Assessment of the use of chlorhexidine digluconate gel for cord care at Kangundo Level 4 Hospital

Abstract

Background: Sepsis continues to be an important cause of morbidity and mortality in neonates. One of the most important portals of entry for infections is the umbilical cord. Proper care of the cord can prevent many of these cases of sepsis and hence reduce neonatal mortality rates. In Kenya, the use of chlorhexidine digluconate (CHX) gel was introduced to scale in 2016 and received with mixed reactions in some hospitals with reports of medication errors and ineffectiveness being received. This study sought to find out the knowledge, practices and attitude on its use in Kangundo Level 4 hospital. Methods and materials: The study was carried out at Kangundo level 4 hospital between June and August 2019. It was a descriptive cross-sectional study with both quantitative and qualitative components. A questionnaire was used for the quantitative data collection while focus group discussions were held for the qualitative data collection. Ethical approval was sought prior to commencement of data collection. Results: A total of 19 clients and 24 healthcare workers were interviewed and two focus group discussions held. All the 19 clients had delivered in the hospital and only three were first-time mothers. Education on how to use chlorhexidine (CHX) was given to 16/19 (84%) of the clients interviewed. Duration of application varied among clients; 4 days 5/19 (26%), 7 days, 12/19 (64%) and until the stump falls off, 2/19 (10%). Twenty of the 24 HCWs (83%) interviewed advised the patients on cleaning the cord prior to application of CHX, frequency of application varied from OD 15/24 (62%), BD 3/24 (13%) and TID 6/24 (25%). Two FGDs were held for HCW; lack of training and clear instructions on how to use the gel as major contributors to ineffectiveness of CHX. Conclusion: There was poor understanding on the use of CHX among both clients and HCWs at Kangundo level 4 hospital. Cleaning of the stump prior to gel application is important to prevent accumulation of the dry gel and allow contact with the wound. There is need for training and development of a standard operating procedure on use of CHX.