2% aqueous vs alcohol-based chlorhexidine for skin antisepsis in VLBW neonates undergoing peripheral venipuncture: a non-inferiority trial

Objective To compare 2% aqueous chlorhexidine gluconate (AQC) vs. 2% chlorhexidine gluconate in 70% isopropyl alcohol (ALC) for pre-venipuncture skin antisepsis in very-low-birth-weight neonates (VLBW, birth-weight <1500 grams). Study design Double-blind, non-inferiority trial randomized 199 VLBW neonates, age 2–28 days, to receive pre-venipuncture skin preparation using single application of swabstick impregnated with AQC ( n = 99) or ALC ( n = 100). Skin clearance rate (percentage post-cleansing skin swabs with <15 bacterial colony forming units) with a 10% non-inferiority margin for AQC was primary outcome. Absolute and relative CFU reduction and adverse skin reactions were compared. Results AQC’s clearance was non-inferior to ALC (91% vs. 88%; 95% CI −6.6%, +12.4%). Median (interquartile range) absolute [61 (16, 110) vs. 63 (18, 100); p = 0.65] and relative [100% (97%, 100%) vs. 100% (99.7%, 100%); p = 0.20] CFU reductions were similar. Neither group experienced any adverse reactions. Conclusion AQC may provide non-inferior skin disinfection to ALC in VLBW neonates. Clinical Trial registration ClinicalTrials.gov NCT01270776.