EBP poster

1. Disposable Bed Bath Wipes Versus Bed Bath
S Katlyn Link
Old Dominion University
The purpose of this presentation is to explore
alternatives to bathing standards in healthcare
settings. Current evidence based practice
(EBP) suggests disposable bed bath wipes as
an ideal replacement to traditional bed baths to
reduce hospital acquired infections (HAIs) and
improve patient health outcomes.
Traditional bed baths are commonly performed on
bedridden patients by a nurse using a basin, water,
soap, and a wash cloth. According to the American
Association of Critical Care Nurses (AACN) this
practice is no longer recommended due to research
showing that traditional bed baths have increased
patients’ risks of developing hospital acquired
infections (HAIs). Therefore, bathing measures
should be changed to protect the safety of the patients,
especially to those patients in long-term care
facilities, intensive care units (ICU), and/or unable to
clean themselves (Nurse.com, 2013).
Preventing HAIs should be important to all people
because HAIs can be deadly, are costly, and are
completely preventable. A suggested way to reduce
the prevalence of HAIs is to use disposable bed baths
rather than traditional bed baths. Studies have been
conducted to test the effectiveness of using packaged
cloths soaked in chlorhexidine (CHG) to bathe
patients to reduce and prevent the spread of various
bacteria, such as methicillin-resistant Staphylococcus
aureus (MRSA), vancomycin-resistant Enterococcus
(VRE), and hospital acquired bloodstream infections
(BSI). Knowing attainable ways to prevent HAIs,
such as using disposable bed baths, is extremely
invaluable to all healthcare systems, nurse
organizations, and healthcare workers alike (LA
BioMed, 2015).
PURPOSE
INTRODUCTION
Bleasedale et al. conduced a 52 week, 2 arm, crossover clinical trial to ascertain if patients who
received disposable bed baths with CHG wipes (independent variable) were less likely to develop
primary BSI compared to patients who were cleaned using the traditional soap and water method.
The study population comprised of 836 ICU patients. Randomization was used when choosing the
intervention and control groups, and the target population were patients from two geographically
separate but comparable medical ICUs. Patients in the intervention group were bathed using the
CGH wipes. Based on the study’s result, patients in the intervention group were notably less likely to
develop primary blood stream infections (4.1 vs. 10.4 infection per 1000 patient days). It was also
found that CHG cleaning protected patients from primary BSI after 5 or more days in the ICU unit.
Therefore, this study determined bathing ICU patients daily with CHG cloths was a simple and
effective approach to reduce BSIs and could be useful with other infection control approaches. Some
of this study’s limitations were it could not be a blinded study, and that the results may not be
applicable to all ICUs. It was also recommended that future research studies should use this study’s
design because it was able to capture infection events comprehensively when performing
surveillance (Bleasdale, et al., 2007).
In another study, Climo et al. performed a multi-center, cluster-randomized, non-blinded
crossover study to determine the impact CHG wipe bathing (independent variable) had on the
development of multi-drug resistant organisms (MDROs) and incidence of primary BSI acquired in
the hospital (dependent variables). Nine ICUs and bone marrow transplant units in 6 different
hospitals were randomly chosen to clean patients (consisting of 7727 patients total) with CHG
washcloths versus non-antimicrobial wash cloths (traditional method) for the first 6 months, then
alternate the products/procedures for the later 6 months. The results of the study found that using
CHG wipes significantly reduced the risk of both acquiring MDROs and BSI. The intervention group
was 23% less likely to be infected by a MDRO and 28% less likely to developed a BSI compared to
the control group. Ultimately, this study found that bathing patients with CHG wipes was an
attainable and cost-effective approach to prevent HAIs (Climo, et al., 2013).
Lastly, Choi et al. performed a meta-analysis on randomized control trials (RCT) evaluating the
efficacy CHG wipes had on reducing hospital acquired BSIs. A number of non-RCT studies found
that CHG wipes reduced rates of MDROs, such as MRSA and VRE, as well as BSIs in critically ill
patients. Therefore, researchers in this study felt it necessary to perform a meta-analysis on 5
different RCTs to determine if CHG wipes also reduced hospital acquired BSIs compared to patients
who received traditional bed baths. Overall, the incidence of hospital acquired BSIs (the dependent
variable) were significantly lower in the intervention group who received baths with CHG wipes (the
independent variable) compared to the control group (57.7%). Additionally, gram positive bacterium
was less common among members in the intervention group, and there was less an incidence of
MRSA in patients who received both CHG baths and mupirocin (an antibiotic) (30.3%). In the end,
this analysis suggests CHG wipes may effectively reduce hospital acquired BSIs, but CHG bathing
alone may be limited in preventing/reducing MRSA infections. This study also had a number of
limitations, such as small study sample, so future international, large, multi-locational studies are
recommended to confirm the effectiveness disposable bed baths have on reducing HAIs (Choi, Park,
Kim, & Park, 2015).
FINDINGS
Bleasdale, S., Trick, W., Gonzalez, I., Lyles, R., Hayden, M., & Weinstein, R. (2007).
Efffectiveness of chlorhexidine bathing to reduce catheter-associated bloodstream
infections in medical intensive care unit patients. Arch Intern Med, 167(19), 2073-2079.
Choi, E., Park, D.-A., Kim, H., & Park, J. (2015). Efficacy of chlorhexidine bathing for
reducing healthcare associated bloodstream infections: a meta-analysis. Annals of
Intensive Care, 5(31).
Climo, M., Yokoe, D., Warren, D., Perl, T., Bolon, M., Herwaldt, L., . . . Wong, E. (2013).
Effect of daily chlorhexidine bathing on hospital-acquired infection. New England
Journal of Medicine, 368, 533-542.
LA BioMed. (2015, May 14). Study finds bathing patients in chlorhexidine reduced MRSA
contamination. Infection Control Today.
Nurse.com. (2013, April 21). AACN issues new protocols for bathing patients. Retrieved
from Nurse.com: https://news.nurse.com/2013/04/21/aacn-issues-new-protocols-for-
bathing-patients-2/
Numerous studies have been conducted to test the
effectiveness of using packaged cloths soaked in
CHG to bathe patients to reduce and prevent HAIs.
Not only can disposable bed baths prevent the spread
of life threatening or deadly infections, it can also
improve the patient’s quality of care, which is
extremely important to patients and their families
(LA BioMed, 2015). Therefore, more hospitals
should implement and test interventions using
disposable bed bath wipes to see if these wipes are
effective in reducing HAIs at various facilities, as
well as improve both patient and nurse satisfaction.
Significant amounts of research have proven that
bathing crtically ill patients daily with CHG wipes is
a simple, effective and efficient approach to reduce
HAIs, such as MRSA. While some studies have
determined pre-packaged wipes more expensive than
traditional baths, these disposable bed baths require
less time and allows nurses to be more efficient with
their time.
Implementing Bed Wipes in nursing will help:
• Meet patient’s hygienic needs
• Prevent contamination
• Decrease colonization of bacteria on patient skin
• Reduce HAIs
• Reduce costs associated with HAIs
• Reduce bathing time of patient
• Improve Nursing care efficiency
NURSING IMPLICATIONS
CONCLUSION
REFERENCES
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