Effects of 70% Isopropyl Alcohol, Plain NSS & Sterile Water

On Umbilical Cord Separation

Monina Hernandez Gesmundo, RN,RM,MAN(C)September 19, 2009

The First International Nursing Research Conference of the World Academy of Nursing Science

Kobe International Exhibition Hall, Kobe, Japan

Objective

To identify and compare the effects of using 70% Isopropyl Alcohol, Plain Normal Saline Solution & Sterile Water in the care of the newborn’s umbilical cord

Design

Prospective randomized controlled trial design

Setting

Postpartum ward of a tertiary-level government hospital in the Philippines

Study Participants

Sample size of thirty (n = 30) singleton, full-term newborns

roomed-in at the postpartum ward

of a tertiary-level government hospital

Sampling Design

Random assignment with ten (10) newborns in each of the 70% Isopropyl Alcohol, Plain NSS and Sterile Water group

Twenty-six (26) completed the study with nine (n = 9) in the Sterile Water group (Group A), eight (n = 8) in the Plain NSS group (Group B) and nine (n = 9) in the 70% Isopropyl Alcohol Group (Group C)

Bioethical Considerations

Principle of beneficencePrinciple of respect for human dignityInformed consentPrinciple of justice

Interventions

Mothers were taught to clean the newborn’s umbilical cord according cord care protocol

handwashing before cord care clean equipments use respective solutions proper direction of wiping done three times a day cord is exposed to air and allowed to dry

Interventions

Cord care was done daily until the cord fell-offA checklist of signs of infection was

accomplished daily both by the investigator and the mother during hospitalization, and by the mother upon discharge

Follow-up phone calls and home visit was done by the investigator to ascertain mother’s compliance to the cord care protocol and to assess the cord status

Main Outcome Measures

Length of cord separation time Maternal concerns with regard to the

state of their newborn’s cords and cord care treatment

Umbilical cord infectionCost of cord care

Data PresentationLength of Cord Separation Time (days)

Grouped Frequency Distribution of Length of Cord Separation Time 

Length of Cord Separation Time

(in days)

Sterile Water Plain NSS Isopropyl Alcohol

 freq

 %

 freq

 %

 freq

 %

Less than 5 days 1 11.1 1 12.5 0 0

5-15 days 8 88.9 7 87.5 9 100.0

More than 15 days 0 0 0 0 0 0

Total 9 100.0 8 100.0 9 100.0

Mean 7.11 days 6.50 days 9.56 days

Median 7.00 days 7.00 days 10.00 days

Length of Cord Separation Time (days)

7.116.5

9 .56

0123456789

10

Leng

th o

f Cor

d S

epar

atio

n Ti

me

(day

s)

Sterile W ater P lain NSS Isopropyl Alcohol

C ord C are Treatment

Mean of Length of C ord S eparation T ime According to C ord C are Treatment

Length of Cord Separation Time

Plain Normal Saline Solution had the shortest length of cord separation time with a mean of 6.50 days (S.D. = 1.85 days), followed by Sterile Water with a mean of 7.11 days (S.D. = 2.32 days).

70% Isopropyl Alcohol had the longest

length of cord separation time with a mean of 9.56 days (S.D. = 2.07days).

Signs of Cord Complication

0

0 .5

1

1 .5

2

F re q u e n c y

S te r ile W a te r P la in N S S Is o p ro p y l A lc o h o l

C o rd C a re T re a tm e n t

S ig n s o f C o rd C o m p lic a tio n O b s e rv e d a n d R e p o rte d b y M o th e rs A c c o rd in g to C o rd C a re T re a tm e n t

R e d n e s s Y e llo w is h D is c h a rg e R e d d is h D is c h a rg e B le e d in g F o u l O d o r

Maternal Concerns

15% of mothers reported signs of complications - redness at the base, reddish or yellowish discharge at the time of cord separation and mild odor.

There was no reported sign of bleeding from the cord.

Percentage of Mothers Who Observed Signs of Cord Complication

P e rc e n ta g e o f M o th e rs W h o O b s e rv e d S ig n s o f C o rd C o m p lic a tio n s

1 5 .4

8 4 .6

W ith O b s e rve d S ig ns o f C o m p lic a tio n

W i tho u t O b s e rve d S ig ns o f C o m p lic a tio ns

Umbilical Cord Infection

None of the newborns developed cord infection based on the assessment of both the investigator and the attending physician.

Cost of Cord Care

0 .0 5 4 0 .0 5 8

0 .0 8

00.01

0.020.030.040.050.060.07

0.08

M e a n o f C o s t o f C o rd C a re

S o lu tio n

C o rd C a re S o lu tio n

M e a n o f C o s t o f C o rd C a re S o lu tio n (in P h ilip p in e P e s o p e r M illilite r)

S terile W ater P la in NS S Is opropyl Alc ohol

Cost of Cord Care

Comparing the mean price per milliliter of the three solutions - Sterile Water is the cheapest cord care solution at PhP 0.054, followed by PNSS at PhP 0.058.

70% Isopropyl Alcohol is the most expensive

at PhP 0.080 per milliliter.

Results of Statistical AnalysisLength of Cord Separation Time

One-way Analysis of Variance (ANOVA) showed a statistically significant difference (significance level of p = 0.014, p < 0.05) in the length of cord separation time between the different cord care solutions.

Where is the difference?

Scheffe post hoc test results showed a

statistically significant difference(significance level of p= 0.022, p < .05) in the length of cord separation time between Plain Normal Saline Solution and 70% Isopropyl Alcohol.

Maternal Concerns

All mothers (100%) rated their newborn’s cord status and cord care treatments as walang problema (no perceived problem) despite reports of signs of cord complication.

Cost of Cord Care

There is no statistically significant difference between the cost of Sterile Water, Plain Normal Saline and 70% Isopropyl Alcohol (p = 0.613, p > 0.05).

Conclusion

The length of cord separation time is shortest in the Plain Normal Saline Solution Group and longest in the 70% Isopropyl Alcohol Group.

Signs of complication were noted in the different cord care treatment groups but none of the newborns developed cord infection.

Conclusion

This study supports literature that suggests cleaning with alcohol delays healing and drying of the umbilical stump (Cabalum, R., 1996; Dore, S. et al, 1998; WHO, 1999; Largo, J.M & Nafarete, M., 2000).

Conclusion

This study does not support the use of 70% Isopropyl Alcohol for newborn cord care.

Nurses, lead the way!

(End of Presentation)