A sequential study of various modes of skin and umbilical care and the incidence of staphylococcal colonization and infection in the neonate.

The rates of colonization and infection of newborns with coagulase-positive staphylococci were studied during five sequential periods using various modes of skin care in the nursery. Colonization and infection were low during the baseline period when total body bathing with 3% hexachlorophene was employed (period 1), but increased dramatically (80% colonization, 9.5% infection) when hexachlorophene was discontinued and replaced by Ivory Soap baths (period 2). Reinstitution of hexachlorophene (period 3) reduced both colonization and infection, but not to the low levels seen during period 1. A second Ivory Soap period (period 4) resulted in a return to high colonization (77%) and infection (11.5%) rates. During period 5, daily Ivory Soap baths were continued and bacitracin ointment was applied to the umbilical area at least three times daily. Colonization was reduced to 10% and infection to 3.0%. Bacitracin could not be detected in serum in 15 infants studied. Colonization with gram-negative enteric bacilli was highest while using hexachlorophene or Ivory-bacitracin, but no increase in gram-negative infections was seen. Colonization of newborns with non-group A beta-hemolytic streptococci was not influenced predictably with various modes of skin care. The local application of bacitracin is a safe and effective method of controlling staphylococcal colonization and disease for infants in nurseries.