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AACN issues new protocols for bathing patients

The long-held tradition of using a basin, soap and water to bathe bed-bound hospitalized patients no longer is the recommended standard of practice, according to a new practice alert from the American Association of Critical-Care Nurses.

The alert outlines updated, evidence-based protocols related to bathing adult patients.

In most acute care facilities, bed-bound patients unable to provide self-care are bathed by nursing personnel using a basin of warm tap water, soap and washcloths. This traditional method of bathing can result in significant variation from caregiver to caregiver, excessively dry skin on patients and exposure to bacteria, increasing the risk of healthcare-associated infection, according to an AACN news release. Such baths also take longer and require more nursing time.

The practice alert cites several studies that demonstrate the benefits of bathing patients with prepackaged cleansers that do not require rinsing. The AACN continues to advocate for daily bathing to improve hygiene and promote patient comfort.

“Current evidence tells us that even such a routine activity as bathing a bed-bound patient needs to be updated to reduce the risk and increase the benefit to the patient,” Ramón Lavandero, RN, MA, MSN, FAAN, senior director of the AACN, said in the news release. “Nurses also will need to educate patients and their families about how bathing technology has changed to improve patient care and reduce risk of infection.”

The practice alert also advocates scheduling bath times based on patient preference and clinical needs, not on nursing convenience. The period between midnight and 6 a.m. is a common time for bed baths and other nursing care activities, but the AACN said nurses should determine optimal bath time by individual patient preference and clinical stability, and avoid waking patients solely to bathe them.

Based on the latest available evidence, the expected practice related to bathing adult patients includes:

• Provide a daily bath for bed-bound patients to improve hygiene and promote comfort. More frequent baths may be performed upon patient request or to respond to patient needs.

• Determine bath time based on patient preference and clinical stability instead of based on organizational factors.

• Use disposable basins and dispose of them after one use to reduce risk of bacterial contamination.

• Avoid use of unfiltered tap water. Alternatives include prepackaged bathing products, sterile or distilled water or filtered water from faucets.

• Use no-rinse pH balanced cleansers, which are superior to alkaline soaps that require wash-rinse cycles.

• Apply emollients after each non-prepackaged bath to prevent dry skin. Prepackaged bathing products include skin emollients.

• Use prepackaged bathing products to reduce process variation.

• Bathe patients daily using a disposable cloth that is prepackaged with a 2% solution of chlorhexidine gluconate. Use of CHG is associated with significant reductions in colonization of specific bacteria and infections with multidrug-resistant organisms.

Supported by authoritative evidence, each AACN practice alert seeks to ensure excellence in practice along with promotion of a safe and humane work environment. Topics address both nursing and interprofessional activities of importance to patients in acute and critical care environments. Some alerts include additional resources for staff education and performance-improvement activities.

Additional alerts address ventilator associated pneumonia, pulmonary artery pressure monitoring, dysrhythmia monitoring, ST segment monitoring, family presence during resuscitation and invasive procedures, and verification of feeding-tube placement.

The alerts can be downloaded free of charge at www.aacn.org/practicealerts.

By | 2013-04-21T00:00:00+00:00 April 21st, 2013|Categories: Nursing specialties, Specialty|9 Comments

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  1. Avatar
    Melissa Gillespie January 14, 2017 at 5:43 am - Reply

    In my facility, we are supposed to give both a traditional soap and water bath with a generic standard bar soap AND a CHG cloth bath daily.

    My confusion with this practice is that I was under the impression that a soap and water bath was redundant if a CHG bath was given.
    Is this true or not.

    • Avatar
      Kathleen Mary Vollman MSN, RN, CCNS, FCCM, FAAN March 30, 2017 at 5:13 am - Reply

      The large study done by Huang et al, did not allow any use of tap water on the skin. Their bathing protocol can be found at http://www.AHRQ.org and in the search window ICU decolonization. The second half of the document is dedicated to the bath procedure they used to receive the outcomes of 44% reduction in CLABSI from all pathogens and a 37% reduction in MRSA infections.

  2. Avatar
    Robert Herp RN MICU /CICU January 25, 2017 at 11:56 pm - Reply

    I don’t believe from the evidence it is redundant as much as duplicity in effort. The CHG bathing is only found to be effective if it is allowed to remain on the skin until dry. I will say from experience that CHG bathing does not remove body odor or dead skin as well as soap and water with a washcloth. So bathing with soap and water and completing with a CHG 2% wipe may be the best for long term bed ridden patient. Some of our ICU pts are on the floor for 6 weeks and need both baths. Hope this helps.

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      Melanee Randall, RN, BSN March 2, 2017 at 6:10 pm - Reply

      Actually, while it may seem redundant and as a duplicity in effort, it actually is not. Here are a few things to consider:
      -Much misconception in acute care around “CHG bathing”. If you read the indications on the back of the package of the 2% CHG wipe, I will bet it says this is not intended for general cleansing or bathing. That is because it is a wipe; simply a “vehicle” to get CHG on to the patient’s skin. Therefore, it never was intended to remove odor, grime and dead skin from the patient
      -Unless your cleanser is CHG compatible, there is a good chance a real bath following the CHG wipe may be removing a large portion of the CHG.
      Solution: Coloplast’s EasiCleanse Bath…it is CHG compatible, no-rinse, self-foaming cloth with only 3 ingredients (one of them is lanolin, an emollient) and packaged dry so no preservatives. And, it is extremely cost-effective. Staff, patients and their families love this product. Check it out!

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    Monica January 4, 2018 at 11:42 pm - Reply

    The current facility I work with is using the bottle of CHG not wipes, what is the protocol for this practice? Is it added to bath water, or put on separate via a clean washcloth after a bath, and how much should be used from a 6 oz. bottle? Does anyone have protocol/policy I can review?

  4. Avatar
    Sally Pettit January 17, 2019 at 5:05 am - Reply

    Had cellulitis with septic shock coma 4 days. 10 days more, catheters in both places, diaper rash, only cleaned with some sand like cleaner on rear end. Begged for better hygiene. Denied. Sent to nursing home upon dismissal. Only 2 showers a week. Why did I get UTI, c-diff and MRSA?
    Now told I need to keep hygienic. I knew that!

  5. Avatar
    Sally Pettit January 17, 2019 at 5:11 am - Reply

    I posted a few minutes ago that I got MRSA c-diff from not bring bathed enough in hospital and nursing home. It would not post because it was a duplicate. I was diagnosed with MRSA 12 hours ago and never on this site

  6. Avatar
    Anna March 19, 2019 at 5:49 pm - Reply

    An agency nurse currently working in the Trust wakes patients from 5am to wash them, he does this regularly and I think it’s very wrong to intrude like that instead of a quick change and letting them go back to sleep

  7. Avatar
    Randy Davis May 9, 2019 at 7:42 pm - Reply

    We are currently using a soap product that uses no water. It foams on body with light scrubbing and wipes off clean with a towel. Patients love this because they are not cold by water drying on body, the soap leaves them moisturized with no dryness or rash on skin. The CNA’s love it because it takes 5-8 minutes to completely wash a patient with 60% less labor!

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