EBPI: Improving Umbilical Care in the Newborn Nursery

Our PICO question for this EBPI project was: In the healthy term newborn, does natural drying of the umbilical cord affect the risk of infection compared with the use of triple dye? Our proposal, then, was to change the current standard of practice and discontinue the use of triple dye on the umbilical cord, simply allowing the cord to dry naturally. We performed a systematic search of the literature and found overwhelming evidence to support natural drying of the umbilical cord. We also found evidence that the application of the dye actually delays umbilical drying and separation time. The presence of the cord stub also was shown to increase parental anxiety. The recommendation to the Northern Westchester Hospital Neonatal Advisory Board was to allow natural drying and to give a sponge bath until separation; the important aspect is to keep the area clean and dry.
After reviewing the information the board members agreed to the change in practice. Our standard newborn orders for medications were changed to remove triple dye application. Our discharge instructions for parents include keeping the area clean and dry until natural separation occurs. We are in the process of evaluating our discharge teaching for parents and collecting data on infection rate. These data will be available for presentation.