Neonatal skin care : staff awareness and practice within the neonatal unit

Abstract

Background: Maintaining an intact skin barrier is necessary for all newborns especially during the adaptation from intrauterine to extrauterine life. However, this is particularly challenging for premature and full-term newborns requiring intensive or special care. The skin is subject to potential disruption and trauma during clinical practices, such as bathing and nappy changing. Aims: To investigate neonatal staff awareness and neonatal skin care practices in the only neonatal unit in Malta. Methods: A total of 50 nurses and midwives (N=50) were recruited using purposive sampling, from the neonatal intensive care unit (NICU). In total, 38 questionnaires were returned, resulting in a 76 per cent (n=38) response rate. Analysis of the closed questions was carried out manually using simple, descriptive statistics. The results are presented in the form of absolute numbers, calculated percentages, pie-charts, bar-graphs, and frequency tables. Findings: The findings suggested that the neonatal staff carry out good practices in relation to skin cleansing, the prevention of nappy dermatitis, and umbilical cord care. Despite this, some practices, such as neonatal bathing and nappy changing, are done routinely, every three to four hours, and not according to evidence-based recommendations. Most of the participants seemed to be unaware of the possible harm of antiseptics, and emollient use in the unit seems to be inconsistent. There was lack of agreement between participants when they were asked about the availability of neonatal skin care protocols on the unit. Conclusion and clinical recommendations: It is recommended that neonatal skin care evidence-based protocols are introduced in the neonatal unit and a practitioner specialising in neonatal skin care is involved in the implementation of skin care guidelines.