The most important practice in preventing cross-infection is proper hand washing of all delivery and nursery room personnel. The nurse washes her hands before and after handling the infant. In some institutions sterile gloves are worn during the delivery.
In addition to hand washing, several procedures are done to prevent infection, These include eye care, bathing, and care of the circumcision or umbilical stump. To protect against injury, vitamin K is administered and several safety measures are practiced. In addition, screening tests such as the Guthrie blood test for phenylketonuria are performed to prevent the serious consequences of undiagnosed disorders.
Prophylactic eye treatment against Neisseria gonorrhoeae, which can cause blindness in infants born of mothers with gonorrhea, is done by instilling 2 drops of 1% silver for each eye. Rinsing the eyes with sterile normal saline is not recommended because it decreases the drug's effectiveness. One minute after the drug has been in the eye, any excess is wiped away. Proper instillation of silver nitrate into the conjunctival sac is essential because incorrect technique can cause a transient severe chemical conjunctivitis. Other local antibiotic preparations such as erythromycin (0.5%) or tetracycline (1%) can also be used for prophylaxis of gonorrhoeal ophthalmia neonatorum. It is very important for nurses to explain the reason for the instillation of these drops, since the resultant conjunctivitis can be upsetting for new parents.
Traditionally antimicrobial preparations have been instilled in the newborn's eyes only minutes after birth. Studies on maternal attachment emphasize that in the first hour of life, a newborn has a greater ability to focus on coordinated movement than at any other time during the next several days. This initial hour is very important in the development of maternal-infant bonding, one component of which is the establishment of eye-to-eye contact. Based on these findings, it is recommended that the routine administration of silver nitrate or antibiotics be postponed until after the parents and child have established such visual contact and bonding has begun. If the procedure is delayed, there must be some kind of checklist to ensure that the drug is given as soon as possible.
The bath time can be an opportunity for the doctor and nurse to accomplish much more than general hygiene. It is an excellent time for observations of the infant's behavior. In hospitals where there is rooming in of infant and mother, the bath time provides an opportunity for the nurse to involve the parents in the care of their child and to learn about his individual characteristics, Parents should be encouraged to examine every finger and toe of their infant. Frequently normal variations such as Epstein pearls, mongolian spots, or stork bites cause parents much worry because they are unaware of the insignificance of such findings. Minor birth injuries may appear as major defects to them. Explaining how these occurred and when they will disappear reassures parents of their infant's normalcy.
Bathing should be done in the nursery after the vital signs have stabilized. There is no need to immediately wash a newborn, except to removed the blood from the face and head. In fact the vernix caseosa probably has bacteriostatic and insulating properties, which make leaving it on the skin advantageous. Plain warm water is used for the bath. Oils are not used because they clog pores and provide a medium for bacterial growth. Lotion can be used to cleanse or massage the skin to provide pleasurable tactile stimulation. This is particularly effective for a sick newborn, which is often denied the warmth and comfort of close human contact.
The ears are cleaned with the twisted end of a washcloth or very carefully with a cotton-tipped swab. The swab is not inserted into the canal but is gently rotated around the pinna and immediate site of entry into the external canal. The rest of the body is washed in a similar manner. Although the infant's skin requires little rubbing for adequate cleansing, certain areas such as the folds of the neck, the axillae, and creases at joints need special attention. The area around the neck is especially prone to a rash from regurgitation of feeding and shoul be thoroughly washed and dried.
The genitalis of both sexes require careful cleansing. In the female the labia are separated to remove the vernix caseosa, which is usually thick and adherent to the skin. Some fo the vernix caseosa is removed at each diaper change, rather than at one time, in order to avoid irritation. In some instances it is helpful to sit the infant in a few inches of warm water and let the vernix caseosa soak off. However, when the sit bath is given, care must be taken to keep the umbilical area dry and to prevent chilling. Cleansing of the vulva is done in a front-to-back direction. The bath is a perfect opportunity to stress this part of hygiene to the mother, both for the infant's and her protection against urinary tract infection.
Cleansing the male genitalia involves washing the penis and scrotum. Sometimes smegma needs to be removed by wiping around the glans. The foreskin is not retracted because it is normally tight in newborns. If the infant is not to be circumcised, the nurse explains to the parents how to clean under and around the foreskin by retracting it gently and returning it to its normal position. Leaving the prepuce in a retracted position constricts the blood vessels supplying the glans penis, causing edema.
The buttocks and anal area are thoroughly cleansed of any fecal material. Mild soap or lotion can be used. As with the rest of the body, the area is dried to prevent a warm, moist environment that fosters growth of bacteria. Diapers are put on the infant after bath. They should fit snugly around the thighs and abdomen to prevent urine from leaking. In males, cloth diapers should be folded with extra thickness in the front to provide greater absorbency. In females, the placement of the extra fold depends on whether the infant is prone or supine. Diapers are fastened with the back side overlapping the front side to allow full flexion of the hips.