You may be aware that back in 2021 NPPG published a , endorsed by 天涯海角APP, on the use of chlorhexidine for skin cleansing in neonates. NPPG and 天涯海角APP are currently working on an updated version of this document, which we hope will be ready for publication in spring 2026.

The current version of the document recommends the use of a 0.5% aqueous chlorhexidine solution for skin cleansing in babies born prior to 34 weeks gestation and who are under 7 days chronologically. There is not currently a licensed 0.5% aqueous chlorhexidine solution available, and as a consequence unlicensed products are used. Information on available unlicensed products can be found on the . 

Supply problems with unlicensed 0.5% aqueous chlorhexidine solutions have occurred several times in recent years, requiring neonatal services to seek alternatives. There is currently insufficient evidence to suggest a single suitable alternative. The following products are suggested options, which should be assessed for suitability locally, considering the relative risks and benefits of each:

  1. Sterile sodium chloride 0.9%.
  2. 0.5% alcoholic chlorhexidine solution - available via NHS Supply Chain. An example product is shown here, but others are available, also via NHS Supply Chain. 
  3. 2% aqueous chlorhexidine solution - available via NHS Supply Chain. An example product is shown here, but others are available, also via NHS Supply Chain.  
  4. 2% aqueous chlorhexidine sponge - product information here.

The careful use of any product is essential to preventing skin damage and minimising the risk of burns. This includes:

  • Using a 鈥渄abbing鈥 rather than a 鈥渞ubbing" technique during application.
  • Avoiding pooling of the product on the skin by ensuring that excessive amounts are not applied. If decanting solution from a bottle to a tray/pot prior to a procedure, pour out the minimum amount required. 

As ever, where chlorhexidine is being used in neonates, caregivers should ensure that solutions do not "pool", as this increases the probability of chemical burns.

NPPG and 天涯海角APP are keen to collect intelligence on chemical burns associated with chlorhexidine use in neonates. We therefore ask that burns, or suspected burns are reported to the local neonatal ODN pharmacist, or in the absence of a pharmacist being in post, the ODN governance lead.