Background: 2% Chlorhexidine gluconate in a 70% alcohol solution is considered the gold standard for skin disinfection in adult and paediatric patients prior to insertion of a central venous catheter. The use of chlorhexidine gluconate in infants remains controversial due to concerns about potential risks of skin injury such as chemical burns, contact dermatitis and systemic absorption. The objective of this survey is to investigate the practice of skin disinfection with 2% chlorhexidine gluconate in 70% isopropyl alcohol prior to central venous catheterization in infants in Italy.

Methods: Over a one-year period, we conducted an online survey in 114 neonatal intensive care units on the use of skin antiseptics for central venous catheters in neonates.

Results: Sixty-five percent of the centers use a 2% chlorhexidine solution in a 70% alcohol solution for skin disinfection before inserting central catheters in neonates. Ten percent use povidone-iodine, and two percent use sodium hypochlorite. Among those using alcoholic chlorhexidine, sixty-five percent use it without any restrictions, thirty percent limit its use based on the gestational age of the neonate, and five percent limit it based on the neonatal weight. Thirty-seven percent of the centers rinse off the chlorhexidine solution due to concerns about chemical injuries.

Conclusions: The survey revealed that there’s still a lack of uniformity in the use of skin disinfectants before central catheter placement. The Neonatal Vascular Access Group (AVN GdS) of the Italian Society of Neonatology reiterates the use of 2% chlorhexidine in a 70% alcohol solution for skin disinfection before central catheter insertion, as recommended by recent guidelines. However, specific precautions must be taken to avoid complications.

D’Andrea V, Capasso A, Rodriguez-Perez C, Tota F, Mastroianni R, Prontera G, Barone G. The use of 2% chlorhexidine gluconate in 70% isopropyl alcohol for skin disinfection prior to central venous catheterization in infants: a national survey of the Italian Society of Neonatology. Ital J Pediatr. 2025 Jun 6;51(1):172. doi: 10.1186/s13052-025-02016-5. PMID: 40481592.