Development of Alternative Procedures for Central Line Dressing Changes and Antimicrobial Bathing for Pediatric Patients Sensitive to Chlorhexidine and Betadine Using Hypochlorous Acid

Problem:

Encountering pediatric and infant patients who are sensitive to Chlorhexidine (CHG) and Betadine is becoming increasingly common. In addition to needing an alternative antimicrobial substance for skin cleansing when changing central line dressings, there has previously been no safe alternative for the recommended daily antimicrobial “bath” to help prevent Central-Line Associated Blood-Stream Infection (CLABSI).

Past Management:

Standard policy for children and most infants with a central line is a daily antimicrobial “bath” by wiping the patient’s body down with wipes impregnated with CHG. For central line dressing changes, the central-line dressing kit contains an antimicrobial disc and skin cleansing sponge—both containing CHG.

Use of CHG-containing products on the skin can lead to rashes and skin erosion ranging from mild to severe in patients sensitive to CHG. Betadine rinsed off with sterile NS or sterile Water is a common first alternative for cleansing skin around the central line, but this is not practical to use for the daily antimicrobial bath. Additionally, some children also have sensitivities to Betadine.

New Management:

Non-CHG-containing products are now utilized in following current practices to prevent CLABSI’s. Products that reduce the risk of Medical Adhesive Related Skin Injury (MARSI) are frequently combined with the non-CHG orders as the two seem to go hand-in-hand for many children.

Results:

A sterile liquid containing Hypochlorous acid has been employed as an appropriate and safe antimicrobial cleansing option for children and infants when CHG and/or Betadine use is contraindicated for known or suspected sensitivity.

Conclusions:
The hypochlorous acid product has been used with no reported or observed untoward effects on any patient in this pediatric setting.