title: Chlorhexidine antisepsis significantly reduces the incidence of sepsis and septicemia during parenteral nutrition in surgical infants.
abstract: OBJECTIVE
  After a change in national policy, central venous catheter (CVC) antisepsis with chlorhexidine was introduced in our hospital. Our aim was to evaluate whether this change reduced the rate of infection seen during parenteral nutrition (PN) in infants requiring gastrointestinal surgery.
  
  
  METHODS
  Two groups of consecutive infants were compared: control, 98 infants who had CVC antisepsis with 70% isopropanol alone, and chlorhexidine, 112 infants who had CVC antisepsis with 2% chlorhexidine in 70% isopropanol. Incidence rates of sepsis (blood cultures taken) and septicemia (blood cultures positive) were compared by Poisson regression.
  
  
  RESULTS
  Seventy-one percent of infants experienced clinically suspected sepsis. The incidence of septicemia was 32%. The incidence rate ratio for sepsis was 0.72 (95% confidence interval, 0.61-0.84) for the chlorhexidine group vs control (P < .0005). The incidence rate ratio for septicemia was 0.49 (95% confidence interval, 0.36-0.67; P < .0005); that is, over a given period of PN, patients had half the rate of positive blood cultures after the introduction of chlorhexidine antisepsis compared with before.
  
  
  CONCLUSIONS
  (1) The incidence of sepsis and septicemia among surgical infants on PN for gastrointestinal anomalies is high. (2) Chlorhexidine CVC antisepsis has significantly reduced this incidence, and we advocate its use in this group of patients.
authors.affiliation: Surgery Unit, University College London Institute of Child Health and Great Ormond Street Hospital for Children, London WC1N 1EH, United Kingdom.
authors.forename: Mark
authors.initials: M
authors.lastname: Bishay
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Retrosi
authors.forename: Venetia
authors.initials: V
authors.lastname: Horn
authors.forename: Elaine
authors.initials: E
authors.lastname: Cloutman-Green
authors.forename: Kathryn
authors.initials: K
authors.lastname: Harris
authors.forename: Paolo
authors.initials: P
authors.lastname: De Coppi
authors.forename: Nigel
authors.initials: N
authors.lastname: Klein
authors.forename: Simon
authors.initials: S
authors.lastname: Eaton
authors.forename: Agostino
authors.initials: A
authors.lastname: Pierro
mesh_terms: D000985:Antisepsis / Q000379:methods; D016022:Case-Control Studies; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D002710:Chlorhexidine / Q000494:pharmacology*; D004202:Disinfectants / Q000494:pharmacology; D020345:Enterocolitis, Necrotizing / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D004866:Equipment Contamination / Q000517:prevention & control; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D053208:Kaplan-Meier Estimate; D008297:Male; D010288:Parenteral Nutrition / Q000009:adverse effects / Q000379:methods; D011182:Postoperative Care / Q000379:methods; D011183:Postoperative Complications / Q000517:prevention & control; D012016:Reference Values; D012189:Retrospective Studies; D018570:Risk Assessment; D018805:Sepsis / Q000453:epidemiology* / Q000517:prevention & control*; D015996:Survival Rate
chemical_list: D004202:Disinfectants; D002710:Chlorhexidine