The lateral approach water bath: A novel method of ultrasound imaging of the hand.

BACKGROUND: Traditional water baths for ultrasound exams place a hand into a pan of water and submerge an ultrasound probe into the water. While this improves ultrasound transmission and moves structures into the focal zone to make higher resolution images, this method does have limitations. Patients must be manipulated directly under the probe, which can be limited by pain or normal movement restrictions. The probe must also be held very still in water to minimize motion artifact. The lateral approach water bath method addresses such limitations by imaging through the side of a thin-walled plastic container without submerging the probe. This reduces much need for patient manipulation by imaging through the side of a column-shaped bath, which has 360 degrees of imaging freedom. It also stabilizes the probe directly against the flat, firm container to reduce image degrading motion artifact. We hypothesized that because of these improvements the lateral approach water bath might create higher quality images than traditional water baths. METHODS: We compared twenty images from each method, which were obtained with the same model and ultrasound operator at the same time. Two ultrasound fellowship trained blinded reviewers rated the images for quality and adequacy for clinical decision making on a scale from 1 to 5. RESULTS: Image quality was better for the lateral water bath, with an average rating of 4.2 compared to the traditional bath's 2.6 (p < 0.001). Adequacy to aid clinical decision making was better for the lateral approach bath with an average rating of 4.0 compared to the traditional bath's 2.6 (p < 0.001). The lateral bath also had a smaller range for image quality and thus greater consistency. CONCLUSIONS: The lateral approach water bath is a method of hand imaging that produces higher quality, more consistent, and more clinically useful images than traditional water bath imaging.

Waterless bathing for inpatients with neurological issues and complex needs.

Waterless bathing techniques can enhance the care of patients with neurological difficulties. Traditional methods can be uncomfortable and time consuming. Hospital-acquired infections in the NHS are a significant concern because of both financial burdens and antibiotic resistance, and preventing them is paramount. ContiTM waterless bathing products help reduce infection risks, save time and improve the patient experience. Four case studies illustrate the application of these techniques in a specialist hospital for people with complex and serious neurological conditions, demonstrating their practicality and efficacy as well as improvements in patient care and infection control within healthcare facilities.

Pediatric preoperative bathing process: An infection prevention perspective for development of a highly reliable organization.

Surgical site infections are a burden to patients, families and healthcare systems. Preoperative preparation is a crucial part in the multifaceted approach to SSI prevention. Preoperative bathing is a customary procedure that is seemingly straightforward yet challenging to implement. On the basis of best-practices and lived experience, this essay identifies potential barriers and presents several recommendations for improvement of preoperative preventive measures.

Nasal Iodophor Antiseptic vs Nasal Mupirocin Antibiotic in the Setting of Chlorhexidine Bathing to Prevent Infections in Adult ICUs: A Randomized Clinical Trial.

Importance: Universal nasal mupirocin plus chlorhexidine gluconate (CHG) bathing in intensive care units (ICUs) prevents methicillin-resistant Staphylococcus aureus (MRSA) infections and all-cause bloodstream infections. Antibiotic resistance to mupirocin has raised questions about whether an antiseptic could be advantageous for ICU decolonization. Objective: To compare the effectiveness of iodophor vs mupirocin for universal ICU nasal decolonization in combination with CHG bathing. Design, Setting, and Participants: Two-group noninferiority, pragmatic, cluster-randomized trial conducted in US community hospitals, all of which used mupirocin-CHG for universal decolonization in ICUs at baseline. Adult ICU patients in 137 randomized hospitals during baseline (May 1, 2015-April 30, 2017) and intervention (November 1, 2017-April 30, 2019) were included. Intervention: Universal decolonization involving switching to iodophor-CHG (intervention) or continuing mupirocin-CHG (baseline). Main Outcomes and Measures: ICU-attributable S aureus clinical cultures (primary outcome), MRSA clinical cultures, and all-cause bloodstream infections were evaluated using proportional hazard models to assess differences from baseline to intervention periods between the strategies. Results were also compared with a 2009-2011 trial of mupirocin-CHG vs no decolonization in the same hospital network. The prespecified noninferiority margin for the primary outcome was 10%. Results: Among the 801 668 admissions in 233 ICUs, the participants' mean (SD) age was 63.4 (17.2) years, 46.3% were female, and the mean (SD) ICU length of stay was 4.8 (4.7) days. Hazard ratios (HRs) for S aureus clinical isolates in the intervention vs baseline periods were 1.17 for iodophor-CHG (raw rate: 5.0 vs 4.3/1000 ICU-attributable days) and 0.99 for mupirocin-CHG (raw rate: 4.1 vs 4.0/1000 ICU-attributable days) (HR difference in differences significantly lower by 18.4% [95% CI, 10.7%-26.6%] for mupirocin-CHG, P < .001). For MRSA clinical cultures, HRs were 1.13 for iodophor-CHG (raw rate: 2.3 vs 2.1/1000 ICU-attributable days) and 0.99 for mupirocin-CHG (raw rate: 2.0 vs 2.0/1000 ICU-attributable days) (HR difference in differences significantly lower by 14.1% [95% CI, 3.7%-25.5%] for mupirocin-CHG, P = .007). For all-pathogen bloodstream infections, HRs were 1.00 (2.7 vs 2.7/1000) for iodophor-CHG and 1.01 (2.6 vs 2.6/1000) for mupirocin-CHG (nonsignificant HR difference in differences, -0.9% [95% CI, -9.0% to 8.0%]; P = .84). Compared with the 2009-2011 trial, the 30-day relative reduction in hazards in the mupirocin-CHG group relative to no decolonization (2009-2011 trial) were as follows: S aureus clinical cultures (current trial: 48.1% [95% CI, 35.6%-60.1%]; 2009-2011 trial: 58.8% [95% CI, 47.5%-70.7%]) and bloodstream infection rates (current trial: 70.4% [95% CI, 62.9%-77.8%]; 2009-2011 trial: 60.1% [95% CI, 49.1%-70.7%]). Conclusions and Relevance: Nasal iodophor antiseptic did not meet criteria to be considered noninferior to nasal mupirocin antibiotic for the outcome of S aureus clinical cultures in adult ICU patients in the context of daily CHG bathing. In addition, the results were consistent with nasal iodophor being inferior to nasal mupirocin. Trial Registration: ClinicalTrials.gov Identifier: NCT03140423.

Racial and Ethnic Variations in Skin Barrier Properties and Cultural Practices in Skin of Color Newborns, Infants, and Children.

BACKGROUND: The skin of newborns and infants of all races/ethnicity is more susceptible to skin barrier disruption than adult skin. This consensus paper offers insights into potential skincare implications for using gentle cleansers and moisturizers for skin of color (SOC) newborns, infants, and children. METHODS: Six pediatric dermatologists and dermatologists used a Delphi communication technique to adopt 5 statements for SOC newborns, infants, and children on skin barrier integrity and the importance of skin care to promote a healthy skin barrier.  Results: Regardless of ethnicity, newborn and infant skin is still developing and more susceptible to infections and chemical and thermal damage. A growing body of evidence supports skincare starting early in life, recognizing that the ongoing daily use of gentle cleansers and moisturizers containing barrier lipids, such as ceramides, promotes a healthy skin barrier. Understanding cultural differences in everyday skincare practices for SOC newborns, infants, and children is critical for developing an evidence base to substantiate skincare practices.  Conclusions: Closing knowledge gaps in the clinical presentation, cultural differences, and approach to treating skin conditions using skincare for SOC newborns, infants, and children may improve patient outcomes.   Schachner  LA, Andriessen A, Benjamin  L, et al. Racial/ethnic variations in skin barrier properties and cultural practices in skin of color newborns, infants and children. J Drugs Dermatol. 2023;22(7):657-663. doi:10.36849/JDD.7305.

Digital educational technology content production and validity about Japanese bathtub (ofurô) in neonatal unit.

OBJECTIVE: To describe the elaboration and content validity stages of a digital educational technology for nursing professionals about Japanese bathtub (ofurô) in newborns in neonatal care units. METHOD: A methodological study conducted between August 2019 and July 2021, in a public maternity hospital in Manaus, Amazonas, developed in two stages. In the first, the e-book images, text and editing were produced. In the second, material content validity was carried out, through the opinion of 15 expert judges, nurses and neonatal care experts. In data analysis, the percentage of agreement was applied with agreement score estimation. Items with 80% or more agreement were considered valid. RESULTS: The e-book "Japanese bathtub: manual for nursing professionals" was produced, organized into nine sessions, which describe the technique execution. Content was considered valid by expert judges (general score 90%). CONCLUSION: The e-book was considered suitable for use in training nursing professionals, with potential for dissemination of knowledge regarding humanization of care for premature babies.

Effect of Palmar Grasp Reflex Stimulation on Physiological Parameters and Crying Time During Neonatal Bath: A Randomized Controlled Trial.

OBJECTIVE: This study aimed to determine the effect of palmar grasp reflex stimulation during a neonatal bath on the physiological parameters and crying time of the newborn. DESIGN, SETTING, AND PARTICIPANTS: This study was designed as a parallel randomized clinical trial. Parents fully understood the study procedure at the Neonatal Intensive Care Unit in Turkey (N = 82). Both written and verbal consent was obtained from the parents. Newborns who were ineligible for tub bathing were excluded from the study. The babies in the control group were given baths according to the tub bathing standards. Babies in the experimental group were given palmar grasp reflex stimulation during the baths. The variables examined included body temperature, respiratory rate, pulse, oxygen saturation levels, and crying time. In all analyses, p < 0.05 was accepted as statistically significant. RESULTS: The heart rate of the experimental group was 5.2 beats per minute slower than the control group (χ2 = 12.272; p < 0.001). The respiratory rate of the experimental group was 1.3 lower per minute compared to the control group (χ2 = 43.219; p < 0.001). In addition, the oxygen saturation level (%) of the experimental group was 0.4 higher than the control group (χ2 = 5.793; p < 0.016). Crying time was higher in the control group during bathing (p < 0.001). CONCLUSION: The results showed that the palmar grasp reflex in newborn bathing helps to maintain the stability of physiological parameters and shortens the crying time of babies. Palmar grasp reflex stimulation is recommended in interventions that may cause stress.

The use of radon baths in the rehabilitation of patients with osteochondrosis.

OBJECTIVE: One of the most common methods of rehabilitation for this disease is balneotherapy. Radon therapy is one of the types of balneotherapy based on radon radiation (Rn) for therapeutic, prophylactic, and rehabilitation purposes. A significant number of authors report a positive effect of radon baths on the condition of patients with osteochondrosis. Some authors report the absence of a real therapeutic effect when using radon therapy. The work aimed at investigating the therapeutic efficacy of radon baths in patients suffering from osteochondrosis. PATIENTS AND METHODS: We examined 40 patients with osteochondrosis of various parts of the spine with radicular syndrome. The patients were randomly divided into two groups of 20 people with an equal number of men and women. The study group received a course of balneotherapy using radon water (general baths at a temperature of 34-36°C, duration 10-15 minutes, every other day, No. 10). The control group received balneotherapy using ordinary tap water in the same regimen to decrease placebo effects. RESULTS: Decreased pain and movement difficulties were observed only in the study group. These changes refer only to the spine but not to the joints of the extremities. CONCLUSIONS: Our studies have shown that using radon baths helps to reduce pain and increase the mobility of the spine in patients with osteochondrosis. These data substantiate the prospects for further research of this technique in the complex rehabilitation of osteochondrosis.

Health care staff perceptions of gaps and education needs for patient-led preoperative hygiene using chlorhexidine gluconate skin cleansing products.

Through survey-led interviews, health care staff recognizes that patients have different bathing techniques and need more education on chlorhexidine gluconate cleansing. Preliminary findings gathered will be used to develop and test electronic competency-based tools to ensure patients are provided with the same comprehensive instructions before using chlorhexidine gluconate bathing products.

La douche préopératoire chez les patients obèses : ce qu'en disent les patients et les soignants.

Introduction : At least one preoperative shower is recommended to avoid surgical site infection. Caregivers must explain the showering technique, help the patient if necessary, and assess skin cleanliness after showering.Context : Showering may be more difficult for obese patients because of inadequate equipment and difficulties moving, as well as insufficient explanation regarding the showering technique and an insufficient skin cleanliness assessment from caregivers.Objective : to assess whether patients and/or caregivers report difficulties in the preoperative shower process that could be linked to patient obesity. Methods : pilot qualitative survey with semi-structured interviews conducted with 9 obese surgery patients and 11 surgery caregivers.Results : Patients did not report feelings of discrimination. They described no problem with equipment, but declared having received little explanation on the showering technique and no visual skin cleanliness assessment. Caregivers reported equipment as inadequate, they stated having delivered detailed information, but found the skin cleanliness assessment difficult.Discussion : The lack of skin cleanliness assessment by caregivers after preoperative showering is new information. Limits : preliminary study with a small number of interviews and no non-obese patients.Conclusion : the subject warrants additional work with both quantitative and qualitative surveys to better understand the difficulties with preoperative showering.

Effects of swaddled and traditional tub bathing on stress and physiological parameters of preterm infants: A randomized clinical trial in China.

PURPOSE: The present research aims to study the effects of swaddled and traditional tub bathing on premature infants to identify better ways to bathe. DESIGN AND METHODS: Eligible premature infants (n = 60) were randomly assigned to either swaddled bathing or traditional tub bathing group. Stress scores and physiological indicators were measured 10 min before, immediately after, and 10 min after bathing. Crying times were also recorded for both groups. Data were reported as mean and standard deviation (SD) or frequency (percentage). For analyzing the data, the Student t-test and Chi-square test were employed. RESULTS: Swaddled bathing has less effect on the respiratory rate, heart rate, and oxygen saturation (p < 0.05). Both bathing methods led to a decrease in the temperature of infants. Still, the temperature of infants 10 min after bathing, in the swaddled bathing group was rose higher than the traditional tub bathing (t = 2.813, p < 0.05). The stress score of the swaddled bathing group, immediately after and ten minutes after bathing was lower than the traditional tub bathing group. The crying time of the swaddled bathing group was 32 ± 24.740(s) lower than the traditional tub bathing group 94.43 ± 41.625(s). CONCLUSIONS: The advantages of swaddled bathing over traditional tub bathing were validated for feasibility in China's preterm infants. Swaddled bathing is recommended method for bathing technique in the neonatal intensive care unit. PRACTICE IMPLICATIONS: Swaddled bathing is beneficial for the development of premature infants, as it results in less noxious stimuli and stress on the developing premature neonates.

Effect of Two Bathing Methods on Physiologic Parameters in Pediatric Intensive Care.

To determine the effect of traditional and disposable bed baths performed in the pediatric intensive care unit (PICU) on the physiologic parameters of children. This research was conducted as a randomized controlled trial with children who were monitored in the PICU. It was found that the pulse and blood pressure immediately after the bath were higher for both bath applications and was the lowest 30 minutes after the bath (p < .05). Children who used traditional baths had a lower body temperature than those who used the disposable bed bath after bathing for the second day. Oxygen saturation averages were found that within the group to be the highest 30 minutes after bathing methods (p < .05). Both bathing methods applied in the PICU had a positive effect on physiologic parameters. It may be recommended to regularly perform the most appropriate bathing for patients with stable hemodynamics in PICUs.

Positividade de culturas por modalidades de banho no leito hospitalar: estudo ecológico / Positividad de culturas por modalidades de baño en cama hospitalaria: estudio ecológico / Culture positivity by hospital bath bed modalities: an ecological study

Resumo Objetivo Verificar positividade de culturas microbiológicas de pacientes hospitalizados, com prescrição de enfermagem para banho no leito, em três períodos disjuntos e sequenciais das modalidades de banho no leito: convencional (BLC), descartável (BLD) e descartável acrescido de clorexidina degermante à 2% (BLD-CX). Métodos Estudo ecológico, tipo séries temporais de 48 meses, em três períodos (P1=BLC; P2=BLD; P3=BLD-CX), com dados secundários de prontuário eletrônico, de pacientes que estiveram internados em hospital do estado de São Paulo, Brasil. Resultados Nos períodos de banhos descartáveis, o percentual de positividade foi, em média, 14,6% menor quando comparado aos meses cujo banho de leito foi convencional. No período de BLD-CX o percentual de positividade foi, em média, 19,3% menor quando comparado aos meses do período de BLC. Contudo, não há evidências de diferença no percentual de positividade entre o BLD (b = -14,6%; IC95% = (-18,9% a -10,3%) e o BLD-CX (b = - 19,3%; IC95% = (-24,4% a -14,22%). A cada ano a mais na idade média do paciente, o percentual de positividade aumenta, em média 0,3% (p=0,060). Não houve associação sazonal para positividades das culturas microbiológicas nas modalidades de banho. Conclusão A positividade de culturas microbiológicas, em pacientes com prescrição de enfermagem para banho no leito, é menor quando se utiliza as modalidades descartáveis. Recomenda-se adotar rotineiramente o BLD, deixando a prescrição de BLD-CX, somente para degermação da pele para procedimentos invasivos, operatórios e higienização das mãos de profissionais de saúde.

Resumen Objetivo Verificar los resultados positivos de culturas microbiológicas de pacientes hospitalizados, con prescripción de enfermería de baño en cama, en tres períodos disjuntos y secuenciales de las modalidades de baño en cama: convencional (BCC), descartable (BCD) y descartable con clorhexidina al 2 % (BCD-CX). Métodos Estudio ecológico, tipo series temporales de 48 meses, en tres períodos (P1=BCC; P2=BCD; P3=BCD-CX), con datos secundarios de historia clínica electrónica, de pacientes que estuvieron internados en hospital del estado de São Paulo, Brasil. Resultados En los períodos de baños descartables, el porcentaje de resultados positivos presentó un promedio 14,6 % inferior en comparación con los meses en que el baño en cama fue convencional. Durante el período de BCD-CX el porcentaje de resultados positivos fue, en promedio, 19,3 % inferior en comparación con los meses del período de BCC. Sin embargo, no hay evidencias de diferencias en el porcentaje de resultados positivos entre el BCD (b = -14,6 %; IC95 % = (-18,9 % a -10,3 %) y el BLD-CX (b = - 19,3 %; IC95 % = (-24,4 % a -14,22 %). Por cada año que se suma a la edad promedio del paciente, el porcentaje de resultados positivos aumenta en promedio 0,3 % (p=0,060). No se verificó una asociación estacional en las respuestas positivas de las culturas microbiológicas en las modalidades de baños. Conclusión Los resultados positivos de culturas microbiológicas de pacientes con prescripción de enfermería de baño en cama son menores cuando se utilizan las modalidades descartables. Se recomienda adoptar de forma rutinaria el BCD y dejar la prescripción de BCD-CX solo para la eliminación de los gérmenes de la piel en procedimientos invasivos, quirúrgicos e higienización de manos de los profesionales de salud.

Abstract Objective To verify microbiological culture positivity of hospitalized patients, with a nursing prescription for bed bath, in three disjoint and sequential periods of bed bath modalities: conventional (CBB), disposable (DBB) and disposable plus 2% chlorhexidine degerming (DBB-CX). Methods This is an ecological, time series study of 48 months, in three periods (P1=CBB; P2=DBB; P3=DBB-CX), with secondary data from electronic medical records of patients who were admitted to a hospital in the state of São Paulo, Brazil. Results In the periods of disposable baths, the percentage of culture positivity was, on average, 14.6% lower when compared to the months in which bed bath was conventional. In the DBB-CX period, the percentage of culture positivity was, on average, 19.3% lower when compared to the CBB period months. However, there is no evidence of difference in the percentage of culture positivity between DBB (b = -14.6%; 95%CI = (-18.9% to -10.3%) and DBB-CX (b = - 19.3%;95%CI = (-24.4% to -14.22%) For each year more in patients' mean age, the percentage of culture positivity increases by an average of 0.3% (p=0.060). There was no seasonal association for microbiological culture positivity in bath modalities. Conclusion Microbiological culture positivity in patients with a nursing prescription for bed bath is lower when disposable modalities are used. It is recommended to routinely adopt DBB, leaving the prescription of DBB-CX only for skin degermation for invasive and operative procedures and hand hygiene of health professionals.

Desenvolvimento de tecnologia educacional para familiares sobre o banho de ofurô no domicílio para recém-nascidos / Development of educational technology for family members about the hot tub at home for newborns / Desarrollo de tecnología educativa para familiares sobre el baño de ofuro en casa para recién nacidos

Objetivo: Desenvolver uma tecnologia educacional para familiares sobre o banho de ofurô no domicílio em RN. Método: Estudo metodológico de desenvolvimento tecnológico, realizado em três etapas: revisão da literatura, produção tecnológica, validação de conteúdo a partir da manifestação de juízes-especialistas. Coleta de dados por meio de instrumento com escala de Likert. Análise dos dados por aplicação do Índice Kappa e do Índice de Validade de Conteúdo. Resultados: Na etapa de revisão emergiram os temas geradores. Na etapa de produção obteve-se um livro ilustrado digital intitulado "Banho de Ofurô em Casa: Guia de Orientação aos Pais e Familiares de Recém-Nascidos Prematuros e com Baixo Peso". Na etapa de validação verificou-se que a tecnologia é válida e adequada, apresentando informações coerentes com a literatura, organizadas de forma objetiva e clara, contendo descrição detalhada da técnica, com ilustrações expressivas e sincrônicas com o texto. Conclusão: A tecnologia desenvolvida revelou-se válida para a preparação dos familiares para a alta e, com potencial para a difusão do conhecimento quanto ao cuidado neonatal. (AU)

Objective: To develop an educational technology for family members about the hot tub bathing at home for premature and/ or low weight newborns. Methods: Methodological study of technological development, carried out in three stages: literature review, technological production, content validation based on the opinion of 17 expert judges. Data collection using a Likert scale instrument. In the data analysis, the Kappa Index and Content Validity Index were applied. Results: In the review stage, the generating themes emerged. In the production stage, a digital illustrated book was obtained entitled "Bath of Ofuro at Home: Orientation Guide for Parents and Family of Premature and Low Weight Newborns". In the validation stage, it was found that the technology is valid and adequate, presenting information consistent with the literature, organized in an objective and clear manner, containing a detailed description of the technique, with expressive and synchronous illustrations with the text. Conclusion: The technology developed proved to be valid for the preparation of family members for discharge and, with the potential for the dissemination of knowledge regarding neonatal care. (AU)

Objetivo: Desarrollar una tecnología educativa para familiares sobre el baño de ofuro en casa para recién nacidos prematuros y/o de bajo peso. Métodos: Estudio metodológico del desarrollo tecnológico, realizado en tres etapas: revisión de literatura, producción tecnológica, validación de contenido en base a la opinión de 17 jueces expertos. Recolección de datos utilizando un instrumento de escala Likert. En el análisis de datos se aplicó el Índice Kappa y el Índice de Validez de Contenido. Resultados: En la etapa de revisión surgieron los temas generadores. En la etapa de producción se obtuvo un libro ilustrado digital titulado "Baño de ofuro en casa: Guía de Orientación para Padres y Familia de Recién Nacidos Prematuros y de Bajo Peso". En la etapa de validación, se encontró que la tecnología es válida y adecuada, presentando información consistente con la literatura, organizada de manera objetiva y clara, conteniendo una descripción detallada de la técnica, con ilustraciones expresivas y sincrónicas con el texto. Conclusión: La tecnología desarrollada demostró ser válida para la preparación de los familiares para el alta y, con potencial para la difusión de conocimientos sobre la atención neonatal. (AU)

Real-world experience of how chlorhexidine bathing affects the acquisition and incidence of vancomycin-resistant enterococci (VRE) in a medical intensive care unit with VRE endemicity: a prospective interrupted time-series study.

BACKGROUND: Critically ill patients in intensive care units (ICUs) often acquire opportunistic infections or are colonized by vancomycin-resistant enterococci (VRE), which limits therapeutic options and results in high case-fatality rates. In clinical practice, the beneficial effects of universal chlorhexidine gluconate (CHG) bathing on the control of VRE remain unclear. This study aimed to investigate whether 2% CHG daily bathing reduced the acquisition of VRE in the setting of a medical ICU (MICU) with VRE endemicity. METHODS: This quasi-experimental intervention study was conducted in a 23-bed MICU of a tertiary care hospital in Korea from September 2016 to December 2017. In a prospective, interrupted time-series analysis (ITS) with a 6-month CHG bathing intervention, we compared the acquisition and incidence of VRE and the incidence of methicillin-resistant Staphylococcus aureus (MRSA) and carbapenem-resistant Acinetobacter baumannii (CRAB) between the pre-intervention and intervention periods. The primary and secondary outcomes were a change in the acquisition of VRE and incidence of VRE, MRSA, or CRAB between the two periods, respectively. RESULTS: All the adult patients admitted to the MICU were enrolled in the pre-intervention (n = 259) and intervention (n = 242). The overall CHG daily bathing compliance rate was 72.5%. In the ITS, there was a significant intervention effect with a 58% decrease in VRE acquisition (95% CI 7.1-82.1%, p = 0.038) following the intervention. However, there was no significant intervention effects on the incidence trend of VRE, MRSA, and CRAB determined by clinical culture between the pre-intervention and intervention periods. CONCLUSION: In this real-world study, we concluded that daily bathing with CHG may be an effective measure to reduce VRE cross-transmission among patients in MICU with a high VRE endemicity.

Effectiveness of a Multicomponent Intervention to Reduce Multidrug-Resistant Organisms in Nursing Homes: A Cluster Randomized Clinical Trial.

Importance: Multidrug-resistant organisms (MDROs) can cause significant morbidity and mortality. Preventing MDROs can reduce the risk of subsequent transmission and infection. Objective: To determine whether a multicomponent infection prevention intervention can reduce MDRO prevalence in nursing homes (NHs). Design, Setting, and Participants: This cluster randomized clinical trial of a multicomponent intervention was conducted in 6 NHs in Michigan from September 2016 to August 2018. Three NHs adopted a multicomponent intervention, while 3 control NHs continued without investigator intervention. Study visits were conducted at baseline; days 7, 14, 21, and 30; and monthly thereafter for up to 6 months or discharge. Visits included clinical data collection and MDRO surveillance culturing of multiple body sites and high-touch surfaces in patient rooms. Any patients who provided informed consent within 14 days of admission to the NH were enrolled in this study. Non-English speakers and patients receiving hospice care were ineligible. Analysis was performed from November 2018 to February 2020. Interventions: Intervention NHs adopted a multicomponent intervention that included enhanced barrier precautions, chlorhexidine bathing, MDRO surveillance, environmental cleaning education and feedback, hand hygiene promotion, and health care worker education and feedback. Control nursing homes continued standard care practices. Main Outcomes and Measures: The primary outcome, presence of MDROs, was measured longitudinally in the patient and room environment and was evaluated using generalized mixed effect models. The secondary outcome, time to new MDRO acquisition, was assessed using Cox proportional hazard models. Results: A total of 6 NHs were included, with 245 patients (mean [SD] age, 72.5 [13.6] years; 134 [54.7%] women) enrolled; 3 NHs with 113 patients (46.1%) were randomized to the intervention group and 3 NHs with 132 patients (53.9%) were randomized to the control group. A total of 132 patients (53.9%) were White, and 235 patients (95.9%) were receiving postacute care. Over 808 study visits, 3654 patient cultures and 5606 environmental cultures were obtained. The intervention reduced the odds of MDRO prevalence in patients' environment by 43% (aOR, 0.57; 95% CI, 0.35-0.94), but there was no statistically significant difference on the patient level before or after adjustment (aOR, 0.57; 95% CI, 0.29-1.14). There were no significant reductions in time to new acquisition for methicillin-resistant Staphylococcus aureus (hazard ratio [HR], 0.20; 95% CI, 0.04-1.09), vancomycin-resistant enterococci (HR, 0.84; 95% CI, 0.46-1.53), or resistant gram-negative bacilli (HR, 1.14; 95% CI, 0.73-1.78). Conclusions and Relevance: This cluster randomized clinical trial found that the multicomponent intervention reduced the prevalence of MDROs in the environment of NH patients. Our findings highlight the potential for multicomponent interventions to directly and indirectly reduce MDRO prevalence in NHs. Trial Registration: ClinicalTrials.gov Identifier: NCT02909946.

Newborn bath: construction and validation of the instrument content.

OBJECTIVE: To build and validate the content of a good practice tool in the newborn bath. METHOD: Methodological study, developed from December 2018 to January 2019, in a Joint Neonatal Housing Unit of a teaching hospital, in three stages: bibliographic survey, construction of the instrument and content validation by nine judges. The content validity index was used above 80% and general analysis with ten requirements. RESULTS: The instrument was organized in three domains: before bathing, during bathing and after bathing, with a total of 20 items. Two rounds of validation were carried out to adjust the suggestions; the second presented a percentage of agreement between the judges, equal to or above 0.82. CONCLUSION: The instrument "Good practices in the newborn's bath" was considered representative and valid in terms of content.

Unmet Need for Equipment to Help With Bathing and Toileting Among Older US Adults.

Importance: Home modification through seemingly mundane equipment, such as grab bars and shower seats, mitigates injury, dependence, and reduced quality of life in older adults coping with increasing disability. However, whether these interventions are underused in the US is unclear. Objective: To estimate how many older adults who need equipment to help with bathing and toileting do not have it, describe factors associated with not having equipment, and describe how many who did not initially have equipment acquired equipment over time. Design: This observational cohort study of participants 65 years or older used secondary data from the 2015 to 2019 waves of the US National Health and Aging Trends Study. Participants included community-dwelling older adults who would unequivocally benefit from equipment, defined as those with poor physical performance or substantial difficulty bathing, toileting, transferring, or walking. Respondents were representative of the US population 65 years and older. Data were collected from May 2015 to October 2019 and analyzed from August 1, 2019, to February 24, 2021. Exposures: Population characteristics (eg, age, sex, income, health conditions, and physical performance), environmental factors (eg, home ownership and living arrangement), and health behaviors (eg, prior knee and/or hip surgery). Main Outcomes and Measures: Prevalence of any unmet need for equipment, defined as either needing bathing equipment (bath grab bars and shower seat) but having none or needing toileting equipment (toilet grab bars and raised toilet seat) but having none and the cumulative incidence of equipment acquisition during 4 years of follow-up. Results: A total of 2614 participants representing 12 million US individuals would benefit from equipment. The mean (SD) age was 80.5 (8.2) years, and 1619 individuals (62%) were women. Of these, an estimated 5 million individuals (42%; 95% CI, 39%-44%) had an unmet need. After adjustment for age, sex, and race/ethnicity, unmet need was associated with younger age (49% if aged 65-74 years, 37% if aged 75-84 years, and 29% if aged ≥85 years; P < .001), having fewer health conditions (55% if none vs 39% if ≥3; P = .002), non-White race/ethnicity (40% if White vs 51% if Black, 54% if Hispanic, and 55% if other; P < .001), no recent hospitalization (46% vs 37% if hospitalized; P = .001), and no prior knee and/or hip fracture or surgery (46% vs 35% if prior fracture or surgery; P < .001). After 4 years of follow-up, 35% of those with bathing equipment needs and 52% of those with toileting equipment needs never received equipment. Conclusions and Relevance: This cohort study suggests that in the US, 42% of older adults with impairments that would make bathing or toileting difficult lack equipment to assist. This situation is a missed opportunity to help 5 million individuals live independently and safely.

An Organization-Wide Initiative to Implement Parent-Performed, Delayed Immersion Bathing.

OBJECTIVE: To implement an organization-wide evidence-based practice change to parent-performed, delayed immersion newborn bathing across nine facilities at a military health care system. DESIGN: Organization-wide evidence-based practice initiative using preimplementation and postimplementation data. SETTING: A military health system consisting of four medical centers and five community hospitals that averages 4,000 births each year. PARTICIPANTS: Term newborns (≥37 weeks gestation) born within the nine facilities. INTERVENTION/MEASUREMENTS: Champions were identified at each facility to change bathing practice. Baths for newborns were delayed until 24 hours of age, unless otherwise requested. Parents were instructed how to tub bathe their newborn and encouraged to complete the bath in less than 5 minutes. The team reviewed 100 records from each hospital and compared pre- and postimplementation temperature data. RESULTS: The organization-wide practice change showed a statistically significant association between time point (i.e., before vs. after implementation) and postbathing hypothermia (χ2 = 30.91, p < .001). In addition, data also showed fewer hypothermic temperature readings (i.e., <97.7 °F [<36.5 °C]) from the onset of birth until 8 hours of life with the new bathing process. Although this difference was not statistically significant (p = .11), it holds clinical significance if it can be replicated; newborn hypothermia requires provider notification and can lead to additional testing to rule out infection and other concerns. CONCLUSION: Delaying newborns' first bath was associated with a significant decrease in the number of newborns who had hypothermic temperature readings immediately after the bath. The intervention involved minimal cost with multiple benefits. Delayed immersion bathing is a family-friendly process that can be implemented across an organization.

Heat-retention effects of hydrogen-rich water bath assessed by thermography for humans.

Hydrogen-rich water bath devices are commercially available, but have been scarcely clarified for heat-retention effects. In this study, heat-retention effects of hydrogen-rich water bath were assessed by thermographic clinical trials, which employed twenty-four healthy subjects. The thermograms indicated that, under the same conditions (41 °C, 10-min bathing), hydrogen-rich water bath (hydrogen concentrations: 185-548 µg/L; oxidation-reduction potentials: -167 to -91 mV, versus 0.8 µg/L and +479 mV for normal bath, respectively) brought about the heat-retention being more marked than those of normal water bath for several body-parts in the order as follows: abdomen > upper legs > arms > hands > feet, for 30- and 60-min post-bathing, being in contrast to scarce heat-retention for head, armpits and lower legs. Then, as reflection to promotive effects on blood stream, we also examined the thickness of fingertip-capillary in hands. The thickness was expanded in the hydrogen-rich water bath more markedly than that in the normal water bath, suggesting that the hydrogen-rich water bath may have the hydrogen-based promotive effect, exceeding over mere heat retention-based effects, on blood circulation of the whole body. Meanwhile, the heat-retention in hydrogen-rich water bath weakly or moderately correlated with contents of the subcutaneous fat, whole body fat and body mass index, and inversely correlated with skeletal muscle rates, although their correlation degrees did not obviously exceed over normal water bath, with a poor relation with the basal metabolism rate. Thus, the hydrogen-rich water bath was suggested to exert heat-retention effects exceeding over normal water bath, in diverse body-parts such as abdomen, upper legs, arms and hands, via promotion to blood flow which was reflected by expanding the thickness of capillary. The heat-retention after bathing can be noted as effects of the hydrogen-rich water bath, which is applicable for most of people widespread regardless of their body composition index.