nursing policy on handling infant that is not bathed

[kms6417]

We have recently been having more and more parents who request their newborn NOT to receive an admission bath and shampoo. Sometimes these infants are not bathed for their entire stay. We do follow universal precautions, but I am wondering if any other hospital has developed a policy on how to handle these infants. We are considering a crib tag that states "contact precautions". I work at a hospital with over 4000/deliveries a year. I appreciate anyone's input on how this situation is handled at your hospital. Thanks!

[Jory, MSN, APRN, CNM]

That's really interesting. Fully submerging in a tub is normal practice here. I have NEVER heard that it's inadvisable to submerge until the cord has fallen off.

You should, especially since there are documented cases of infants dying of infections stemming directly through the umbilical cord.

If it rehydrated, it can bleed, if it can bleed, then it is a portal for infection. If it is a portal for infection, it needs to be PROTECTED until COMPLETELY healed...and you know it's healed when the umbilical cord naturally falls off...no pulled, not tugged, not yanked off by some idiot pediatrician, naturally falls off.

I cannot believe that you were never taught to protect the cord.

[Jory, MSN, APRN, CNM]

I personally do not touch anyone without gloves, babies or moms. I even put them on to do a blood pressure.

I think that is a little extreme.

[Jory, MSN, APRN, CNM]

And on 99% of our patients, we know their HIV, Hepatitis, Herpes, other communicable disease status, so the "unknown" really is a non issue for us the vast majority of the time.

You don't know what Mom has contracted between the time of testing and delivery. You also need to know that some of the testing, it takes weeks for a test to reveal an infection.

If you consult with the CDC, it takes 25 days to THREE MONTHS for HIV to have enough antibodies to be detectable on a blood test.

HSV also takes several weeks to show up on a blood test.

Average time for Hep C to show up is 4 to 6 weeks.

So your unit really needs an in-service with infection control if you are relying on a very false sense of security.

The bath is for the STAFF, not the baby.

[melmarie23, MSN, RN]

You don't know what Mom has contracted between the time of testing and delivery. You also need to know that some of the testing, it takes weeks for a test to reveal an infection.

If you consult with the CDC, it takes 25 days to THREE MONTHS for HIV to have enough antibodies to be detectable on a blood test.

HSV also takes several weeks to show up on a blood test.

Average time for Hep C to show up is 4 to 6 weeks.

So your unit really needs an in-service with infection control if you are relying on a very false sense of security.

The bath is for the STAFF, not the baby.

We use universal precautions. I believe I said such in my original post, which you truncated. I know for whom the bath is for.

We too do tubbie baths (baby is submerged) and its never been an issue. Clearly my unit is pretty rogue by your standards though.

[olallie]

I've been an L&D RN for about 15 years and the reasons we delay bathing are these:

1) vernix is anti microbial, anti fungal, etc and protects skin from dryness, therefore lessening the chance of cracking and letting pathogens in

2) bathing can chill a baby and this can lead to bad feeds and hypothermia.

3) when a baby is born it has far fewer microbes on it than we PUT on them from bathing, and those microbes are the ones they are supposed to have: lady partsl flora. see Research Summaries for Normal Birth and Science & Sensibility » Unintended Consequences: Cesarean Section, The Gut Microbiota, and Child Health (amongst many). For example, c section babies are 50% more likely to become obese as adults! That's because they don't get colonised by the mother's lady partsl flora! see Caesarean section delivery may double risk of childhood obesity — BMJ

Then there is the matter of soaps, which can dry the skin, and the separation from the parents, etc etc. So, there are many reasons not to bathe. I wash the babies hair but forget trying to "wash off" vernix, you'd wash off tar easier than you wash off vernix and you should not be doing it anyways!

[olallie]

Also this notion that Johnson's Baby Shampoo is going to wash off bloodborne pathogens enough to make babies "safe" enough to handle without gloves - ha. We should always handle babies with gloves for BOTH our sakes. Nurses have THE GROSSEST germs on their hands most of the time, and there are times when we don't gel in and out, but if we do, then we'd kill anything we pick up from the babies anyhow. When we touch babies we give THEM far more than they give us.

[KYgirlRN]

We do immediate skin to skin for at least the first two hours. Our policy is to wait at least 6-8 hours for the first bath, or the first successful breastfeed if it takes longer. We generally do baths on postpartum in the crib and immediately move skin to skin for rewarming. The only babies bathed immediately after birth are HIV or hepatitis moms.

[NicuGal, MSN, RN]

Hm, you don't gel in and out and nurses have the grossest germs on their hands...boy that would make me feel good about being a patient in your hospital!

[TexRN, BSN, RN]

My son was not bathed for 9 days until his belly cord came off. The rationale behind it is that the vernix protects the baby's fragile skin and helps to create a bond when the mother can smell her baby.

Wait! Don't Wash That Newborn! | RaisingNaturalKids

[rnkaytee]

I took a class about 5 years ago and was told then that if the baby was "dunked" in its own tub (i.e. pink bucket) the risk for infection was the same as if you waited until the cord dried and fell off. I'll see if I can find the studies.