UMBILICAL CORD CARE

1. UMBILICAL CORD CARE • Clinical Question • - Is the rate of infection and separation time of umbilical cords for hospital-born babies improved with the application of alcohol versus air-drying? • Method • - Search Engines: EBSCO host, Cochrane Library, Medline, guidelines.gov, PubMed • - Search/Mesh terms: "umbilical cord care", "umbilical cord separation", "umbilical cord infection", "alcohol" and "cord care” Implementation  - Parents should be educated about what research suggests for cord care: that there is not enough statistically significant data to support the idea that alcohol reduces the rate of infection and that alcohol can actually prolong separation time. However, the decision made by the parent in this regard should ultimately be respected by the health care professionals.  - Nurses should be provided with Continuing Education in this regard, and encouraged not to use alcohol to avoid unnecessary interventions as well as unnecessary use of resources (ex: alcohol wipes). Discussion  - It is important to educate new parents on cord care to prevent infection and improve cord separation time. Evidence suggests that air drying is effective in reducing infection and proper separation. Therefore, we will train nurses to educate parents from the most current standards based on evidence. Current standard practice guidelines include use of dry care for cord separation and infection control. More research is warranted in areas where aseptic techniques are not widely used, or culturally-specific topical agents are applied. Literature Review  - Systematic Review: : examines 21 random or quasi-random studies studying the effects of topical antiseptics and/or antibiotics vs. no topical treatment on cord infection (Cochrane, 2009) - Other studies: RCT of 109 preterm infants (<34 weeks gestational age) examining bacterial colonization, cord infection, and cord detachment with alcohol vs. natural drying. - Observational cohort study of 150 healthy full-term newborns (1:1 vaginal:cesarean delivery) equally divided into three groups receiving topical povidone-iodine, dry care, or topical human milk. - Prospective, RCT of 1,876 newborns (1,811 of which completed the study) looking at the effects of 70% isopropyl alcohol vs. air drying (Nov/Dec 1998). Synthesis of findings - All findings suggest that application of alcohol to umbilical cords has no demonstrable effects on rate of infection - There is evidence that application of alcohol delays cord separation compared to dry care • Decision about practice • - Topical application of alcohol to umbilical cords is superfluous, though not necessarily harmful.  • References • - Evens K, George J, Denise A, & Schweig L. (2004). Does umbilical cord care in preterm infants influence cord bacterial colonization or detachment? Journal of Perinatology, 24, 100-104. • -  Vural, G, & Kisa, S. R. (2006). Umbilical cord care: a pilot study comparing topical human mlk, povidone-iodine, and dry care. Journal of Obstetric, Gynecologic, and Neonatal Nursing, 35, 123-128. • - Zupan, J., Garner, P., & Omari, AAA. (2004). Topical cord care at birth. Cochrane Database Systematic Reviews, 3(CD001057). doi: 10.1002/14651858.CD001057.pub2. • Dore, S., Buchan, D., Coulas, S., Hamber, L., Stewart, M., Cowan, D. and Jamieson, L. (1998), Alcohol Versus Natural Drying for Newborn Cord Care. Journal of Obstetric, Gynecologic, & Neonatal Nursing, 27: 621–627. doi: 10.1111/j.1552-6909.1998.tb02631.x • Evaluation • - Survey nurses anonymously for compliance with cord care measures • - Collect data on rates of infection and cord separation times