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AACN issues new protocols for bathing patients

Sunday April 21, 2013
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The long-held tradition of using a basin, soap and water to bathe bed-bound hospitalized patients no longer is the recommended standard of practice, according to a new practice alert from the American Association of Critical-Care Nurses.

The alert outlines updated, evidence-based protocols related to bathing adult patients.

In most acute care facilities, bed-bound patients unable to provide self-care are bathed by nursing personnel using a basin of warm tap water, soap and washcloths. This traditional method of bathing can result in significant variation from caregiver to caregiver, excessively dry skin on patients and exposure to bacteria, increasing the risk of healthcare-associated infection, according to an AACN news release. Such baths also take longer and require more nursing time.

The practice alert cites several studies that demonstrate the benefits of bathing patients with prepackaged cleansers that do not require rinsing. The AACN continues to advocate for daily bathing to improve hygiene and promote patient comfort.

"Current evidence tells us that even such a routine activity as bathing a bed-bound patient needs to be updated to reduce the risk and increase the benefit to the patient," Ramón Lavandero, RN, MA, MSN, FAAN, senior director of the AACN, said in the news release. "Nurses also will need to educate patients and their families about how bathing technology has changed to improve patient care and reduce risk of infection."

The practice alert also advocates scheduling bath times based on patient preference and clinical needs, not on nursing convenience. The period between midnight and 6 a.m. is a common time for bed baths and other nursing care activities, but the AACN said nurses should determine optimal bath time by individual patient preference and clinical stability, and avoid waking patients solely to bathe them.

Based on the latest available evidence, the expected practice related to bathing adult patients includes:

• Provide a daily bath for bed-bound patients to improve hygiene and promote comfort. More frequent baths may be performed upon patient request or to respond to patient needs.

• Determine bath time based on patient preference and clinical stability instead of based on organizational factors.

• Use disposable basins and dispose of them after one use to reduce risk of bacterial contamination.

• Avoid use of unfiltered tap water. Alternatives include prepackaged bathing products, sterile or distilled water or filtered water from faucets.

• Use no-rinse pH balanced cleansers, which are superior to alkaline soaps that require wash-rinse cycles.

• Apply emollients after each non-prepackaged bath to prevent dry skin. Prepackaged bathing products include skin emollients.

• Use prepackaged bathing products to reduce process variation.

• Bathe patients daily using a disposable cloth that is prepackaged with a 2% solution of chlorhexidine gluconate. Use of CHG is associated with significant reductions in colonization of specific bacteria and infections with multidrug-resistant organisms.

Supported by authoritative evidence, each AACN practice alert seeks to ensure excellence in practice along with promotion of a safe and humane work environment. Topics address both nursing and interprofessional activities of importance to patients in acute and critical care environments. Some alerts include additional resources for staff education and performance-improvement activities.

Additional alerts address ventilator associated pneumonia, pulmonary artery pressure monitoring, dysrhythmia monitoring, ST segment monitoring, family presence during resuscitation and invasive procedures, and verification of feeding-tube placement.

The alerts can be downloaded free of charge at www.aacn.org/practicealerts.


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