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Patient Care Services / Nursing

Newborn Cord Care is Clean Cord Care asEffective as Antiseptic Agents in PreventingInfection and Decreasing Cord Separation Time?Jaclynn Carl BSN, RNLehigh Valley Health Network

Amy Hess BSN, RNLehigh Valley Health Network

Felicia Mazzoni BSN, RNLehigh Valley Health Network

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Published In/Presented AtCarl, J., Hess, A., Mazzoni, F. (2014, June 5). Newborn Cord Care is Clean Cord Care as Effective as Antiseptic Agents in PreventingInfection and Decreasing Cord Separation Separation Time? Poster presented at: LVHN UHC/AACN Nurse Residency ProgramGraduation, Lehigh Valley Health Network, Allentown, PA.Carl, J., Hess, A., Mazzoni, F. (2015). Newborn Cord Care is Clean Cord Care as Effective as Antiseptic Agents in Preventing Infection andDecreasing Cord Separation Separation Time? Poster presented: Lehigh Valley Health Network Publicatoin Magnet Attractions.

NEWBORN CORD CARE: IS CLEAN CORD CARE AS EFFECTIVE AS ANTISEPTIC AGENTS IN PREVENTING INFECTION

AND DECREASING CORD SEPARATION TIME?

Mother/ Baby Unit:

Felicia Mazzoni, BSN, RN

Jaclynn Carl, BSN, RN

Amy Hess, BSN, RN

BACKGROUND/SIGNIFICANCE

• Different strategies can be used to prevent

infection of umbilical cords

• General Antiseptics

• Triple-Dye

• Chlorhexidine

• General Antibiotics

• Alcohol

• Olive-Oil

• Breast Milk

http://newborns.stanford.edu/PhotoGallery/Cord.html

CURRENT PRACTICE AT LVHN

• Triple-dye is applied to cord after initial bath and followed with alcohol to the cord three times a day

• Care is taken to prevent spill-over of dye onto surrounding skin

• Diapers are

arranged to prevent

urine from contaminating

the cord

• Clamp is removed after

24 hours; cord naturally

falls off by 2 weeks but care

practices may delay separation

http://www.smartparentshealthykids.com/blog/wpcontent/uploads/2008/06/Cord.jpg

PURPOSE

The purpose of the proposed project is to

change the practice of healthy newborn cord

care on the Mother/Baby unit at Lehigh Valley

Hospital (Cedar Crest Campus) from the use of

Triple-dye antiseptic and alcohol application to the use

of clean cord care (soap & water) using the best

available evidence.

PICO QUESTION

• P: healthy newborns

• I: clean cord care (soap and water)

• C: antiseptic agents

• O: increased risk for infection

Are healthy newborns who receive clean cord care

(soap & water) compared to those who receive

antiseptic agent application (triple dye & alcohol) at an

increased risk for infection and prolonged cord

separation?

IOWA MODEL OF EVIDENCE-BASED PRACTICE

• Knowledge Focused Trigger

• New research and other literature

• Unnecessary practice

• Evidence shows that in developed countries, there

is no need for the use of

triple-dye or alcohol for

the prevention of

infection.

http://www.smartparentshealthykids.com/blog/wp-content/uploads/2008/06/tripledye.jpg

RESEARCH

• Search engines used: • PubMed • Ebscohost • Medline • CINAHL • Google Scholar • Cochrane

• Key words used: • Dry cord care • Topical umbilical cord care • Omphalitis • Antiseptic agents • Umbilical cord care • Anti-septic agents, local

http://research.unc.edu/offices/research-development/

EVIDENCE

• 16 articles

• 4 Level I

• 8 Level II

• 3 Level III

• 1 Level IV

• Interventions

• Dry Cord Care (13), General Antiseptics (4), Triple

Dye (7), Chlorhexidine (5), General Antibiotics (4),

Alcohol (14), Olive-Oil (2), Breast Milk (2)

EVIDENCE

• There is no need for either alcohol or antiseptic

• Use of alcohol and general antiseptics (Triple-dye, etc.) increase cord separation time

• Increased cord separation

time is likely to increase risk

for infection

• All umbilical cords have

normal bacteria present, but

that bacteria rarely leads to

infection http://www.nlm.nih.gov/medlineplus/ency/imagepages/9055.htm

EVIDENCE • Triple-Dye and alcohol on infant’s skin can lead to skin breakdown • If mothers are taught appropriately about what to expect from clean cord care their reactions are more positive towards clean cord care compared to Triple- Dye or alcohol

• Clean cord care is the suggested for of care in developed countries, such as the United States of America • Infection rates are not found to be higher for babies treated with clean cord care compared to those treated with triple-dye and alcohol

IMPLEMENTATION

• Preparation:

• Unit staff educated on clean cord care prior to

implementation

• Handouts

• Verbal education

• Follow-up questionnaire sheet

created

IMPLEMENTATION

• Implementation: Beginning 05/05/14 @0000 on MBU

• Triple Dye and alcohol no longer applied to cords

• Handouts on clean cord care placed in admission

folder for mother’s education

• Mother’s educated on admission by admitting RN

• Mothers advised to record date of cord separation

• Mothers informed about follow-up phone calls after

2 weeks of delivery

IMPLEMENTATION • Education:

• Mothers instructed to clean the

umbilical cord 2-3x day/as needed

using a cotton ball or clean

washcloth with baby soap and

water. Pat dry using

clean washcloth and fold diaper

down to allow air drying.

• Mothers instructed to monitor for

signs and symptoms of infection

such as redness, drainage/pus, swelling, bleeding or

lesions

http://www.lifemartini.com/how-to-care-for-umbilical-cord-of-the-baby/

IMPLEMENTATION • Education (cont’d.)

• Mothers instructed to notify their pediatrician if they

notice any signs of infection.

• Mothers will take home a paper to write record the

date of cord separation. They will also keep track of

any signs of infection and any phone calls made to

the pediatrician.

• Education is key to this practice change.

IMPLEMENTATION • Follow-up

• RN’s will make follow-up phone calls and record data for

cord separation time, signs of infection, phone calls to

pediatricians, mothers’ comfort level, and

mothers’ compliance with clean cord care

• Evaluation Process:

• Mothers called after weeks of delivery date (starting 05/19/14)

• Same questionnaire used for all mothers

• Practice Guideline

• If no infections reported by 06/14/14, guideline will be updated to clean cord care with discontinuation of Triple-Dye and alcohol

EVALUATION • Reponses: 123 total infants born (05/05/14-05/17/14)

• 119 calls made (one set of twins)

• 63/120- responded to questionnaire

• 6/63-disqualified for using alcohol

• 47/120- no response to questionnaire (x2)

• 3/120- Spanish speaking only

• 3/120- unable to contact by phone

• 7/120- cords still attached

• 6/120- not called due to infants in NICU

http://www.sellcell.com/blog/cell-phones-could-damage-unborn-babies/

RESULTS

• Infections

• Average: 0% infection rate

• Cord Separation Time

• Average: 10.7 days until separation

• Maternal Compliance

• Average: 93% compliant

• Average Maternal Comfort

• Average: 95% comfortable

• Mothers had no current concerns

• Educate staff and newborn parents

• Change/update the written policy

• Publish as an article

• Present at conferences

STRATEGIC DISSEMINATION OF RESULTS

http://wesleyankids.org/children-and-youth-policies/

IMPLICATIONS FOR LVHN

• Our proposal is to eliminate the use of triple-dye and alcohol on the Mother/Baby Unit at LVHN and replace it with clean cord care (soap and water) per Evidence-Based Research by June 14, 2014

http://media2.arabia.msn.com/medialib/2012/12/05/child.jpg

REFERENCES • Dore, S., Buchan, D., Coulas, S., Hamber, L., Stewart, M., Cowan, D., &

Jamieson, L. (1998). Alcohol versus natural drying for newborn cord care. Journal Of Obstetric, Gynecologic, And Neonatal Nursing: JOGNN / NAACOG, 27(6), 621-627.

• Evens, K., George, J., Angst, D., Schweig, L. (2004). Does umbilical cord care in preterm infants influence cord bacterial colonization or detachment?. Journal of Perinatology, 24, 100-104. doi: 10.1038/sj.jp.7211027

• Fatma Mohamed Nasr El-Din Shoaeib, Sohair Abu El-Fadle Abdel All, Mohamed Abbas El-Barrawy (2005). Alcohol or traditional methods versus natural drying for newborn's cord care. The ]ournal of the Egyptian Public Health Association, 80(1), 170-201. Retrieved from http://www.epha.eg.net/pdf/u1daa7.PDF

• Golombek, S. G., Brill, P., Salice, A. (2002). Randomized trial of alcohol versus triple dye for umbilical cord care. Clinical Pediatrics, 41(6), 419-423. doi: 10.1177/000992280204100607

• Guala, A., Pastore, G., Garipoli, V., Agosti, M., Vitali, M., Bona, G. (2003). The time of umbilical cord separation in healthy full-term newborns: a controlled clinical trial of different cord care practices. European Journal of Pediatrics, 162, 350-351. doi:10.1007/s00431-003-1174-2

REFERENCES

• Imdad, A., Bautista RMM, Senen KAA, Uy MEV, Mantaring III JB, Bhutta ZA (2013). Umbilical cord antiseptics for preventing sepsis and death among newborns. Cochrane Database Of Systematic Reviews, (11), doi:10.1002/14651858.CD008635.pub2

• Janssen, P., Selwood, B., Dobson, S., Peacock, D., & Thiessen, P. (2003). To dye or not to dye: a randomized, clinical trial of a triple dye/alcohol regime versus dry cord care. Pediatrics, 111(1), 15-20._

• Karumbi, J., Mulaku, M., Aluvaala, J., English, M., Opiyo, N. (2013). Topical umbilical cord care for prevention of infection and neonatal mortality. The Pediatric Infectious Disease Journal, 32(1), 78-83. doi: 10.1097/INF.0b013e3182783dc3

• Lacombe, Tania; Miller, Mary; and Ziegler, Grace, "Umbilical Cord Care: Cord Detachment and Prevention of Infection" (2012). Pharmacy and Nursing Student Research and Evidence-Based Medicine Poster Session. Paper 39. http://digitalcommons.cedarville.edu/pharmacy_nursing_poster_sessio n/39

• McConnell, T. P., Lee, C.W., Couillard, M., Sherrill, W.W. (2004). Trends in umbilical cord care: Scientific evidence for practice. Newborn and Infant Nursing Reviews, 4(4), 211-222. doi: 10.1053/j.nainr.2004.09.004

REFERENCES

• Medves, J. M., O’Brien, B.A. (1998). Cleaning the umbilical cord with water rather than alcohol shortened the time to separation with no change in colonisation. Evidence-Based Nursing, 1(4), 112-113. doi: 1 0.1136/ebn.1.4.112

• Mullany, L. C., Shah, R., Arifeen, S., Mannan, I., Winch, P.J., Hill, A., Darmstadt, G.L., Baqui, A. (2013). Chlorhexidine cleansing of the umbilical cord and separation time: A cluster-randomized trial. Pediatrics, (131), 708-715. doi: 10.1542/peds.2012-2951

• Shafique, M. F., Ali, S., Roshan, E. & Jamal, S. (2006) Alcohol Application Versus Natural Drying of Umbilical Cord. Rawal Medical Journal, 31 (2), 58-60.

• Suliman, A. K., Watts, H., Beiler, J., King, T.S., Khan, S., Carnuccio, M., Paul, I.M. (2010). Triple dye plus rubbing alcohol versus triple dye alone for umbilical cord care. Clinical Pediatrics, 49(1), 45-48. doi: 10.1177/0009922808329455

• Vural, G. and Kisa, S. (2006), Umbilical Cord Care: A Pilot Study Comparing Topical Human Milk, Povidone-Iodine, and Dry Care. Journal of Obstetric, Gynecologic, & Neonatal Nursing, 35: 123–128. doi: 10.1111/j.1552-6909.2006.00012.x

• Zupan, J., Garner, P., & Omari, A. (2004). Topical umbilical cord care at birth. The Cochrane Database Of Systematic Reviews, (3), CD001057.

MAKE IT HAPPEN

• Questions/Comments?

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