As of 2022, the below information reflects outdated global consensus and guidance.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.

Umbilical Cord Care

Get Ready   |   Plan   |   Execute   |   About    |   Country Specific Resources

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.

Chlorhexidine Global Scale-Up Tracker

Dashboard Thumbnail
Click on the map to view the tracker

Over 25 countries are now moving toward implementation of chlorhexidine for umbilical cord care. The global scale-up tracker is a real-time, interactive dashboard that illustrates the global progress of chlorhexidine implementation and scale-up. Dashboard users can see a wealth of information regarding the current status of chlorhexidine engagement in these countries, including policy status, type of product used, location of use, regulatory status, and locations of local manufacture.

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.

Cautionary note

As with all medications, care must be taken to ensure that the product is used appropriately. 7.1% chlorhexidine digluconate for umbilical cord care should be kept out of eyes and ears and should be applied only to the umbilical stump.

In 2015, it came to the attention of the global Chlorhexidine Working Group (CWG) that 7.1% chlorhexidine digluconate aqueous solution (liquid) for umbilical cord care was mistakenly applied to the eyes of at least five children in Nigeria, causing eye injury.   Chlorhexidine has been in use for over 50 years and has a well–characterized safety profile when used as directed. The formulation of chlorhexidine digluconate used for cord care (7.1% w/v), when used as directed, is effective in preventing neonatal sepsis due to bacterial exposure through the fresh umbilical stump.  However, it can cause serious harm if applied to the eyes and should also not be put into the ear canal. It is important that persons and organizations responsible for chlorhexidine for umbilical cord care programs and for the distribution of the chlorhexidine for umbilical cord care product to caregivers ensure that instruction is provided on the appropriate use of the product, including appropriate warnings.

Memorandum: Safety Concerns Over Misuse of Chlorhexidine (CHX)

Alert No. 133: Chlorhexidine 7,1% digluconate (CHX): Reports of serious eye injury due to errors in administration

Get Ready

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.

Back to CHX HOMEPAGE

Resources

Activity 1: Gaining Consensus

Activity 2: Building Evidence for Implementation

Activity 3: Aligning Policies and Guidelines

Plan

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.

Back to CHX HOMEPAGE

Resources

Component 1: Integrating Demand Generation

Component 2: Orientation/Training

Component 3: Product Manufacturing and Distribution

Component 4: Monitoring and Evaluation (M&E)

Component 5: Financing 

Execute

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.

Back to CHX HOMEPAGE

About

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.

Back to CHX HOMEPAGE

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

Country Specific Resources

Bangladesh:

Democratic Republic of the Congo:

India:

Madagascar:

Nepal:

Nigeria:

Pakistan: 

RESOURCES

Safe Delivery App
List of Manufacturers of 7.1% Chlorhexidine Digluconate for umbilical Cord Care 2021
Effectiveness of social and behavioral change communication intervention to promote the use of 7.1% chlorhexidine for umbilical cord care in hard-to-reach rural Bangladesh: A mixed method study
View All Related Resources

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Photo of a health worker providing umbilical cord care to a newborn while the mother watches.
Retiring the Chlorhexidine Issue Page: An Update from the HNN Editorial Team
Bangladesh Photo Essay: Johnson & Johnson Improving Newborn Survival Project (INSP)
Bangladesh’s experience of Chlorhexidine utilized through a dropper bottle
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