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!

[bagladyrn, RN]

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.

Just want to point out that you only "know" the patient's communicable disease status at the time the testing was done - usually at the first prenatal visit or early in the pregnancy for everything except Group B strep. You do NOT know their current status. It's always best to treat all with universal precautions when there is exposure to mom's body fluids, etc. on unwashed infant.

(This wasn't to you specifically - I keep seeing this as an assumption that we can "know" which patients are "safe"}

[Esnooopy, BSN, MSN, DNP, RN, NP]

of course, absolutely nothing should make one not use universal precautions. however, i don't think using a gown for every interaction with an unbathed (but already toweled off etc) infant necessarily falls under universal precautions. it's fine to wear one, but i would not think of on the same level with always wearing gloves while drawing blood, etc.

[bagladyrn, RN]

of course, absolutely nothing should make one not use universal precautions. however, i don't think using a gown for every interaction with an unbathed (but already toweled off etc) infant necessarily falls under universal precautions. it's fine to wear one, but i would not think of on the same level with always wearing gloves while drawing blood, etc.

When you pick up an infant do you hold it at arms length or do you cradle it in your arms or hold it up against your shoulder? If you hold the unwashed infant against you then you have now contaminated your scrub top and would then risk passing along any contaminant to any other infant you pick up in a similar manner throughout the shift.

[Esnooopy, BSN, MSN, DNP, RN, NP]

if i were just picking up a newborn infant in the hospital, their hair would be covered by a hat and their body would be swaddled. RNZeke pointed out, somewhere above in the thread, that the babies are stripped down for their assessments, which is a different story but in that case i wouldn't be cradling them, and i would be wearing gloves. in either case - and even if i were cradling an infant wearing nothing but a diaper - the "contaminants" to be worried about would be mostly the same ones for which patients would be put on contact isolation... certainly holding an unbathed (almost accidentally typed "unborn" - lol that's another story) infant without gowning up first wouldn't be a likely risk for HIV, even if the baby and/or mom were HIV+. your point about possibly spreading infection is valid, i'm just saying it covers organisms and precautions above and beyond *universal*.

[mugwump]

so just a little devils advocate what is diffrent between a baby not getting a bath and you holding the hand of your patient who maybe has HSV that just was in the bathroom scratching a leison did not wash their hands and is now holding yours (i guess my point is chances are very slim. I think there are a whole host of germs out there that we don't see and know about that can do just as much damage (but donlt) than a baby without a bath

[CEG]

There are plenty of reasons not to bathe- temperature regulation (leading to blood sugar problems, etc), bonding, breastfeeding, leaving vernix on the skin, and more. Reason to bathe-- so the staff does not have to glove and gown. Seriously-- I very often touch, hug, etc my patients and I have no way of knowing what they have on their skin and hands. How about mom that just held her unwashed baby. You bathe the baby but mom still has the "contaminants" on her but I have never seen anyone glove up to take mom's pulse or bp. "Just" having baby under the warmer has plenty of negative effects. We need to understand that less is more in OB.

[TexasCourgette]

Just want to point out that you only "know" the patient's communicable disease status at the time the testing was done - usually at the first prenatal visit or early in the pregnancy for everything except Group B strep. You do NOT know their current status. It's always best to treat all with universal precautions when there is exposure to mom's body fluids, etc. on unwashed infant.

(This wasn't to you specifically - I keep seeing this as an assumption that we can "know" which patients are "safe"}

At my hospital, we actually draw labs when we start their IV/saline lock (the IV/lock is recommended to everyone, even if they're having a drug-free birth, in the event of an unforeseen emergency) and test for these same things the day of delivery. If it's a fast labor or stat/emerg situation, we send the lab stat, so we know what we're potentially dealing with. I don't know if it's the same at any hospital, but just wanted to point out--at at least some facilities, there ARE safeguards in place to provide staff with the knowledge of disease development that the prenatal record may not reflect--and bath or not, every nurse I know uses gloves to touch baby, generally for the protection of the baby more than the nurse.

[doulamamaq]

Modern science and Western Medicine recognizes the benefits of vernix. A study regarding the significance of vernix was published in the American Journal of Obstetrics and Gynecology, 191 (6), 2090-2096, titled: Antimocrobial Properties of Amniotic Fluid and Vernix Caseosa are Similar to Those Found in Breast Milk. This study revealed that a number of immune substances were present in both amniotic fluid and vernix samples. Tests using antimicrobial growth inhibition essays show these substances are effective at deterring the growth of common perinatal pathogens-- group B. Streptococcus, K. pneumoniae, L. monocytogenes, C. albicans and E. coli.

[stephanie.]

Well, it is official... if it comes from a friend-of-a-friend, and of another friend...then, it is true. My friend's friend had a friend..and he was a great friend of a friend's friend.

Well it's official... If it comes from a random AN poster we shouldn't do it. Barf. Right?

People have the right to make their own choices without having to explain themselves. Whatever the reasoning, it's their reasoning.

Just like your barfalicious opinions are, well, yours.

Keep in mind that babies have been birthed for many, many years and I'm sure that up until this past half a century- a majority didn't get an immediate bath with antibacterial soap. I think our bodies -for the most part- know what their doing.

[M/B-RN]

To each their own, but I would want my baby squeaky clean! I want him/her to be able to be held and kissed by grandma and grandpa, comforted by the nurses when they make it cry, and not held like he/she is a grenade.

I agree that I'm happy to live in a place where we have choices, but I also think it's okay for some of us to think that not bathing a newborn is gross.

[L&Dnurse13]

I'm a l&d nurse and had a c/s at the hospital I work at 9 months ago. I refused for my son to go to the nursery or have a bath. There was no religious or cultural reason. Just a personal preference to allow him to transition to this cold, bright, noisy world before giving him a bath. He was with me warm and safe for 38 weeks and I wanted him to transition that way. He was held only briefly by his daddy and big sisters and no one else but me the first day. His first bath was at48 hrs old at home. The nurses just wore gloves when doing an assessment.

[ejp80]

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