The Impact of Bathing Hospitalized Dependent Patients with Disposable Washcloths Instead of Traditional Bath Basins on Infection Rates and Skin Condition
Bath basins are a known reservoir for hospital pathogens. Our objective was to evaluate the impact of use of bath in a bag in place of basins on hospital-acquired infections (HAIs), multi-drug resistant organisms (MDROs) and skin deterioration.
A prospective, open-label, crossover study in two medical-surgical units was conducted. During each of two 8-month periods on the intervention unit, bath basins were replaced with pre-packaged washcloths; and standard bathing using a bath basin was conducted on the control unit. HAI, MDRO and skin deterioration data were prospectively collected. Bath basins were swabbed of patients who had a culture positive for one of seven MDROs
2,637 patients were evaluated. There were 7,981 patient days in the intervention group and 8,053 in the control group. 85% of subjects were African-American (mean age 57 years (SD: 17)). 19% of subjects in each group lacked independence with functional status. Over 30% of the study population was diabetic. Patients receiving the washcloth intervention were significantly less likely to experience skin deterioration during stay on the study unit (2.5% intervention group versus 5.5% control group; OR=0.45; 95% CI: 0.22, 0.88). HAI rates were similar between bathing methods (2.4 per 1000 patient days in intervention group versus 2.3 per 1000 patient days in control group; IRR=1.04; 95% CI 0.55-1.95). The rate of hospital-acquired MDROs was lower in the intervention group (17.4 per 1000 patient days versus 30.3 in the control group; IRR= 0.66; 95% CI 0.41-1.08). Four patients had similar isolates from both clinical and basin cultures; 2 with MRSA, 1 with carbapenem-resistant K. pneumoniae (KPC), and 1 with A. baumannii (ACB). Spa typing indicated a match between both pairs of MRSA (t002 and t681, respectively) and MLST identified both KPC isolates as ST258. MLST for ACB isolates determined the two isolates to be unrelated.
Although no impact on HAI acquisition was noted, use of pre-packaged washcloths and elimination of bath basins was associated with notable reductions in skin deterioration and MDRO acquisition (although the latter was not statistically significant). Direct links were demonstrated between MDROs isolated from patients and their basins.
D. Marchaim, None
E. Martin, None
G. Divine, None
K. Kaye, Sage: Grant Investigator and Speaker's Bureau, Grant recipient and Speaker honorarium
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