This document discusses evidence-based guidelines for skin disinfectants used in newborn care. It recommends chlorhexidine gluconate (CHG) as the preferred disinfectant due to its efficacy against bacteria and residual effect. Proper application technique is important to avoid toxicity, irritation or burns. Diaper dermatitis is a common skin issue that can be prevented by frequent changing and gentle cleansing. Risk factors include frequent stooling and antibiotics. Treatment focuses on identifying causes, using protective barriers and antifungal agents if needed.

1. DISINFECTANTS USED IN NEWBORN
Presented by
MalarKodi S
AssistantProfessor
Collegeof Nursing,AIIMS, Rishikesh

2. INTRODUCTION
 Nurses working in the NICU are caring for some of
the most fragile infants.
 Skin care in the NICU has been based on tradition
 Today’s nurses, especially NICU nurses, are
realizing the importance of having evidence based
guidelines to direct them in their practice.
 By providing NICU nurses with evidence based
guidelines, premature infants will have less
iatrogenic injuries and less skin breakdown in
particular

3. NEED FOR DISINFECTANT IN SKIN CARE
 Before invasive procedures
 To reduce the risk of bacteremia
 To prevent catheter-related infections
 To Prevent skin contamination during blood culture
sampling
 To Prevent Extraluminal and Intraluminal colonization
and infection of central Catheters.

4. HOW TO SELECT THE DISINFECTANT
 Disinfectant before being used on a
neonate’s fragile skin, the risks and benefits
of skin disinfectants should be evaluated on
 Efficacy
 Less toxicity
 Reduce probability of skin irritation,
chemical burns, or erosive contact
dermatitis

5. BASED ON EFFICACY THE CHOICE OF DISINFECTANT
 Chlorhexidine Gluconate ( CHG)
 0.5% CHG in 70% Iso-Propyl alcohol
 2% CHG in 70% Iso-Propyl alcohol
 3.15% CHG in 70% Iso-Propyl alcohol
 10% Povidone-Iodine

7. ADVANTAGES OF CHG
 Chlorhexidine gluconate is a chlorinate cationic
biguanide and is used in both aqueous solutions and
in combination with isopropyl alcohol.
 Its bactericidal properties increase cell membrane
permeability, and it is effective against both gram-
positive and gram negative organisms.
 It also binds to protein in the stratum corneum of the
epidermis, leaving a residual bactericidal effect that
is resistant to alcohol removal

8. TOXICITY
Povidine-iodine
 Alteration in thyroid function in premature and
term newborns
CHG
 Contact dermatitis
Chlorhexidine gluconate can be safely used on the
scalp for IV or central line placement if applied
judiciously, without splashing or excess solution,
and should be completely removed after the
procedure is complete

9. SKIN IRRITATION, CHEMICAL BURNS, OR
EROSIVE CONTACT DERMATITIS.
 It Damages or destroy fibroblasts and
keratinocytes in healing wounds
 Potential damage to neonatal skin, particularly for
premature neonate
 Case reports indicating chemical burns from
isopropyl alcohol and povidone- iodine solutions in
extremely low birth weight infants

10. TECHNIQUES FOR APPLYING DISINFECTANTS
 Antiseptics should be allowed to dry according to the
manufacturer’s recommendation
 Apply CHG for 30 seconds or with two consecutive
application
 Apply povidone-iodine as per facility guideline and allow
to dry for 30 seconds
 Remove all disinfectants as completely as possible with
sterile water or saline after the procedure is complete.
 Avoid the use of isopropyl alcohol as a primary
disinfectant or for removing povidone-iodine or CHG
 Use isopropyl alcohol or 2% CHG in Isopropyl alcohol for
disinfection of needleless connectors and other IV access
ports and hubs.

11. SKIN PREPARATION FOR VENIPUNCTURE
 Wash and dry hands.
 Wear sterile gloves.
 Prepare skin site, confine to smallest possible area of
skin.
 Swab with alcohol/chlorhexidine 2% first, allow it to dry.
 Swab iodine on site and allow it to dry.
 Swab again with alcohol to wipe off iodine, allow it to dry.
 Skin is now ready for puncture of prick.
 www.newbornwhocc.org

12. DIAPER DERMATITIS AND DIAPER WIPES

13. DEFINITION
 Diaper dermatitis is an acute inflammatory reaction
of skin in the perineal area.
 Diaper dermatitis typically begins to appear after 1-
3 weeks of life

14. HOW TO PREVENT DIAPER DERMATITIS?
 Change diapers every 1-3 hours during the
day and at least once at night.
 The genital area should be gently and
thoroughly cleansed, avoid rubbing when
cleansing the diaper area

15.  Use appropriate methods to cleanse the
diaper area. Consider products that have
been safety-tests on neonates. Some
suggestions include :
 Soft cloths and water
 Soft cloths water and a gentle cleanser
 Disposable diaper wipes

16. RISK FACTORS FOR DIAPER DERMATITIS
 Frequent stooling
 Antibiotic Use
 Malabsorption
 Opiate withdrawal
 Abnormal rectal sphincter and Tone

17. STRATEGIES TO REDUCE THE RISK
 Perform a focused skin assessment of the
perineal area
 Encourage and support breastfeeding
 Use petrolium based ointments or skin
barriers containing zinc oxide at every diaper
change in infants at risk for developing
diaper dermatitis

18. METHODS TO TREAT THE SKIN
EXCORIATION FROM DIAPER DERMATITIS
 Identify and treat the underlying cause
 Protect injured skin with application barrier
cream or paste, such as zinc oxide
 Apply barrier paste or cream in thick coating
 Consider oral or topical cholestyramine agents as
ordered by the health care provider.

19. DIAPER DERMATITIS COMPLICATED BY CANDIDA
ALBICANS
 Apply topical treatment including antifungal
ointments or creams, as ordered
1. Nystatin ointment
2. Clotrimazole ointment
3. Mupirocin

20.  Use of talcum baby powder or cornstarch is
unnecessary and Is not recommended to prevent
or treat diaper dermatitis in neonates
 Use of antibiotic ointment is not recommended
 Use of topical corticosteroids should discouraged

22. CONCLUSION
 Evaluate the effectiveness of therapeutic
interventions and consider allergic contact
dermatitis as a potential diagnosis if the response
to therapy is not favorable.
 Consider using dye free diapers for allergen
avoidance in special circumstances, such as an
infant with known allergic contact dermatitis

23. Thank you