Incorrect Administration Of Antiseptic Agent Used In Umbilical Cord Care Leading To Eye Injuries, Warns WHO

Errors in the administration of an essential medicine used in umbilical cord care have led to severe eye injuries including blindness in nine sub-Saharan African countries, said the World Health Organization (WHO).

Available as a gel or aqueous solution, Chlorhexidine gluconate (CHX) is a broad-spectrum antiseptic applied to the umbilical cord stump to prevent infection and save lives.

Nearly 3 million newborns die every year across the world and almost 13% of these deaths are due to postpartum infections. Lack of hygiene and antiseptics at birth has led to an increase in the risk of deadly yet preventable infections. Several clinical trials have demonstrated that applying 7.1% of CHX to the umbilical cord prevented infections and newborn fatalities.

CHX has also been used to prevent skin infections and treat oral health conditions like gingivitis. It has also been used as a topical antiseptic agent to sanitize hands prior to performing medical procedures and clean injured or uninjured skin in preparation for surgery.

However, the WHO was informed of multiple reports of eye injuries and blindness associated with misadministration of this antiseptic.

"Clean, dry cord care is recommended for newborns born in health facilities, and at home in low neonatal mortality settings. Use of chlorhexidine in these situations may be considered only to replace the application of a harmful traditional substance such as cow dung to the cord stump," said the WHO.

Implications of administration errors of CHX

More than 40 cases of incorrect administration were reported and recorded in the literature or media reports since 2015. These eye injuries occurred when either liquid or ointment formulations of CHX were mistaken for eye drops or ointments.

The WHO’s recent alert has been issued to warn all stakeholders involved in the umbilical cord care programs about this potential administration error and the likelihood of serious eye injuries associated with the use of CHX.

Healthcare professionals, caregivers, and other professionals involved in the distribution, use, and administration of CHX have been urged to take all necessary measures and precautions to prevent misadministration.

National neonatal and reproductive health programs and regulators have been advised to assess all the products used in a newborn care package and select the optimal dosage form for CHX or modify the container in such a way that it will easily be distinguished from other medicines. They are also urged to update the product label with appropriate information pertaining to its safety and to develop more detailed instructions of the product to prevent misadministration and incorrect use.