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Safety and Effect of Chlorhexidine Skin Cleansing on Skin Flora of Neonates in Bangladesh

Darmstadt, Gary L. MD, MS*; Hossain, M Monir MBBS, FCPS, MD; Choi, Yoonjoung DrPH*; Shirin, Mahfuza MBBS, FCPS; Mullany, Luke C. PhD*; Islam, Maksuda BA; Saha, Samir K. PhD

The Pediatric Infectious Disease Journal: June 2007 - Volume 26 - Issue 6 - p 492-495
doi: 10.1097/01.inf.0000261927.90189.88
Original Studies

Background: Chlorhexidine cleansing of newborn skin is a highly promising intervention for reducing neonatal mortality in developing countries, yet little is known of the mechanism of action. This study examined the impact of a single skin cleansing of hospitalized newborn infants in Bangladesh with baby wipes containing 0.25% chlorhexidine on both qualitative and quantitative skin flora.

Methods: Within 72 hours of birth, the skin of newborns admitted to Dhaka Shishu Hospital was wiped with baby wipes containing 0.25% chlorhexidine (n = 67) or placebo (n = 66) solution. Skin condition was assessed and skin swabs were taken from 3 sites (axillary, peri-umbilical, inguinal) at baseline and 2 hours, 24 hours, 3 days and 7 days after treatment. Skin flora was quantified and colonizing species were identified.

Findings: Skin cleansing with chlorhexidine had no adverse effects on skin condition, and resulted in minimal reduction (mean 0.5°C) in body temperature. Positive skin culture rates 2 hours after skin cleansing were approximately 35%–55% lower than the baseline rates for placebo and chlorhexidine groups at all 3 sites. For the chlorhexidine group, positive skin culture rates remained significantly lower than the baseline rates for 24 hours to 3 days, whereas for the placebo group, beyond the first 2-hour follow-up, these values were not lower than baseline in any of the 3 sites.

Interpretation: Chlorhexidine skin treatment produced more extended skin cleansing effects than the placebo treatment. It is possible that the quantitative and qualitative reductions observed in the skin flora might contribute to reducing neonatal infections.

Supplemental Digital Content is Available in the Text.

From the *Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD; Departments of †Neonatology and ‡Microbiology, Bangladesh Institute of Child Health, Dhaka Shishu Hospital, Dhaka, Bangladesh.

Accepted for publication February 16, 2007.

Address for correspondence: Gary L. Darmstadt, MD, MS, Department of International Health, E8153, Bloomberg School of Public Health, The Johns Hopkins University, 615 North Wolfe Street, Baltimore, MD 21205. E-mail:

© 2007 Lippincott Williams & Wilkins, Inc.