Implementation of a standardized neonatal skin-care bundle using the neonatal skin condition score: a quality improvement initiative in a resource-limited neonatal intensive care unit

Vollständiger Abstract

Worum geht es in dieser Arbeit?

Background: Neonatal skin, particularly in preterm and low-birth-weight (LBW) infants, is structurally immature and prone to injury, predisposing to increased transepidermal water loss, infection and prolonged hospitalization. Objective assessment of skin condition is seldom embedded in routine practice in many resource-limited neonatal intensive care units (NICUs). In our NICU, skin assessment was subjective, without a standardized scoring system, and root cause analysis identified inadequate staff training and lack of routine documentation as the main modifiable contributors. Objectives were to reduce abnormal skin findings by 50% within four weeks by embedding routine neonatal skin condition score (NSCS) assessment into practice. Methods: This prospective quality improvement initiative ran for four weeks in a 35-bed tertiary NICU using two plan-do-study-act (PDSA) cycles. A standardized skin-care bundle comprising staff education, routine NSCS assessment, bedside charts and improved adhesive practices, was implemented. Proportions with dryness, erythema and breakdown were compared before and after using Fisher's exact test. Results: Baseline prevalence of dryness, erythema and breakdown was 54.5%, 27.3% and 4.5%. By four weeks, dryness fell to 26.1% (p=0.07) and erythema to 13.0% (p=0.28), each with ~52% relative reduction, while breakdown was unchanged (4.3%; p=1.00). Neither reached statistical significance, but both showed a downward trend, and routine NSCS assessment continued beyond the project. Conclusions: A standardized skin-care bundle incorporating routine NSCS assessment was feasible and associated with clinically meaningful reductions in dryness and erythema, with sustained adoption of objective skin assessment. Larger, longer initiatives are warranted to confirm these findings.