Infant Bathing Research Articles

Development of an intervention for reducing infant bathing frequency.

Bathing babies less frequently and intensively in the first six months of life may prevent eczema, but this has not yet been definitively tested in a randomised controlled trial. Such a trial would require evidence-based support to help parents engage with a minimal bathing routine. The present study reports the development of this support. We adopted a four-stage design process: (i) Pregnant women and their families (n = 31) were interviewed to ascertain key barriers and facilitators towards following the minimal bathing intervention. (ii) These barriers and facilitators were mapped to behaviour change techniques, focussing on the intervention types of education, persuasion and environmental restructuring, alongside appropriate modes of delivery, and prototype intervention materials were developed. (iii) We iteratively refined these materials in a workshop with multidisciplinary experts and Patient and Public Involvement and Engagement (PPIE) representatives (n = 13) and an (iv) intervention walkthrough with families (n = 5). The design process was informed by the Behaviour Change Wheel, Theoretical framework of acceptability and the Template for intervention description and replication. Social influences and motivational factors are likely to influence both uptake and adherence to the intervention. Anticipated emotional reward from participating in research for the benefit of others was indicated to be a strong facilitator for intervention uptake. Alternatives to bathing, having fun with the baby and the night-time routine, alongside family support, were notable facilitators suggested to aid adherence to the intervention. Barriers included hygiene concerns and anticipated negative social appraisal. Barriers and facilitators were mapped to thirty-six behaviour change techniques, focussing on the intervention types of education, persuasion and environmental restructuring, all of which were embedded into the package of support. The prototype intervention materials received positive feedback from the expert workshop and study walkthrough with families. The final package of support comprises printed and digital prompts and cues, a study booklet, video, and digital tool for self-monitoring. The intervention design process incorporated the 'real world' views and experiences of families, experts and PPIE representatives, alongside criteria for designing behavioural interventions. The effectiveness of the package of support will be tested in a feasibility trial and embedded process evaluation.

Running water while bathing is a risk factor for pediatric scald burns

IntroductionScalds are the most common mechanism of burn injury in pediatric populations and scald burns sustained during bathing present a unique opportunity for injury prevention. Evidence-based infant bathing educational resources recommend checking water temperature and having a caregiver present for the duration of the bath, but do not explicitly recommend avoiding running water or explain the associated risks. This study seeks to determine the incidence and role of running water in bathing scald burns at our institution. MethodsThis is a retrospective review of pediatric patients (<3 years) admitted to the University of Chicago Burn Center with scald injury from bathing between 2010 and 2020. Cases were reviewed to assess the following risk factors: whether there was running water, whether water temperature was checked before placing the child in water, and whether a caregiver was present for the entire bath. Injuries in which the manner of injury was abuse or indeterminate were excluded. ResultsThe study cohort included 101 cases of scalds due to bathing, with a mean age of 13 months and mean burn size of 7% TBSA. Of these 101 cases, 96 (95%) involved running water. Thirty-seven cases (37%) had only one of the three risk factors and 95% of those 37 cases involved running water. Twenty-nine cases (29%) involved all three risk factors while only two cases (2%) involved none of the three risk factors. Sixty-one cases (60%), thirty-nine cases (39%), and one case (1%) occurred in a sink, bathtub, or infant tub, respectively. ConclusionWe found that the vast majority of bathing scald burns involved running water, identifying a specific bathing recommendation that should be added to existing guidelines to reduce the incidence of bathing scald burns.

Sensitive infant caregiving among the rural Gusii in Kenya

ABSTRACT The Gusii in rural Kenya represent a particularly interesting community for the study of sensitivity, as they have previously been described as not showing sensitive care. This study focuses on the observation of sensitivity in seven families with a 7-to 23-month-old infant, with extensive naturalistic video observations (ca. 2–4 h per infant) in a multiple caregiver setting, and potential co-existing harsh parenting practices. The average score for received sensitive caregiving was rather low at 5.3, but four out of seven infants were rated as receiving at least adequately sensitive care. Sensitivity was mostly expressed non-verbally in the form of (subtle) physical responsiveness by a variety of caregivers, and seen to a high extent during infant feeding. Insensitivity was seen when caregivers were occupied with chores, and during infant bathing. Results are discussed in terms of the nature of sensitive caregiving among the Gusii, and factors that might explain within-group differences.

Examination of the Appropriateness of Teaching Materials for Preventing Dangers during Ablution and Bathing of Infants by Mothers and Family Members

Purpose: This study aimed to develop teaching materials to prevent the dangers of ablution and bathing infants, based on the dangerous experiences of mothers and family members, and examine their appropriateness. Methods: A total of 20 midwives and public health nurses were selected as participants. Teaching materials and anonymous self-administered questionnaires were distributed, and the participants were asked to view the teaching materials and fill in the questionnaires. Retrieval was done by mail. The teaching materials included digital content, such as videos, sounds, and characters, which incorporated dangerous situations, preventions, and innovations in ablution and bathing procedures. The analysis was conducted by simple tabulation for each survey item. The free description was coded to preserve anonymity. This study was conducted with the approval of the Research Ethics Review Board of the authors’ affiliated university. Results: The teaching materials were found to be appropriate in terms of suitability to purpose, degree of difficulty of content, ease of viewing the videos, validity of time, appropriateness of expression, and usability. Conclusions: Ablution teaching materials that are used at the present time do not focus on dangers, and to date, no resources on bathing have been used as teaching materials. The created teaching materials in this study can be viewed multiple times, and mothers and family members who are unfamiliar with ablution and bathing can acquire knowledge regarding dangers and danger prevention. The addition of specific preventive measures and countermeasures for the occurrence of danger, along with practice, would result in the development of further appropriate teaching materials to reduce danger and alleviate anxiety.

1220. Public Health Investigations of Water-Related Organisms in Neonatal Intensive Care Units—United States, 2014–2022

Abstract Background Preterm and critically ill infants cared for in neonatal intensive care units (NICUs) are vulnerable to a wide variety of infections. Water use in healthcare settings is a known risk factor for opportunistic pathogen transmission due to the ability of such pathogens to persist in premise plumbing, though facility water risk assessments may also not account for practices within NICUs. We describe Centers for Disease Control and Prevention (CDC) consultations involving NICU patients and water-related organisms to help inform infection prevention and control response. Methods We searched internal CDC records from January 1, 2014, through December 31, 2021, to identify consultations involving investigations of potential or confirmed transmission of water-related organisms in NICU settings. We used available information to determine number of consultations and patients affected, most common organisms implicated, and potential exposure pathways and transmission routes. Results Of 92 consultations involving NICUs in the United States during the study period, we identified 30 consultations (33%) of water-related organism infections or outbreaks; combined, water-related organisms were isolated from 178 patients during these investigations. Serratia marcescens was the organism reported in the greatest number of investigations (n=10, 33%), followed by Pseudomonas spp. and Burkholderia cepacia complex (each n=4, 13%). Definitive transmission routes were not determined for all consultations, though investigations frequently identified concerns with water use in infant activities of daily living, such as bathing or feeding (n=14, 47%). Examples of such exposures unique to the NICU setting included the use of tap water to remove disinfectant residue from humidified isolettes and storage of supplies rinsed in water in infant bath basins to dry. Conclusion Consultations involving water-related organisms are common in the NICU. While clear sources of transmission are not always found, investigations often identified water exposures that may pose infection risks. To protect critically ill infants, hospitals should account for the extensive and unique characteristics of water use in NICUs when developing water management programs. Disclosures All Authors: No reported disclosures.

60 Running Water While Bathing Is a Risk Factor for Pediatric Scald Burns

IntroductionScalds are the most common mechanism of burn in children, and a significant proportion of these injuries are associated with bathing. Burns sustained while bathing present a unique opportunity for injury prevention; previous studies have examined lowering water heater temperatures, however reputable infant bathing educational resources do not explicitly recommend avoiding running water and the risks that it could pose. In an effort to inform prevention programs, this study seeks to determine the incidence and circumstances of running water in bathing scald burns at our institution.MethodsA retrospective review was performed of records from an American Burn Association verified center over a ten year period (1/1/2010 to 12/31/2019). This center treats both children and adults and is affiliated with an academic hospital in a major urban center. The burn database was queried for scald injuries in children less than three years involving bathing. The Child Advocacy and Protective Services team provides inpatient consultation for all children less than three years old with burn injuries allowing us to analyze the specific events surrounding the bathing scald burns in this cohort.ResultsA total of 123 patients met inclusion criteria. Three bathing safety risk factors were specifically noted in the chart review: (1) running water, (2) lack of caregiver presence for duration of bathing, and (3) failure of caregiver to check water temperature before bathing. Of the cases identified, 107 (87%) had clear documentation of running water as part of the history of injury, 66 (54%) cases involved failure of caregiver to check the water temperature before bathing and 53 (43%) cases did not have a caretaker present for the duration of the bath. In cases with only one risk factor, running water was identified in 34 (94%) out of 36 cases, and in cases with one or two risk factors, running water remained the primary risk factor with 38 (90%) out of 42 cases. When looking at the combination of risk factors, only three (2%) cases had no risk factors while 77 (63%) involved two or more risk factors.ConclusionsThe vast majority of bathing burn injuries in this series involved running water. In addition, a significant number of scald burns occurred from running water alone, even without the other identified risk factors. Conversely, only 2% of scald burns associated with bathing featured none of these three risk factors, suggesting that these injuries could be greatly impacted by safe bathing education.

Infant Bathing

As well as being a sensory organ, the skin performs several important functions including moisture retention, thermoregulation, vitamin D synthesis and protection from chemical, mechanical and thermal injury.1 The skin’s ability to fulfil these functions is dependent upon its pH level remaining balanced and its hydration being maintained, as disruption of these properties can result in skin complaints such as cradle cap, nappy rash, atopic dermatitis, baby acne and candidiasis (thrush).2 Newborn babies’ skin is known to be particularly sensitive and this fragility needs to be taken into consideration when giving parents advice about appropriate products and techniques to use when bathing their new baby.

Designing and Implementing a Skin Care Protocol for Infants With Neonatal Abstinence Syndrome to Decrease Rates of Diaper Dermatitis.

Infants with neonatal abstinence syndrome (NAS) are at an increased risk for diaper dermatitis, which can cause skin breakdown and lead to significant pain and potential infection exposure. Skin care protocols in the neonatal intensive care unit (NICU) setting seldom specifically address the needs of this at-risk population, leading to inconsistent skin care management. The goal was to support a decrease in the rate of diaper dermatitis for infants with NAS by designing and implementing an evidence-based skin care protocol. A retrospective medical record review was used to examine outcomes of 25 infants preintervention and 8 infants postintervention. The skin care protocol was a bundle of 5 evidence-based interventions: (1) a specific diaper dermatitis assessment tool; (2) frequent diaper changes with superabsorbent diapers; (3) application of petroleum jelly and alcohol-free wipes; (4) infant bathing in pH neutral soap; and (5) application of zinc oxide barrier cream for erythema. There was an overall 80.5% decrease in diaper dermatitis from pre- to postimplementation (P ≤ .01) as noted when comparing positive cases of diaper dermatitis with negative cases from pre- to postintervention. Expanding the skin care protocol to all neonates in the NICU and nursery could aid in maintaining skin integrity and decreasing diaper dermatitis in the NICU. More research is needed following this study for the data to be generalizable to other NICUs. This study offers key takeaways including using a specific diaper dermatitis assessment tool and consistently using the bundle of interventions. https://journals.lww.com/advancesinneonatalcare/Pages/videogallery.aspx?autoPlay=false&videoId=47.

A Survey of Bath Time Incidents Experienced by Mothers and Families of Children Aged 18 Months

Purpose: The potential dangers of infant bathing have an effect not only on the infant’s body and life but also on the formation of emotional bonds in the parent-child relationship. This study will explore actual dangers experienced by mothers and families. Method: We distributed an anonymous, self-reported questionnaire at infants’ 18-month health checkup, which was collected via postal service. 304 valid responses were received and formed our sample data. Descriptive statistical analysis was performed for each category surveyed. Inferential statistics were used to compare the dangerous incidents experienced with regard to differences between primipara/multipara and the presence/absence of guidance concerning such incidents. This study was approved by the research ethics committees of the affiliated university. Results: 70% of mothers and families experienced incidents while bathing their infants, with the most common incidents consisting of, in order of frequency, near immersion of the face, actual immersion of the face, and falling into the bath. The most common situations reported when incidents occurred were bathing the infant by oneself, the infant moving unexpectedly, or taking care of other children, in that order. Approximately 70% of mothers and families had not received instruction on the potential dangers or how to prevent them. Conclusion: This study has elucidated the dangerous situations experienced in the course of bathing infants in the home and the measures taken to prevent such situations. Instructive tools are needed which can be used to easily provide mothers and families with correct information.

Decontamination effectiveness and the necessity of innovation in a large-scale disaster simulation.

Chemical, biological, radiologic, nuclear, and explosive (CBRNE) events threaten the health and integrity of human populations across the globe. Effective decontamination is a central component of CBRNE disaster response. This paper provides an objective determination of wet decontamination effectiveness through the use of a liquid-based contaminant proxy and describes the mobilization and adaptation of easily available materials for the needs of decontamination in pediatric victims. In this in-situ disaster simulation conducted at a pediatric hospital, decontamination effectiveness was determined through a liquid-based contaminant proxy, and standard burn charts to systematically estimate affected total body surface area (TBSA) in 39 adult simulated patients. Two independent raters evaluated TBSA covered by the contaminant before and after decontamination. On average, simulated patients had 59 percent (95 percent CI [53, 65]) of their TBSA covered by the simulated contaminant prior to decontamination. Following a wet decontamination protocol, the average reduction in TBSA contamination was 81 percent (95 percent CI [74, 88]). There was high inter-rater reliability for TBSA assessment (intraclass correlation coefficient = 0.83, 95 percent CI [0.68, 0.92]. A modified infant bath was tested during the simulated decontamination of infant mannequins and thereafter integrated to the local protocol. Wet decontamination can remove more than 80 percent of the initial contaminant found on adult simulated patients. The use of a liquid-based visual tool as a contaminant proxy enables the inexpensive evaluation of decontamination performance in a simulated setting. This paper also describes an innovative, low-cost adaptation of a local decontamination protocol to better meet pediatric needs.

Sensitive infant caregiving among the rural Gusii in Kenya

ABSTRACT The Gusii in rural Kenya represent a particularly interesting community for the study of sensitivity, as they have previously been described as not showing sensitive care. This study focuses on the observation of sensitivity in seven families with a 7-to 23-month-old infant, with extensive naturalistic video observations (ca. 2–4 hours per infant) described qualitatively and quantitatively. Sensitivity ratings showed substantial individual variation, ranging from low (2) to high (8). Sensitivity was mostly expressed non-verbally in the form of (subtle) physical responsiveness by a variety of caregivers, and seen to a high extent during infant feeding. Insensitivity was seen when caregivers were occupied with chores, and during infant bathing. Both warmth and harshness were observed, but infrequently. Results are discussed in terms of the nature of sensitive caregiving among the Gusii, and factors that might explain within-group differences.

PROMOTION OF PARENT’S COMPETENCE IN INFANT FLOATING

Currently, there are conflicting views around the world regarding infant floating. There is no consensus on the most effective techniques for facilitating infant swimming skills. Infant floating is dominated by a therapeutic and pedagogical approach that ensures parents' involvement in the process. There is no unified methodology for infant floating in Latvia. Furthermore, the number of infant swimming specialists, as well as adequate infrastructure, is insufficient and limited. In the existing situation, it is important to increase parents' competence in infant floating so that parents are able to carry out infant bathing independently. The aim of the study is to develop a model for improving parental competence in infant floating. The main research methods comprised of studying and analysing scientific literature and modelling. The paper is based on 27 scientific literature sources, 22 of them in English, 2 in Latvian and 3 in Russian. The developed model of parental competence improvement in infant floating includes parents' theoretical knowledge of infant floating; independent research on infant floating; water safety; the application of infant floating skills under a specialist’s guidance and the ability to independently use acquired skills without guidance. In the future it will be possible to test the developed model to evaluate its usefulness in promoting parental competence in infant floating, thus ensuring parents' ability to float the infant independently.

Infant skin care: updates and recommendations.

Neonatal skin acclimates rapidly to dry, aerobic conditions at birth and skin function gradually matures throughout infancy. Gentle skin care practices support the ongoing development and function of newborn skin. This article reviews research updates and current skin care recommendations for full-term infants, premature infants, and infants born with severe cutaneous manifestations of genetic skin disorders. Although safe early bathing of full-term infants with environmental controls is possible, delaying the first newborn bath for 12-24 h of life offers benefits of increased parental bonding and breastfeeding success. Swaddled bathing every 4 days is an effective bathing strategy for premature neonates. Among infants with a family history of atopic dermatitis, regular application of bland skin moisturizers reduces their risk of developing the disease. For newborns with erosive or blistering genetic skin conditions, use of specialized wound dressings and emollients promotes wound healing and helps limit skin damage. Environmental control with humidified incubators helps prevent life-threatening hypernatremic dehydration among babies born with collodion membranes; however, affected infants can tolerate breaks outside of the humidifier to promote parent-infant bonding. This article reviews infant skin care recommendations relevant to pediatric practice. Research to further optimize newborn skin care is ongoing, particularly, for the special populations of premature neonates and infants born with severe skin disease.

Impact on delayed newborn bathing on exclusive breastfeeding rates, glucose and temperature stability, and weight loss

ObjectiveDetermine impact delayed newborn bathing for 24 hours has on exclusive breastfeeding rates, temperature and glucose stability, and percentage of weight loss and, to determine if there was a difference in the nurses’ knowledge and comfort levels regarding delayed bathing pre and post implementation. DesignPre-post retrospective chart review and, pre-post survey. SettingMidwestern health system with three hospitals that has a combined average delivery rate of 2100 births. Participants330 charts were reviewed pre-implementation, 330 charts were reviewed post-implementation, and 100 RNs were asked to participate in the pre and post-survey. MethodsNewborn baths were delayed 24 hours after birth unless contraindicated by a blood borne pathogen or upon parental requests. ResultsPost-intervention there was a significant decrease in the number of blood glucose level checks (p = .002) and the amount of blood glucose levels equal or below 45 (p = .001). There was a trend in decreased weight loss post-intervention, but was not significant (p = .227). Cold stress significantly decreased (p < .001) post-intervention. Exclusive breastfeeding rates did not change. Nurses’ perception of comfort and knowledge level increased post-intervention. ConclusionDelaying an infant's bath until 24 hours after birth seems to have positive impact on the infant's temperature regulation as well as glucose stability.

Effects of bathing interval on skin condition and axillary bacterial colonization in preterm infants

AimThe objective of this study was to evaluate the effects of preterm infant bathing periods on skin condition and axillary skin colonization. BackgroundReducing the frequency of bathing in preterm infants is beneficial in reducing the risk of hypothermia and exposure to stress from frequent nursing contacts. MethodsThe subjects of this study were observed at The V hospital at the C University in South Korea between December 2012 and August 2013. A total of 32 preterm infants were included and were randomly assigned to two different bathing intervals; every four days (n=16) and the other every two days (n=16) bathing groups. A neonatal skin conditions were assessed on a daily basis, whereas, axillary skin colonization was measured every eight days before bathing. Data was analyzed via the SPSS program with a non-inferiority test, t-test, chi-square test, Fisher's exact test, and paired t-test. ResultsMean differences of skin condition between the four-day bathing and two-day bathing groups were 0.065 and the 97.5% one-sided confidence limit was 0.196 (less than the non-inferiority margin, 0.3). There were no statistically significant differences in skin condition and axillary skin colonization between the two groups (p>0.05). ConclusionThe interval of bathing for preterm infants can be changed from every two days to every four days without increasing the incidence of skin condition problems or axillary skin colonization. Less-frequent bathing may decrease the chance of physiological instability caused by the caring process, while providing them with a better environment for growth and development.

Estimating infants' and toddlers' inhalation exposure to fragrance ingredients in baby personal care products.

Fragrance ingredients are commonly added to many personal care products to provide a pleasant scent, including those intended for babies. While fragrance chemicals have a long history of safe use, at sufficiently high concentrations some may act as respiratory irritants or sensitizers. Little data have been reported on the inhalation exposures to fragrance compounds to infants and toddlers during bathing and lotion applications. This study demonstrates an in vitro method for measuring breathing zone air concentrations of fragrances from bath products and lotions. It employed simulated infant bathing and lotion application events and a robot to mimic a toddler's movement within a bathroom setting. The air concentrations in an infant's breathing zone were between <1 and 5 μg/m3 for each of seven common fragrance ingredients, while that in the breathing zone of toddlers in the bathroom was ≤ 1μg/m3. The air concentrations from the bathing additive were linearly related to their Henry's law constants and from the lotion inversely related to their octanol-air coefficients. The proposed approach can help refine risk estimates from inhalation exposure to fragrances used in baby products and guide future risk assessments of new products' safety for their use in baby bath products.

Weaning and the rendering of substances nourishing: food shamanism amongst the Warekena of northwestern Brazil

The paper explores the nurturing and nourishing practices of a small group of Amerindians, the Xié river dwelling Brazilian Warekena, and focuses on the gradually expanding diet of infants, babies and toddlers. Unlike other instances of food shamanism, the rituals surrounding infant feeding, and in particular during weaning, are topics that have received little attention. This paper provides ethnographic detail of the Warekena’s infant feeding practices and offers an alternative perspective on food shamanism: one that is based on the Warekena’s own insistence on mediating vital processes, through attention-directing practices, such as when eating. In particular, the paper seeks to throw light on food preparation, the ritualised consumption of foods, including the prior bathing of infants and the blessing of new foods introduced in the infant’s diet. Working within animic relationality, the focus here is on the mediation of foodstuffs and of the vital processes of the body itself, so as to promote the cosmological and bodily balance that engenders the good health of infants.

Infant Skin Care Products: What Are the Issues?

Infant skin is susceptible to dryness and irritation from external factors, including topical skin care products not formulated for the infant's skin. This may increase the risk of contact dermatitis. Parents frequently express concern regarding potential harm from ingredients in skin care products and seek information. This is complicated by several skin care myths. The purpose of this literature review was to provide evidence-based information to educate parents on the use of products for preterm and term infants. Multiple searches using PubMed were conducted including the search terms "infant skin care," "infant products," "infant bath," "emollients," "diaper skin care," and "diaper wipes." Reference lists of comprehensive reviews were also scanned. Google searches were used to assess consumer information, product information, and regulatory guidelines. There is little scientific evidence to support safety of natural/organic products on infant skin. Raw materials originate from different sources, complicating testing and comparisons of ingredients. Research shows that cleansers formulated for infant skin do not weaken the skin barrier the way harsher soaps and detergents can. Oils with the lowest oleic acid content provide a lower risk of irritant contact dermatitis. Nurses must be informed about natural and organic products, preservatives, and fragrances and know the definition of commonly used marketing terms. Decisions regarding the use of infant products in preterm and term infants should be evidence based. More research is needed to support claims regarding the safety of products used on infant skin.

Recommendations from a European Roundtable Meeting on Best Practice Healthy Infant Skin Care.

BackgroundEuropean roundtable meeting recommendations on bathing and cleansing of infants were published in 2009; a second meeting was held to update and expand these recommendations in light of new evidence and the continued need to address uncertainty surrounding this aspect of routine care.MethodsThe previous roundtable recommendations concerning infant cleansing, bathing, and use of liquid cleansers were critically reviewed and updated and the quality of evidence was evaluated using the Grading of Recommendation Assessment, Development and Evaluation system. New recommendations were developed to provide guidance on diaper care and the use of emollients. A series of recommendations was formulated to characterize the attributes of ideal liquid cleansers, wipes, and emollients.ResultsNewborn bathing can be performed without harming the infant, provided basic safety procedures are followed. Water alone or appropriately designed liquid cleansers can be used during bathing without impairing the skin maturation process. The diaper area should be kept clean and dry; from birth, the diaper area may be gently cleansed with cotton balls/squares and water or by using appropriately designed wipes. Appropriately formulated emollients can be used to maintain and enhance skin barrier function. Appropriately formulated baby oils can be applied for physiologic (transitory) skin dryness and in small quantities to the bath. Baby products that are left on should be formulated to buffer and maintain babies’ skin surface at approximately pH 5.5, and the formulations and their constituent ingredients should have undergone an extensive program of safety testing. Formulations should be effectively preserved; products containing harsh surfactants, such as sodium lauryl sulfate, should be avoided.ConclusionHealth care professionals can use these recommendations as the basis of their advice to parents.

Skin antisepsis survey in Australia–New Zealand neonatal nurseries

Central line-associated blood stream infections are responsible for 20–40% of health-care-associated infection in both paediatric and adult patients,1 placing a strain on limited resources in terms of staff and cost. A recent study in the USA showed an increase of 4–7 days in length of stay associated with nosocomial bacteraemia.2 Chlorhexidine (CHG)-based antiseptic for skin preparation before central line insertion and dressing changes has been recommended for use in infants over 2 months of age.3 There is a lack of uniformity regarding usage of skin antisepsis in newborn infant, and its usage is currently not approved by the US Food and Drug Administration for infants less than 2 months. However, a national US survey of neonatology program directors revealed that 78% of neonatal intensive care units use CHG4 with wide variation in preparations used. Our intention was to survey and identify the extent of usage of CHG and other skin antiseptic solutions and its adverse effects in various neonatal nurseries including neonatal transport services and surgical units across Australia–New Zealand (ANZ). The survey was sent by using the web-based software Survey Monkey (Survey Monkey Inc., Palto Alto, CA, USA) in December 2011 to the unit directors and the nursing unit manager if no response was obtained. All the responses were anonymous. Of the 31 tertiary units in ANZ, 29 units responded (93%). Over half of the units (52%) responded that nosocomial infection was a serious concern in the last 18–24 months, and six units responded that skin antisepsis policy was a concern as well. The type (Table 1) and concentration (Table 2) of CHG used in the neonatal intensive care unit varied considerably. Alcohol-based CHG was commonly used in term infants, whereas majority of units (72%) used aqueous CHG in preterm infants. Three units reported using iodine first with a secondary use of CHG. Most units used CHG of a strength >0.1% with a range between 0.1% and 2.0%. In terms of indications of CHG, peripheral intravenous access, central vascular access and umbilical catheterisations and maintenance were the commonly used procedures. Daily bathing of newborns (three units) and Methicillin Resistant Staphylococcus Aureus decolonisation (five units) were other less often indications. Adverse effects of CHG were reported by 12 units, in form of skin erythema or burns or blisters. Six out of 10 units who reported the adverse effects were using higher concentration of CHG (>0.5%). Seventeen units (59% of respondent) reported using iodine in the past and hypothyroidism was common side effect observed then. In contrast to the US national survey by Tamma et al.,4 all respondents from ANZ in our survey used CHG in some form for term infants and almost 90% in preterm infants as well. Victor Yu5 surveyed 20 neonatal intensive care units in Australia more than two decades ago and identified lack of uniformity with regard to skin antisepsis policy including intravascular access. Our survey showed that while most units used CHG in their neonatal nurseries, there was a 20-fold range in concentration, indicating a lack of consensus. CHG has been used in various invasive procedures like central/umbilical line insertions, central line maintenance and bathing of newborn infants as well. The use of alcohol or aqueous base and the addition of iodine is an additional concern. The literature in adults suggests that aqueous CHG is as effective as alcohol base and safe, although alcohol may provide longer antiseptic effect.6 Adverse effects of CHG are reported in form of skin burns, erythema and blisters,7 although more so in preterm infants. Although CHG is clearly effective as skin antiseptic solution, a further research and data into its optimal strength, type and associated skin adverse effects needs to be established.