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“Wash me without water”

Introduction:

Bathing serves body hygiene and skin integrity, which in turn is vital to the prevention of disease. Hygiene
is important to maintain health. Bathing assistance is a major task in nursing and the quality and
efficiency of bathing can have a large impact on health and health care costs. Traditional bed baths have
been the standard in bathing of bedridden patients for a long time.

For bedridden patients, a bed bath is the only bathing option. Traditionally, the bed bath is performed with
water and soap. One of the problem of the bedridden patients was having body odors and risk for
infection. Poor hygiene may increase the risk for infection of these patients and having a bath is one of
the things that can help in decreasing the chance of acquiring infections. Some patients cannot safely leave
their beds to bathe. For these people, daily bed baths can help keep their skin healthy, control odor, and
increase comfort.

It is said that bed bath increases work load of nurses. However, alternatives are increasingly used in
health care. Washing without water is one such alternative that has been claimed to offer several
advantages, such as improved hygiene and skin condition. A new method of bed bath had been
discovered which is known as the “disposable bed bath.”

Statement of the problem:

 To compare the effectiveness of traditional bed bath and disposable bed bath in providing care to the
patient
 To determine the advantages and disadvantages of using disposable bed bath to the patients and
healthcare providers
 To know how this new bed bath method is being done and used

Evidences:

Research Study Objectives Results


How does washing without water To determine which is more The results of these high quality
perform compared to the better, the traditional bed bath studies show that washing
traditional bed bath: a systematic or the disposable bed bath without water performed better
review than the traditional bed bath
regarding skin abnormalities
Fabian M. V. Groven,Sandra M. G. Z and bathing completeness.
wakhalen,
Gaby Odekerken-Schröder,
Erik J. T. Joosten and,Jan P. H. Ham
ers –January 25, 2017

Out of 33 potentially relevant articles


subjected to full text screening, six
studies met the eligibility criteria.
Skin hydration in nursing home To evaluate a new way for The post minus pre skin
residents using disposable bed applying bed baths and hydration scores were higher for
baths reducing the risk for dry skin the intervention group (washing
by comparing the effect of two without water) compared to the
Katrin Gillis, MScN, RN , Inge Tency, washing methods on skin control group (traditional bed
PhD, MSc, RM, Ella Roelant, PhD, hydration bath) at the cheek (p = 0.02)
MSc, Sarina Laureys, RN, Hendrik showing a higher increase in
Devriendt, BS, Dirk Lips, PhD skin hydration for this skin site
-June, 2016 Volume 37, Issues 3 in the intervention group.

A cluster randomized trial was


conducted. Skin hydration was
measured before and after
implementation of disposable was
gloves, using a Moisture Meter SC at
three skin sites.
 150 Residents in pre-test and
post-test stages (108 in the
intervention group and 42 in the
control group)

Completeness of assisted bathing To explore differences in Bathing completeness was


in nursing homes related to completeness of assisted more often found in the
dementia and bathing method: bathing in relation to bathing intervention group (washing
results from a secondary analysis method without water) (p < 0.0001).
of cluster-randomised trial data When all body parts were
cleaned, bathing was
Theo van Achterberg RN, PhD,
considered complete.
FEANS, Betsie G.I. van Gaal RN,
PhD, MEANS, Wytske W. Geense
RB, MSc,
Geert Verbeke PhD, Carine van der
Vleuten MD, PhD, Lisette
Schoonhoven RN, PhD, FEANS
-December 10, 2015

Secondary analysis of a cluster


randomized trial including 500
nursing home residents designed to
compare traditional bathing methods
for skin effects and cost-sequences.
Logistic mixed modeling was used to
relate resident characteristics and
bathing method to bathing
completeness.
 450 Residents (257 in the
intervention group and 193 in the
control group)
Cost-consequence analysis of
“washing without water” for
nursing home residents: A cluster
randomized trial

Lisette
Schoonhoven1,'Correspondence
information about the author Lisette
SchoonhovenEmail the author
Lisette Schoonhoven, Betsie G.I. van
Gaal1, Steven Teerenstra, Eddy
Adang, Carine van der Vleuten, Theo
van Achterberg

-January 2015, Volume 52, Issue 1,


Pages 112-120

 450 Residents (257 in the  To determine which of the There is a difference in


intervention group and 193 in the two bed bath method can prevalence of any skin
control group) cause skin problems abnormalities over time
(p = 0.04). The number of skin
abnormalities decreased in the
intervention group (washing
without water) and increased in
the control group (traditional
bed bath). Any skin
abnormalities included bright
red discoloration, erythema,
white, green or yellow
discoloration of the wound bed,
atrophic and shiny skin, satellite
lesions, fissures, erosions, or
ulcerations on the buttocks,
eyes, neck, armpits, elbows,
sub-mammary region,
umbilicus, abdomen, groins,
anal cleft, or the skin between
the toes.

 275 Nurses  To know which of the two Nurses gave an average grade
bed bath method is more of 7.5 (out of 10) for washing
preferred by the nurses without water with a standard
deviation of 1.2. 61% Of the
nurses would replace water and
soap bed baths with washing
without water.

 55 Residents  To know which of the two Residents gave an average


bed bath method is more grade of 7.1 (out of 10) for
preferred by the residents washing without water with a
standard deviation of 2.0. 94%
Thought washing without water
cleaned the skin sufficient or
good and 83% felt at least
sufficiently fresh after being
washed with washing without
water. 61% Would permanently
replace water and soap bed
baths with washing without
water.

 206 Observations of traditional  To determine the There is no difference in costs


baths and 272 observations of difference of these two at a confidence interval of 0.95.
washing without water bed bath methods when it The total average costs over a
comes to cost time period of 6 weeks was
€218,30 for washing without
water and €232,20 for the
traditional bed bath.

Elderly patients' and nurses' To compare the traditional Significantly less time was used
assessment of traditional bed bath basin bed bath to a disposable with the disposable baths (p <
compared to prepacked single bed bath, there are four factors 0.001). There were 46 cases
units – randomised controlled trial that need to be considered: (1) during the trial where nurses
duration and quality of the preferred the disposable bath
Lis Horstmann Nøddeskou Master in
bath, (2) cost, (3) nurse method. The washbasin method
Clinical Nursing, Lars E.
satisfaction and (4) patient was preferred in six cases. And
Hemmingsen Master of Science
satisfaction there was one case where the
Pharmacology,
nurse was equally satisfied with
Britta Hørdam PhD, MScN, RN
both types of baths. The nurses
6 September 2014
rated the disposable bath
significantly higher than the
basin method. In most cases,
Fifty-eight patients received bed
patients and nurses preferred
baths on two consecutive days – a
the same type of bath (70%). In
traditional bed bath on 1 day and a
terms of total expenditure, the
disposable bed bath on the other.
disposable bath cost 11.84 DKK
The patients were bathed by the
and the basin method cost
same nurse on both days. The baths
11.87 DKK, resulting in an
were observed in relation to duration,
insignificant difference (p >
use of supplies and quality. Nurses
0.05).
and patients were interviewed about
their preferences.

Synthesis:

Strength:

Evidence #1:

Many relevant articles had been used.

Evidence #2:

The use of disposable wash gloves does not increase the risk for dry skin in comparison with traditional
washing methods. They used a measuring device to assess the skin.

Evidence #3:
Introduction of washing without water is likely to lead to more bathing completeness in nursing homes.

Evidence #4:

There are parameters used to assess the efficacy of disposable bed bath.

Evidence #5:

There are parameters used to assess the efficacy of disposable bed bath.

Weaknesses:

Evidence #1:

Only two studies (of the same research group) were considered of high quality.

Evidence #2:

The difference was only significant at cheek site.

Evidence #3:

The study was only focused on the completeness of bathing.

Evidence #4:

The costs related to the nursing time needed to clean up after a bed bath was excluded from the
calculation.

Evidence #5:

There is no significant difference when it comes to the cost of the two bed bath method.

Answer to the Problem:

1. Disposable bed bath is known to be more effective and better than the traditional bed bath. According
to research, it helps the nurses to fulfill their duty in providing bed bath to their patients without increasing
the nurses workload.

2. Bed-bath can be a pleasant or stressful experience; for some patients, a bath is a source of pleasure,
while for others, it may be understood as an aggressive behavior that causes distress or fear. Many
patients experience fear, anxiety, and frustration related to the techniques used in bed-bath, which are
selected according to nurses’ judgment not to patient needs and preferences. Nurses should not try to
force their own standards of hygiene. The washcloth is disposable so it will decrease the workload of the
nurse in disposing it after being used. On the positive side, disposable wash products are –most often –
made of a mix of soft fibers and contain ingredients such as skin friendly cleaning and caring lotions that
could optimize hygiene and skin integrity. Bed baths with disposable wash gloves supposedly cost less
than traditional bed baths, increase patient satisfaction and improve professional ergonomic aspects.
Washing without water and traditional bed bathing have similar effects on significant skin lesions, yet
washing without water mildly protects from any skin abnormality/lesion. As costs for preparing and
performing bed baths were more or less similar for both bed baths we conclude that washing without
water is favored to traditional bed bathing and generally the more efficient alternative.
Conclusion:

We therefore conclude that 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.

Recommendation:

References:

https://bmcgeriatr.biomedcentral.com/articles/10.1186/s12877-017-0425-4

http://www.gnjournal.com/article/S0197-4572(15)00421-8/fulltext

http://onlinelibrary.wiley.com/doi/10.1111/opn.12104/abstract

http://www.journalofnursingstudies.com/article/S0020-7489(14)00204-1/fulltext

http://onlinelibrary.wiley.com/doi/10.1111/scs.12170/abstract