Trends in Umbilical Cord Care: Scientific Evidence for Practice

Tammy P. McConnell, MSN, RN; Connie W. Lee, EdD, ARNP, IBCLC; Mary Couillard, PhD, RN, CS, FNP; Windsor Westbrook Sherrill, PhD, MBA, MHA

Disclosures

NAINR. 2004;4(4):211-222. 

In This Article

The History of Umbilical Cord Care

In the 1950s, frequent epidemic outbreaks of staphylococcus in newborn nurseries were occurring. There were cited cases of mastitis, pyoderma, septicemia, osteomyelitis, pneumonia, omphalitis, and fetal death related to these epidemics.[5] During this era, it was typical for an infant to be in the nursery at least 10 days before discharge. "Rooming in" was not the standard of care. Nursery personnel were scrubbing, wearing scrubs, gowning, wearing caps, wearing masks, and washing hands between infants. The use of clean gloves was not a standard of care. The "no bathing technique" was a standard of care. Most infants were not bathed after delivery until discharge, which was usually day 10.[5] As a reaction to these epidemic outbreaks, studies were conducted to address effectiveness of skin care, staff infection control practices, comparisons of umbilical cord care, maternal carrier states, maternal and infant colonization, and environmental contamination.[5–15]

Some studies concluded that the use of hexachlorophane wash (eg, pHisoHexR, GlaxoSmithKlein, Triangle Park, NC) or powder (Ster-zacR, SSL, Western Australia) as a skin cleansing agent substantially reduced staphylococcal colonization.[5–7,9,11,14,15] In the 1960s, hexachlorophane wash or powders became a standard of care in newborn nurseries around the country.

In 1969, a six and a half year study of hexachlorophane baths substantiated its effectiveness in eliminating staphylococcal infections and resulted in recommendations for major changes in the standard of care for newborns.[15] These recommendations eliminated certain traditional elements of nursery routine. The use of caps and masks, deferring initial baths until thermal homeostasis, the use of hairnets, admission of students and parents into the nursery, and the use of gowning were no longer a part of routine nursery care.

In late 1971, the Food and Drug Administration (FDA) and the American Academy of Pediatrics (AAP) recommended the discontinuance of routine infant bathing with hexachlorophane due to studies that revealed potential toxic effects of the cleansing agent.[16] Within a month, some facilities experienced an increase in staphylococcal colonization and staphylococcal disease.[17] This instigated immediate studies to determine a safe alternative for skin and cord care.[16–19] These studies evaluated triple dye compared with other cleansing agents. All studies found that triple dye was able to significantly reduce staphylococcal colonization, even with a one-time application. Triple dye became an alternative umbilical cord treatment for hexachlorophane. Other topical antimicrobials such as povidone-iodine (Betadine) and antibiotic ointments also significantly reduced staphylococcal colonization. Thus, variance in standards of care was often based on physician and staff preference.[20]

Since the 1970s, it has been widely accepted to use some form of topical antimicrobial to treat the umbilical cord. Other accepted cord care practices include assessment of the cord for signs of infection, good hand washing between infants, folding down the diaper to avoid unnecessary friction or soiling, avoidance of tub baths until separation of the cord occurs, and avoiding the use of oils, lotions, and creams on the cord.[20] In the 1980s, the use of clean gloves between patients became an infection control standard.

Since the 1980s, studies have continued to evaluate differences in cord care regimens and staphylococcal colonization and infection and cord separation times.[1–4,20–27] Recent literature describes current cord care practices as being based on the assumptions of historic health care routines instead of research evidence.[1,4,23]

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