NursPainPrevent: A Prospective Observational Study on Pain During a Bed Bath.

BACKGROUND: Although bed baths are known to cause pain, the engendered pain frequency and intensity remain poorly studied. This prospective, observational study was undertaken to examine prospectively, on a given day, patients' bed bath-associated pain in the general in-hospital population. METHODS: Eight external investigators observed 166 bed baths given in 23 units in 5 hospitals. Using validated assessment scales specific to the patients' clinical situations, they established pain scores. RESULTS: Expert observers rated bed bath-induced pain as moderate-to-severe for 48% of the patients, among whom 51.9% had not received prophylactic analgesia prior to the procedure. Only 7.2% benefited from evaluation with a validated pain scale. Astute attention-distraction techniques were applied to shift attention during 16.8% of the bed baths. Caregivers used verbal guidance for 85% of the procedures, and adapted touch and rhythm of the gestures for 84.3%. CONCLUSION: Bed baths generate moderate-to-severe pain intensity. Evaluation and recourse to analgesia remain insufficient despite caregivers' attention accorded to patient comfort and positioning. CLINICAL IMPLICATIONS: The results of this study could contribute to sensitizing professionals to preventing pain linked with routine nursing care. Four axes for improvement were highlighted: evaluation improvement, analgesia, nonpharmacological approaches, and adapted mobilization techniques.

Effects of traditional and dry bed baths on patients admitted in intensive units: A randomized crossover clinical trial.

BACKGROUND: The bed bath is an important part of nursing care. There are few studies evaluating the effects of traditional and dry bed baths on patients. AIM: This study was performed with the aim of investigating the effect of traditional and dry bed baths given to intensive care unit patients on the patients' hemodynamic parameters, the duration of the bathing procedure and the cost of consumable items. METHODS: This was a randomized crossover clinical trial and a prospective study. The study was conducted in a General Surgery Intensive Care Unit with 22 intensive care patients aged 18 and over, who had a nursing diagnosis of bathing personal care deficiency. Each patient was given two types of bed baths at an interval of 24 h: a traditional bed bath and a dry bed bath performed with single-use tissues. Immediately before each bath, in the 5th, 10th and 15th minute of bathing, immediately after bathing and 30 min after bathing, body temperature, heart rate, blood pressure, breathing rate and peripheral oxygen saturation measurement changes over time were compared within the group using the Friedman test. The Wilcoxon signed ranks test was used to compare the variables of bathing duration and bathing consumable item costs between the bathing procedures. RESULTS: It was found that at the completion of traditional and dry bed bathing, the participants' body temperature, blood pressure, heart rate and breathing rate parameters were statistically significantly lower than before bathing, whereas peripheral oxygen saturation values showed a significant increase (p < 0.05). It was found that the dry bed bath took a statistically significantly shorter time than the traditional bed bath and that the cost of consumable bathing materials was less (p < 0.05). CONCLUSIONS: It was concluded that traditional and dry bed baths given to intensive care patients affected their hemodynamic parameters and that the dry bed bath was superior to the traditional bed bath in that it took less time and that it cost less.

Effects of consecutive bed bathing with weak versus ordinary pressure on skin barrier recovery of hospitalised older adults: A within-person randomised controlled trial.

AIM: Wiping pressure (WP [mmHg]) during bed baths is essential to maintain skin integrity and care quality for older adults. However, effects of different wiping pressures on skin barrier recovery over multiple days remain unclear. This study evaluated and compared the effects of consecutive bed bathing with weak pressure and that with ordinary pressure on skin barrier recovery of hospitalised older adults. METHODS: This within-person, randomised, controlled trial involved 254 forearms (127 patients) and was conducted at a general hospital. Forearms were blinded and randomly assigned a site and sequence of two bed bathing sessions: wiping three times with weak (10≤WP<20) and ordinary pressure (20≤WP<30) once per day for 2 consecutive days. The skin barrier was assessed daily based on transepidermal water loss (TEWL) and stratum corneum hydration (SCH) before and 15 min after the interventions. Dry skin was assessed using the overall dry skin score. RESULTS: A linear mixed model showed that the time courses of TEWL and SCH differed significantly between groups. Impaired skin barrier function caused by ordinary pressure on the first day did not recover to baseline values the next day, whereas weak pressure did not cause significant changes. During subgroup analyses, TEWL of patients with dry skin was more likely to increase with ordinary pressure. CONCLUSIONS: Despite decreased skin barrier recovery experienced by older adults, our findings suggest the safety of weak pressure and highlight the importance of WP during bed baths. Weak pressure is particularly desirable for patients with dry skin. TRIAL REGISTRATION: UMIN000048838.

Comfort during the bed bath-A randomised crossover trial on the effect of washing without water versus water and soap in nursing students.

AIMS AND OBJECTIVES: To compare the washing without water method with the water and soap method regarding comfort perceptions of the bed bath. BACKGROUND: Bathing affects nurses' and care recipients' comfort. Bedridden care recipients can be bathed in bed with water and soap or with washing without water products. Little is known about the differences between these two bed bath methods regarding comfort perceptions among care recipients and nurses. DESIGN: Crossover randomised laboratory-controlled trial, conducted from March 2018-November 2019, according to the CONSORT guidelines. METHODS: Nursing students were randomly allocated roles as a patient (who received both types of bed baths) or a nurse (who provided both types of bed baths). Also, the order in which the bed baths were received/provided was randomised. A total of 97 students were included in the analysis. Student patients filled out the Patient Evaluation of Emotional Comfort Experienced (PEECE) scale to measure emotional comfort and a single-item question on physical comfort after each bed bath. Student nurses filled out the Physical Demands scale after each bed bath to measure their physical comfort perceptions. RESULTS: No differences were found between the two bed bathing methods regarding student patients' emotional or physical comfort levels. Among student nurses, the washing without water method was less physically demanding than the water and soap method. CONCLUSIONS: Taking into account time-efficiency and physical comfort for nurses, washing without water seems to be a valuable alternative to water and soap from a care recipient comfort perspective, which should be assessed in a clinical setting in future research. RELEVANCE TO CLINICAL PRACTICE: The washing without water method is less physically demanding for nurses and takes less time. It does not have a detrimental effect on care recipients' emotional and physical comfort. The trial is registered at www.trialregister.nl (ID = NL6787).

Comparison of wiping methods for the removal of cleaning agent residue from hair follicles.

PURPOSE: This study aimed to clarify the influence of different wiping methods on cleaning agent residue in hair follicles when using skin cleaning agents that are "removable-by-wiping." METHODS: A total of 18 male volunteers were recruited and a cleaning agent containing 10% fluorescein sodium salt (cleaning agent) was used in this study. After gentle washing, the cleaning agent was removed via the washing method (control) or three distinct wiping methods (experiment). Hairs were obtained from the measurement area. The fluorescence intensities of the residual cleaning agent on the hair root and hair bulb were then evaluated after normalizing for autofluorescence from the hair. Fluorescence intensity was used to estimate the amount of cleaning agent residue. RESULTS: No significant differences were found among cleaning agent removal methods (hair root: P = 0.67, hair bulb: P = 0.62) with respect to the amount of residual cleaning agent on hair. CONCLUSION: Cleaning agent residual index did not differ according to removal method. Cleaning agent remained in the hair follicle (hair roots, hair bulbs) despite removal from the skin by washing or wiping. Further studies are required to apply "removable-by-wiping" cleaning agents for people with vulnerable skin.

How does washing without water perform compared to the traditional bed bath: a systematic review.

BACKGROUND: For immobile patients, a body wash in bed is sometimes the only bathing option. Traditionally, the bed bath is performed with water and soap. However, alternatives are increasingly used in health care. Washing without water is one such alternative that has been claimed to offer several advantages, such as improved hygiene and skin condition. This systematic review aims to provide a comprehensive overview of the evidence on outcomes of the washing without water concept compared to the traditional bed bath. METHODS: Controlled trials about washing without water outcomes published after 1994 were collected by means of a systematic literature search in CINAHL, Embase, MEDLINE, and PUBMED at the 25th of February, 2016. Additionally, references and citations were searched and experts contacted. Studies were eligible if (1) the study designs included outcomes of washing without water products developed for the full body wash compared to the traditional bed bath, and (2) they were controlled trials. Two researchers independently used a standardized quality checklist to assess the methodological quality of the eligible studies. Finally, outcomes were categorized in (1) physiological outcomes related to hygiene and skin condition, (2) stakeholder-related outcomes, and (3) organizational outcomes in the data synthesis. RESULTS: Out of 33 potentially relevant articles subjected to full text screening, six studies met the eligibility criteria. Only two studies (of the same research group) were considered of high quality. The results of these high quality studies show that washing without water performed better than the traditional bed bath regarding skin abnormalities and bathing completeness. No differences between washing without water and the traditional bed bath were found for outcomes related to significant skin lesions, resistance during bathing and costs in the studies of high quality. CONCLUSIONS: There is limited moderate to high quality evidence that washing without water is not inferior to the traditional bed bath. Future research on washing without water is needed and should pay special attention to costs, hygiene, and to stakeholder-related outcomes, such as experiences and value perceptions of patients, nursing staff and family.

Pilot study on benefits of applying a hot towel for 10 s to the skin of elderly nursing home residents during bed baths: Towards safe and comfortable bed baths.

This study examined the effects of applying a hot towel to the skin of elderly people for 10 s (AHT10s) during a bed bath. We hypothesized from our previous studies that AHT10s would increase the stratum corneum water content and improve the skin barrier function of the elderly and invited residents (n = 21) of long-term care facilities to participate in this crossover study. Each participant received a bed bath with AHT10s and also a bed bath without hot towel application. The stratum corneum water content and transepidermal water loss (TEWL) were measured during bed bathing sessions and the experience was subjectively evaluated by participants. The TEWL increased significantly when bed bath did not involve AHT10s, but there was no such significant increase when AHT10s was performed. AHT10s also raised the skin surface temperature and provided warmth and comfort to all participants. These results suggest that, in the target population, AHT10s will lead to TEWL advantages and provide warmth and comfort.

[Chlorhexidine Bed-Bath Improves CLABSI: A Meta-Analysis].

BACKGROUND: Central catheters are used primarily in ICU settings. Bloodstream infections in the central line of central catheters have been shown to cause longer hospital stays for patients and result in higher medical costs. PURPOSE: The present study applies a systematic review and meta-analysis to assess the effect of a 2% chlorhexidine (CHG) bed-bath on the risk of central line-associated bloodstream infections (CLABSI). METHODS: The Public Health Resource Unit of England issued the Critical Appraisal Skills Programme and evaluated the standardized crucial appraisal tools from the Joanna Briggs Institute that are used to assess methodological quality. The present study identified 6 studies that met the criteria from a keyword search that included: CHG and soap-water for bed-bath experiment. The experiment used RevMan 5 software to conduct the meta- analysis. RESULTS: The results support the homogeneity (p = .002, I2 = 64%) of the sample. Comprehensive effectiveness was 0.45 (95% CI [0.35, 0.58], p < .001). The CHG bed-bath intervention was shown to effectively reduce CLABSI. CONCLUSIONS / IMPLICATIONS FOR PRACTICE: The meta-analysis indicated that bed-bath with CHG reduces the incidence of CLABSI. We recommend that center catheter bundle care be applied in ICUs in combination with CHG bed-bath in order to reduce the risk of CLABSI.

Elderly patients' and nurses' assessment of traditional bed bath compared to prepacked single units--randomised controlled trial.

BACKGROUND: There are two types of bed baths: the traditional basin used with soap and water, and the disposable bath, which is prepacked in single-use units and heated before use. OBJECTIVE: To compare the traditional basin bed bath to a disposable bed bath, there are four factors that need to be considered: (1) duration and quality of the bath, (2) cost, (3) nurse satisfaction and (4) patient satisfaction. METHODS: Fifty-eight patients received bed baths on two consecutive days - a traditional bed bath on 1 day and a disposable bed bath on the other. The patients were bathed by the same nurse on both days. The baths were observed in relation to duration, use of supplies and quality. Nurses and patients were interviewed about their preferences. RESULTS: Both types of baths scored very highly in the area of quality. There was no difference in the cost of supplies. Significantly less time was used with the disposable baths (p < 0.001). In terms of total expenditure, the disposable bath cost 11.84 DKK and the basin method cost 11.87 DKK, resulting in an insignificant difference (p > 0.05). Taking the nurses salaries into account, it was much cheaper to bathe patients using the disposable bath. Most patients preferred the disposable bath, while others preferred the basin method or were equally satisfied with both types of baths. There was no significant difference in these results (p > 0.22). There were 46 cases during the trial where nurses preferred the disposable bath method. The washbasin method was preferred in six cases. And there was one case where the nurse was equally satisfied with both types of baths. The nurses rated the disposable bath significantly higher than the basin method. In most cases, patients and nurses preferred the same type of bath (70%). CONCLUSION: This study presents a comparison of the new method of bed bathing to the traditional basin method, in relation to cost, duration, quality and nurse and patient preference. In the case of disposable baths, the costs are lower as significantly less time is used. The nurses were very clear in their preference for disposable baths, and this was also the case for the majority of patients. There was consistency between the nurses and the patients in terms of their preference of bath type. When patients need assistance with personal hygiene, the nurse should inform the patient about the two methods and involve the patient in the decision.

The Effect of Two Bed Bath Practices in Cost and Vital Signs of Critically Ill Patients.

By promoting personal hygiene and improving comfort, bed baths can decrease the risk of infection and help maintain skin integrity in critically ill patients. Current bed-bathing practices commonly involve the use of either soap and water (SAW) or disposable wipes (DWs). Previous research has shown both bed-bathing methods are equally effective in removing dirt, oil, and microorganisms. This experimental study compared the cost, staff satisfaction, and effects of two bed-bathing practices on critically ill patients' vital signs. We randomly assigned 138 participants into 2 groups: an experimental group that received bed baths using DWs and a control group that received bed baths using SAW. We compared the bath duration, cost, vital sign trends, and nursing staff satisfaction between the two groups. We used the chi-square test and t-test for the statistical analysis, and we expressed the quantitative data as mean and standard deviation. Our results showed the bed baths using DWs had a shorter duration and lower cost than those using SAW. There were no significant differences in the vital sign trends between the two groups. The nursing staff preferred to use DWs over SAW. This study can help clinical nursing staff decide which method to use when assisting patients with bed baths.

Myocardial oxygen consumption in the bed bath and shower bath in patients with acute coronary syndrome.

BACKGROUND: Bed and shower hygiene measures are performed by the nursing staff in patients admitted with Acute Coronary Syndrome (ACS). Few studies have evaluated the difference in energy consumption between the two types of bath. OBJECTIVES: To analyse and compare the variation in Heart Rate (HR), Systolic Blood Pressure (SBP) and rate-pressure-product (RPP) between bed and shower bath in ACS patients. DESIGN: Quantitative, analytical, prospective study. SETTINGS: This study was conducted in a Coronary Intensive Care Unit, including patients over 18 years admitted for ACS in Killip classes I and II. MAIN OUTCOME MEASURES: The level of myocardial oxygen consumption was assessed by calculating the RPP before, immediately after and 5 minutes after the first bed bath and the first shower bath. Differences in mean RPP before, during and 5 minutes after each body hygiene were compared using the paired-samples Student's t-test. RESULTS: Seventy patients were included. No important clinical variation was found in HR, SBP and RPP during bed bath and during shower bath. The comparison of HR, SBP and RPP between bed bath and shower showed no statistically significant difference. CONCLUSION: Bed bath and shower bath did not significantly increase energy expenditure in patients with acute coronary syndrome and there was no difference in energy expenditure between the two types of body hygiene.

Effect on autonomic nervous activity of applying hot towels for 10 s to the back during bed baths.

BACKGROUND: Bed baths are a daily nursing activity to maintain patients' hygiene. Those may provide not only comfort but also relaxation. Notably, applying a hot towel to the skin for 10 s (AHT10s) during bed baths helped to reduce the risk of skin tears and provided comfort and warmth in previous studies. However, it is still unclear whether autonomic nervous system is affected by bed baths. Thus, this study investigated the effect on the autonomic nervous activity of applying hot towels for 10 s to the back during bed baths. METHODS: This crossover study had 50 participants (25 men and women each; average age 22.2 ± 1.6 years; average body mass index 21.4 ± 2.2 kg/m2) who took bed baths with and without (control condition: CON) AHT10s on their back. Skin temperature, heart rate variability (HRV), and blood pressure (BP) were measured. Subjective evaluations and the State-Trait Anxiety Inventory in Japanese were also performed. RESULTS: A significant interaction of time and bed bath type on skin surface temperature was observed (p < .001). Regarding the means of skin surface temperature at each measurement time point, those for AHT10s were significantly higher than those for CON. Although the total state-anxiety score significantly decreased in both the bed bath types after intervention, the mean values of comfort and warmth were higher for bed baths with AHT10s than for CON (p < .05) during bed baths; AHT10s was significantly higher in warmth than CON after 15 min (p = .032). The interaction and main effects of time on HRV and BP and that of bed bath type were not significant. CONCLUSION: Bed baths that involved AHT10s caused participants to maintain a higher skin temperature and warmer feeling than under the wiping-only condition; they also provided comfort during the interventions. However, the bed baths with AHT10s did not allow participants to reach a relaxed state; moreover, there was no change in autonomic nerve activity. This may be due to participants' increased anxiety from skin exposure and the intervention being limited to one part of the body.

Cost-consequence analysis of "washing without water" for nursing home residents: a cluster randomized trial.

BACKGROUND: No-rinse disposable wash gloves are increasingly implemented in health care to replace traditional soap and water bed baths without proper evaluation of (cost) effectiveness. OBJECTIVES: To compare bed baths for effects on skin integrity and resistance against bathing and costs. DESIGN: Cluster randomized trial. SETTING: Fifty six nursing home wards in the Netherlands. Participants: Five hundred adult care-dependent residents and 275 nurses from nursing home wards. METHODS: The experimental condition 'washing without water' consists of a bed bath with disposable wash gloves made of non-woven waffled fibers, saturated with a no-rinse, quickly vaporizing skin cleaning and caring lotion. The control condition is a traditional bed bath using soap, water, washcloths and towels. Both conditions were continued for 6 weeks. Outcome measures were prevalence of skin damage distinguished in two levels of severity: any skin abnormality/lesion and significant skin lesions. Additional outcomes: resistance during bed baths, costs. RESULTS: Any skin abnormalities/lesions over time decreased slightly in the experimental group, and increased slightly in the control group, resulting in 72.7% vs 77.6% of residents having any skin abnormalities/lesions after 6 weeks, respectively (p=0.04). There were no differences in significant skin lesions or resistance after 6 weeks. Mean costs for bed baths during 6 weeks per resident were estimated at €218.30 (95%CI 150.52-286.08) in the experimental group and €232.20 (95%CI: 203.80-260.60) in the control group (difference €13.90 (95%CI: -25.61-53.42). CONCLUSION: Washing without water mildly protects from skin abnormalities/lesions, costs for preparing and performing bed baths do not differ from costs for traditional bed bathing. Thus, washing without water can be considered the more efficient alternative.