Authors: (including presenting author): :
Chung PL(1), Lam MY(1), Li H(1), Li WS(1), SY Yu(1)
Affiliation: :
(1) Department of Paediatric and Adolescent, Pamela Youde Nethersole Eastern Hospital
Keyword 1: :
Perianal and Perineal Skin Care
Keyword 2: :
Infants in NICU
Keyword 3: :
Diaper dermatitis
Introduction: :
Diaper dermatitis (DD) impacts the well-being of infants in our Neonatal Intensive Care Unit (NICU), ranging from mild erythema to severe skin breakdown and bleeding. Despite using non-fragrance, alcohol-free wipe and changing diapers every 3 - 4hours, the rate of DD remained unchanged. Key contributing factors included inconsistent nursing practices, a focus on curative rather than preventive care, and no standardized treatment protocol. To address these challenges, a continuous quality improvement program was developed to improve the prevention and management of DD in NICU.
Objectives: :
1.Decrease the incidence of DD, and minimize the severity of DD in NICU infants with a standardized skin care approach.
2.Reduce medical costs associated with barrier creams.
Methodology: :
This quasi-experimental study was conducted in NICU with a convenient sample of infants admitted from August to December 2025. A retrospective medical record review from 5 months prior to intervention was compared with post-intervention outcomes. A skin care bundle (SCB) with treatment algorithm was developed. SCB emphasized 1. Introduction of a Diaper Dermatitis Scale (DDS) chart for daily assessment; 2. gentle cleansing techniques; 3. Applying a thick layer of petroleum jelly at each diaper change. Based on the treatment algorithm, the DDS score guided the skin care and choice of barrier creams. Training on intervention strategies was provided to all staff (42 nurses and 10 patient care assistants). After a five-month implementation, DDS charts of the discharged infants were evaluated to determine the effectiveness of the interventions, and medical cost for DD cases were compared pre- and post- intervention.
Result & Outcome: :
Following the intervention, 55 infants (born at 24 - 41 with gestational weeks) were evaluated. The prevalence of DD decreased from 65% (32 out of 49 infants) born at 28 - 41 gestational weeks, with an average of 23 hospital days pre-intervention, to 51% (28 out of 55 infants), with an average of 20 hospital days post-intervention; representing a 14% reduction (P value 0.138). Among 28 infants with DD, there were 720 hospital days recorded: 72.5% (518 days) were free from DD, 23.5%(169 days) experienced mild DD, and 4.6%(33 days) had moderate DD, with no severe cases reported. After standardized treatment algorithm, the medical expenditures associated with barrier creams for infants with DD decreased from $1658 pre-intervention to $698 post-intervetnion, signifying a 57.9% reduction. This program effectively decreased medical costs and noted the severity of DD remained low. However, the change in the overall prevalence of DD was not statistical significance (P >0.05). Further study with large sample sizes may be required to validate the effectiveness of the skin care bundle in decreasing the DD rate.
