SKIN DISINFECTION IN PRETERM INFANTS

Greater care and a more thorough approach to intravenous catheter site disinfection may be important for the prevention of catheter related sepsis, especially with coagulase negative staphylocci in preterm infa nts. The efficacy of skin disinfection was evaluated in preterm infant s using a skin swabbing technique after disinfectant exposure. In the first part of the study, 25 peripheral intravascular catheter sites we re quantitatively sampled immediately after routine cannula insertion. Bacterial counts greater than 100 colony forming units/cm2 were obser ved from 10 (40%) sites. In the second part, sampling for bacterial co lony counts was done after skin cleansing with various durations of ex posure of chlorhexidine/alcohol swabs or povidone iodine. The overall mean reduction in bacterial colony counts after skin cleansing ranged from 90-99%. Skin sterilisation was achieved in 33-92% of cases. The u se of two consecutive 10 second exposures resulted in a significantly improved reduction in colony counts compared with a single 10 second w ipe. A longer 30 second exposure also resulted in a greater reduction of bacterial numbers compared with a shorter duration of 5 or 10 secon ds. Repopulation of disinfected sites occurred within 48 hours. This e ffect was delayed by occluding the cleansed site with a semipermeable dressing. There were no significant differences between povidone iodin e and the chlorhexidine swabs in reducing bacterial numbers. This stud y has demonstrated that a brief exposure with a premoistened disinfect ant swab is not sufficient for complete elimination of resident skin f lora of newborn infants. The use of two consecutive cleanings, or a lo nger duration of cleansing is recommended for more effective skin ster ilisation.