Background: Infants born at less than 32 weeks of gestation age (GA) are nursed in closed humidified incubator to minimise transepidermal water loss and prevent electrolytes imbalances. However, high or prolonged humidified environment is associated with Candida albicans, which has high mortality rate of 21-32% in very low birth weight infants. In 2014, two infants in the Neonatal Intensive Care unit were found to have acquired skin Candida albicans infection.

Aims: To minimise skin candida infection in infants requiring closed humidified incubator.

Methods: This evidence-utilisation project was conducted in an 18-bed NICU at National University Hospital, Singapore in January 2015. An evidence search found that Joanna Briggs Institute’s (JBI) recommended reducing incubator humidification after the first week by 5% daily from 85% to 50%. Taking into consideration that the NICU humidity level is 65%, the weaning off of incubator humidification period after the first week was reduced from 1.5 – 3 months to 4 days. Early weaning off of the humidity setting schedule was placed at all incubators as a quick reference to staff. Three post-implementation and six sustainment audits to monitor staff compliance to practice change were conducted in April – June 2015, and January - June 2016, respectively.

Results: All audits showed 100% staff compliance to early weaning off of incubator humidification. Since the implementation of the change of practice, no skin candida infections were reported in 2015 and 2016 after the two acquired in 2014. The change of practice has reduced the duration of incubator humidification from 1.5-3 months to 11 days, which saved about SGD$193.20 consumable cost per infant. This translates to a total estimated cost saving on consumable for 101 babies of SGD$19,513 from 2015 to 2016.

Conclusions: Early weaning off of incubator humidification has successfully reduced Candida infection in NICU.