chlorhexidine gluconate for skin cleansing in neonates

UK guidance has been published that aims to balance risks of neonatal infection due to inadequate skin antisepsis against those of skin injury due to inappropriate chlorhexidine use (1):

Use of chlorhexidine gluconate for skin cleansing prior to procedures in neonates is an important intervention to reduce the risk of infection in this vulnerable patient group

• note that neonatal skin reactions and burns secondary to chlorhexidine solution use are widely reported in the literature
  • factors which influence the risk of skin reactions include
    • the concentration of the chlorhexidine solution used;
    • whether the solution is in an aqueous or alcoholic base; and
    • application technique
  • pooling of excessive quantities of solution and prolonged contact time significantly increase the risk of burns occurring
• is limited evidence to inform the optimum approach to balancing the risk of infection against the risk of skin reactions in neonates. However, based on expert consensus opinion, the following is recommended:
  • 1. in babies born before 28 weeks' gestation and who are under 7 days old, use aqueous solutions of 0.5% chlorhexidine gluconate
  • 2. in babies born from 28 weeks' gestation onwards, and for those babies born before 28 weeks' gestation who are now 7 days or older, use a solution of 2% chlorhexidine gluconate in 70% isopropyl alcohol
  • 3. where available, chlorhexidine should be applied using a pre-filled applicator containing an appropriate quantity of solution, as this is likely to reduce pooling of excessive quantities of solution on the skin
  • 4. where pre-filled applicators are not available and the solution requires decanting from a bottle to a tray/pot prior to a procedure, pour out the minimum amount required
    • soak a sterile gauze in the chlorhexidine solution and ensure the gauze is thoroughly wrung out before applying to the skin
  • 5. Regardless of product used, employ a “dabbing” rather than a “rubbing technique during application

Notes:

• is not currently a licensed aqueous 0.5% chlorhexidine solution available in the UK
• chlorhexidine impregnated dressings should not be used in neonates as the resultant prolonged skin exposure to chlorhexidine increases the risk of burns

Reference:

1. Neonatal and Paediatric Pharmacists Group (NPPG) and British Association of Perinatal Medicine (BAPM) (2024) Chlorhexidine Position Statement: Skin cleansing for neonates prior to invasive procedures. Available at: nppg.org.uk (Accessed: 21 July 2026)