Perspectives of Mothers and Healthcare Workers on the Implementation of Routine Chlorhexidine Gluconate Cleansing for Sepsis Prevention in a Neonatal Unit in Botswana

Background Neonatal sepsis remains a major cause of mortality globally, especially in low- and middle-income countries (LMICs), where overcrowding, understaffing, and limited infection prevention and control (IPC) capacity heighten the risk of healthcare-associated infections (HAIs). Routine whole-body chlorhexidine gluconate (CHG) cleansing is an increasingly used, low-cost strategy to reduce skin colonization and prevent sepsis in LMIC neonatal units. While safety and feasibility data for this practice are accumulating, little is known about how caregivers and healthcare workers (HCWs) understand and implement this practice. Methods We conducted a qualitative study in a 33-bed neonatal ward at a tertiary hospital in Botswana (March 2024–March 2025), where twice-weekly CHG cleansing for eligible infants (>24 hours old and >1 kg) had been implemented one year earlier. Semi-structured interviews were completed with mothers and HCWs to explore perceptions of HAIs, routine cleansing, and CHG use. Interviews were conducted in English or Setswana, transcribed, translated when necessary, and analyzed using a team-based rapid qualitative approach to identify themes across respondent groups. Results Twenty interviews were completed (10 mothers, 10 HCWs). Both mothers and HCWs described HAIs as frequent and severe. Mothers explained they had been taught how to prevent infection by HCWs and attributed transmission to not following IPC practices. HCWs highlighted persistent structural barriers to IPC—including staffing shortages, overcrowding, and shared equipment. CHG cleansing was widely perceived as beneficial; HCWs viewed CHG cleansing as addressing a prior “practice gap,” but expressed concern that CHG cleansing was withheld from those most vulnerable to HAIs (i.e. <1kg preterm neonates) due to exclusion criteria. Task-shifting of cleansing to mothers was acceptable given staff shortages, Mothers reported enhanced confidence, infant comfort, and meaningful participation in IPC through CHG cleansing. Some mothers expressed concerns about long-term safety, and desired clearer communication about the intervention from staff. Conclusions HCWs perceived CHG cleansing as valuable within a resource-constrained neonatal unit and mothers viewed cleansing as a meaningful caregiving role, supporting family-centered IPC. Strengthening caregiver education, supply reliability, and guidance for fragile infants will be essential to optimize implementation. Further research should evaluate fidelity and clinical impact of caregiver-performed CHG cleansing.