Evaluating the Use of Chlorhexidine Gel in the Management of Newborns' Umbilical Cord in the Greater Accra Regional Hospital

Abstract

Introduction: Good umbilical cord care is paramount in the reduction of incidences of neonatal tetanus and omphalitis. Various public health interventions have demonstrated effectiveness in reducing the incidence and fatalities from these infections. The use of chlorhexidine gel decreased the incidence of omphalitis by an appreciable 75% and reduced overall neonatal mortality by 26% as compared to dry cord care. Despite this, the uptake and application of the gel in the management of the umbilical cord are less known, especially in Ghana and other SSA countries. Objective: This study evaluated the use of chlorhexidine gel in managing the umbilical cords of newborns in the Greater Accra Regional Hospital. Methods: This study adopted an exploratory case study design to determine the use of chlorhexidine gel in newborns at Greater Accra Regional Hospital. A purposive sampling technique was used to identify and select the participants. The data were collected until saturation was attained. The study population, hence, comprised 8 midwives, 2 nurses, and 8 post-natal mothers. In-depth interviews were conducted by the principal investigator using an interview guide and audio-recorded with permission from the study participants. The audio recorded interviews were transcribed verbatim and analyzed using the ATLAS software. Thematic analysis was done, and quotations were used to illustrate the results. Results: All the midwives and nurses confirmed that Ridge Hospital has instituted guidelines and conducts workshops for the use of chlorhexidine gel which addresses the prevention of sepsis and other neonatal infections by advocating for a sterile procedure and providing details on the steps to follow in applying the gel. Also, on the comparison of the use of the Methylated spirit and Chlorhexidine gel, the midwives and nurses stated that the gel is the preferred method of cord care due to its antibacterial properties and reduced risk of infection, however, it has a slower drying time. In this regard, some post-natal mothers stated that they prefer the use of the spirit to the gel as the spirit makes the cord heal faster. Further, the majority of the care providers indicated that the use of methylated spirit has been phased out and replaced with Chlorhexidine gel as the primary method of cord care. While the benefits of the chlorhexidine gel over methylated spirit are well established as the gel contains antibiotics, which reduces the risk of infection in newborns, some post-natal mothers maintained that the use of the gel leads to cord infections. Other side effects with regards to the use of the gel as stated by both healthcare providers and post-natal mothers include; delayed cord drying off, cord stump, delayed cord fall off, and adverse reactions when the gel touches other parts of the baby. On the side of the midwives and nurses, they explained that cord infections resulting from the use of the gel arise from improper use of the gel and excessive gel application. Some symptoms of an infected umbilical cord as revealed by this study include redness and swelling, the base of the cord may also be warm to the touch a strong, unpleasant odour coming from the umbilical cord, and other discharges coming from the cord. Conclusion: There is a perception that the use of Chlorhexidine gel for cord care in the Greater Accra Regional Hospital in Ghana is an effective method of reducing the risk of neonatal infections. There are, however, some setbacks associated with the use of Chlorhexidine gel, such as delayed cord drying time and a higher rate of stumps, these are outweighed by its benefits in reducing the risk of infection. It is, therefore, recommended that the hospital consider educating mothers on the benefits of Chlorhexidine gel and the potential drawbacks to alleviate any concerns they may have. Additionally, continuous monitoring of the use of Chlorhexidine gel and evaluate its long-term effects on the health of newborns.