153 - Comparative Efficacy of 0.5% Chlorhexidine and Aqua Beta-Iodine in Reducing Peripherally Inserted Central Catheter-related Infections in Neonates

Publication Number: 153.4162

YU CHING SHEN, Cathay general hospital, Taipei, Taipei, Taiwan (Republic of China); Wu-Shiun Hsieh, Department of Pediatrics Cathay General Hospital and Department of Pediatrics National Taiwan University College of Medicine, Taipei, Taiwan, Taipei City, Taipei, Taiwan (Republic of China); Yi-Li Hung, Cathay General Hospital, Taipei, Taipei, Taiwan (Republic of China); Chung-Min Shen, Cathay General Hospital, Taipei, Taipei, Taiwan (Republic of China)

Background: Preterm infants and neonates in Neonatal Intensive Care Unit often require prolonged intravenous nutrition and parenteral medications,making peripherally inserted central catheters(PICC) a common intervention.However,the immaturity of their immune systems increases the risk of PICC related infections.Aqua beta-iodine and 0.5% chlorhexidine are frequently used skin disinfectants;however, their efficacy in neonates has not been fully evaluated.

Objective: This study aimed to compare the efficacy of aqua beta-iodine and 0.5% chlorhexidine in neonates with PICC insertions by assessing their impact on catheter-related infection rates and skin reactions.

Design/Methods: This retrospective study was conducted in the NICU of Cathay General Hospital, Taipei,Taiwan, on neonates requiring PICC insertion between 2023 and 2024.PICC placement was indicated for long-term nutritional support,high-concentration infusions, and prolonged antibiotic use.In 2023, aqua beta-iodine then normal saline were used for disinfection, followed by weekly dressing changes.In 2024,0.5% chlorhexidine was applied for one-time disinfection,without weekly dressing changes.The distal 5 cm of the catheter was cultured after PICC removal.Skin injuries were assessed using a validated neonatal skin integrity tool.

Results: The study included 34 neonates: 27 preterm infants (15 in 2023, 12 in 2024) and 7 full-term infants (2 in 2023, 5 in 2024). There were no significant differences in average gestational age or birth weight between the groups. The average PICC indwelling time was 14.5±6.5 days (14±7 days in 2023 vs. 15±6 days in 2024). Reasons for PICC removal included infection (2023: n=8 vs. 2024: n=1), routine replacement (2023: n=4 vs. 2024: n=2), and treatment completion (2023: n=4 vs. 2024: n=13). In 2023, there were three cases of catheter dislodgement during disinfection. Infection rates were 47% in 2023 (8/17) and 5.8% in 2024 (1/17). Cultures identified Staphylococcus epidermidis (6), E. coli (1), and Enterobacter cloacae (1) in 2023, and Coagulase-negative Staphylococcus (1) in 2024. One preterm infant in 2023 had skin redness and swelling, while one full-term infant in 2024 developed suspected phlebitis due to improper catheter size; both cultures were negative.

Conclusion(s): This study suggests that 0.5% chlorhexidine significantly reduced catheter-related infection rates and eliminated the need for routine weekly PICC dressing changes, decreasing the incidence of catheter dislodgement. Large-scale, multicenter studies are necessary to confirm the efficacy of this practice in NICUs

Table 1. Demographic Data on 2023 (Aqua beta-iodine) Group and 2024 (0.5% Chlorhexidine) Group
The characteristics were similar in the 2023 and 2024 groups

Table 2. Indication and complication of PICC and Skin reaction in both groups
In 2023, there were three cases of catheter dislodgement during disinfection. Infection rates were 47% in 2023 (8/17) and 5.8% in 2024 (1/17). One preterm infant in 2023 had skin redness and swelling, while one full-term infant in 2024 developed suspected phlebitis due to improper catheter size; both cultures were negative.

Figure1. Comparison of PICC-Related Infection Rate and Catheter Dislodgement Rate
Peripherally inserted central catheter (PICC) infection rates were 47% in 2023 (8/17) and 5.8% in 2024 (1/17). Catheter dislodgement rates were 17% in 2023 (3/17) and 0% in 2024 (0/17).