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Sponge Bath

Hygiene must be maintained in all hospitalized babies. Daily sponge bath pose risk of heat loss, physiological alterations including changes in heart rate, oxygen requirements and saturation levels, and detrimental behavioral cues including crying, whimpering and thrashing. Critically ill and preterm infants should not be bathed as it is recognized to be detrimental to their well being. Minimal handling is now encouraged for these babies to reduce their stress.

PROCEDURE​

  • Make sure that the baby is stable enough to be washed. If in doubt, ask the doctor.
  • Preferably wash when the baby is awake, before feeding and with the support of a parent. If a parent is not available, two nurses should be present when washing sick and/or preterm babies. Ideally parents/relatives should perform the daily washing under supervision and guidance from the nursing staff.
  • Have all necessary equipment in close reach before washing:
    • Thermometer, diaper, linen, new nest and cotton
    • Clean, lukewarm water without soap
    • Dextrose 10%
    • Suction catheters
    • Gloves
  • Evaluate the respiratory pattern of baby. Is the baby in respiratory distress, using accessory muscles, grunting or having nasal flaring? How is the respiratory rate?
  • Measure the baby’s temperature. If the baby is hypothermic, the wash cannot continue. If not, consider whether the heat from the Radiant Warmer should be increased during washing to prevent a fall in temperature.
  • If suctioning is required, use gloves.
  • To maintain a stabile circulation and respiration during washing, keep the nest as support until washing is finished. Preferably turn the baby as little as possible.
  • Gently remove unnecessary tapes and administer 10% Dextrose on a wick for pain relief. Coconut oil should be used to make the removal of the tape less painful, but do not use oil if the baby is in phototherapy.
  • Begin with the face of baby. After washing one part of the baby, gently dry by patting (do not rub) before continuing in order to maintain baby’s temperature. Use different part of the cotton for each eyeball. Wash from nose towards ear to prevent passing of bacteria’s from one eye to the other. Make sure to get rid of all secretion around the mouth. Wash ears, behind ears, neck, underarms, feet and obvious soiled body parts. During the washing, observe the umbilical cord, and look for signs of infection, e.g., redness, swelling, and discharge. Inform the doctor if an infection is suspected. Observe the skin for trauma, rashes and color.
  • Last, wash the diaper area while wearing gloves (if soiled). Always wash from the front to the back.
  • To keep the umbilical cord dry, fold the diaper below the level of the stump. Make sure to fold the diaper outwards, so that there is no friction between baby’s skin and diaper.
  • Weigh the baby if possible and use the old sheet to swaddle the baby on the weight. Discard old sheet. Place the baby in a clean bed/ nest.
  • The baby should be closely observed during washing. This is a good time for observing the skin, the color, the CRT, baby’s reactions to stimuli and whether the baby is having apneas or bradycardia.

IMPORTANT POINTS​

  • Always wash your hands before the procedure.
  • Parents should be actively involved in the process of bathing the baby.
  • Only clean and disinfected utensils should be used for bathing.
  • Change the position of the SpO2 sensor. To reduce the risk of pressure marks and sores, cotton should be placed between the probe and the baby's skin.
warning

Give the baby a break or stop the wash entirely if the baby becomes stressed, cyanotic, drops in saturation or heart rate, or have apnea. Never disconnect the ventilator during washing or changing of linen.

References​

  • Oslo University Hospital Procedure on Washing a Baby in Incubator (2014)
  • Practical Procedures for the Newborn Nursery
  • A Manual for Physicians & Nurses, by Deorari, Paul, Singhal
  • Scotland and McMillan, Third Edition (2010)
  • Neonatal Intensive Care by Merenstein & Gardner, 7 edition (2011)
  • Comprehensive Neonatal Nursing Care, by Kenner and Lott, fifth edition (2014).
  • Peters K.L. Bathing premature infants: physiological and behavioural consequences. Am J Crit Care 1998;7(2): 90-100.
  • Peters K.L. Association between autonomic and motor systems in the preterm infant. Clin Nurs Crit Care 2001; 7(2): 90-100.
  • Lee H.K. Effects of sponge bathing on vagal tone and behavioural responses in preterm infants. J Clin Nurs 2002; 11(4): 510-19.
  • Liaw J-J., Yang L., Yuh Y-S., Yin T. Effects of tub bathing procedures on preterm infants behavior. J Nurs Res 2006; 14(4): 297-305.

Document Information​

Current Version

Version: 2.0
Published: August 20, 2015
Revised by: Dr Chetan Meena and Neonatal Nurse Johanne M. E. Huurnink
Contributors: Teaching Nurses from Norway and FBNCU Nursing Staff, JK Lone Hospital, SMS Medical College, Jaipur
Previous Versions: v1.0