Purpose for the program:

The Professional Practice Committee hypothesized: can we improve wellborn baby care post delivery by switching from sponge to immersion bathing? A research review revealed evidence supporting the theory that immersion bathing improved temperature stability, bonding, breastfeeding and parental education. Current practice in the

PAMC Maternity Center is doing sponge bathing under a radiant warmer within two hours of birth in the absence of birth stress or trauma. Parental involvement is minimal due to decreased mobility from anesthesia, exhaustion and environmental or social distractions during the immediate post partum period. Nurses also reported breastfeeding and skin-to-skin bonding time was often interrupted to complete baths in the allotted two hour recovery time.

Proposed change:

The Professional Practice Committee proposed a policy and procedural change to immersion bathing founded on Evidence Based Research and incorporating these key principles:

1)      Delay infant baths 2-4 hours to establish thermoregulation and decrease negative side effects of hypothermia including increased O2 consumption, respiratory distress and hypoglycemia.

2)      Stable temperature defined as 97.7F -99.5F for 2-4 hours.

3)      Tub bathing appears to be more effective than sponge bathing at maintaining body temperature and preventing temperature loss. Also, studies showed there is no difference in umbilical cord infection and healing rates and infants appeared more relaxed and less agitated during tub baths. 

(4)      Infants at risk of transmission of Hepatitis B and HIV from maternal sources will be bathed within 2 hours.

Implementation, outcomes and evaluation:

The Professional Practice Council presented their research and findings to the Nursery Committee and received permission to proceed with a practice change.  Currently, Professional Practice is developing a training video, policy and care competency. These tools will be presented to the staff at regularly scheduled staff meetings. Hands on training of nurses and techs will be conducted to assure comfort and competency in practice.

The goals for this project are consistent immersion bathing per guidelines, increased infant relaxation, increased parental involvement and education covering proper positioning, temperature regulation and signs and symptoms of infant distress.

Implications for nursing practice:

The implications to Nursing are increasing parental involvement in newborn care resulting in greater uninterrupted bonding time, improved breastfeeding, extended skin to skin contact in the post partum period, improved neonatal outcomes from decreased cold stress and calmer stabilization.

Keywords:

Bathing 

Education  

Thermoregulation

Infant stability   

Newborn Care