Implementation of chlorhexidine gluconate bathing to reduce HAIs.

A nurse leader-led evidence-based practice change.

Energy consumption, CO2 emissions and costs related to baths water consumption depending on the temperature and the use of flow reducing valves.

In the domestic segment, various appliances and processes consume great amount of water and, consequently, energy. In this context, the main aim of this study is to analyse the impact of water temperature, flow and bath duration in water and energy consumptions. The impact on CO2 emissions and a simple costs analysis were also carried out. It included a monitoring plan of 197 baths taken under different scenarios of water temperature and flow. It was concluded that increasing water consumption leads to an increase on energy consumption and that both resources consumptions increase with bath duration. Bath temperature had influence not only on energy consumption, as expected, but also in water consumption, what may be explained by the user's satisfaction during baths with higher temperatures. The use of a flow reducing valve is not a guarantee of water saving which can also be related to the user's satisfaction patterns, given that the introduction of a flow reducing valve can lead to a bath duration increase. In what concerns to the CO2 emissions, it was concluded, as expected, that higher values are obtained for baths with higher temperatures given their relation with higher energy consumptions patterns. A simple costs analysis revealed that having flow reducing valves, with a bath temperature of 75 °C, increased the costs with electricity and water in 119% and 32%, respectively, when compared with a temperature of 60 °C.

Bathing Habits in Emergency Department Patients with Cellulitis or Abscess Versus Controls.

OBJECTIVE: Cellulitis is a leading cause of emergency department (ED) visits, with more than 200 cases per 100,000 people per year. Although many risk factors have been identified, including edema, skin breakdown, and penetrance of the skin, there are few data available on whether personal hygiene habits (bathing and clean clothes) are associated with increased risk for soft tissue infection. Studies looking at chlorhexidine baths in the intensive care unit to prevent soft tissue infections have shown conflicting and limited efficacy. Our objective was to determine whether poor personal hygiene, as manifested in poor bathing habits, a lack of access to clean clothes, or frequent needle self-injections, are associated with cellulitis or abscesses. METHODS: The research is a cross-sectional cohort study of patients with either cellulitis, soft tissue abscess, or both (cases) versus a control group of patients with abdominal pain without prior surgeries in a large, urban ED in a convenience sampling. We asked about bathing habits, access to clean clothing, and skin breaks from intravenous (IV) drug use as risk factors. The two groups were compared using descriptive statistics, and a regression analysis was performed to determine the characteristics that are predictive of soft tissue infections. The study was powered at 0.8 to detect a 20% difference in adequate bathing habits with 100 per group. RESULTS: In an approximate 1-year study period, 108 cases were identified and compared with 104 abdominal pain controls selected at random from patients presenting to the same ED. In the cellulitis/abscess group the mean age was 47 and 81% were men, and in the control group the mean age was 45 and 39% were men. There were significantly more men in the cellulitis/abscess group (Diff 22%, 95% confidence interval [CI] 8-34, P < 0.01). Seventy percent (76 of 108) of cases versus 58% (80 of 104) of controls bathed daily (odds ratio [OR] 1.7, 95% CI 0.98-3.1, not significant). There was a significant difference between the two groups in laundry habits: 66% (71 of 108) of cases versus 42% (44 of 104) of controls did not have access to clean laundry daily (adjusted OR [AOR] 2.5, 95% CI 1.4-5.0, P < 0.01). The most profound and significant difference was noted between cases and controls regarding the use of IV drugs, in which 20 of 108 cases (19%) used IV drugs versus 3 of 104 controls (3%, P < 0.01). Finally, 35 of 108 (32%) of our cases had a history of infections, whereas only 5 of 104 (5%) of the controls had cellulitis or an abscess previously (P < 0.01). On regression analysis significant predictors of soft tissue infection were history of skin infection (AOR 7.0) and not cleaning clothes daily (AOR 2.5). CONCLUSIONS: There was no significant difference in bathing habits, but there was a significant difference in laundry habits between the case and control groups. Our study further confirms that IV drug use is a risk factor for cellulitis and no access to clean clothes daily was significantly related to the development of cellulitis. Failing to obtain daily showers was not associated with an increase in infection.

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.

Making a splash!

The installation of a birthing pool can be a costly and time consuming process. This article provides some practical tips for making the installation run as smoothly as possible, saving work--and money--in the process. This article gives some advice as to what needs to be considered before you go ahead with installing a pool.

Chlorhexidine bathing to reduce central venous catheter-associated bloodstream infection: impact and sustainability.

BACKGROUND: Chlorhexidine bathing has been associated with reductions in healthcare-associated bloodstream infection. To determine the impact and sustainability of the effect of chlorhexidine bathing on central venous catheter-associated bloodstream infection, we performed a prospective, 3-phase, multiple-hospital study. METHODS: In the medical intensive care unit and the respiratory care unit of a tertiary care hospital and the medical-surgical intensive care units of 4 community hospitals, rates of central venous catheter-associated bloodstream infection were collected prospectively for each period. Pre-intervention (phase 1) patients were bathed with soap and water or nonmedicated bathing cloths; active intervention (phase 2) patients were bathed with 2% chlorhexidine gluconate cloths with the number of baths administered and skin tolerability assessed; post-intervention (phase 3) chlorhexidine bathing was continued but without oversight by research personnel. Central venous catheter-associated bloodstream infection rates were compared over study periods using Poisson regression. RESULTS: Compared with pre-intervention, during active intervention there were significantly fewer central venous catheter-associated bloodstream infections (6.4/1000 central venous catheter days vs 2.6/1000 central venous catheter days, relative risk, 0.42; 95% confidence interval, 0.25-0.68; P<.001), and this reduction was sustained during post-intervention (2.9/1000 central venous catheter days; relative risk, 0.46; 95% confidence interval, 0.30-0.70; P<.001). During the active intervention period, compliance with chlorhexidine bathing was 82%. Few adverse events were observed. CONCLUSION: In this multiple-hospital study, chlorhexidine bathing was associated with significant reductions in central venous catheter-associated bloodstream infection, and these reductions were sustained post-intervention when chlorhexidine bathing was unmonitored. Chlorhexidine bathing was well tolerated and is a useful adjunct to reduce central venous catheter-associated bloodstream infection.

Effectiveness of 2 methods of chlorhexidine bathing.

The purposes of this study were to examine the impact of chlorhexidine on the transmission of methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE) on an inpatient oncology unit, compare the cost of 2 chlorhexidine bath delivery methods, and evaluate nursing time and satisfaction to administer the baths. MRSA and VRE transmission rates decreased from those during the previous years. Costs associated with bathing increased, but time to administer the bath decreased with the chlorhexidine cloths, and nursing staff reported satisfaction with their use.

Economic value of dispensing home-based preoperative chlorhexidine bathing cloths to prevent surgical site infection.

OBJECTIVE: To estimate the economic value of dispensing preoperative home-based chlorhexidine bathing cloth kits to orthopedic patients to prevent surgical site infection (SSI). METHODS: A stochastic decision-analytic computer simulation model was developed from the hospital's perspective depicting the decision of whether to dispense the kits preoperatively to orthopedic patients. We varied patient age, cloth cost, SSI-attributable excess length of stay, cost per bed-day, patient compliance with the regimen, and cloth antimicrobial efficacy to determine which variables were the most significant drivers of the model's outcomes. RESULTS: When all other variables remained at baseline and cloth efficacy was at least 50%, patient compliance only had to be half of baseline (baseline mean, 15.3%; range, 8.23%-20.0%) for chlorhexidine cloths to remain the dominant strategy (ie, less costly and providing better health outcomes). When cloth efficacy fell to 10%, 1.5 times the baseline bathing compliance also afforded dominance of the preoperative bath. CONCLUSIONS: The results of our study favor the routine distribution of bathing kits. Even with low patient compliance and cloth efficacy values, distribution of bathing kits is an economically beneficial strategy for the prevention of SSI.

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.

[Approaches to optimization of the organizational and economic management of a sanatorium-and-spa facility].

The main goals of reorganization of sanatorium-and-spa facilities and their activities under current economic conditions should be standardization of services provided to the patients, improvement of their quality, efficacious exploitation of the available resources, and motivation of the personnel.

Bath emollients for atopic eczema: why use them?

Emollient preparations play a central role in the treatment of people with dry skin associated with conditions such as atopic eczema.1,2 As well as being advised to apply emollient creams or ointments directly to the skin, people with atopic eczema are commonly prescribed bath emollients.3 Each year, the NHS spends over pound16million on bath emollients (at an average cost of pound6.29 per item).4 This represents 38% of the total cost of treatments prescribed for preschool children with eczema, matching the proportion spent on emollients for application directly to the skin.5 What clinical contribution do bath emollients make in the treatment of people with atopic eczema?

Comparison of traditional and disposable bed baths in critically ill patients.

BACKGROUND: For bedridden patients unable to perform personal hygiene measures because of acute illness or chronic debilitation, the bed bath, with either the traditional basin or, more recently, disposable baths, has long been a measure for improving hygiene and costs. OBJECTIVE: To compare the traditional basin bed bath with a prepackaged disposable bed bath in terms of 4 outcomes: time and quality of bath, microbial counts on the skin, nurses' satisfaction, and costs. METHODS: Forty patients in surgical, medical, or cardiothoracic intensive care units received both types of bath on different days. Baths were observed, timed, and scored for quality. Cultures of the peri-umbilicus and groin were obtained before and after each bath. At the end of the study, nurses were interviewed about their preferences. RESULTS: Neither total quality scores nor microbial counts differed significantly between the 2 bath types. Significantly fewer products (P < .001) and less time were used, cost was lower, and nurses' ratings were significantly better with the disposable bath. CONCLUSION: The disposable bath is a desirable form of bathing for patients who are unable to bathe themselves in critical care and long-term care settings, and it may even be preferable to the traditional basin bath.

The cost-effective use of BagBath: a new concept in patient hygiene.

The future of nursing promises dynamic change and continual challenges, with exciting healthcare reform in progress and technologies as yet undreamed of on the nursing horizon. The modern nurse must offer high-quality patient care and should be constantly striving for cost-effective methods of providing that care. In this product focus, the prevalent practice of 'bed bathing' is considered along with cost-effectiveness of the practice and infection control potential when compared with the new concept of BagBath (Westholme Ltd). BagBath is a quick-drying one-step bed bath product offered as an alternative to the bowl of water, soap and flannel.