Can Soap and Water Baths in Hospitals Increase Infections?

Friday, June 21st, 2013 @ 4:23PM

In a word, YES! For years, it has been the standard of care to provide daily baths for bed-bound hospitalized patients using soap and water from a bath basin. However, recent scientific evidence has challenged this practice. It has been discovered that the type of bath a patient receives can impact multiple factors, including the spread of microorganisms.

Consider these facts:

  • An estimated 1.7 million health care-associated infections (HAIs) occur annually in hospitals in the United States
  • These infections are responsible for approximately 100,000 deaths and an estimated cost of $45 billion a year
  • One out of every 17 patients in a hospital will develop an infection, resulting in significant increases in patient morbidity, mortality, length of stay, and use of health care resources

The hospital environment itself is recognized as a significant reservoir for bacteria and a factor in the spread of infection. Bath basins have been shown to harbor bacteria and are a source of transmission of multidrug-resistant organisms (MDROs).

In most hospitals, nursing personnel provide baths using a basin of warm tap water, soap and washcloths for patients who are bed bound and unable to care for themselves. This traditional method of bathing can result in the potential for bacterial growth on the skin and the spread of microorganisms.

What can be done?

  1. Eliminate the Use of Reusable Bath Basins
    • The potential exists for a bath basin to become a reservoir for microorganisms and for cross contamination of the immediate environment and health care personnel
    • Both gram-negative and gram-positive organisms were identified in bath water sampled after patients received a soap-and-water basin bath
    • This is similar to the amount of bacteria found in urine samples of patients with urinary tract infections (UTIs)
    • The mechanical friction of bathing results in the large removal of surface skin cells that are released into the bath water
    • The skin flora of hospitalized patients differs from the general population; hospitalized patients have a larger presence of gram-negative bacilli and more antibiotic-resistant organisms
    • A study examining 92 visibly clean basins from 3 ICUs in various regions of the country found 98% of all basins grew bacteria
    • In a multicenter basin sampling study in 88 hospitals in the United States and Canada, 62.2% of 1103 basins sampled were contaminated with common hospital-associated pathogens (disease-causing agents or microorganisms)
  2. Eliminate bathing with tap water, which is a source of contamination because of bacterial biofilm in pipes and faucets
    • Using tap water for bathing exposes patients to waterborne pathogens
    • In one review of the literature, 43 outbreaks of waterborne HAIs were reported with an associated 1400 deaths
    • 14-50% of patients’ infections were found to be due to bacteria in the water supply
    • The primary cause of poor water quality is the buildup of bacterial biofilm in the pipes, faucets, and distribution systems
    • Bacterial biofilm may be disseminated to at-risk patients and health care staff by direct contact with water used for routine hand washing, bathing and cleaning of equipment
    • Centers for Disease Control and Prevention (CDC) guidelines
      for environmental infection control strongly recommend the elimination of environmental reservoirs including bath basins
  3. Use Prepackaged Bath Products to Deliver Consistent Evidence-Based Care
    • Commonly known as a Bath-in-a-Bag, the prepackaged bathing system consists of 8 hypoallergenic heavyweight cleansing washcloths saturated with purified water enriched with moisturizers
    • The cloths can be used on all areas of the body
    • Washcloths are kept in warmers to maintain warmth throughout the bath
    • The traditional method of a bed bath results in the potential for colonization of the skin and the spread of microorganisms with the use of tap water and basins
    • A number of studies have compared soap-and-water basin bathing to non-medicated prepackaged bathing, finding reductions in urinary tract infections (UTIs)
  4. Patient & Family Education
    • Communicate to the patient that bathing technology has changed to improve the condition of the skin and reduce the spread of microorganisms
    • Patients and families need to understand the changes in bathing technology and the benefits of eliminating soap and water bed baths
    • Since most people identify a bath with soap and water, they may not understand that they have received a bath with a prepackaged bathing system
    • It is important that both patients and families are educated about the new bathing technology

In conjunction with other measures to continue to reduce hospital-acquired infections, all Noland Hospitals converted to the use of prepackaged bath products in the Fall of 2012. For the safety of our patients, bath basins have been removed from Noland hospitals for bathing. Hospital-acquired infection rates have continued to decline since that time, reaching an all- time low.

Donna Alvey Smaha, RN, MSN, ACNP
Chief Clinical Officer, Hospital Division

Based on a presentation by Kathleen M. Vollman, RN, MSN, CCNS, FCCM, FAAN
Approved by the AACN Evidence-Based Practice Resources Work Group, April 2013

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