In the NICU, to prevent bloodstream infections during vascular access, which skin antiseptic is recommended?

• A. Iodine-based skin antiseptic
• B. 0.5% chlorhexidine gluconate with alcohol (often 2% with 70% alcohol)
• C. Alcohol alone
• D. Hydrogen peroxide

Answer: (B)

The main idea is that skin antisepsis for NICU vascular access should combine fast action with lasting protection on the skin. Chlorhexidine gluconate in alcohol provides both: the alcohol component acts rapidly to kill surface bacteria, and the chlorhexidine leaves a persistent antimicrobial film on the skin, reducing the risk of bloodstream infections during the time the line is in place. This pairing is preferred in neonates because it offers strong immediate efficacy plus ongoing protection, which is more effective than alcohol alone and avoids some drawbacks of iodine-based preparations (such as slower action and potential thyroid effects) and hydrogen peroxide (which can irritate tissue). In the NICU, using a low-concentration CHG in alcohol balances effectiveness with skin safety for vulnerable infants.