Antiseptic use in the neonatal intensive care unit - a dilemma in clinical practice: An evidence based review

Table 1 Characteristics of topical antiseptic agents used in neonates (World Health Organization 2009)

Antiseptic agent	Mechanism of action	Advantages	Disadvantages	Preparations/compounds
Chlorhexidine	Disruption of cytoplasmic membranes	Broad spectrum antimicrobial activity	Non-sporicidal	0.25%, 0.5%, 1%, 2%, 4% - aqueous and alcohol based
	Denaturation of proteins	Kills yeasts	Not effective against mycobacteria
		Intermediate onset of action	Local dermatitis
		Activity not affected by organic material	Neurotoxicity
		Residual activity	Non-sporicidal
Alcohols	Damages cell membrane	Broad spectrum antimicrobial activity	Not active in presence of organic material	Ethanol, isopropyl alcohol, methanol
	Denaturation of proteins	Faster onset of action	No residual activity
			Skin reactions
			Systemic absorption
Iodine	Forms complexes with proteins and lipids	Broad spectrum antimicrobial activity	Skin irritation	10% povidone-iodine
	Impaired protein synthesis and alteration of cell membranes	Sporicidal	Systemic absorption with hypothyroidism
		Effective against mycobacteria
		Has some residual activity
Hexachlorophene	Inactivates essential enzyme systems	Good activity against gram positive, weak against gram negative	Residual activity	Currently not recommended for bathing neonates
			Neurotoxicity