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Bacterial Colonization in Neonates with Sibling Visitation
Volume 9, Number 2, March/April 1980
Journal of Obstetric, Gynecologic and Neonatal Nursing
Bacterial Colonization in Neonates with Sibling Visitation J O HELEN UMPHENOUR, RN, MSN The effect of postpartum sibling visitation on the incidence of bacterial colonization in neonates was investigated in a 25-bed ob/gyn unit at a military hospital. The visitation policy allowed siblings to visit with the infant at the mother’s bedtide, and siblings were allowed unrestricted contact with the infant aJler handwashing with an iodine scrub preparation. Data comparison revealed bacterial colonization on discharge in 70% of 214 control infants (admitted prior to sibling visitation program) and 67% of 182 study infants. It was concluded that postpartum sibling visitation did not increase the incidence of bacterial colonization in neonates.
In the past few years there has been increasing interest in the concept of family-centered maternity care. Couples who have previously experienced or heard negative reports of traditional maternity care, which does not allow their participation in care planning, are seeking the type of care that will meet their individual needs. Unfortunately, in many localities, choices are limited and a decision sometimes is made to deliver at home without medical supervision or in a hospital setting that offers a less than satisfying experience. T h e situation has encouraged a reexamination of many policies in maternity care and has resulted in the goal of making the hospital delivery and postpartum care as home-like and family-centered as possible.’ There are several care policies inherent in the broad concept of family-centered maternity care, and these approaches are generally instituted as a program evolves: 1) participation by the father in the labor, delivery, and postpartum period to the extent desired by the couple; 2) a flexible rooming-in policy which allows parent-infant interaction to the extent desired by the parents; and 3) a sibling visitation policy that allows the other children to participate in the events surrounding the birth March/April 1980JOCN Nursing 0090-0311/80/03l9-0073$0100
and fosters the integration of the new baby into the family unit.
Policies and Unit Design A program of family-centered maternity care has evolved at Dwight David Eisenhower Army Medical Center over the last few years with full implementation of the first two care policies. This Army Medical Center is a 500-bed facility serving Fort Gordon, Georgia. The obstetrical service provides prenatal, delivery, and postpartum care to dependents of active d u t y personnel, a n d averages 70 deliveries a month. The average daily postpartum census is ten to 12 patients and the average length of hospitalization is three days postpartum. T h e ob/gyn nursing unit has a 25-bed capacity and provides care to gynecological surgical patients and antepartum and postpartum obstetrical patients. Postpartum patients are assigned primarily to two four-bed rooms and one two-bed room. Several private rooms are generally available if required by specific patient need (cesarean or twin births, eclamptics, isolation, etc.). A
73
Figure 1. Neal gets acquainted with his new baby brother at Dwight David Eisenhower Army Medical Center.
four-bed room is designated as a recovery area for patients during the first six hours after delivery. The nursery is centrally located and infants are admitted from the delivery room for assessment and observation. The majority of infants are taken to their parents in the recovery room for a visit and initial feeding at approximately one hour of age as soon as the mother is settled in the recovery room. Rooming-in is generally initiated at approximately six hours postpartum and is a flexible policy that offers rooming-in 24 hours a day, five AM to ten PM, or any other arrangement that the parents desire. In preparation for implementing a policy of sibling visitation a MEDLINE search of the literature was conducted. At the time of that review (September 1977) there was no documented prior experience with sibling visitation either in general or with particular regard to the problem of infection control. This study was performed to assess the possible impact of sibling visitation on bacterial colonization in newborns.
Sibling Visitation Policy The policy implemented at Dwight David Eisenhower Army Medical Center allows siblings to visit at the mother’s bedside with the baby present during a twohour period every evening. Parents are asked to cooperate in not bringing obviously ill children to the hospital, and compliance is excellent. T h e children are required to adhere to the handwash policy using an iodine scrub preparation required of all visitors on entrance to the mother’s room. Siblings then are allowed unrestricted contact with their mother and the new baby (Figure 1). T h e use of cover gowns for visitors was eliminated in an earlier phase of the family-centered maternity care pro74
gram evolution. (It was our belief that a cover gown offers the wearer a false sense of safety that often precludes adequate handwashing.)
Methodology Several months prior to implementing the sibling visitation program, nasal and umbilical cord swab specimens were obtained on each newborn at admission to the nursery and on the day of discharge. This group of infants (N = 214) was designated as the control group. In March 1978 the sibling visitation program was instituted and the nursery staff continued to obtain nasal and cord swab specimens on every newborn at the time of admission and discharge. This group of infants (N = 182) was designated as the study group. According to laboratory policy the swab specimens were plated on tryptic soy agar enriched with 5% sheep’s blood. Readings were reported by the laboratory at 48 hours’ growth and the returned reports were filed in the nursery. A record audit was conducted as an additional measure to investigate the incidence of postnatal infection in which the causative organisms supposedly would have been acquired in the hospital.’ Available outpatient records of infants in each group who had negative admission cultures and positive day of discharge cultures reported as gram-negative rods (not specified) and/or staphylococcus were reviewed. Of a total 178 colonized infants, 89 records were available for review. Every infant had been examined at two to three weeks of age in the Well Baby Clinic or physician’s office. All charts were examined for documented or historical evidence of infection in the first two to three weeks of life. March/April 1980JOCN Nursing
Table 1. Overall Bacterial Colonization of Neonates Before Implementation of Sibling Visitation (214 Infants) Category
N
1. No growth on admission; 33 no growth on discharge II. Growth on admission; no growth on discharge 3 111. Growth on admission; 29 growth on discharge IV. No growth on admission; growth on discharge 149
After Implementation of Sibling Visitation (1 82 Infants)
%
N
%
15
28
15
1
2
1
14
31
17
70
121
67
Results Laboratory reports were classified in four categories as shown on Table I. The most prevalent organisms isolated in both control and study groups were reported as gram-negative rods (not specified) and staphylococcus species (see Table 11). T h e category having major impact on this study was Category IV: infants who had negative cultures on admission and positive cultures at the time of discharge. Bacterial growth from either nasal or cord site was designated as a positive culture. Comparison of the culture data obtained in the control and study groups showed no significant difference in the overall bacterial colonization rate after implementation of the sibling visitation program (Table I). The only positive findings in the record audit of 89 charts were two cases of monilial diaper rash and one case of conjunctivitis that cultured Staphylococcus epidermis. The remaining 86 infants had no evidence or history of illness following discharge from the hospital. Conclusions T h e sibling visitation policy at Dwight David Eisenhower Army Medical Center is considered an integral part of the family-centered maternity care program. It has been documented that this policy does not significantly change the rate of bacterial colonization in the neonates and does not cause apparent infection or illness. The policy has been favorably endorsed by the medical and nursing staffs and has been enthusiastically accepted by the clients. For the majority of families the birth of their baby at Dwight David Eisenhower Army
March/April IS8OJOCN Nursing
Table 2. Incidence ot Prevalent Organism Colonization of Infants in Category IV Before program implementation After program implementation (1 12 infants) (66 infants) Organism Gram-negative rods (Not specified) Staphylococcusspecies (Not specified) TOTAL
N
Organism
Gram-negative rods (not specified) Staphylococcusspecies 32 (not specified) 80
112
TOTAL
N
30 36 66
Medical Center is their first experience in a truly familycentered maternity care setting and the overwhelmingly positive response is exciting and rewarding. Acknowledgments T h e author wishes to thank Captains Kathy Badger and Michelle Renaud for their assistance with data correlation and Major David Harburchak, chief of the Infectious Disease Section, for his review and assistance. T h e opinions or assertions in this paper are the private views of the author and are not to be construed as official or as reflecting the views of the Departments of Army or of Defense. References 1. American Medical Association Statement on Parent-Newborn Bonding. American Medical Association News Release. Pediatr Nurs Curr 25: No. 2, 1978 2. Van k u w e n G: A Manual of Newborn Medicine. Chicago, Year Book Medical Publishen, Inc, 1973, p 141 Address for correspondence:,Jo Helen Umphenour, LTC, ANC, 629 Thomas Drive, Martinez, C A 30907.
L T C Umphenour is chief of the Famib Health Nursing Section at Dwight David Eisenhower Medical Center, A. Cordon, Georgia. Her previous nursing experience has been primarily in neonatal nursing. A member of NAACOG, L T C Umphenour attended Mercy School of Nursing in Ft. Scott, Kansas; Lmetto Heights College (BSN) in Denwr, Colorado; and the Univcrs i b oJColorado (MSN) in Dene.
75
Journal of Obstetric, Gynecologic and Neonatal Nursing
Bacterial Colonization in Neonates with Sibling Visitation J O HELEN UMPHENOUR, RN, MSN The effect of postpartum sibling visitation on the incidence of bacterial colonization in neonates was investigated in a 25-bed ob/gyn unit at a military hospital. The visitation policy allowed siblings to visit with the infant at the mother’s bedtide, and siblings were allowed unrestricted contact with the infant aJler handwashing with an iodine scrub preparation. Data comparison revealed bacterial colonization on discharge in 70% of 214 control infants (admitted prior to sibling visitation program) and 67% of 182 study infants. It was concluded that postpartum sibling visitation did not increase the incidence of bacterial colonization in neonates.
In the past few years there has been increasing interest in the concept of family-centered maternity care. Couples who have previously experienced or heard negative reports of traditional maternity care, which does not allow their participation in care planning, are seeking the type of care that will meet their individual needs. Unfortunately, in many localities, choices are limited and a decision sometimes is made to deliver at home without medical supervision or in a hospital setting that offers a less than satisfying experience. T h e situation has encouraged a reexamination of many policies in maternity care and has resulted in the goal of making the hospital delivery and postpartum care as home-like and family-centered as possible.’ There are several care policies inherent in the broad concept of family-centered maternity care, and these approaches are generally instituted as a program evolves: 1) participation by the father in the labor, delivery, and postpartum period to the extent desired by the couple; 2) a flexible rooming-in policy which allows parent-infant interaction to the extent desired by the parents; and 3) a sibling visitation policy that allows the other children to participate in the events surrounding the birth March/April 1980JOCN Nursing 0090-0311/80/03l9-0073$0100
and fosters the integration of the new baby into the family unit.
Policies and Unit Design A program of family-centered maternity care has evolved at Dwight David Eisenhower Army Medical Center over the last few years with full implementation of the first two care policies. This Army Medical Center is a 500-bed facility serving Fort Gordon, Georgia. The obstetrical service provides prenatal, delivery, and postpartum care to dependents of active d u t y personnel, a n d averages 70 deliveries a month. The average daily postpartum census is ten to 12 patients and the average length of hospitalization is three days postpartum. T h e ob/gyn nursing unit has a 25-bed capacity and provides care to gynecological surgical patients and antepartum and postpartum obstetrical patients. Postpartum patients are assigned primarily to two four-bed rooms and one two-bed room. Several private rooms are generally available if required by specific patient need (cesarean or twin births, eclamptics, isolation, etc.). A
73
Figure 1. Neal gets acquainted with his new baby brother at Dwight David Eisenhower Army Medical Center.
four-bed room is designated as a recovery area for patients during the first six hours after delivery. The nursery is centrally located and infants are admitted from the delivery room for assessment and observation. The majority of infants are taken to their parents in the recovery room for a visit and initial feeding at approximately one hour of age as soon as the mother is settled in the recovery room. Rooming-in is generally initiated at approximately six hours postpartum and is a flexible policy that offers rooming-in 24 hours a day, five AM to ten PM, or any other arrangement that the parents desire. In preparation for implementing a policy of sibling visitation a MEDLINE search of the literature was conducted. At the time of that review (September 1977) there was no documented prior experience with sibling visitation either in general or with particular regard to the problem of infection control. This study was performed to assess the possible impact of sibling visitation on bacterial colonization in newborns.
Sibling Visitation Policy The policy implemented at Dwight David Eisenhower Army Medical Center allows siblings to visit at the mother’s bedside with the baby present during a twohour period every evening. Parents are asked to cooperate in not bringing obviously ill children to the hospital, and compliance is excellent. T h e children are required to adhere to the handwash policy using an iodine scrub preparation required of all visitors on entrance to the mother’s room. Siblings then are allowed unrestricted contact with their mother and the new baby (Figure 1). T h e use of cover gowns for visitors was eliminated in an earlier phase of the family-centered maternity care pro74
gram evolution. (It was our belief that a cover gown offers the wearer a false sense of safety that often precludes adequate handwashing.)
Methodology Several months prior to implementing the sibling visitation program, nasal and umbilical cord swab specimens were obtained on each newborn at admission to the nursery and on the day of discharge. This group of infants (N = 214) was designated as the control group. In March 1978 the sibling visitation program was instituted and the nursery staff continued to obtain nasal and cord swab specimens on every newborn at the time of admission and discharge. This group of infants (N = 182) was designated as the study group. According to laboratory policy the swab specimens were plated on tryptic soy agar enriched with 5% sheep’s blood. Readings were reported by the laboratory at 48 hours’ growth and the returned reports were filed in the nursery. A record audit was conducted as an additional measure to investigate the incidence of postnatal infection in which the causative organisms supposedly would have been acquired in the hospital.’ Available outpatient records of infants in each group who had negative admission cultures and positive day of discharge cultures reported as gram-negative rods (not specified) and/or staphylococcus were reviewed. Of a total 178 colonized infants, 89 records were available for review. Every infant had been examined at two to three weeks of age in the Well Baby Clinic or physician’s office. All charts were examined for documented or historical evidence of infection in the first two to three weeks of life. March/April 1980JOCN Nursing
Table 1. Overall Bacterial Colonization of Neonates Before Implementation of Sibling Visitation (214 Infants) Category
N
1. No growth on admission; 33 no growth on discharge II. Growth on admission; no growth on discharge 3 111. Growth on admission; 29 growth on discharge IV. No growth on admission; growth on discharge 149
After Implementation of Sibling Visitation (1 82 Infants)
%
N
%
15
28
15
1
2
1
14
31
17
70
121
67
Results Laboratory reports were classified in four categories as shown on Table I. The most prevalent organisms isolated in both control and study groups were reported as gram-negative rods (not specified) and staphylococcus species (see Table 11). T h e category having major impact on this study was Category IV: infants who had negative cultures on admission and positive cultures at the time of discharge. Bacterial growth from either nasal or cord site was designated as a positive culture. Comparison of the culture data obtained in the control and study groups showed no significant difference in the overall bacterial colonization rate after implementation of the sibling visitation program (Table I). The only positive findings in the record audit of 89 charts were two cases of monilial diaper rash and one case of conjunctivitis that cultured Staphylococcus epidermis. The remaining 86 infants had no evidence or history of illness following discharge from the hospital. Conclusions T h e sibling visitation policy at Dwight David Eisenhower Army Medical Center is considered an integral part of the family-centered maternity care program. It has been documented that this policy does not significantly change the rate of bacterial colonization in the neonates and does not cause apparent infection or illness. The policy has been favorably endorsed by the medical and nursing staffs and has been enthusiastically accepted by the clients. For the majority of families the birth of their baby at Dwight David Eisenhower Army
March/April IS8OJOCN Nursing
Table 2. Incidence ot Prevalent Organism Colonization of Infants in Category IV Before program implementation After program implementation (1 12 infants) (66 infants) Organism Gram-negative rods (Not specified) Staphylococcusspecies (Not specified) TOTAL
N
Organism
Gram-negative rods (not specified) Staphylococcusspecies 32 (not specified) 80
112
TOTAL
N
30 36 66
Medical Center is their first experience in a truly familycentered maternity care setting and the overwhelmingly positive response is exciting and rewarding. Acknowledgments T h e author wishes to thank Captains Kathy Badger and Michelle Renaud for their assistance with data correlation and Major David Harburchak, chief of the Infectious Disease Section, for his review and assistance. T h e opinions or assertions in this paper are the private views of the author and are not to be construed as official or as reflecting the views of the Departments of Army or of Defense. References 1. American Medical Association Statement on Parent-Newborn Bonding. American Medical Association News Release. Pediatr Nurs Curr 25: No. 2, 1978 2. Van k u w e n G: A Manual of Newborn Medicine. Chicago, Year Book Medical Publishen, Inc, 1973, p 141 Address for correspondence:,Jo Helen Umphenour, LTC, ANC, 629 Thomas Drive, Martinez, C A 30907.
L T C Umphenour is chief of the Famib Health Nursing Section at Dwight David Eisenhower Medical Center, A. Cordon, Georgia. Her previous nursing experience has been primarily in neonatal nursing. A member of NAACOG, L T C Umphenour attended Mercy School of Nursing in Ft. Scott, Kansas; Lmetto Heights College (BSN) in Denwr, Colorado; and the Univcrs i b oJColorado (MSN) in Dene.
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