Alternative to chlorhexidine and Betadine-based Skin Preparation and Bathing for Central Venous Access Devices and Left Ventricular Assist Devices in Infants and Pediatric Patients Sensitive to Standard Antimicrobial Solutions

Introduction: Encountering pediatric and infant patients who are sensitive to Chlorhexidine (CHG) and Betadine is becoming increasingly common. If the patient is sensitive to CHG and Betadine, there is no routine “next” alternative antimicrobial agent for cleansing the site. Neither is there a “go-to” alternative method for maintaining the standard of a daily antimicrobial bath for the patient with a central line of any kind to help prevent Central-Line Associated Blood-Stream Infections (CLABSI). A solution containing the natural antimicrobial preservative hypochlorous acid has proven to be a safe and effective practical alternative to meet both of these needs, and has proven safety in infants and children. Method: We describe our experience with patients over the past 4 years and counting using a pure hypochlorous acid  (HOCl) solution for dressing changes for Central Venous Access Devices (CVAD) and Left Ventricular Assist Devices (LVAD) patients. This solution is also used when applicable for bathing patients with central lines in a regional pediatric acute care facility. We have especially used the fibroblast-sparing HOCl solution when other products and medical adhesives have caused a dermatologic sensitivity reaction under sterile line dressings. Results and Conclusion: We present photographic evidence of improvement in skin condition for infants and children that illustrate the non-toxic and well-tolerated application of the HOCl solution for bathing as well as skin preparation during sterile dressing changes. Long-term use of the antimicrobially preserved hypochlorous acid solution for mechanical removal of microbes has shown no untoward effects when used for both CVAD/LVAD sites and for daily bathing.