Table 2.
Practices based on income status groups of the respondent units
| Practices | Low and LMIC (175/842, 21%) | UMIC (275/842, 33%) |
HIC (392/842, 47%) |
Level of association, P |
|---|---|---|---|---|
| Local skin care guideline available (n = 799) | 100/167 (60) | 190/260 (73) | 284/372 (76) | < 0.001 |
| Local skin antisepsis guideline available (n = 805) | 99/170 (58) | 195/260 (75) | 306/375 (82) | < 0.001 |
| Skin cleansing solution prior to sterile procedures (n = 842)a | n = 175 | n = 275 | n = 392 | < 0.001 |
| Aqueous chlorhexidine solution | 50 (29) | 93 (34) | 211 (54) | |
| Combination alcohol and antiseptic | 106 (61) | 72 (26) | 107 (27) | |
| Iodine-based solution | 72 (41) | 146 (53) | 93 (24) | |
| Hexachlorophene | 2 (1) | 3 (1) | 8 (2) | |
| Sterile water | 12 (7) | 28 (10) | 50 (13) | |
| Skin cleansing solution prior to clean procedures (n = 828)a | n = 172 | n = 271 | n = 385 | < 0.001 |
| Aqueous chlorhexidine solution | 15 (9) | 44 (16) | 106 (28) | |
| Combination alcohol and antiseptic | 129 (75) | 172 (63) | 180 (47) | |
| Iodine-based solution | 10 (6) | 34 (13) | 9 (2) | |
| Hexachlorophene | 1 (1) | 2 (1) | 3 (1) | |
| Sterile water | 7 (4) | 4 (1) | 16 (4) | |
| Othersb | 10 (6) | 15 (6) | 71 (18) | |
| Differing skin antisepsis for infants ≤ 25 wk GA (n = 833)c | 24/172 (14) | 60/273 (22) | 119/388 (31) | < 0.001 |
| Skin integrity assessment tool (n = 842)a | n = 175 | n = 275 | n = 392 | < 0.001 |
| Braden Q | 6 (3) | 70 (25) | 39 (10) | |
| Neonatal skin risk assessment tool | 66 (38) | 57 (21) | 61 (16) | |
| Neonatal skin condition score | 26 (15) | 55 (20) | 56 (14) | |
| Starkid skin scale | 1 (1) | 5 (2) | 1 (-) | |
| Neonatal skin risk assessment scale | 12 (7) | 65 (24) | 34 (9) | |
| Glamorgan pressure injury risk assessment | 0 (0) | 9 (3) | 12 (3) | |
| Other local toolsd | 4 (2) | 9 (3) | 49 (13) | |
| None | 40 (23) | 32 (12) | 74 (19) | |
| Umbilical cord care practices (n = 842)a | n = 175 | n = 275 | n = 392 | < 0.001 |
| Leave alone | 105 (60) | 162 (59) | 283 (72) | |
| Sterile water | 46 (26) | 33 (12) | 50 (13) | |
| A drying agent | 20 (11) | 57 (21) | 25 (6) | |
| Topical antibiotic agent | 8 (5) | 25 (9) | 11 (3) | |
| Topical antifungal agent | 2 (1) | 5 (2) | 1 (-) | |
| Topical breast milk | 2 (1) | 7 (3) | 0 (0) | |
| Otherse | 16 (9) | 29 (11) | 44 (11) | |
| Routine use of topical emollients (n = 805), of these 41 (5%) were used for specific GA infants | 96/167 (57) | 135/258 (52) | 104/380 (27) | < 0.001 |
| Frequency of emollient use (n = 334) | n = 95 | n = 136 | n = 103 | 0.004 |
| Once daily | 37 (39) | 63 (46) | 38 (37) | |
| Twice daily | 41 (43) | 29 (21) | 32 (31) | |
| More than twice daily | 13 (14) | 31 (23) | 17 (16) | |
| Others | 4 (4) | 13 (10) | 16 (16) | |
| Type of topical emollient useda (n = 842), not just prophylactic | n = 175 | n = 275 | n = 392 | < 0.001 |
| Oil-based | 99 (57) | 123 (45) | 95 (24) | |
| Petrolatum-based | 27 (15) | 70 (25) | 59 (15) | |
| Othersf | 6 (3) | 32 (12) | 52 (13) | |
| Issues (often, almost always and always) from any use of emollientsa | ||||
| Interference with other adhesives (n = 469) | 27/110 (25) | 47/178 (26) | 39/181 (22) | 0.550 |
| Increased incidence of CONS infection (n = 471) | 4/109 (4) | 8/179 (4) | 7/183 (4) | 0.930 |
| Hyperthermia (n = 465) | 4/110 (4) | 11/176 (6) | 3/179 (2) | 0.080 |
| Tissue burns (n = 463) | 6/110 (5) | 5/176 (3) | 4/177 (2) | 0.300 |
| Environmental contamination causing invasive sepsis (n = 463) | 9/109 (8) | 11/176 (6) | 3/178 (2) | 0.020 |
| MARSI prevention | ||||
| Tapes for securing tubes (n = 848)a | n = 175 | n = 275 | n = 392 | 0.001 |
| Transparent film dressing | 70 (40) | 116 (42) | 131 (33) | |
| Hydrocolloid base with transparent film or adhesive tape | 30 (17) | 98 (36) | 154 (39) | |
| Silicone tape | 32 (18) | 39 (14) | 68 (17) | |
| Plastic polymer skin barrier film | 9 (5) | 34 (12) | 29 (7) | |
| Zinc oxide adhesive | 26 (15) | 16 (6) | 16 (4) | |
| Plastic perforated tape | 10 (6) | 26 (10) | 39 (10) | |
| Hydrogel adhesive | 8 (5) | 25 (9) | 49 (13) | |
| Othersg | 27 (15) | 54 (20) | 94 (24) | |
| Use of barrier film underneath the adhesive for skin protection (n = 787) | 69/162 (43) | 132/254 (52) | 220/371 (59) | 0.002 |
| Use of adhesive remover when removing tapes (n = 787) | 56/162 (35) | 170/257 (66) | 298/368 (81) | < 0.001 |
| Type of adhesive remover used (n = 524 as 4 did not identify their country)a | n = 56 | n = 170 | n = 298 | < 0.001 |
| Alcohol/organic-based products | 31 (55) | 58 (34) | 55 (19) | |
| Oil-based solvents | 22 (39) | 80 (47) | 92 (31) | |
| Silicone-based removers | 3 (5) | 45 (27) | 96 (32) | |
| Othersh | 5 (9) | 17 (10) | 56 (19) | |
| Additional strategy for MARSI prevention (n = 842)a | n = 175 | n = 275 | n = 392 | < 0.001 |
| Remove adhesive slowly and carefully using moistened gauze/pad | 121 (69) | 212 (77) | 312 (80) | |
| Pull adhesive tape in a horizontal plane | 55 (31) | 114 (42) | 144 (37) | |
| Fold the tape back onto itself while continuously wetting the adhesive-skin interface | 56 (32) | 138 (50) | 177 (45) | |
| Othersi | 4 (2) | 5 (2) | 14 (4) | |
Six respondents did not identify their country. Responses reported as number (%), percentage rounded to the nearest whole number. LMIC lower middle-income country, UMIC upper middle-income country, HIC high-income country, GA gestational age, MARSI medical adhesive-related skin injury, CONS coagulase-negative Staphylococcal. aMultiple responses allowed; bother solutions were alcohol, chlorine, chlorhexidine/alcohol and benzalkonium, sodium chloride, octenidine and hypochlorite; cother practices such as use of only sterile water, povidone-iodine, weak non-alcoholic solution, octenidine with sterile water and wiping off the cleansing solution with sterile water; dvisual inspection, homegrown local tool, neonatal skin injury and pressure injury risk assessment, Swiss neonatal skin score, Norton pressure sore risk; eother topical cord application practices included application of varying strengths of chlorhexidine or alcohol-based solutions, normal saline, calendula tincture, hydrogen peroxide, iodine-based solutions, octinidine solution, methylated spirits, and use of soap and water; fbaby oil, benzalkonium, ceramide base, cold cream, dimethacone, eucerin, silicone ointment, oil with vitamin E; gadhesive paper or plaster, band aid, brown tape, cotton or cloth tape, polyacrylate tape, silk tape; hcoconut oil, water, soap and water, emollient, saline, octenidine dihydrochloride and 2-phenoxyethanol; ikeep adhesive tapes for 24 hours, olive oil moistened cotton wool, avoid band aids, loosen edges of tape with adhesive remover and carefully peel back dressing until it is removed followed by clean site with saline wipe