Key Points
➤ Central line-associated bloodstream infections (CLABSIs) are among
the most frequent invasive infections in infants in the neonatal
intensive care unit (NICU) and contribute to substantial morbidity and
mortality.
Management
Table 1. Recommendations
1. NICU patients who are likely to benefit from use of chlorhexidine gluconate (CHG)
skin antisepsis for central venous catheter (CVC) insertion and maintenance:
• Skin antisepsis should occur for all infants in the NICU and optimally should be
performed with a CHG-containing product.
• For infants ≥8 weeks of age, 2% CHG in 70% alcohol should be used.
• For infants <8 weeks of age, the authors' clinical experience shows that a
CHG-containing product may be used safely. Additionally, the US Food and
Drug Administration (FDA) has stated that CHG may be "[used] with care in
premature infants or infants under 2 months of age."
• For infants born at <28 weeks' gestation, especially when ≤7 days of age, NICUs
may consider use of aqueous 2% CHG for skin antisepsis.
2. Frequency of CVC dressing changes in NICU infants:
• To reduce skin barrier breakdown and the risk for dislodgement of the CVC,
CVC dressings should be changed only if soiled, damp, or loose, regardless of
gestational age (and not according to a specific interval of time, e.g., every 7 days).
• The integrity of the CVC dressing should be inspected by designated healthcare
personnel (HCP) at least daily.
3. Use of CHG-impregnated sponges or other CHG-impregnated dressings in NICU
patients:
• CHG-impregnated dressings are associated with an increased risk of contact
dermatitis in NICU infants. Benefits have not been demonstrated in NICU
infants, and these products are not recommended by the authors.
• If other interventions have failed to reduce CLABSI in an infant in the NICU, or
if there is an increase in the NICU's baseline CLABSI rates, CHG-impregnated
dressings may be considered in infants ≥28 weeks' gestation and ≥7 days of age.
4. Use of alcohol disinfectant caps in the NICU:
• NICUs may consider use of disinfectant caps as an additional intervention to
reduce CLABSI rates when other interventions have failed.
