Table 3.
Practices based on geographic region of the respondent units
| Practices | Europe (300/848) |
Asia (259/848) |
North America (121/848) | Africa (69/848) |
South America (58/848) | Oceania (35/848) | Level of association, P |
|---|---|---|---|---|---|---|---|
| Local skin care guideline available (n = 799) | 213/288 (74) | 159/240 (66) | 89/115 (77) | 42/67 (63) | 46/55 (84) | 25/34 (74) | 0.020 |
| Local skin antisepsis guideline available (n = 805) | 231/287 (80) | 157/244 (64) | 88/116 (76) | 42/67 (63) | 52/57 (91) | 30/34 (88) | < 0.001 |
| Skin cleansing solution prior to sterile procedures (n = 842)a | n = 300 | n = 259 | n = 121 | n = 69 | n = 58 | n = 35 | < 0.001 |
| Aqueous chlorhexidine solutionb | 109 (36) | 96 (37) | 56 (46) | 16 (23) | 46 (79) | 31 (89) | |
| Combination alcohol and antiseptic | 98 (33) | 93 (36) | 27 (22) | 49 (71) | 13 (22) | 5 (14) | |
| Iodine-based solution | 1000 (33) | 122 (47) | 63 (52) | 24 (35) | 1 (2) | 1 (3) | |
| Hexachlorophene | 3 (1) | 8 (3) | 2 (2) | 0 (0) | 0 (0) | 0 (0) | |
| Sterile water | 37 (12) | 24 (9) | 17 (14) | 6 (9) | 4 (7) | 2 (6) | |
| Skin cleansing solution prior to clean procedures (n = 828)a | n = 295 | n = 254 | n = 120 | n = 67 | n = 57 | n = 35 | < 0.001 |
| Aqueous chlorhexidine solution | 66 (22) | 36 (14) | 24 (20) | 0 (0) | 28 (49) | 11 (31) | |
| Combination alcohol and antiseptic | 166 (66) | 162 (64) | 67 (56) | 53 (79) | 22 (39) | 11 (31) | |
| Iodine-based solution | 13 (4) | 29 (11) | 6 (5) | 4 (6) | 1 (2) | 0 (0) | |
| Hexachlorophene | 1 (-) | 5 (2) | 0 (0) | 0 (0) | 0 (0) | 0 (0) | |
| Sterile water | 10 (3) | 5 (2) | 2 (2) | 4 (6) | 1 (2) | 5 (14) | |
| Others | 39 (13) | 17 (7) | 21 (18) | 6 (9) | 5 (9) | 8 (23) | |
| Differing skin antisepsis for infants ≤ 25 wk GA (n = 833) | 78/297 (26) | 57/258 (22) | 40/120 (33) | 4/67 (6) | 12/57 (21) | 12/34 (35) | 0.001 |
| Skin integrity assessment tool (n = 842)a | n = 300 | n = 259 | n = 121 | n = 69 | n = 58 | n = 35 | < 0.001 |
| Braden Q | 48 (16) | 38 (15) | 16 (13) | 1 (1) | 10 (17) | 2 (6) | |
| Neonatal skin risk assessment tool | 53 (18) | 58 (22) | 17 (14) | 34 (49) | 12 (21) | 10 (29) | |
| Neonatal skin condition score | 43 (14) | 49 (19) | 25 (21) | 5 (7) | 5 (9) | 10 (29) | |
| Starkid skin scale | 1 (-) | 5 (2) | 1 (1) | 0 (0) | 0 (0) | 0 (0) | |
| Neonatal skin risk assessment scale | 41 (14) | 44 (17) | 12 (10) | 2 (3) | 7 (12) | 5 (14) | |
| Glamorgan pressure injury risk assessment | 6 (2) | 4 (2) | 3 (2) | 0 (0) | 0 (0) | 8 (23) | |
| Other local tools | 28 (9) | 13 (5) | 14 (12) | 0 (0) | 2 (3) | 5 (14) | |
| None | 54 (18) | 38 (15) | 22 (18) | 15 (22) | 13 (3) | 4 (11) | |
| Umbilical cord care practices (n = 842)a | n = 300 | n = 259 | n = 121 | n = 69 | n = 58 | n = 35 | < 0.001 |
| Leave alone | 221 (74) | 158 (61) | 100 (83) | 13 (19) | 26 (45) | 32 (91) | |
| Sterile water | 41 (14) | 34 (13) | 9 (7) | 34 (49) | 8 (14) | 3 (9) | |
| Drying agent | 26 (9) | 37 (14) | 6 (5) | 13 (19) | 20 (34) | 0 (0) | |
| Topical antibiotic agent | 10 (3) | 25 (10) | 4 (3) | 5 (7) | 0 (0) | 0 (0) | |
| Topical antifungal agent | 1 (-) | 6 (2) | 1 (1) | 0 (0) | 0 (0) | 0 (0) | |
| Topical breast milk | 0 (0) | 6 (2) | 0 (0) | 1 (1) | 2 (3) | 0 (0) | |
| Others | 26 (9) | 32 (12) | 6 (5) | 14 (20) | 9 (16) | 2 (6) | |
| Routine use of topical emollients (n = 805), of these 41 (5%) were used for specific GA infants | 131/290 (45) | 106/242 (44) | 36/120 (30) | 41/65 (63) | 14/54 (26) | 7/34 (20) | < 0.001 |
| Frequency of emollient use (n = 334) | n = 131 | n = 105 | n = 36 | n = 41 | n = 14 | n = 7 | 0.002 |
| Once daily | 53 (40) | 49 (47) | 12 (33) | 12 (29) | 10 (71) | 2 (29) | |
| Twice daily | 36 (27) | 28 (27) | 12 (33) | 24 (59) | 0 (0) | 2 (29) | |
| More than twice daily | 23 (18) | 22 (21) | 7 (19) | 5 (12) | 3 (21) | 1 (14) | |
| Others | 19 (15) | 6 (6) | 5 (14) | 0 (0) | 1 (7) | 2 (29) | |
| Type of topical emollient used (n = 842)a not just prophylactic | n = 300 | n = 259 | n = 121 | n = 69 | n = 58 | n = 35 | < 0.001 |
| Oil-based | 127 (42) | 107 (41) | 21 (17) | 45 (65) | 15 (26) | 2 (6) | |
| Petrolatum-based | 69 (23) | 47 (18) | 24 (20) | 9 (13) | 4 (7) | 3 (9) | |
| Others | 37 (12) | 14 (5) | 21 (17) | 4 (6) | 7 (12) | 7(20) | |
| Issues (often, almost always and always) from any use of emollientsa | |||||||
| Interference with other adhesives (n = 469) | 46/196 (23) | 37/132 (28) | 13/59 (22) | 10/51 (20) | 4/18 (22) | 3/13 (23) | 0.880 |
| Increased incidence of CONS infection (n = 471) | 3/196 (2) | 10/134 (7) | 4/60 (7) | 2/50 (4) | 0/18 (0) | 0/13 (0) | 0.080 |
| Hyperthermia (n = 465) | 8/193 (4) | 5/134 (4) | 2/57 (4) | 3/50 (6) | 0/18 (0) | 0/13 (0) | 0.950 |
| Tissue burns (n = 463) | 2/191 (1) | 10/133 (8) | 1/58 (2) | 2/50 (4) | 0/18 (0) | 0/13 (0) | 0.370 |
| Environmental contamination causing invasive sepsis (n = 463) | 5/192 (3) | 12/132 (9) | 3/58 (5) | 3/50 (6) | 0/18 (0) | 0/13 (0) | 0.150 |
| MARSI prevention | |||||||
| Tapes for securing tubes (n = 842)a | n = 300 | n = 259 | n = 121 | n = 69 | n = 58 | n = 35 | < 0.001 |
| Transparent film dressing | 100 (33) | 117 (45) | 68 (56) | 16 (23) | 15 (26) | 1 (3) | |
| Hydrocolloid base with transparent film or adhesive tape | 91 (30) | 76 (29) | 52 (43) | 11 (16) | 34 (59) | 18 (51) | |
| Silicone tape | 39 (13) | 46 (18) | 22 (18) | 24 (35) | 1 (2) | 7 (20) | |
| Plastic polymer skin barrier film | 33 (11) | 29 (11) | 8 (7) | 2 (3) | 0 (0) | 0 (0) | |
| Zinc oxide adhesive | 170 (6) | 13 (5) | 2 (2) | 21 (30) | 1 (2) | 4 (11) | |
| Plastic perforated tape | 38 (13) | 19 (7) | 13 (11) | 2 (3) | 1 (2) | 2 (6) | |
| Hydrogel adhesive | 32 (11) | 28 (11) | 13 (11) | 1 (2) | 3 (5) | 5 (14) | |
| Other methods | 76 (25) | 42 (16) | 27 (22) | 7 (10) | 16 (28) | 7 (20) | |
| Use of barrier film underneath the adhesive (n = 787) | 143/286 (50) | 132/233 (57) | 70/117 (60) | 22/65 (34) | 34/53 (64) | 20/33 (61) | 0.004 |
| Use of adhesive removers when removing tapes (n = 787) | 236/286 (83) | 141/235 (60) | 80/114 (70) | 12/64 (19) | 31/55 (56) | 24/33 (73) | < 0.001 |
| Type of adhesive remover used (n = 524, country unknown for 4)a | n = 226 | n = 141 | n = 80 | n = 12 | n = 31 | n = 24 | < 0.001 |
| Alcohol/organic-based product | 52 (22) | 59 (42) | 23 (29) | 3 (25) | 4 (13) | 3 (13) | |
| Oil-based solvent | 75 (32) | 64 (45) | 25 (31) | 9 (75) | 17 (55) | 4 (17) | |
| Silicone-based remover | 81 (34) | 19 (14) | 27 (34) | 0 (0) | 6 (19) | 11 (46) | |
| Other agent | 43 (18) | 14 (10) | 9 (11) | 1 (8) | 5 (16) | 6 (25) | |
| Additional strategy for MARSI prevention (n = 842)a | n = 300 | n = 259 | n = 121 | n = 69 | n = 58 | n = 35 | < 0.001 |
| Remove adhesives slowly using moistened gauze | 243 (81) | 201 (78) | 95 (79) | 36 (52) | 39 (67) | 31 (89) | |
| Pull adhesive tapes in a horizontal plane | 109 (36) | 83 (32) | 57 (47) | 31 (45) | 19 (33) | 14 (40) | |
| Fold the tape back onto itself while continuously wetting the adhesive-skin interface | 146 (49) | 109 (42) | 52 (43) | 12 (17) | 32 (55) | 20 (57) | |
| Other methods | 13 (4) | 3 (1) | 6 (5) | 1 (2) | 0 (0) | 0 (0) | |
Responses reported as number (%), percentage rounded to the nearest whole number. GA gestational age, CONS coagulase negative staphylococci, MARSI medical adhesive-related skin injury. aMultiple responses allowed; bthe strength of the chlorhexidine solution varied from 0.01% to 100%