Bag Bath EBP Poster

1. Effectiveness of Bag Baths at Reducing Skin Integrity Complications and Decreasing Hospital Acquired Infections Kelsey Czajka , Karlie Dougherty, Diana Leas NUR440 York College of Pennsylvania METHODOLOGY EVIDENCE SUMMARY TABLE CONCLUSIONS Are bag baths (as compared to traditional bed baths) more effective at reducing complications with skin integrity and other hospital acquired infections ? Databases Used CINAHL, EBSCO, OVID, Google Scholar Keywords bed bath, basinless bath, bag bath, chlorhexidine wipes, skin integrity, disposable wipes, infection, microbial counts on skin, disposable washcloths, ICU bathing, hospital-acquired infections Inclusion Criteria Full text, References Included, Scholarly Journals, Johns Hopkins Levels 1-3, Adult Patients, published from 2008- present Level Type Number of Sources Summary of Findings Overall Quality Rating Level I 2 The emollients in bag baths aid in the maintenance of skin integrity and decrease the incidence of skin impairments. 4 The use of soap with the traditional basin baths causes skin dryness and makes the skin vulnerable to skin impairments and infection. 4 Bath basins are hard to keep clean and were found to harbor microorganisms that pose a risk for infection in patients. 3 Bag baths take significantly less time than traditional basin baths. The duration of disposable bag baths (mean= 29 minutes) were significantly less (p < 0.001) than a traditional basin bath (mean= 36 minutes). 3 More patients prefer the disposable bag bath (47%) over the traditional bath (22%). Patients communicated feeling clean and that the time spent on bathing was adequate. 3 A significant number of nurse (87%) preferred disposable bag baths over traditional baths. 3 A-B Level II 4 Bag baths are effective at decreasing bacterial counts while concurrently cleansing and moisturizing the skin. 6 In traditional basin baths, the basin and bath water was found to become contaminated with skin microorganisms. 1 A reduction in gram-negative microbial count on both the periumbilicus and groin area after bathing patients with the disposable bag bath. 1 Bag baths containing Chlorhexidine gluconate (CHG) cleansing wipes decreased gram-negative bacterial skin colonization and the incidence of hospital acquired infections . 2 Bag bath decreased recontamination of bacteria from one area of the body to another part. 2 The Pampers Sensitive wipes, were used as bath wipes in the NICU. They increased barrier function as well as maintained skin integrity . 5 Pampers Sensitive wipes were found to facilitate acid mantle development which assisted in decreased bacterial colonization and infection control . 5 Nurses found bag bath to require significantly (P=<.001) less time and fewer resources compared to a traditional bed bath. 1 Patients prefer bag baths for their ease and comfort. 6 Evidence found bag baths to convenient, easy to use, take less time, require fewer supplies, warmed in warmer, clean and moisturize patient’s skin effectively, and more comfortable for the patient. 6 Most nurses (75.5%) prefer bag baths over traditional bed baths. 1 B Level III 1 Bag baths meet the cleansing needs for frail skin in the older population . 7 Bag baths are the best alternative to traditional basin baths due to no-soap, no-rinse, and no-drying process which is easier on the skin . 7 Nurses found bag bath to require significantly less time and fewer resources compared to a traditional bed bath. 7 B INTRODUCTION IMPLICATIONS FOR NURSING PICO QUESTION There are currently no national guidelines for patient bathing regimens to help maintain skin integrity and to decrease hospital acquired infections. Studies have shown that the use of traditional bed baths actually decreases the skin's resistance to microbial invasion. 4  Research findings suggest bag baths being the method of choice for bed baths to help improve overall skin integrity and reduce risk for infection. 6 The action plan that can be put into place to initiate the change in health care institutions would be to create a change in policies and procedures with the help of the joint commission. Implementing change in nursing practice through policies and procedures to only bag bath bathing for pts who meet criteria, can result in improved skin integrity for patients in health care facilities. Hygiene care, including bathing and skin maintenance, is an essential part of nursing care.  A bed bath is the standard of practice used to provide hygiene care in patients that are bed bound and too ill to meet their own hygiene needs 1 .  The traditional basin bath and the disposable bag bath are the two most common practices used in hospitals. Research suggests that basin baths threaten skin integrity and pose a risk for infection in patients 2 . Bathing and skin care should be aimed at promoting hygiene and comfort while reducing the risks of skin breakdown and infection. The implementation of bag baths in nursing practice will help to: meet the hygiene needs of patients 6,7 maintain patient skin integrity 4,5 prevent dryness caused by basin bathing 4 prevent contamination of other parts of the skin by basin bathing 1 decrease the colonization of bacteria on patient’s skin 1,2,3,4,5,6 decrease hospital acquired infections 4,2 decrease the time spent bathing a patient 6,7 more time efficient for nursing care1, 7   Research findings and the literature recommendations support a change in current practice from traditional basin baths to bag baths . References 1 . Larson , E., Ciliberti , T., Chantler , C., Abraham, J., Lazaro, E., Venturanza , M., & Pancholi , P. (2004). Comparison of traditional and disposable bed baths in critically ill patients.  American Journal Of Critical Care , 13(3), 235-241 . 2. Cassir , N., Thomas, G., Hraiech , S., Brunet, J., Fournier, P., La Scola, B., & Papazian , L. (2015). Chlorhexidine daily bathing: Impact on health care–associated infections caused by gram-negative bacteria.  American Journal Of Infection Control ,  43 (6), 640-643 . doi:10.1016/j.ajic.2015.02.010 3. Nøddeskou , L. H., Hemmingsen , L. E., & Hørdam , B. (2014). Elderly patients' and nurses' assessment of traditional bed bath compared to prepacked single units - randomised controlled trial. Scandinavian Journal Of Caring Sciences, 29(2), 347-352. doi:10.1111/scs.12170 4. Schoonhoven, L., van Gaal , B. I., Teerenstra , S., Adang , E., van der Vleuten , C., & vanAchterberg , T. (2015). Cost-consequence analysis of ''washing without water'' for nursing home residents: A cluster randomized trial. International Journal Of Nursing Studies 5. Visscher , M., Odio , M., Taylor, T., White, T., Sargent, S., Sluder , L., & ... Bondurant, P. (2009). Skin care in the NICU patient: effects of wipes versus cloth and water on stratum corneum integrity.  Neonatology ,  96 (4), 226-234. doi:10.1159/000215593 6. Kron-Chalupa , J., Benda, T., & Williams, B. (2014). A Basinless Bath: A Study on Skin Dryness and Patient Satisfaction. Nursing World, 10 (4). , 52 (1), 112-120. doi:10.1016/j.ijnurstu.2014.08.001 7. Collins, F., & Hampton, S. (2003). Product focus. BAGBATH: the value of simplistic care in the community.  British Journal Of Community Nursing ,  8 (10), 470.   Bag Baths. (2015 ). [Image of painting]. CWI Medical. Retrieved from http ://www.cwimedical.com/caregivers/personal-hygiene