Improving Perianal Skin Care in a level III Neonatal Intensive Care Unit

Abstract

Problem: In a level III neonatal intensive care unit (NICU) in a large urban hospital, there was a lack of standardization in perianal skin care and inconsistent documentation practices for the perianal region. Assessment of the unit's current practice revealed variable approaches to perianal skin care. A pre-implementation audit revealed that 18% (n=3) of infants had diaper dermatitis and 0% of infants had documentation of topical barrier application or perianal skin care assessment. Purpose: The purpose of this quality improvement initiative was to standardize perianal skin care and prevent diaper dermatitis. Current evidence supports the consistent application of topical barriers to prevent diaper dermatitis, accurate documentation of perianal skin integrity, assessment of dermatitis severity, treatment requirement, length of treatment, treatment strategy, and patient response. Methods: A standardized evidence-based perianal skin care bundle was implemented and included the application of Aquaphor as a topical barrier, and documentation utilizing an evidence-based validated perianal scoring tool. Formal education was provided to the 73 registered nurses and 8 attending physicians regarding topical barrier prophylaxis, when to escalate to treatment, and documentation practices. All infants admitted to the NICU were included, and those with known skin conditions or those whose parents preferred a different product were excluded. Weekly audits were conducted to assess adherence with Aquaphor application and rates of diaper dermatitis. Results: During the project initiative 95% (n= 317) of infants received Aquaphor prophylaxis. The incidence of diaper dermatitis was initially 18% and decreased to 3.7% (n=12) compared to pre-implementation and reached the goal of 0% five times during the project initiative which is reflective of the literature. Conclusions: Findings suggest that the consistent application of Aquaphor to the perianal region helps reduce the incidence of diaper dermatitis in NICU patients. Key words: Perianal, Diaper dermatitis, Diaper rash