The long-held tradition of using a basin, soap and water to bathe bed-bound hospitalized patients is no longer the recommended standard of practice, according to the American Association of Critical-Care Nurses (AACN). A new AACN Practice Alert R 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. Such baths also take longer and require more nursing time.
The AACN Practice Alert cites several studies that demonstrate how bathing patients with prepackaged cleansers that don't require rinsing offers several improvements to traditional methods. 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," said AACN Senior Director Ramón Lavandero, RN, MA, MSN, FAAN. "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 and 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 AACN recommends nurses determine optimal bath time by individual patient preference and clinical stability, and avoid waking patients solely to bathe them.
This alert is the latest in a series of guidelines issued by AACN to standardize practice and update nurses and other healthcare providers on new healthcare advances and trends. All alerts are available on the AACN website, www.aacn.org/practicealerts.
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, rather than 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 percent solution of chlorhexidine gluconate (CHG). 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.
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