Bathtime Shenanigans: Implementing Evidence-Based Bathing Practices

Abstract

Problem: Bathing practices vary among neonatal intensive care units (NICU), despite guidelines developed by the Association of Women’s Health, Obstetrics and Neonatal Nurses (AWHONN). Bathing should occur allowing for optimal outcomes in the neonate, while attempting to minimize negative physiologic effects due to the stress of bathing. Purpose: The purpose of this project was to implement evidence-based bathing practices in a level IV NICU, where practices vary. Through the utilization of AWHONN’s Neonatal Skin Care Guidelines (NSCG), the goal was to reduce signs of neonatal stress, particularly temperature and behavioral signs of distress during bathing. Methods: The population consisted of neonates ranging in age from 24 to 40 weeks’ gestation in a 52 bed NICU. Implementation occurred over a twelve-week period in the fall of 2019, which included collection of baseline data, identification of unit-based champions, staff education, competency assessments, and development of resources and reminders for staff. Guideline-based algorithms were created, which determined inclusion and exclusion criteria for bathing. Documentation on bedside charts included the age of the infant, the type of bath given, and measures of tolerance to bath assessed by pain/sedation scores and patient temperature 15 minutes post bath. Results: Training resulted in guideline competency among 16% of the NICU nurses. The bedside documentation tool was completely filled out 36 times over the six-week period of implementation, on a unit where the patient census averages 45-52 patients a day. Although, limited, there were some apparent trends in the data that suggests evidence-based bathing practices are needed on this unit. There were no negative effects of increased pain/sedation scores when the infants were swaddle bathed, pain/sedation scores remained < 3, requiring no interventions. Normal temperatures were more likely if the infant was swaddled bathed. However, about 36% of the documented temperatures were <36.5, despite the type the bath. Conclusion: Evidence-based bathing practices help to reduce negative outcomes in the neonatal population. Implementing a practice change within a large unit requires continuing education to enforce the strategies set forth by AWHONN and cement strategies for sustainability and accountability into practice.