Research presentation for the first international nursing research conference of the world academy...
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Effects of 70% Isopropyl Alcohol, Plain NSS & Sterile Water
On Umbilical Cord Separation
Monina Hernandez Gesmundo, RN,RM,MAN(C)September 19, 2009
The First International Nursing Research Conference of the World Academy of Nursing Science
Kobe International Exhibition Hall, Kobe, Japan
Objective
To identify and compare the effects of using 70% Isopropyl Alcohol, Plain Normal Saline Solution & Sterile Water in the care of the newborn’s umbilical cord
Design
Prospective randomized controlled trial design
Setting
Postpartum ward of a tertiary-level government hospital in the Philippines
Study Participants
Sample size of thirty (n = 30) singleton, full-term newborns
roomed-in at the postpartum ward
of a tertiary-level government hospital
Sampling Design
Random assignment with ten (10) newborns in each of the 70% Isopropyl Alcohol, Plain NSS and Sterile Water group
Twenty-six (26) completed the study with nine (n = 9) in the Sterile Water group (Group A), eight (n = 8) in the Plain NSS group (Group B) and nine (n = 9) in the 70% Isopropyl Alcohol Group (Group C)
Bioethical Considerations
Principle of beneficencePrinciple of respect for human dignityInformed consentPrinciple of justice
Interventions
Mothers were taught to clean the newborn’s umbilical cord according cord care protocol
handwashing before cord care clean equipments use respective solutions proper direction of wiping done three times a day cord is exposed to air and allowed to dry
Interventions
Cord care was done daily until the cord fell-offA checklist of signs of infection was
accomplished daily both by the investigator and the mother during hospitalization, and by the mother upon discharge
Follow-up phone calls and home visit was done by the investigator to ascertain mother’s compliance to the cord care protocol and to assess the cord status
Main Outcome Measures
Length of cord separation time Maternal concerns with regard to the
state of their newborn’s cords and cord care treatment
Umbilical cord infectionCost of cord care
Data PresentationLength of Cord Separation Time (days)
Grouped Frequency Distribution of Length of Cord Separation Time
Length of Cord Separation Time
(in days)
Sterile Water Plain NSS Isopropyl Alcohol
freq
%
freq
%
freq
%
Less than 5 days 1 11.1 1 12.5 0 0
5-15 days 8 88.9 7 87.5 9 100.0
More than 15 days 0 0 0 0 0 0
Total 9 100.0 8 100.0 9 100.0
Mean 7.11 days 6.50 days 9.56 days
Median 7.00 days 7.00 days 10.00 days
Length of Cord Separation Time (days)
7.116.5
9 .56
0123456789
10
Leng
th o
f Cor
d S
epar
atio
n Ti
me
(day
s)
Sterile W ater P lain NSS Isopropyl Alcohol
C ord C are Treatment
Mean of Length of C ord S eparation T ime According to C ord C are Treatment
Length of Cord Separation Time
Plain Normal Saline Solution had the shortest length of cord separation time with a mean of 6.50 days (S.D. = 1.85 days), followed by Sterile Water with a mean of 7.11 days (S.D. = 2.32 days).
70% Isopropyl Alcohol had the longest
length of cord separation time with a mean of 9.56 days (S.D. = 2.07days).
Signs of Cord Complication
0
0 .5
1
1 .5
2
F re q u e n c y
S te r ile W a te r P la in N S S Is o p ro p y l A lc o h o l
C o rd C a re T re a tm e n t
S ig n s o f C o rd C o m p lic a tio n O b s e rv e d a n d R e p o rte d b y M o th e rs A c c o rd in g to C o rd C a re T re a tm e n t
R e d n e s s Y e llo w is h D is c h a rg e R e d d is h D is c h a rg e B le e d in g F o u l O d o r
Maternal Concerns
15% of mothers reported signs of complications - redness at the base, reddish or yellowish discharge at the time of cord separation and mild odor.
There was no reported sign of bleeding from the cord.
Percentage of Mothers Who Observed Signs of Cord Complication
P e rc e n ta g e o f M o th e rs W h o O b s e rv e d S ig n s o f C o rd C o m p lic a tio n s
1 5 .4
8 4 .6
W ith O b s e rve d S ig ns o f C o m p lic a tio n
W i tho u t O b s e rve d S ig ns o f C o m p lic a tio ns
Umbilical Cord Infection
None of the newborns developed cord infection based on the assessment of both the investigator and the attending physician.
Cost of Cord Care
0 .0 5 4 0 .0 5 8
0 .0 8
00.01
0.020.030.040.050.060.07
0.08
M e a n o f C o s t o f C o rd C a re
S o lu tio n
C o rd C a re S o lu tio n
M e a n o f C o s t o f C o rd C a re S o lu tio n (in P h ilip p in e P e s o p e r M illilite r)
S terile W ater P la in NS S Is opropyl Alc ohol
Cost of Cord Care
Comparing the mean price per milliliter of the three solutions - Sterile Water is the cheapest cord care solution at PhP 0.054, followed by PNSS at PhP 0.058.
70% Isopropyl Alcohol is the most expensive
at PhP 0.080 per milliliter.
Results of Statistical AnalysisLength of Cord Separation Time
One-way Analysis of Variance (ANOVA) showed a statistically significant difference (significance level of p = 0.014, p < 0.05) in the length of cord separation time between the different cord care solutions.
Where is the difference?
Scheffe post hoc test results showed a
statistically significant difference(significance level of p= 0.022, p < .05) in the length of cord separation time between Plain Normal Saline Solution and 70% Isopropyl Alcohol.
Maternal Concerns
All mothers (100%) rated their newborn’s cord status and cord care treatments as walang problema (no perceived problem) despite reports of signs of cord complication.
Cost of Cord Care
There is no statistically significant difference between the cost of Sterile Water, Plain Normal Saline and 70% Isopropyl Alcohol (p = 0.613, p > 0.05).
Conclusion
The length of cord separation time is shortest in the Plain Normal Saline Solution Group and longest in the 70% Isopropyl Alcohol Group.
Signs of complication were noted in the different cord care treatment groups but none of the newborns developed cord infection.
Conclusion
This study supports literature that suggests cleaning with alcohol delays healing and drying of the umbilical stump (Cabalum, R., 1996; Dore, S. et al, 1998; WHO, 1999; Largo, J.M & Nafarete, M., 2000).
Conclusion
This study does not support the use of 70% Isopropyl Alcohol for newborn cord care.
Nurses, lead the way!
(End of Presentation)