Applying and changing a nappy

Rationale
To maintain personal hygiene and comfort, to monitor urinary and faecal output and to assess and/or maintain skin integrity.

Equipment:
Changing mat
Clean disposable nappy or cotton nappy, liner and safety pin(s)
Clean clothing/bedding as required
Bowl, water and soap or cleansing wipes
Barrier cream

Procedure	Rationale
Wash and dry hands thoroughly and don gloves and apron	To prevent cross-infection
Assess the infant’s nappy for soiling and wetness	To determine equipment needs
Determine the infant’s stage of development	To determine care needs
Assess the type and size of nappy required	To ensure correct fit
Collect and prepare equipment and environment	To promote infant safety
Place the infant on a flat surface and keep at least one hand on the infant at all times	To prevent the infant falling. NB Never leave an infant unattended either out of the cot or in a cot with the side down
Remove the soiled nappy noting colour, amount and consistency of any faecal material	To aid evaluation and future care planning. NB In critical-care areas it may be necessary to weigh the nappy to ensure
	accurate monitoring of input and output. This is achieved by comparing the weight of a clean nappy with the soiled nappy. One millilitre is approximately = one gramme. If in doubt, always check before disposing of the nappy and its contents
Roll the nappy to retain the contents and place out of reach of the infant	To maintain safety
Clean the genitalia, groin and perineum (from front to back for females and the tip of the penis to the scrotum for males) with warm water and wipes	To restore hygiene and reduce the potential for soreness and cross-infection. Cotton wool should not be used as fibres may be left on the skin
Commercially produced baby wipes may be used once the infant reaches two weeks of age	Commercially produced baby wipes are not recommended for babies under two weeks of age as they destroy the normal skin flora
Assess skin integrity noting any redness, swelling, marks, allergy or other disorders of integrity and treat as appropriate	To identify actual/potential problems and initiate care. If in doubt about appropriate care needs seek guidance from a more experienced member of staff
If the skin is sore and reddened, a barrier cream should be applied	Barrier cream prevents urine and faeces coming into contact with the skin and allows it to heal
With one hand lift the infant’s buttocks and with the other place the clean nappy underneath (thickest part forwards)	For ease of application and to maintain infant safety
Pull the front of the nappy through the legs and ensure a snug, but not tight, fit round the legs and waist (below the umbilical cord if this is still healing) and secure with tapes or safety pin as appropriate	To prevent the nappy falling off whilst reducing the potential for pressure sore development. NB If safety pins are used you should place your fingers between the nappy and the infant and insert from front to back to prevent injury
Change other clothing/bedding if soiled	To maintain hygiene and skin integrity
Return the infant to his/her cot and secure cot sides before leaving infant	To ensure infant safety
Dispose of equipment and soiled materials following local policies, and wash hands	To prevent cross-infection
Document output on fluid balance record/ stool chart. Report any abnormalities in evaluation and either modify care plan accordingly or alert a more senior member of staff	Legal requirement to maintain documentation and safeguard infant through effective communication