Evaluation of Antiseptic Use in Pediatric Surgical Units in the United Kingdom-Where Is the Evidence Base?

Aim Our aim was to conduct a survey of practice regarding skin preparation products for premature neonates (under 32 weeks gestation, below 1.5 kg) in the United Kingdom (UK) pediatric surgical units and to review the evidence on the safety and efficacy of the commonest skin preparation products used. Methods For the survey, following Cambridge University Hospitals NHS Foundation Trust's (Addenbrooke's Hospital) approval, the UK pediatric surgical units were contacted. Each unit was asked for both unit policy and individual consultant preference for skin preparation in infants. A structured literature search was performed using Medline and EMBASE. All study types investigating skin antisepsis with povidone iodine or chlorhexidine in neonates were included. Abstracts and non-English language articles were excluded. Target outcomes related to effectiveness and potential risks of the product. Results A total of 28 pediatric surgical units were surveyed. Overall, 14 units had a standardized policy, with 8 units using Betadine (Purdue Products L.P., Stamford, CT), 4 using alcoholic chlorhexidine, and 2 using aqueous chlorhexidine. A total of 34 articles fulfilled the criteria for inclusion. There is moderate quality evidence to support the efficacy of chlorhexidine over povidone iodine for preoperative skin antisepsis. There is evidence that povidone iodine can be absorbed, causing reactive hypothyroidism. Chlorhexidine can be absorbed but there is no evidence of this being significant. Both alcoholic and aqueous chlorhexidine can cause skin damage, including burns. Conclusion A majority of pediatric surgical units and individual surgeons use Betadine in premature and below 1.5 kg infants despite this being outside the product license. There is no ideal product choice based on current evidence but surgeons must be aware of the inherent risks and benefits of each product.