Alcohols for skin antisepsis at clinically relevant skin sites. Antimicrob. Agents Chemother. 53, 4778–4782 (2009).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Hibbard, J. S. Analyses comparing the antimicrobial activity and safety of current antiseptic agents: a review. J. Infus. Nurs. 28, 194–207 (2005).

    Article  PubMed  Google Scholar 

  29. Garland, J. S. et al. A randomized trial comparing povidone-iodine to a chlorhexidine gluconate-impregnated dressing for prevention of central venous catheter infections in neonates. Pediatrics 107, 1431–1436 (2001).

    Article  CAS  PubMed  Google Scholar 

  30. Neri, I. et al. Chlorhexidine-induced chemical burns in very low birth weight infants. J. Pediatr. 191, 262–265.e2 (2017).

    Article  PubMed  Google Scholar 

  31. Mannan, K., Chow, P., Lissauer, T. & Godambe, S. Mistaken identity of skin cleansing solution leading to extensive chemical burns in an extremely preterm infant. Acta Paediatr. 96, 1536–1537 (2007).

    Article  CAS  PubMed  Google Scholar 

  32. Sharma, A. et al. Aqueous chlorhexidine 1% versus 2% for neonatal skin antisepsis: a randomised non-inferiority trial. Arch. Dis. Child. Fetal. Neonatal. Ed. 106, 643–648 (2021).

    Article  PubMed  Google Scholar 

  33. Chapman, A. K. et al. Absorption and tolerability of aqueous chlorhexidine gluconate used for skin antisepsis prior to catheter insertion in preterm neonates. J. Perinatol. 33, 768–771 (2013).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  34. Garland, J. S. et al. Pilot trial to compare tolerance of chlorhexidine gluconate to povidone-iodine antisepsis for central venous catheter placement in neonates. J. Perinatol. 29, 808–813 (2009).

    Article  CAS  PubMed  Google Scholar 

  35. Jain, A. et al. 2% aqueous vs alcohol-based chlorhexidine for skin antisepsis in VLBW neonates undergoing peripheral venipuncture: a non-inferiority trial. J. Perinatol. 42, 636–641 (2022).

    Article  CAS  PubMed  Google Scholar 

  36. Clarke, P. et al. 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. Arch. Dis. Child. Fetal. Neonatal. Ed. 109, 202–210 (2024).

    Article  PubMed  Google Scholar 

  37. Kieran, E. A. et al. 2% chlorhexidine-70% isopropyl alcohol versus 10% povidone-iodine for insertion site cleaning before central line insertion in preterm infants: a randomised trial. Arch. Dis. Child. Fetal Neonatal. Ed. 103, F101–F106 (2018).

    Article  PubMed  Google Scholar 

  38. McDonnell, G. & Russell, A. D. Antiseptics and disinfectants: activity, action, and resistance. Clin. Microbiol. Rev. 12, 147–179 (1999).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  39. Stefaniak, A. B. et al. International guidelines for the in vivo assessment of skin properties in non-clinical settings: part 1. pH. Ski. Res. Technol. 19, 59–68 (2013).

    Article  Google Scholar 

  40. du Plessis, J. et al. International guidelines for the in vivo assessment of skin properties in non-clinical settings: Part 2. transepidermal water loss and skin hydration. Ski. Res. Technol. 19, 265–278 (2013).

    Article  Google Scholar 

  41. Cartner, T. et al. Effect of different alcohols on stratum corneum kallikrein 5 and phospholipase A2 together with epidermal keratinocytes and skin irritation. Int. J. Cosmet. Sci. 39, 188–196 (2017).

    Article  CAS  PubMed  Google Scholar 

  42. Saha, A., Haque, M., Karmaker, S. & Mohanta, M. Antibacterial effects of some antiseptics and disinfectants. J. Life Earth Sci. 3, 19–21 (2009).

  43. Goad, N. & Gawkrodger, D. J. Ambient humidity and the skin: the impact of air humidity in healthy and diseased states. J. Eur. Acad. Dermatol. Venereol. JEADV 30, 1285–1294 (2016).

    Article  CAS  PubMed  Google Scholar 

  44. Marissen, J. et al. The delicate skin of preterm infants: barrier function, immune-microbiome interaction, and clinical implications. Neonatology 120, 295–307 (2023).

    Article  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Consultant Neonatologist, Milann hospital, Bangalore, India

    Madhu Jagalasar

  2. Department of Neonatology, Chettinad Hospital and Research Institute, Tamilnadu, India

    Kadiyala Meena & Giridhar Sethuraman

  3. Department of Microbiology, Chettinad Hospital and Research Institute, Tamilnadu, India

    Priyadarshini Shanmugam

  4. Department of Neonatology, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Puducherry, India

    Usha Devi

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  4. Priyadarshini Shanmugam
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Contributions

Conception/design of the research, G.S,U.D; Acquisition, analysis, or interpretation of the data, M.J, K.M,G.S,U.D; Interpretation of microbiological data: P.S; Initial Draft of the manuscript, K.M,M.J; Critical revision of the manuscript, G.S, U.D,P.S; and Supervision, G.S, U.D. All authors read and approved the final manuscript

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Correspondence to Usha Devi.

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Jagalasar, M., Meena, K., Sethuraman, G. et al. Efficacy and safety of three antiseptics for neonatal skin disinfection: a cohort study. Pediatr Res 97, 1943–1950 (2025). https://doi.org/10.1038/s41390-024-03706-2

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