A new clinical study[i] conducted by the University of Utah Hospital’s Neonatal Intensive Care Unit (NICU) in Salt Lake City, US, reveals that implementation of new perineal skin care guidelines, along with use of WaterWipes® reduced overall nappy rash incidence in premature babies by 17% and severe nappy rash by over a third (35%). Duration of severe nappy rash was also shortened by more than half (57%) – 3.5 days per 100 patient-days.
Published in Adv in Neonatal Care1, the robust, independent year-long study amongst 1,070 premature babies, is an important milestone in the management of perineal skincare. This is the first clinical study in a NICU to show that WaterWipes baby wipes are well tolerated by both term and preterm infants, including those less than 30 weeks gestation (11% were <30wk GA). Nappy rash has been shown to cause emotional and physical distress in premature infants[ii] and can also lead to an increased risk of infection,[iii] it is therefore essential that steps are taken to reduce the incidence of nappy rash across all NICUs.
Prevalence of nappy rash and lack of standardised care in NICUs
Nappy rash remains prevalent in NICUs, despite studies documenting an understanding of prevention and treatment among healthcare professionals.[iv] Many NICUs lack a standardised approach to perineal skin care[v] as skin assessment and reporting of nappy rash is often inconsistent – leading to underestimations in the prevalence of nappy rash and challenges in monitoring improvements in care.
The high nappy rash incidence at the University of Utah’s NICU (46%) called for the development of a prevention focused guideline to address inconsistent skincare management. A multidisciplinary quality improvement team formed to develop the Perineal Skin Care Guidelines to standardise skin assessment, documentation, prevention and treatment – changing current practice from use of wipes containing many ingredients to wipes containing just two ingredients – WaterWipes.
“Diaper dermatitis is a major issue for infants in the NICU; leading to increased medical costs, risk of infection and emotional distress for both babies and parents,” says Misty Williams, NICU Advanced Practice Partner, University of Arkansas for Medical Sciences, Arkansas, US. “The reduced incidence and duration of DD in the NICU at the University of Utah Hospital is a great accomplishment for the team. It provides a best in practice case to inspire other NICUs to review current management of nappy rash, use of baby wipe products and to implement guidelines to help improve perineal skincare outcomes and maintain skin integrity for premature babies’ delicate skin.”
Choice of baby wipe product can impact premature babies’ skin
All infants, especially premature babies, have a less effective skin barrier function compared to that of older children and adults. The epidermis and stratum corneum are thinner and underdeveloped and therefore more susceptible to permeability and dryness. As a result, premature babies’ skin is far more delicate and vulnerable; requiring special care and protection. The use of baby wipes to cleanse perineal skin is shown to be more beneficial than cleaning with cotton wool / cloth and water and can help to reduce skin irritation.[vi],[vii],[viii] The study also found WaterWipes were less expensive than the cloth/water cleansing method ($0.79/day saving).
Choice of baby wipe products is crucial when it comes to supporting perineal skin health. The researchers identified that some baby wipe brands contain additives that can aggravate sensitive skin, without the parent or caregiver’s knowledge.[ix] WaterWipes, the world’s purest baby wipes that are now 100% biodegradable, are a non-medicated baby wipe containing just two ingredients – 99.9% ultra-pure water and a drop of fruit extract to help maintain skin integrity. Following a review of scientific literature, a team of independent experts at the Skin Health Alliance has validated that WaterWipes are purer than cotton wool and water.
Like all WaterWipes formulations, the new biodegradable wipes have also undergone rigorous testing including product quality, microbial and formulation stability and biodegradability to ensure only the highest standard of product is made so parents and healthcare professionals no longer need to compromise between protecting the integrity of infant skin and helping to protect the planet.
The results of the Utah study mirror the findings of a recent clinical study of 698 full-term babies, conducted by the University of Salford in Greater Manchester (UK). The Baby Skin Integrity Comparison Survey (BaSICS) and Utah study both show that babies cleansed with WaterWipes had a reduced incidence and shorter duration of nappy rash. [x], 1
Jill Sommerville, Director of Medical at WaterWipes said, “The results of this independent clinical study are very encouraging – highlighting the importance of choosing baby wipes with minimal ingredients to help reduce the incidence and duration of nappy rash in premature babies and the associated emotional and physical distress. As a result of the study, the University of Utah Hospital’s NICU changed current practice – choosing to use only WaterWipes in place of baby wipe products containing several additives. We hope that these findings will encourage other NICUs to consider WaterWipes, which have been specifically developed to be pure and gentle for premature babies’ delicate skin.”
The key outcome from this study is that use of WaterWipes, along with perineal skin care guidelines, reduced incidence and shortened duration of nappy rash amongst premature babies.
[i] Rogers, S., Thomas, M., Chan, B., Hinckley, S. K. & Henderson, C. A Quality Improvement Approach to Perineal Skin Care: Using Standardized Guidelines and Novel Diaper Wipes to Reduce Diaper Dermatitis in NICU Infants. Adv Neonatal Care 2020. doi:10.1097/anc.0000000000000795 [Epub ahead of print]
[ii] Stamatas GN, Tierney NK. Diaper dermatitis; etiology, manifestations, preventions, and management. Pediatr Dermatol. 2014;31(1):1-7.
[iii] Pogacar MS, Maver U, Varda NM,, Mic·etic´-Turk D. Diagnosis and management of diaper dermatitis in infants with emphasis on skin
microbiota in the diaper area. Int J Dermatol. 2018;57(3):265-275.
[iv] Malik A, Witsberger E, Cottrell L, Kiefer A, Yossuck P. Perianal dermatitis, its incidence, and patterns of topical therapies in a level IV neonatal intensive care unit. Am J Perinatol. 2018;35(5):486-493.
[v] Heimall LM, Storey B, Stellar JJ, Davis KF. Beginning at the bottom: evidence-based care of diaper dermatitis. MCN Am J Matern Child Nurs. 2012;37(1):10-16.
[vi] 13. Blume-Peytavi U, Lavender T, Jenerowicz D, et al. Recommendations form a European roundtable meeting on best practice healthy infant skin care. Pediatr Dermatol. 2016;33(3):311-321.
[vii] Visscher M, Odio M, Taylor T, et al. Skin care in the NICU patients: effects of wipes versus cloth and water on stratum corneum integrity. Neonatology. 2009;96(4):226-234.
[viii] Vongsa R. Benefits of using an appropriately formulated wipe to clean diapered skin of preterm infants. Glob Pediatr Health.
2019:6:2333794X19829186.
[ix] Kuller JM. Infant skin care products. Adv Neonatal Care. 2016;16(5S):S3-S12.
[x] Price AD, Lythgoe J, Ackers-Johnson J, Cook PA, Clarke-Cornwell A, MacVane Phipps F. The BaSICS (Baby Skin Integrity Comparison Survey) Study: a prospective experimental study using maternal observation to report the effect of baby wipes on the incidence of irritant diaper dermatitis from birth to eight weeks of age. Pediatrics & Neonatology 2020. doi:10.1016/j.perneo.2020.10.003. [Epub ahead of print]
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