Effectiveness of the Topical Application of 4% Chlorhexidine on Umbilical Cord Bacterial Colonization – A Non-Randomized Control Study

Abstract

Newborns have the highest risk of death in the first 4 weeks of their life. Umbilical cord of a child is an important site for microorganism colonization and also forms a portal of entry for invasive pathogens. This study focuses on the bacterial colonization with 2 separate cord care regimens: dry cord and 4% chlorhexidine care group. This is a randomized control time-bound study conducted at a tertiary health care centre in Mangalore. A total of 144 newborns fulfilling the inclusion criteria were included and then divided randomly into two groups: dry cord care and 4% chlorhexidine. Two swabs were collected, baseline swab (swab 1) within 3 hours of birth and second swab (swab 2) at 120± 10 hours of birth and these samples were cultured for gram negative and positive organisms. Results were evaluvated with Chi-Square test. Out of 144 samples, in 115 showed no growth at the baseline and only 29 showed growth. In the dry cord care group, 38.9% showed growth of microorganism in comparison with chlorhexidine group which was 1.4% in swab 1 (baseline) and in swab 2, 87.5% in dry cord care group and 18.1% in chlrohexidine group in swab 2 respectively. It was observed that methicilin susceptible Staphylococcus aureus (MSSA) and methicillin resistant Staphylococcus aureus (MRSA) were the most common microorganisms isolated with others being Pseudomonas species, coagulase-negative Staphylococci (CoNS), Enterobacter species and Citrobacter species. Use of 4% chlorhexidine is effective in reducing colonization of bacteria and infection in comparison with dry cord care method. Therefore, decontamination of the umbilical cord with 4% of chlorhexidine should be recommended in a newborn child. However, both cord care methods did not lead to any infections.