Background Infants born less than 32 weeks of gestation age are nursed in closed humidified incubator to minimise transepidermal water loss, prevent electrolytes imbalances and improve thermoregulation. The practice in the unit is these infants are cared for in closed incubators with 85% humidity for first 7 days of life, then from the second week onwards, gradually reducing the incubator humidity to 70%, and from the fourth week, further decrease the humidity to 65%. These infants are nursed in incubator with 65% humidity till they reached body weight of 1.7 kg. The estimated length of stay in the humidified incubator for these infants is 1.5 – 3 months. However, high or prolonged humidified environment is associate with Candida albicans, which has a reported mortality rate of 21–32% in very low birth weight infants. In 2015, two infants nursing in humidified incubator were detected having skin Candida albicans infection.

Objectives To minimise skin candida infection in infants requiring closed humidified incubator based on best available evidence.

Methods The length of stay in the humidified incubator and humidity setting were reviewed. In the new guideline, infant less than 32 weeks of gestation age is nursed in close incubator with humidity of 85% for the first 5 days of life. From the 6th day onwards, to decrease incubator humidity by 5% daily, till it reaches the targeted discontinue setting of 60%, which is 11 days of life. Five briefing sessions were conducted to all staff. Table of incubator humidity setting schedule are pasted in all incubators for easy reference. Staff compliance to new guideline was monitored daily. Project evaluation was by audits in April 2015 to June 2016.

Results The post-implementation and follow-up audit showed a 100% staff compliance. No candida infection was detected. The project has reduced the length of infant requiring humidified incubator to 10 days, which saved about SGD$193.20 per infant per hospitalisation.

There were 244 infants (Year 2017: 52 infants, Year 2018: 68 infants, Year 2019: 59 infants, Year 2020: 65infants) in total who were born less than 32 weeks of gestation age since project implementation to end of 2020. Further data showed there is no candida infection detected among these infants.

Conclusions The project provides clear humidity percentage guidelines for nurses to follow, and successfully achieved zero skin Candida infection on infants who are being nursed in closed incubator. The project provides clear humidity setting guidelines for nurses, and successfully achieved zero skin candida infection for infants who require close incubator.