Randomized Controlled Trial Comparing Efficacy and Safety of 2% Chlorhexidine Gluconate in 70% Alcohol versus 10% Povidone Iodine in Performing Neonatal Blood Culture

Abstract

Background: Blood culture is the gold standard for diagnosis of septicemia, but it can be easily contaminated by microorganisms which colonize skin. Clear recommendations exist regarding suitable skin antiseptics in older children and adults but have not been established for neonates.

Objective: To evaluate the efficacy and safety of 2% chlorhexidine gluconate in 70% alcohol compared with 10% povidone iodine for performing of blood culture in neonates.

Methods: A prospective randomized controlled trial of neonates who were admitted to a Thammasat University Hospital, Thailand, from March to September 2016. 10% povidone iodine or 2% chlorhexidine gluconate in 70% alcohol was used as antiseptics at the time of blood culture sampling; blood cultures were taken by pediatric residents, general physicians, or nurses.

Results: General demographics for the 328 neonates enrolled were not significantly different: 2% chlorhexidine gluconate in 70% alcohol group (n = 164) and 10% povidone iodine group
(n = 164). Seven (2.13%) were contaminated with coagulase negative staphylococci. The overall blood culture contamination rates were not significantly different: (1.83% with chlorhexidinealcohol vs. 2.43% with povidone-iodine; P = 0.71; relative risk 0.75; (95%CI: 0.17-3.30). The risk difference of blood culture contamination was -0.61% (95% CI: -3.77-2.55), P = 0.70. No adverse skin reactions or systemic reactions were observed in antiseptic solution groups.

Conclusion: Both 2% chlorhexidine gluconate in 70% alcohol and 10% povidone iodine had similar efficacy in reducing blood culture contamination as they were well tolerated.