Article Title

The role of chlorhexidine in staphylococcal aureus prophylaxis


The use of routine anti-bacterial lotions for staphylococcus aureus (S.aureus) prophylaxis was introduced in the study setting in the 1970s to prevent skin infection in newborn infants. In 1981 the Australian College of Paediatrics recommended use of simpler measures (such as strict handwashing and reduced infant handling) to prevent cross infection with organisms such as S.aureus. However, unlike many Australian neonatal intensive care nurseries, practice remained unchanged in the study setting (the sole tertiary perinatal referral centre in Western Australia). A lack of empirical evidence to support this practice prompted this two-phase study. In Phase I, an Australia-wide survey of hospitals offering Level I, II and III neonatal care was undertaken to determine current practice regarding routine 'antistaphing' regimens and bathing procedures. Findings from this Phase I survey showed that prophylactic application of Chlorhexidine 1% was not practiced by any hospital other than the study setting. In Phase II, a quasi experimental study using an historical control group was undertaken to determine whether cessation of the standard prophylactic use of Chlorhexidine 1% would increase the incidence of S .aureus rates in newborn infants. Findings from Phase II showed no change in the incidence of staphylococcal aureus infections following cessation of this practice. These compelling findings, together with a lack of empirical evidence resulted in a review of the study setting's neonatal intensive care's manual titled 'Operational Instructions for the Management of Newborn Infants' and cessation of the routine practice of antistaphylococcal prophylaxis.



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