Waterless Hand Cleansing with Chlorhexidine: a Novel Approach to Prevent Neonatal Deaths

Organization: 
The Research Foundation of the State University of New York
Organization Location: 
Buffalo, NY USA

The youngest of babies are the ones most likely to die, often from preventable infections. Handwashing can prevent infections in early childhood. The usual ways to promote handwashing with soap and water are failing - they do not change individuals' behaviors sufficient to impact health. An innovative but low-cost and low-technology solution, chlorhexidine for waterless hand cleansing, could yield dramatic improvements in hand cleansing among mothers and birth attendants, rather than the small changes that typically result from promotion of handwashing with water and soap. Chlorhexidine is portable and can be placed easily in child care areas for use by mothers and other family members, and in birth attendant kits. The waterless nature of chlorhexidine overcomes the critical lack of water availability and drainage inside homes, where births take place and neonates and mothers are often cocooned. Chlorhexidine cleansing can be performed safely and efficiently, lowering neonates' exposure to infection from family members and visitors, including young children who are least likely to wash hands but most likely to carry infections. In a rigorous cluster randomized controlled trial, we propose to evaluate the impact of promoting waterless hand cleansing with chlorhexidine on hand cleansing behavior of mothers, birth attendants, and others during the peripartum and neonatal periods. To inform future scaling up, we will assess the acceptability, barriers and motivators to chlorhexidine for hand cleansing. An evidence-based chlorhexidine hand cleansing intervention represents a robust low-technology solution to address the unconscionably high rates of preventable neonatal mortality worldwide.

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