neonatal hygeine and skin care guidelines

NebraskaRN · Apr 21, 2008

In my hospital a level 4 regional medical center NICU

We have protocols for skin care.

For babies that are out of heat and stable we can give them a bath and bath them as needed.

For extremely low birth weight infants we take precautions to maintain their skin, no EKG leads, tegasorb under anything stuck to the infant, iodine for cleaning the skin for blood or IV insertion and cleaning the iodine off right after done, z-flow pillows under their body, and careful sticking anything to them and moving them.

corks · Apr 21, 2008

Thanks for that. We don't use iodine because of the risk of thyroid dysfunction and use chlorohexidine,limiting contact time to 30 seconds and then wiping off with sterile water. We still use sterets (alcohol swabs) to cleanse the skin for cannula insertion but that concerns me as they contain 70% isopropyl alcohol. It's trying to strike that balance between infection control and maintenance of skin integrity. What do you use when bathing, for example baby bath or do you use plain water?

NebraskaRN · Apr 21, 2008

Thanks for that. We don't use iodine because of the risk of thyroid dysfunction and use chlorohexidine,limiting contact time to 30 seconds and then wiping off with sterile water. We still use sterets (alcohol swabs) to cleanse the skin for cannula insertion but that concerns me as they contain 70% isopropyl alcohol. It's trying to strike that balance between infection control and maintenance of skin integrity. What do you use when bathing, for example baby bath or do you use plain water?

We used to use chlorohexide now we only use it on any admission that is not a ELBW and wipe it off with sterile water, but we use iodine on the ELBW and wipe it off with sterile water due to the amount of chlorohexadine burns. We use plain water with a small amount of baby bath for bathing.

lvnurs9 · Apr 22, 2008

1. We use iodine and sterile water wipes to clean the skin prior to any invasive procedure.

2. Any baby less then 28 weeks corrected gets a sterile water squirt bath. Everyone else can be washed with soap.

3. We use leads on our micros, unless their skin is falling off...point is if they desat low enough, they won't perfuse their limbs enough to get a HR reading. We have little limb leads, though, and they fall off when saturated with water.

4. We use vigilon over breakdown areas as well.

BittyBabyGrower, MSN, RN · Apr 22, 2008

NANN has great skincare guidelines, that is what we used when we wrote up our protocols.

elizabells, BSN, RN · Apr 23, 2008

We're about to start trialling Chlorhex scrubs for PICC lines on all kids over 48 hours of age, regardless of birthweight. We use alcohol for all the regular sticks, don't wipe it off. We have NO protocol about baths, and I actually get a lot of nasty looks in the morning because I bathe kids less often than most. C'mon, they're laying around all day, how dirty can they be? Not the sweaty PPHN chronics, of course, but the regular kids. We don't use Aquaphor or anything else, reasoning being our docs think it increases infection rates. If parents want to bring in special bath stuff or lotion for the kids w/ decent skin, we'll use it. Otherwise we use the Johnson's Head to Toe. The really wee ones I usually just use water. We generally use the regular leads, unless the kid is so gelatinous they swell up the sticky part. We do have limb bands, but I've only seen them used maybe two or three times in the two years I've been on the unit.

The longer I'm on here, the more my unit's almost total lack of protocols is creeping me out. I know it's really upsetting to our travelers, too. I guess when you're sooooooo fancy you don't need silly things like standard practices. :banghead: