The "Enseki" sandbath: A novel, safe and effective far-infrared bathing procedure for health.

BACKGROUND: Far-infrared (FIR) is well known with various therapeutic benefits. Recently, we have developed a novel FIR bathing system called the Enseki sandbath. In this regard, we focused on physical nature of ceramic to radiate FIR rays when heated adequately. METHODS: A bathtub was filled with ceramic beads and was equipped with computerized system which enabled to supply hot water over the ceramic beads and to drain out when beads were sufficiently heated. This system was used like sandbathing. Healthy volunteers were laid in bathtubs, covered in heated ceramic beads and were bathed for 15 minutes. Microbiological analysis was done in samples obtained from the skin surface, ceramic beads, or drained water. Furthermore, various physiological parameters were monitored, including blood pressure, heart rates, oral temperature, body weight, and blood viscosity. Blood samples were simultaneously collected and subjected to biochemical analysis, including blood glucose, HbA1c, uric acid, lactate, fatty acid, and others. RESULTS: All data showed no physiological overload for tested individuals, and any biochemical analysis did not present abnormal score. Bacteriological culture grew no pathogens. Results of questionnaires demonstrated that 90% of the participants answered the comfort and wished to further repeat the bathing. LIMITATIONS: This is a nonrandomized prospective case study. CONCLUSION: We concluded that the Enseki method is a safe and well-tolerated FIR bathing procedure for regeneration and relaxation.

Application of three different methods to determine the prevalence, the abundance and the environmental drivers of culturable Vibrio cholerae in fresh and brackish bathing waters.

AIMS: Three cultivation methods were used to study the prevalence and abundance of Vibrio cholerae in Eastern Austrian bathing waters and to elucidate the main factors controlling their distribution. METHODS AND RESULTS: Vibrio cholerae abundance was monitored at 36 inland bathing sites with membrane filtration (MF), a standard most probable number (MPN) approach and direct plating (DP). Membrane filtration yielded the most reliable and sensitive results and allowed V. cholerae detection at 22 sites with concentrations up to 39 000 CFU per 100 ml, all belonging to serogroups other than O1 and O139 and not coding for cholera toxin and toxin coregulated pilus. Direct plating turned out as an easy method for environments with high V. cholerae abundances, conductivity was the only significant predictor of V. cholerae abundance in the bathing waters at warm water temperatures. CONCLUSIONS: Vibrio cholerae nonO1/nonO139 are widely prevalent in Eastern Austrian bathing waters. Instead of the standard MPN approach, MF and DP are recommended for V. cholerae monitoring. Conductivity can be used as a first easy-to-measure parameter to identify potential bathing waters at risk. SIGNIFICANCE AND IMPACT OF THE STUDY: Vibrio cholerae nonO1/nonO139 infections associated with bathing activities are an increasing public health issue in many countries of the northern hemisphere. However, there are only limited data available on the prevalence and abundance of V. cholerae in coastal and inland bathing waters. For monitoring V. cholerae prevalence and abundance, reliable and simple quantification methods are needed. Moreover, prediction of V. cholerae abundance from environmental parameters would be a helpful tool for risk assessment. This study identified the best culture-based quantification methods and a first quick surrogate parameter to attain these aims.

Inappropriate ICD shock due to hot tub-induced external electrical interference.

BACKGROUND: A 72-year-old white male with a history of rapid nonsustained ventricular tachycardia, hypertrophic cardiomyopathy, and intermittent Brugada-type ECG had a single-lead implantable cardioverter-defibrillator (ICD) implantation and received a sudden ICD shock while in the hot tub. To the best of our knowledge this is the first case report of hot tub jet-induced inappropriate ICD shock. METHODS: ICD interrogation and analysis of intracardiac electrograms and event markers. RESULTS: ICD interrogation revealed inappropriate ICD shocks due to electrical interference of hot tub engine; 60-cycle electrical artifact mimicking fast ventricular fibrillation erroneously detected by the device. The device then delivered a 34.8 joules shock while the patient was actually in sinus rhythm. CONCLUSIONS: Electrical interference due to external sources such as hot tub engines may occur and produce an inappropriate detection and ICD shock. Precaution and patient education is warranted.

A robotic shower system : Acceptance and ethical issues.

BACKGROUND: Being able to maintain personal hygiene plays a crucial role for independent living in old age or when suffering from disabilities. Within the European project ICT Supported Bath Robots (I­SUPPORT) an intelligent robotic shower system is being developed, which enables patients to shower independently at home or in institutionalized settings. OBJECTIVE: The aim of this contribution is the identification of ethical issues in the development of a robotic shower system utilizing the model for the ethical evaluation of socio-technical arrangements (MEESTAR). MATERIAL AND METHODS: In I­SUPPORT a variety of concepts and methods are implemented in order to achieve technology acceptance such as user-centered requirements analysis, usability-tests and analysis of sociocultural and ethical aspects. This article reports the analysis of focus groups with 14 older adults and 9 professional caregivers utilizing MEESTAR as a heuristic approach for analyzing sociotechnical arrangements and identifying ethical problems. RESULTS AND DISCUSSION: The MEESTAR procedure was adapted to the research question and client groups and implemented as a discursive method. This gave an insight into the meaning and background of ethical aspects and also a deeper insight into nursing processes as well as the requirements which the system should fulfil. Shortcomings are that the ethical dimensions are not everyday language and the time restrictions. In the next step a standardized assessment instrument will be developed and piloted.

Algo Used by Homecare Nonoccupational Therapists Selecting Bathing Assistive Technology: Enhancing Standardization by Exploring Clinical Reasoning.

Algo is a clinical decision algorithm developed to support nonoccupational therapists in establishing assistive technology recommendations to enable physically disabled adults to perform their hygiene at home. This study aimed to explore the in-depth clinical reasoning of nonoccupational therapists using Algo to pinpoint the items leading to disagreements regarding recommendations. A multiple-case study was conducted with eight nonoccupational therapists trained to use Algo and filmed while using it with six standardized clients. Explicitation interviews were conducted for the conflicting recommendations. Identifying the key reasoning skills to develop in Algo users has led to three recommendations to enhance standardization with seniors.

Unintentional drowning mortality, by age and body of water: an analysis of 60 countries.

BACKGROUND: To examine unintentional drowning mortality by age and body of water across 60 countries, to provide a starting point for further in-depth investigations within individual countries. METHODS: The latest available three years of mortality data for each country were extracted from WHO Health Statistics and Information Services (updated at 13 November 2013). We calculated mortality rate of unintentional drowning by age group for each country. For countries using International Classification of Disease 10 (ICD-10) detailed 3 or 4 Character List, we further examined the body of water involved. RESULTS: A huge variation in age-standardised mortality rate (deaths per 100 000 population) was noted, from 0.12 in Turkey to 9.19 in Guyana. Of the ten countries with the highest age-standardised mortality rate, six (Belarus, Lithuania, Latvia, Russia, Ukraine and Moldova) were in Eastern Europe and two (Kazakhstan and Kyrgyzstan) were in Central Asia. Some countries (Japan, Finland and Greece) had a relatively low rank in mortality rate among children aged 0-4 years, but had a high rank in mortality rate among older adults. On the contrary, South Africa and Colombia had a relatively high rank among children aged 0-4 years, but had a relatively low rank in mortality rate among older adults. With regard to body of water involved, the proportion involving a bathtub was extremely high in Japan (65%) followed by Canada (11%) and the USA (11%). Of the 13 634 drowning deaths involving bathtubs in Japan between 2009 and 2011, 12 038 (88%) were older adults aged 65 years or above. The percentage involving a swimming pool was high in the USA (18%), Australia (13%), and New Zealand (7%). The proportion involving natural water was high in Finland (93%), Panama (87%), and Lithuania (85%). CONCLUSIONS: After considering the completeness of reporting and quality of classifying drowning deaths across countries, we conclude that drowning is a high-priority public health problem in Eastern Europe, Central Asia, Japan (older adults involving bathtubs), and the USA (involving swimming pools).

Controlling Legionella and Pseudomonas aeruginosa re-growth in therapeutic spas: implementation of physical disinfection treatments, including UV/ultrafiltration, in a respiratory hydrotherapy system.

The study aimed to assess the efficacy of an integrated water safety plan (WSP) in controlling Legionella re-growth in a respiratory hydrotherapy system located in a spa centre, supplied with sulphurous water, which was initially colonized by Legionella pneumophila. Heterotrophic plate counts, Pseudomonas aeruginosa, Legionella spp. were detected in water samples taken 6-monthly from the hydrotherapy equipment (main circuit, entry to benches, final outlets). On the basis of the results obtained by the continuous monitoring and the changes in conditions, the original WSP, including physical treatments of water and waterlines, environmental surveillance and microbiological monitoring, was integrated introducing a UV/ultrafiltration system. The integrated treatment applied to the sulphurous water (microfiltration/UV irradiation/ultrafiltration), waterlines (superheated stream) and distal outlets (descaling/disinfection of nebulizers and nasal irrigators), ensured the removal of Legionella spp. and P. aeruginosa and a satisfactory microbiological quality over time. The environmental surveillance was successful in evaluating the hazard and identifying the most suitable preventive strategies to avoid Legionella re-growth. Ultrafiltration is a technology to take into account in the control of microbial contamination of therapeutic spas, since it does not modify the chemical composition of the water, thus allowing it to retain its therapeutic properties.

Comparison between a new electronic bidet and conventional sitz baths: a manometric evaluation of the anal resting pressure in normal healthy volunteers.

BACKGROUND: A bidet has been proposed as a replacement for the sitz bath. Like a sitz bath, it brings water into contact with the perineum. However, the high force of water from commercially used electronic bidets may harm the anus. We developed a new electronic bidet and evaluated its effects on anal resting pressure compared with a warm sitz bath. METHODS: Forty volunteers used the electronic bidet and sitz bath on separate days. The electronic bidet was newly designed with warm (38 °C) water and very low force (10 mN) with a fountain type of flow. Anal resting pressure at the high-pressure zone was measured before (control) and after the electronic bidet and sitz bath. Pressure changes after bidet or sitz bath were expressed as percentages compared with control. Water temperatures and rectal temperatures were also recorded. RESULTS: The anal resting pressures before the electronic bidet and sitz bath were 90.2 ± 24.6 and 88.1 ± 16.8 mmHg, respectively. At 3 min after the electronic bidet and sitz bath, the anal resting pressures were 71.3 ± 23.4 and 69.6 ± 19.8 mmHg, respectively. The pressure changes compared with the control were 78.2 ± 12.9 and 78.1 ± 12.5%, respectively, which were not significantly different. The maximal increase and minimal decrease were not significantly different. The rectal temperature was not elevated, and the water temperature decreased significantly with the sitz bath (p < 0.001). CONCLUSIONS: Our new electronic bidet may reduce the anal resting pressure much like a warm sitz bath does.

Development, construction, and content validation of a questionnaire to test mobile shower commode usability.

BACKGROUND: Usability is an emerging domain of outcomes measurement in assistive technology provision. Currently, no questionnaires exist to test the usability of mobile shower commodes (MSCs) used by adults with spinal cord injury (SCI). OBJECTIVE: To describe the development, construction, and initial content validation of an electronic questionnaire to test mobile shower commode usability for this population. METHODS: The questionnaire was constructed using a mixed-methods approach in 5 phases: determining user preferences for the questionnaire's format, developing an item bank of usability indicators from the literature and judgement of experts, constructing a preliminary questionnaire, assessing content validity with a panel of experts, and constructing the final questionnaire. RESULTS: The electronic Mobile Shower Commode Assessment Tool Version 1.0 (eMAST 1.0) questionnaire tests MSC features and performance during activities identified using a mixed-methods approach and in consultation with users. It confirms that usability is complex and multidimensional. The final questionnaire contains 25 questions in 3 sections. The eMAST 1.0 demonstrates excellent content validity as determined by a small sample of expert clinicians. CONCLUSION: The eMAST 1.0 tests usability of MSCs from the perspective of adults with SCI and may be used to solicit feedback during MSC design, assessment, prescription, and ongoing use. Further studies assessing the eMAST's psychometric properties, including studies with users of MSCs, are needed.

Can home health aids using the clinical algorithm Algo choose the right bath seat for clients having a straightforward problem?

OBJECTIVE: To determine if Algo, a clinical algorithm to select bathing equipment for 'straightforward' cases, guides home health aides in selecting the appropriate bath seat. DESIGN: Criterion validity study. SETTING: Community home care. SUBJECTS: Eight home health aides used Algo with community-dwelling older adults having a straightforward problem. MAIN MEASURES: Their bath-seat recommendations were compared with those proposed by an occupational therapist (OT), which were considered as the gold standard. In order to determine a clinically acceptable threshold of agreement between the recommendations, a subgroup of community-dwelling elderly people was assessed a third time by another OT. RESULTS: Half of the clients (74/143) for whom bathroom assessments were requested qualified as potentially straightforward cases after triage and were visited at home by a home health aide using Algo. In 84% of cases (95% confidence interval (CI) = [75, 93]), the non-OTs using Algo identified a seat that would enable these older adults to bathe according to their preferences, abilities and environment, as confirmed by the gold standard OT. Moreover, this appropriateness rate did not statistically differ from that obtained when comparing another OT to the gold standard. CONCLUSION: Algo guides non-OTs toward a bath seat that meets the needs of community-dwelling older adults in the majority of cases.

Preventing bath water scalds: a cost-effectiveness analysis of introducing bath thermostatic mixer valves in social housing.

AIMS: To assess the cost-effectiveness of installing thermostatic mixer valves (TMVs) in reducing risks of bath water scalds and estimate the costs of avoiding bath water scalds. METHODS: The evaluation was undertaken from the perspective of the UK public sector, and conducted in conjunction with a randomised control trial of TMVs installed in social housing in Glasgow. Installation costs were borne by the social housing organisation, while support materials were provided by the UK NHS. Effectiveness was represented by the number of families with at-risk bath water temperatures pre- and post-installation, and the number of bath scalds avoided as a result of installation. Differences in the number of families with at-risk temperatures between groups were derived from the RCT. Cost-effectiveness was assessed and a series of one-way sensitivity analyses were conducted. RESULTS: Unit costs associated with installation were calculated to be £13.68, while costs associated with treating bath water scalds ranged from £25,226 to £71,902. The cost of an avoided bath water scald ranged from net savings to public purse of £1887 to £75,520 and at baseline produced a net saving of £3,229,008; that is, £1.41 saved for every £1 spent. CONCLUSION: It is very likely that installing TMVs as standard in social housing in new buildings and major refurbishments accompanied by educational information represents value for money.

Use of different bath grab bar configurations following a balance perturbation.

Although commonly prescribed, little research exists on bath grab bars. This study examined the use of bath grab bars following an experimentally induced balance perturbation, the influence of the task on grab bar use, and the influence of balance loss on acceptance of grab bars. A mixed design documented the use of four different grab bar configurations: (a) no bars, (b) vertical/horizontal combination, (c) L-shaped bar, and (d) vertical/angled combination following balance loss. Eighty adults were randomly assigned to three groups. Each group tried the "no bar" configuration and one of the other grab bar configurations. In 25% of the trials for each configuration, balance perturbation was induced. Older adults used grab bars 59.4% of time to regain balance, compared to 13.6% for younger adults. The vertical bar on the side wall was favored by both groups of participants during both bathtub entry and exit. To promote safety in the home, existing building codes must be revised to recommend minimally a vertical grab bar on the side wall. Additional bars may be needed to ensure safety during stand-to-sit and sit-to-stand phases of bath transfers. Initiatives must be taken to decrease the prejudice associated with grab bars.

Prediction of human thermophysiological responses during shower bathing.

This study develops a model to predict the thermophysiological response of the human body during shower bathing. Despite the needs for the quantitative evaluation of human body response during bathing for thermal comfort and safety, the complicated mechanisms of heat transfer at the skin surface, especially during shower bathing, have disturbed the development of adequate models. In this study, an initial modeling approach is proposed by developing a simple heat transfer model at the skin surface during shower bathing applied to Stolwijk's human thermal model. The main feature of the model is the division of the skin surface into three parts: a dry part, a wet part without water flow, and a wet part with water flow. The area ratio of each part is decided by a simple formula developed from a geometrical approach based on the shape of the Stolwijk's human thermal model. At the same time, the convective heat transfer coefficient between the skin and the flowing water is determined experimentally. The proposed model is validated by a comparison with the results of human subject experiments under controlled and free shower conditions. The model predicts the mean skin temperature during shower fairly well both for controlled and free shower bathing styles.

Improving efficiency, reducing infection, and enhancing experience.

For health professionals to make an informed choice and tailor each bed bath to the individual needs of the patient, they must firstly understand the different bed bath options available, their impact on skin integrity, and any associated risks they may pose to the patient in terms of cross-infection. Only with this knowledge can health professionals determine the appropriate form and frequency of the bed bath. Specialist wipes offer significant improvements in skin care and a reduced risk of cross-infection, compared with the traditional soap and water bed bath. Use of these wipes also improves the efficiency of the process, which links to the Productive Ward Initiative and results in clinical staff (i.e. nursing staff, healthcare assistants) having more time available to undertake additional patient care activities. This product focus highlights the benefits of moving to a wipe-based bed bath method, and the significant efficiency savings that can be realized as a result.

Potentially pathogenic bacteria in shower water and air of a stem cell transplant unit.

Potential pathogens from shower water and aerosolized shower mist (i.e., shower aerosol) have been suggested as an environmental source of infection for immunocompromised patients. To quantify the microbial load in shower water and aerosol samples, we used culture, microscopic, and quantitative PCR methods to investigate four shower stalls in a stem cell transplant unit at Barnes-Jewish Hospital in St. Louis, MO. We also tested membrane-integrated showerheads as a possible mitigation strategy. In addition to quantification, a 16S rRNA gene sequencing survey was used to characterize the abundant bacterial populations within shower water and aerosols. The average total bacterial counts were 2.2 x 10(7) cells/liter in shower water and 3.4 x 10(4) cells/m(3) in shower aerosol, and these counts were reduced to 6.3 x 10(4) cells/liter (99.6% efficiency) and 8.9 x 10(3) cells/m(3) (82.4% efficiency), respectively, after membrane-integrated showerheads were installed. Potentially pathogenic organisms were found in both water and aerosol samples from the conventional showers. Most notable was the presence of Mycobacterium mucogenicum (99.5% identity) in the water and Pseudomonas aeruginosa (99.3% identity) in the aerosol samples. Membrane-integrated showerheads may protect immunocompromised patients from waterborne infections in a stem cell transplant unit because of efficient capture of vast numbers of potentially pathogenic bacteria from hospital water. However, an in-depth epidemiological study is necessary to investigate whether membrane-integrated showerheads reduce hospital-acquired infections. The microbial load in shower aerosols with conventional showerheads was elevated compared to the load in HEPA-filtered background air in the stem cell unit, but it was considerably lower than typical indoor air. Thus, in shower environments without HEPA filtration, the increase in microbial load due to shower water aerosolization would not have been distinguishable from anticipated variations in background levels.