looking for bath protocols

Gompers, BSN, RN · Apr 2, 2006

I was just wondering what everyone's doing as far as bathing their neonates. We are a level 3 with no current bathing protocol and unfortunately it has been known for some of our kids to not be bathed in 2wks which is totally disgusting. Personally I change linen every night that i work and make sure that my kids have had a good scrubby bath at least that week. I feel that if a bath is going to send them to heaven then they are on their way anyway and at least they will go clean. just wondered if you had any written policy or anything.

We were the opposite. People were very anal about daily baths, and they'd be scrubbing down a 23 weeker with baby soap every night! Or they'd be trying to clean every nook and cranny of a sick PPHN kid on nitric, because there was still vernix in the neck folds and it bugged the nurse.

So what we do is that we weigh, change linens, and resite leads/temp probes every evening or night. We also wash their faces, chests, and bottoms with plain water at least once a day. But as far as using baby bath - we switched to Cetaphil because it doesn't change the acid mantle of the baby's skin (which can lead to infection since the skin barrier is disturbed) and we only use it 3 times a week (Tues, Thurs, Sat) unless it's a big post-term chronic baby that is sweaty. We don't even use the Cetaphil on the micropreemies until they're a few weeks old. Tub baths only when umbilical cords are off and the baby is off the vent. Even those we try to limit to 1-2 times a week, as not to dry out the baby's skin. The parents know what days are bath days, and when they're nearing discharge, they start participating in the baths. We also tell them to only bathe 3 times a week at home, because any more than that can cause dry skin. It's better to bathe every other day, and keep the skin healthy - than to scrub down every day and have to use lotion because it's so dry.

It is an unwritten rule that PM and NOC shift does the daily weight, linen change, and bath if it's a bath day. We've never had a problem with babies NOT getting bathed, like I said it was always overbathing that we dealt with. Who wants their patient to be gooky and be laying on dirty linens? Yuck!!!

cathys01 · Apr 2, 2006

We currently do bath nights on Tues, Thurs, Sun. We also do weekly FOC/Length on Sundays. Night shift (7p-7a) does the bathing, and we have trouble getting a full staff on bath nights because nobody wants to do it. In addition to bath night, IV Fluid changes are also mostly done on night shift (supposed to be done by day staff, but they always manage to not fax TPN orders until it's too late to get the TPN on the unit before shift change).

It really is frustrating to arrive on the unit and get a four baby assignment with babies with PICCs or CVLs (sterile fluid changes) and find you have to do all four fluid changes and four baths/weights also.

We are getting ready to go to a twice weekly bath schedule and are "voting" to see what days it will be: either Mon/Thurs or Wed/Sat. Of course all of the "weekenders" (who get $10 more per hour) are voting for Mon/Thurs so that they will never have to do baths...I figure if they're getting paid an extra $1,480 a month, surely they can bathe their patients at least once a week!

NicuNightRN · Apr 2, 2006

We don't really have a protocol on bathing. A lot of the really little babies don't get a good bath until they are stable, which could be a week or more. We keep track of the baths on our kardex, and do them every 3 days or so. Last week we discovered a near term baby who hadn't had a bath in close to 2 weeks...there was so much dirt in her neck folds that her skin was starting to break down. Personally, I like giving baths, and if the baby is okay for a tub bath, I will give them a bath when I have them out to be weighed. At the very least, I change linens/clothing if in clothes, and wipe the baby down with plain water on a cloth.

Gompers, BSN, RN · Apr 2, 2006

I honestly don't get it. Where I work, we love bathing the kiddos!

NicuNightRN · Apr 2, 2006

I love bathing the kiddos, too, as do many of my fellow nightshifters...A few months back I was taking care of a set of twins, both of whom really needed baths, but I had a busy night and could only give one bath. When I gave report, I said that I'd bathed one of them, and that the nurse during the day could do the other one if she'd like, but if not I'd do it that night when I came back. The nurse actually told me she doesn't bathe babies!!! Needless to say (but I'll say it anyway)...I bathed the other twin that night.

dawngloves, BSN, RN · Apr 2, 2006

I know Newborn Nursery has a protocol. (Temp greater than 97.7 before bath, then back on warmer until at least 97.7 again.) But not us.I think we just use common sense and not worry about bathing a kid until stable, which is a real PITA when nothing is sticking to them!

We'll give a wipe down on a daily basis. Face, neck, diaper area. If they are stable a good soap up once a week.The old timers will get a tub bath once a week. Love it! Love to wrap them up afterward and comb their hair. :)

Pet peeve!! When no one cleans out the little girls labial folds!!! I'll find caked in Desetin and poop. So nasty!!! And yes! Clean and dry the fat kids necks!!! Can you say "yeast"?

Gompers, BSN, RN · Apr 2, 2006

I know Newborn Nursery has a protocol. (Temp greater than 97.7 before bath, then back on warmer until at least 97.7 again.) But not us.I think we just use common sense and not worry about bathing a kid until stable, which is a real PITA when nothing is sticking to them!
We'll give a wipe down on a daily basis. Face, neck, diaper area. If they are stable a good soap up once a week.The old timers will get a tub bath once a week. Love it! Love to wrap them up afterward and comb their hair. :)
Pet peeve!! When no one cleans out the little girls labial folds!!! I'll find caked in Desetin and poop. So nasty!!! And yes! Clean and dry the fat kids necks!!! Can you say "yeast"?

I agree about people avoiding the folds - I've seen some really yeasty necks and groins in my career!!! GROSS.

Even when the kids are on the vent, we still clean them up when possible. I can't imagine being a parent and seeing my baby laying there on the same dirty blanket for a week, with crusty junk on the lips, dirty old leads on the chest, yellow betadine stains from old sticks, etc. Maybe we're more anal than other units - but like I said, our problem was getting people to cut BACK on bathing! Some still do it every day despite our new protocol.

Chronic babies seem to sleep better after a bath. If they're a much older chronic (CGA > 2 months) we actually do sponge baths everyday and tub baths three times a week. We'll do an assessment around 9pm, give the baby a bath, change their linens, and then put them down for the night and don't wake them except for feedings or diaper changes if needed. The kids on continous feeds will sleep from 10pm-6am sometimes!

As far as feeder-growers go...what is better than bathing a little 4 or 5 pound baby, dressing them up in a little outfit, feeding them, and snuggling them? The shifts where I get to do that are the ones where I think, "My gosh, I can't believe I get paid to do this!"

To the original poster - is it that assignments are too busy to allow time for bathing? I can see that being an issue, though it only takes about 5 minutes to do a sponge bath and change a baby's linens. Maybe an inservice for the unit about bathing protocols is in order? You could mention the problems related to bathing too frequently (dry skin, disturbance in the normal pH of the skin, excessive stimulation) and too infrequently (yeast and bacterial infections, parental dissatisfaction with unit). I'd have a chat with your nurse manager about this issue.

Mimi2RN, ASN, RN · Apr 3, 2006

We bathe the babes every couple of days, when they are stable. We have the Johnsons baby bath stuff, or Neutrogena soap if we prefer. I like the soap best, the little ones smell so good afterwards. If you have a busy assignment, the bath can always be left till the next night, no hard and fast rule for us. Some of the big ones need a bath everyday, if we have time!

prmenrs, RN · Apr 3, 2006

Premies can feel very panicky and cry in the bath tub, so I use a baby blanket to "contain" them--they feel very secure and enjoy it. Just reach under the blanket to wash. They cry when you take them out until you get the dry blanket around them.

Also, you can keep the bath tub cleaner if you put it inside a plastic trash bag, then fill it w/water. Easier to disinfect afterwards.

We checked Johnson's baby bath w/litmus paper--it was a lot more neutral pH than regular soap, so we got rid of soap. When I fill the tub, I throw the little bottle of baby bath in there to warm up.

Nothing's more fun than giving an older premie his 1st tub bath w/parents looking on and taking pictures. The parents seem to realize that going home is getting closer!

jnsatc · Apr 3, 2006

Thanks for everyone's input. We do baths on the night shift, but we only have 2-3baby assignments, so i can't say that the baths aren't getting done because we are over worked. I think alot of people are afraid to bath a real sick kid, but like i said, if i'm going to die over a bath i want to go clean. We use Dove soap as a rule, have you found better things. I saw mentioned johnson's baby bath and cetaphil. We are starting to be told to bath with just plain water which I find totally disgusting. I'm convinced that with regular linen changes and bathing that our infection rates will decrease.

iceNICUnurse · Apr 3, 2006

We bathe our kids tvice a week. As soon as they are fairly stable the parents do the bathing. We only use plain water, no soap at all. Linen are changed as needed.

We have a very low infection rate. So we are happy with this policy.