This is a very frequently asked question. The decision was not taken lightly.
Nurtured by Design spent three-and-a-half years developing The Zaky ZAK with the approval by healthcare professionals, parents, hospital administration, procurement, risk management/patient safety professionals, hospital volunteers, etc. Since 2010, hundreds of hospitals across the globe have used The Zaky ZAK to safely hold babies from birth, through hospital stay, and then at home. It provides comfort, privacy, easy access to the baby, easy transfer, and many other features.
The design process included testing hooks, zippers, hook-and-loop system (i.e., VELCRO® Brand is a hook-and-loop system and is Trademarked), ties, strings, seams, snaps, knots, and every other available closing mechanism.
The answer is simple: Zippers met all our requirements and passed all our tests. While they were not the inexpensive option, it was by far the best.
They are safe, strong, predictable, and ergonomic, they can be washed and dried numerous times, they are also quiet, easy to use, and adjustable, they facilitate proper and consistent containment, they are quick and easy to open, they can hold the weight of multiple babies, etc. Zippers outperformed the other mechanisms, which did not meet our stringent requirements for an ergonomic design. Therefore, after careful evaluation, we designed the "adjustable zippers" and The Zaky ZAK, and patented it.
HOOK-and-loop fastener systems
Hook-and-loop fastener systems are inexpensive and may be convenient for many uses. However, they did not meet our requirements for caring for a baby in a hospital setting.
Considering the results of all the tests it is our professional opinion that hook-and-loop type fasteners (i.e., Velcro(R)) should have very limited use (if any) by or near a baby.
Here are a just a few tests that we performed:
Babies need a soothing, quiet, soothing, and nurturing environment, during the entire session of skin to skin contact. We define "session" to include from putting it on, to doing transfer to and from the chest, accessing the baby for interventions/breastfeeding/pumping, to taking it off, until the baby is resting on the bed.
Zippers (PASSED): They operate quietly both while being opened and while being closed.
Velcro (FAILED): While it closes quietly, Velcro makes a distinguishable and very loud sound when it is opened or repositioned, making it very disruptive to a baby. Moverover, the decibel level when opening it by the baby's ear may affect sleep and may scare the baby. If used where many babies are sleeping or trying to sleep, the noise of velcro opening may disrupt all the babies in the room.
Ability to be easily washed/dried
To reduce or eliminate the risk of infection, The Zaky ZAK must be properly washed and dried.
Zippers (PASSED): They can be washed/dried in home or industrial machines. The Zaky ZAK includes a washing bag that protects it during the wash/dry process. It can be washed using the same laundry protocol as that of baby blankets/clothes in other settings.
Velcro (FAILED): Clothing fuzz, dust, lint, and other airborne debris can get embedded in the hook side of the Velcro, making it more difficult to close (and thereby keep the baby safe) and/or clean properly. This, in turn, raises infection control concerns. The Velcro manufacturer recommends "air dry[ing] and manually removing surface fuzz, picking out embedded lint and performing hook-and-loop fastener maintenance to keep closures clean and working well." This is not practical for a device that is designed to keep a baby safe in a hospital setting.
Number of times it can be washed
Because babies are held for months, and because The Zaky ZAK is used with different babies in hospital settings, the wrap must withstand at least 20 washes.
Zippers (PASSED): They are strong and can be washed dozens of times without losing their effectiveness. They also hold up to high temperatures.
Velcro (FAILED): With every wash, Velcro loses its adherence properties plus it needs to be closed before washing or it sticks to other clothing in the wash. It’s difficult to determine how many washes it will withstand before losing adherence and becoming a safety hazard. Proper closure keeps a baby safe, so we tried stronger Velcro. However, the stronger the Velcro, the louder it is. The manufacturer could not guarantee how many machine washes the Velcro could withstand before it could no longer hold the weight of a baby.
Ease in putting it on and taking it off
We performed two types of tests: (1) parent wearing The Zaky ZAK before placing the baby in it, skin to skin, and (2) parent closing it after the baby was on the chest.
Velcro (PASSED for ease of adhering the hook and loop; FAILED for everything else): While it is easy to connect the hook and loop sides, the parent needed help to properly close them every time. Therefore, the parent could not always "independently" attach the closure correctly. Four hands were needed to close the Velcro smoothly and correctly the first time (without the need to open and reposition it). The parent could open the Velcro alone, but the sound was loud.
(1) When the velcro was closed before the transfer to skin to skin, the sizing was not always proper or consistent from top to bottom, or it didn't provide optimum containment. Therefore, the Velcro sometimes had to be opened (loud) and repositioned by the baby’s ears.
Proper, reliable, and consistent sizing
Babies and mothers/fathers come in every size. Everyone deserves proper sizing.
Zippers (PASSED): Because The Zaky ZAK has zippers that are adjustable, a parent can make sure the size is right every time, and also use the same zipper setting from session to session. Both the experience and the containment of the baby and parent are consistent and perfect for their size. If needed, changing the size (choosing a different zipper) while in skin to skin is an easy and quiet process.
SIZING is determined by a woman's blouse size (adjust for the size and number of babies, and men reduce 1 size)
Velcro (FAILED): Velcro does not allow for consistency in placement when sizing the wrap. In other words, the users could not ensure consistent containment from session to session, as the Velcro was not always closed in the same position, nor was it always straight, etc. It closes where it lands.
Proper and consistent containment
This is critical for the comfort of mom/baby, the proper positioning of baby, and the peace of mind of the clinician. Proper containment allows the mom to relax knowing that the baby is safe, use the hands to keep the mind occupied and hold longer, prevents the baby from sliding/falling, and keeps any medical equipment in place.
Zippers (PASSED): When combined with the stretchy cotton, zippers remain straight, providing a proper and consistent level of containment from neck to toes. This containment can be individualized depending on the baby’s condition and size.
Velcro (FAILED): There is no way to ensure a constant level of containment across a baby's body because it depends on how it was closed. This causes a risk that, while under the wrap, the baby would slide down the chest. In addition, there was no way to ensure that the Velcro was being closed straight, especially when the baby was already in place. It was usually tighter on the top and looser on the bottom, or it was tighter where there was Velcro and looser where there was no Velcro. This was one of the major reasons why Velcro didn't pass our test for containment.
Ability to be repositioned and adjusted for size after it is on
If the baby is placed in skin to skin but the wrap is not sized correctly, there must be a way to change the size once the baby is in place. This ensures proper sizing and a better experience.
Zippers (PASSED): The Zaky ZAK has three zippers and the user can choose from three sizes. They are made to perfectly fit every size and can be opened fully or partially depending on the needs of the situation. The size can be easily changed, quietly and with minimum disruption.
Velcro (FAILED): It cannot be easily or quietly repositioned to be straightened out, to match the hook and loop, or to change the size/containment of the wrap. Opening the Velcro to fix the problem will lengthen the transfer time and make too much noise. In addition, the Velcro can touch/scratch the baby.
Ability to select how much it is closed/open
One of our requirements was that the wrap had to be able to be partially opened so that parents and clinicians could open/close it, thereby creating the appropriate opening for comfortable golden hour, breastfeeding, movement of the baby while awake, or access to the baby for healthcare interventions.
Zippers (PASSED): The Zaky ZAK uses a zipper that stays open where the slider is left. The zipper does not open or close without someone moving it, so it can be left closed, open, or partially open in any position as needed. This is especially needed for delivery/c-section, and for interventions while in skin to skin contact.
Velcro (FAILED): When the hook and the loop sides touch, they stick, which is one of the features that are beneficial in many other uses. Velcro failed our test because it was not possible to keep it partially open. Parents and clinicians had a hard time keeping the sides from touching each other or from touching the baby. Plus, Velcro was loud. It was hard to keep the hook and loop from sticking to each other, which was frustrating to the user.
How to recognize if it doesn't work anymore
Everything has a life-cycle, so recognizing when it fails is important for safety.
Zippers (PASSED): It is easy and obvious to recognize if a zipper does not work, if it is damaged during the wash, etc. Therefore, If it does not work it cannot be used which is a great safety feature.
Velcro (PASSED for new Velcro, FAILED for washed velcro): It is not easy to recognize when the adhering properties are no longer proper to hold a baby, especially when washed in machines.
Ease in opening to release the baby from skin to skin at the end of the session or in an emergency
When skin to skin contact sessions end, babies must experience minimal disruption so that they will remain asleep on their beds. Likewise, the transfer must be fast, easy, and quiet in an emergency.
Zippers (PASSED): Users can open the zipper in a split second to release the baby, or they can lower the ZAK to uncover the baby and move him/her to the bed for care.
Velcro (FAILED): While Velcro can be easily pulled apart, the noise inflicts stress on an already distressed baby and parent. Also, there is a risk that the Velcro will scratch the baby's skin.