Bathing patients

Daily bathing of bed-bound hospitalized patients is established practice to improve hygiene and to promote comfort.

The type of bath a patient receives is influenced by skin condition, spread of microorganisms, compliance, and nurse satisfaction.

An estimated 1.7 million health care-associated infections occur annually in hospitals.

One out of every 17 patients in a hospital will develop an infection, resulting in significant increases in patient morbidity, mortality, length of stay, and use of health care resources.

The hospital environment is a significant reservoir for bacteria and a factor in the spread of infection.

The bath basin, may serve as a reservoirs and/or vector in the transmission of multidrug-resistant organisms

In most acute care facilities nursing personnel provide baths using a basin of warm tap water, soap, and washcloths

Baths are provided for bed bound patients and those unable to provide self-care.

This traditional method of bathing can result in dry skin, and be the potential for colonization of the skin and the spread of microorganisms.

Patients who are unable to provide self-care, a daily bath should be provided.

Patients may require bathing more frequently than daily for comfort purposes to reduce anxiety, for diaphoresis, or because of incontinence.

Patient privacy should be maintained throughout the procedure, and determining bath time by should be by patient preference and clinical stability rather than institutional priorities.

Bathing should not interfere with patient’s sleep pattern.

The use of reusable basins is no longer acceptable due to their high bacterial contamination rates, being replaced by disposable basins with sterile or distilled water, in place of tap water.

Tap water should not be used, as it is a source of contamination because of bacterial biofilm in pipes and faucets.

Use a prepackaged bathing or product or sterile or distilled water in place of tap water.

Use no-rinse pH-balanced cleansers, with a pH level of 4.5 to 5.5.

Vigorous rubbing should be avoided on skin that is at risk for developing pressure ulcers.

Application of emollients after each bath to prevent dry skin is desirable.

Bathing daily with chlorhexidine is associated with significant reductions in central line-associated bloodstream infections, vancomycin-resistant enterococci (VRE), methicillin-resistant Staphylococcus aureus (MRSA) colonization, and infections with multidrug resistant organisms.

Bathing should begin from the jawline down, as oral secretions are heavily colonized with bacteria and can contaminate the neck region.

Bathing goal with chlorhexidine is to retain 2% on the skin surface at all times.

A no-rinse pH-balanced cleanser should be used to clean the face and the perineal area, as chlorhexidine is not recommended to use nears the eyes or mucosal membranes.

Bath basins have the potential to become a reservoir for microorganisms and for cross-contamination of the immediate environment and health care personnel, as more than 62% of basins sampled were contaminated with common hospital-associated pathogens.

Use of tap water for bathing exposes patients to waterborne pathogens, as poor water quality of water is due to the buildup of bacterial biofilm in pipes, faucets, and distribution systems.

The bacterial biofilm may be spread to at-risk patients and health care staff by direct contact with water used for routine hand washing, bathing, cleaning of equipment, and ingestion of water and ice.

It is recommend reducing exposure to tap water through the use of bottled water, prepackaged disposable bathing products, and faucet water filters.

Intact skin serves as a barrier for colonization, but when altered or physically irritated the water-holding capacity of skin is compromised so that the barrier for bacterial colonization is impaired.

In older individuals the thinning of the subcutaneous layer of the skin occurs, and fewer protective oils are present, impairing the skin’s ability to act as a barrier against pathogens.

A no-rinse pH-balanced cleanser to protect the barrier function of the skin and a prepackaged bath to reduce the risk of dry skin is recommended for elderly patients.

Prepackaged bathing products have pH-balanced no-rinse cloths with emollients embedded, providing moisturizer with each bath.

The use of rough washcloths with rough surfaces increase the amount of transepidermal water loss and increases dry skin.

Studies comparing soap-and-water basin bathing to nonmedicated prepackaged bathing: quality and skin microbial scores were similar, but the prepackaged bathing used less product, reduces skin dryness and skin tears, reduces time, lowers cost, and increases nurse satisfaction.

The use of prepackaged bathing decreases UTIs.

The chlorhexidine Impregnated cloths produced a 2.5 log10 colony count reduction on the skin when compared with soap-and-water bathing, and decreases the incidence of VRE acquisition.

The CHG-impregnated cloths produce colony count reduction on the hands of the health care workers and in the environment.

Chlorhexidine bathing reduces central line associated blood stream infections inside and outside of ICUs.

Chlorhexidine bathing reduces surgical site infections (SSIs), and colonization with VRE and MRSA.

Universal decolonization with daily bathing using 2% CHG-impregnated cloths and nasal mupirocin ointment for 5 days results in significantly greater reductions in infections compared with screening and isolating ICU patients for MRSA bacteria.

Studies show a 23% reduction in new acquisition of multiple drug resistant organisms in patients bathed with a CHG cloth, the rate of hospital-associated bloodstream infections decreased 28%, and the incidence of primary bloodstream infections caused by fungi was reduced by 53%.

Those cases caused by a fungal infection, the CLABSI rate decreased 90% from .77 to .07 per 1000 catheter days.50 Although the majority of studies have involved the use of 2% CHG-impregnated cloths,

A 4% CHG liquid soap has shown similar efficiency as 2% CHG-impregnated cloths.

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