As of 2022, the below information reflects outdated global consensus and guidance. For up-to-date guidance on umbilical cord care, including chlorhexidine, please visit the Umbilical Cord Care page.
Ensuring optimal cord care at birth and during the first week of life, including use of chlorhexidine, especially in settings having poor hygiene, is a crucial strategy to prevent life-threatening sepsis and cord infections and avert preventable neonatal deaths.
Chlorhexidine digluconate is a broad spectrum antiseptic that is available in a range of concentrations and has been safely used for over 40 years for a variety of health-related applications; but its specific use for umbilical cord care was uniquely tested in three clinical trials in Nepal, Bangladesh, and Pakistan, in the form of 7.1% chlorhexidine digluconate (CHX). Given the promising results of the trials, in 2013 the World Health Organization (WHO) added CHX to its Model List of Essential Medicines for Children; and in 2014 the WHO issued a new guideline on umbilical cord care, which included a formal recommendation on the use of chlorhexidine.
This webpage was developed by the Chlorhexidine Working Group (CWG) to help policy makers, program managers, and donors facilitate the introduction of 7.1% chlorhexidine digluconate into existing essential newborn care services in low- and middle-income countries. The document, From Research to Use: Saving Newborn Lives with Chlorhexidine for Umbilical Cord Care chronicles the history and accomplishments of the CWG. The webpage consists of three phases, Get Ready, Plan, and Execute, and is based on the experiences of the CWG partners in introducing chlorhexidine in various countries (see Guide to Implementing 7.1% chlorhexidine digluconate for umbilical cord care: Three phases to ensure sustainable implementation). Each phase is composed of activities that facilitate introduction and scale-up. The phases do not necessarily occur in a sequential manner; however, as some activities/components across the three phases may occur simultaneously while others are dependent upon the results of activities from a previous phase.
2.4M
Newborn lives are claimed every year across the world*
7%
Of the deaths are caused by sepsis and other infectious conditions of the newborn*
*Represents the most recent data available. Please visit our Newborn Numbers page and download the Excel spreadsheet to explore the data further
23%
Reduction in neonatal mortality when 7.1% chlorhexidine digluconate was used on the first day of life, as demonstrated by the clinical trials conducted in South Asia.
Successful program implementation requires the coordinated effort of the key stakeholders and alignment of policies and guidelines. The first step is to gain consensus through consultations with various key stakeholders in the public and private sectors. Further evidence for implementation may need to be generated if stakeholders believe that gaps in operational evidence exist. The final component of coordinating the effort is to align policies and guidelines for chlorhexidine implementation.

Resources
- CWG Tech Brief (English, français, Português)
- CWG Chlorhexidine Products and Uses in Healthcare (English, français, Português)
- UN Commission on Life-Saving Commodities for Women and Children Policy/Advocacy Toolkit
- Results of the randomized controlled trials in Nepal, Bangladesh, and Pakistan, and the meta-analysis of the three trials
- Chlorhexidine gel versus aqueous solution randomized noninferiority trial
- Chlorhexidine safety data
- Chlorhexidine for umbilical cord care: game-changer for newborn survival?
- DRC Technical Working Group structure and outline (français)
- DRC Résumé sur les évidences scientifiques de l’utilisation de la Chlorhexidine(CHX) digluconate 7.1% (français) [DRC scientific evidence presentation]
- Chlorhexidine for Umbilical Cord Care: Evidence Base and the Way Forward
- Umbilical cord-care practices in low- and middle-income countries: a systematic review
- Technical Report: Report on the Regional Meeting for Francophone West Africa on the use of Chlorhexidine for Umbilical Cord Care
- Modeling the potential impact of emerging innovations on achievement of Sustainable Development Goals related to maternal, newborn, and child health
- Safety and Impact of Chlorhexidine Antisepsis Interventions for Improving Neonatal Health in Developing Countries
- Efficacy of chlorhexidine application to umbilical cord on neonatal mortality in Pemba, Tanzania: a community-based randomized controlled trial
- Effectiveness of 4% chlorhexidine umbilical cord care on neonatal mortality in Southern Province, Zambia (ZamCAT): a cluster-randomised controlled trial
- Antiseptic brief (English, français, Português)
- Generic CHX PPT (English, français, Português)
- The Innovation Countdown Report 2030: Reimagining global health
Activity 2: Building Evidence for Implementation
- Madagascar formative research
- Ethiopia formative research
- Bangladesh operations research report and presentation
- Bangladesh product attribute study
- India (Uttar Pradesh) formative research results and end-to-end analysis
- Market research for 7.1% chlorhexidine digluconate: Kenya
- Market research for 7.1% chlorhexidine digluconate: Nigeria
- Health care providers’ perspectives regarding the use of chlorhexidine gel for cord care in neonates in rural Kenya: implications for scale-up
- Newborn cord care practices in Haiti
Activity 3: Aligning Policies and Guidelines
- CWG Country Guidance (English, français, Português)
- CWG Supplementary Country Guidance
- DRC Élaboration d’une politique nationale concernant l’introduction de la chlorhexidine à 7,1 % pour les soins du cordon ombilical (français) [DRC national policy development plan]
- Chlorhexidine Digluconate 7.1% Gel Press Release
The next phase should be to plan for initial implementation. Key components of implementation planning include: developing demand generation strategies, orientation and training of service providers, considering product manufacturing and distribution options, developing a monitoring and evaluation plan, and developing a financing strategy.
Resources
Component 1: Integrating Demand Generation
- Driving Demand for Chlorhexidine: a human-centered design toolkit for the development of demand generation materials
- Demand Generation Implementation Kit (I-Kit) for Underutilized, Life-Saving Commodities
- Madagascar flyer and poster for AroFoitra (Malagasy)
- Madagascar Resultats du pretest des materiels IEC pour AroFoitra (français) [results of the pretest of IEC materials for AroFoitra]
- Madagascar Stratégie de communication (français) [Madagascar communication strategy for AroFoitra]
Component 2: Orientation/Training
- Training materials for single-day application (from Nepal)
- How to use chlorhexidine for umbilical cord care (link to training video)
- Madagascar formation des agents de sante (français) [Madagascar health worker training materials]
- Cahier du formateur [trainer notebook]
- Carnet du participant [participant book]
- Madagascar job aid (Malagasy)
- Nepal job aid
- Sindh Province (Pakistan) training materials
- Aqueous solution (liquid) instructions for use
- How to apply chlorhexidine gel and solution: Instructions for use from Kenya
- Brief on correct use (English, français, Português)
- PATH Chlorhexidine Product Attribute Study (2008)
Component 3: Product Manufacturing and Distribution
- Chlorhexidine Market Sizing Tool (Utilizing User Estimates, Utilizing Market Size Estimates)
- CWG Production Strategy (English, français)
- CWG Procurement Guidance
- CWG List of manufacturers of 7.1% chlorhexidine digluconate for umbilical cord care
- Patient information leaflet
- Nepal Public Private Partnership Case Study
Component 4: Monitoring and Evaluation (M&E)
- CWG Performance Indicators
- Every Newborn Action Plan indicators (includes chlorhexidine)
- Demographics and Health Surveys (DHS) newborn module
- Lives Saved Tool (LiST)
- Demographic and Health Surveys (DHS) newborn module
The final phase is to execute the CHX implementation plan and continuously monitor how it is being implemented to determine if the desired outcomes are being achieved. Data from the initial phase of implementation should be disseminated to key stakeholders within the country. If the program is not being implemented as planned, corrective action should be taken. Ministries of Health or key stakeholders may wish to disseminate data about the progress of CHX implementation in their country through international conferences or publications to help other countries accelerate implementation of CHX.

- Chlorhexidine for umbilical cord care presentations at the Global Maternal Newborn Health Conference (October 2015):
- Introduction of Chlorhexidine in Sindh, Pakistan (MCHIP)
- Introduction de la Chlorhexidine Digluconate 7,1% dans les soins ombilicaux en RDC (MSH/SIAPS)
- Saving the Pair –Integrated Scale-up of Chlorhexidine and Misoprostol for Newborns and Mothers in Rural Madagascar (JSI Research and Training Institute)
- Institutionalizing Chlorhexidine Program and Maintaining Coverage Chlorhexidine Cord Care Program in Nepal (JSI Research and Training Institute)
- Nepal progress towards program sustainability (timeline)
- National Strategy For Scale-Up Of Chlorhexidine in Nigeria
- Chlorhexidine costed scale-up plan in Madagascar
- Guide to implementing 7.1% chlorhexidine digluconate for umbilical cord care: Three phases to ensure sustainable implementation
- Establishing Quality Product Supply of Chlorhexidine for Umbilical Cord Care
- Institutionalizing Chlorhexidine Program and Maintaining Coverage in Nepal
- Introduction de la chlorhexidine digluconate 7,1% dans les soins ombilicaux en RDC (français) [Introduction of 7.1% chlorhexidine digluconate for umbilical cord care in DRC]
- Saving the Pair: Integrated Scale-up of Chlorhexidine and Misoprostol in Rural Madagascar
- Timeline of Nepal progress towards CHX program sustainability
- From Research to Use: Saving Newborn Lives With Chlorhexidine for Umbilical Cord Care
The Chlorhexidine Working Group (CWG) is an international collaboration of organizations committed to advancing the use of 7.1% chlorhexidine digluconate (delivering 4% chlorhexidine) for umbilical cord care through advocacy and technical assistance. PATH serves as the Secretariat of the CWG.

- CWG Terms of Reference
- CWG Strategy Statement
- CWG Capacity Statement (English, Português)
Members include individuals representing:
- PATH [Secretariat]
- ayzh
- Bill & Melinda Gates Foundation
- Boston University
- Burnet Institute
- Centre for Infectious Disease Research in Zambia
- Clinton Health Access Initiative
- Drugfield Pharmaceuticals Ltd. (Nigeria)
- Duke University
- Global Health Action
- Jhpiego
- John Snow, Inc.
- Johns Hopkins Bloomberg School of Public Health
- Johnson & Johnson (USA)
- Lomus Pharmaceuticals Pvt. Ltd. (Nepal)
- Maternal and Child Survival Program
- Ministry of Health, DRC (Reproductive Health)
- Ministry of Health, Ethiopia (Maternal & Child Health)
- Ministry of Health, Kenya (Child & Adolescent Health)
- Ministry of Health, Liberia (Family Health)
- Ministry of Health, Malawi (Reproductive Health)
- Ministry of Health, Mozambique (Child Health)
- Promoting the Quality of Medicines/United States Pharmacopeia
- PSI
- Save the Children/Saving Newborn Lives
- SHOPS Plus/Abt Associates
- Systems for Improved Access to Pharmaceuticals and Services/Management Sciences for Health
- United Nations Children’s Fund
- United States Agency for International Development
- Universal Corporation Ltd. (Kenya)
- University of Illinois at Chicago
- University Research Corporation
- World Health Organization
Bangladesh:
- National Newborn Health Situation Analysis Report 2014
- End preventable child deaths by 2035: Bangladesh Call for Action
- Bangladesh chlorhexidine operations research study 2008-2009
- Impact of cord cleansing with chlorhexidine on neonatal mortality in rural Bangladesh a community based trial
- Chlorhexidine poster
Democratic Republic of the Congo:
- Chlorhexidine Introduction in the DRC
- Chlorhexidine working group structure in the DRC
- Chlorhexidine PowerPoint Presentation
India:
- Effect of 4% chlorhexidine on cord colonization among hospital and community births in India: a randomized controlled study
- Chlorhexidine end-to-end analysis focusing on Uttar Pradesh
- Results from chlorhexidine survey
Madagascar:
- Results of the pretest of IEC materials for the chlorhexidine program in Madagascar
- Chlorhexidine Formative Research Presentation
- Chlorhexidine Job Aid
- Chlorhexidine Flyer
- Chlorhexidine Poster
- Training toolkit for community health workers
- Saving the Pair –Integrated Scale-up of Chlorhexidine and Misoprostol for Newborns and Mothers in Rural Madagascar
- Chlorhexidine Scale-up Plan
- Chlorhexidine medical notice
- Chlorhexidine Flyer
- Study on umbilical cord care practices
- Communications Strategy
Nepal:
- Timeline of Nepal’s progress towards chlorhexidine program sustainability
- Institutionalizing Chlorhexidine Program and Maintaining Coverage – Chlorhexidine Cord Care Program in Nepal
- Chlorhexidine Introduction in Nepal
- Case Study
- USAID, JSI Nepal Case Study
- Innovation in reducing neonatal death using Chlorhexidine in Nepal- a case study
- Chlorhexidine cleansing of the umbilical cord in Nepal: leading by example and saving lives
- Study on cord care practices focus group discussion
- Semi-structured interview with mothers who recently gave birth
- Semi-structured interview with mother-in laws
- Study on cord care practices focus group discussion with mother in laws
- Semi-structured interview with cord cutting occupational groups
- Chlorhexidine poster
- Nepal chlorhexidine presentation
- Chlorhexidine navi care program
- Preliminary experience with chlorhexidine for cord care in Nepal
- Fighting newborn infection in rural Nepal
- Community trial of newborn skin and umbilical cord cleansing on neonatal mortality in Nepal
Nigeria:
- Nigeria Every Newborn Action Plan: A Plan to End Preventable Newborn Deaths in Nigeria
- National Strategy for Scale-up of Chlorhexidine in Nigeria
- Mame Ye Nigeria brochure
Pakistan: