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Electronic letters published:
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Error in microbial classification
Conflict of Interest?
Wiping-Out Wash Basins
Prepackaged Bath Products
Stated Weakness Proves a Good Point
Current Practice of Using Alternative Bathing Methods
Bath Basins vs Disposable Bath Cloths
Epiphany
A Need for Increased Awareness
Article Was Helpful
A Greater Awareness
Article's Impact on Student Nurses
Eye Opening Article
Therapeutic Effect of Water
Old Task, Fresh Eyes
Thanks!
Awareness
All For Prepackaged Baths
Changing Our Bedside Practice for the Better
A Change of Practice
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Angela M Berry, Clinical Nurse Consultant Westmead Hospital, Sydney
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angela_berry{at}wsahs.nsw.gov.au Angela M Berry
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Very interesting study of an essential area of critical care nursing. However there is an error in the classification of Staph aureus as a gram negative organism. This error was made twice in the first paragraph under "Culture Procedures". MRSA and candida albicans are also listed as a gram negative organisms when in fact they are gram positive. |
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Kara K Sprague, student University of Florida, Hilary Mathis
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karak{at}ufl.edu Kara K Sprague, et al.
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As students, we are always hungry to take in the most current evidence-based practice and we were glad to learn while reading this article that a change in practice as simple as using disposable bathing systems instead of bath basins may help reduce the incidence of nosocomial infections. However, we feel that there is a potential conflict of interest in the literature cited by the article. Many of the cited parts of the article that extol the virtues of disposable wipe-based cleansing systems and denounce traditional basin baths reference a paper written by Susan Skewes, who patented a disposable bathing system (U.S. Patent No. 6206863, 2001). Because this individual would, presumably, stand to gain financially from hospitals adopting disposable wipe-based cleansing systems, we feel that her research should not have been included in the literature reviewed by this study. |
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Kathrine R Mann, Student University of Florida, Sarah F. Durham
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katiema{at}ufl.edu Kathrine R Mann, et al.
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As nursing students, our minds are full of what we are taught in lab about asepsis and prevention of pathogen transmission. The research presented in this article has exposed a large gap in the basic patient care that we pride ourselves on providing for our patients. This research has opened our eyes to the immense pathogen spreading potential inherent in the bathing practices in each of the clinical settings we have encountered thus far. We find it so interesting that when we were educated on providing bed baths to our patients, the focus was very much on patient comfort. Although dignity, privacy, and comfort are essential, we find it ironic that our lack of regard for clean techniques in bathing challenges patient comfort by placing them at risk for further illness. This research will have a great impact on the way in which we provide AM care from this point forward. We are encouraged by the call to action demanded by the researchers. Currently, we are assigned to a clinical setting in which disposable cleansing cloths are used to bathe patients. With knowledge of this recent research, we are sure that these bath cloths will be flying off the shelves this week during clinicals. We are confident that this generation of nurses will be motivated by research such as this to seek methods to minimize risks for our patients and make an impact on prevention of nosocomial infection. |
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Stephanie Maisonneuve, Nursing Student , De'Lana Mizell
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smaison{at}ufl.edu Stephanie Maisonneuve, et al.
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As a nursing student I’ve had the opportunity to rotate to different hospitals for clinicals, and one particular hospital used prepackaged disposable washcloths for patients’ baths. The patients really liked them; they were very soft, but durable. I found them easier to use and they saved time. When I read this article, I was very happy to see the researcher mention her preference for using prepackaged basinless products to help combat health care-associated infection. I believe that prepackaged basinless products are the way to go if hospitals want to save money and help their patients, and they will also make the nurses happier because they save time. Because the prepackaged bath products are a soft material, I’ve noticed that they do not aggravate the patients' skin as a rag would, therefore decreasing the potential for skin breakdown in at-risk patients. They also do a great job at moisturizing. Needless to say, I am all for their use. |
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Kaitlyn Zipoli, Student University of Florida
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kgirl8t8{at}ufl.edu Kaitlyn Zipoli
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After reading this article, it is clear that we nurses could potentially be causing harm to patients by using bath basins. The researcher stated that one of the weaknesses in the study was that some basins had incontinence supplies in the basins. I feel this is not a weakness, but illustrates the point that, in reality, these basins are being used for purposes such as incontinence care, proving that bath basins are not sanitary supplies and should not be used for bathing and removing harmful organisms because they are actually causing more damage. This information should be delivered to all nurses so that they can implement a practice change and reduce the number of hospital-acquired infections by reducing the number of bath basins being used. |
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Evan P Farnsworth, Student University of Florida, College of Nursing, Cherysh Kemp
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evanpf{at}ufl.edu Evan P Farnsworth, et al.
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Upon reading this study, we were shocked to learn that bath basins were such a potential reservoir for infectious pathogens. In our experience, we have not seen much attention from other nurses or personal care assistants to the sterility of bath basins. Most nurses we have observed use the basins on patients multiple times without disinfecting them, which allows infectious agents to grow and spread. At our current clinical site, the Veteran's Medical Center in Gainesville, FL, we use disposible bath wipes to bathe our patients. Our current institution provides these disposible wipes as an alternative to the bath basin to reduce the contamination of bath basins. We are glad this study supports our current practice. |
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Kayla R Johnson, student University of Florida, Baylin Pfluke
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kj052306{at}ufl.edu Kayla R Johnson, et al.
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This article showed that bath basins become reservoirs for bacteria that cause infections. One of the solutions suggested was using disposable bathing cloths instead of the basins. There are pros and cons to each method. Basins are the standard bathing method in hospitals today. In our experiences, patients have stated bathing with soap and water makes them feel cleaner than the disposable cloths. However, there are many disadvantages to the bath basins; not just the possibility of bacteria growth. This method can be messy and time consuming for the staff. This is not always cost effective for hospitals. Disposable cloths have been shown to reduce the number of bacteria when bathing by not giving bacteria a place to grow and not spreading bacteria from one body part to another. It takes less time to give a bath with the cloths and creates no mess. One of the drawbacks to disposable cloths is the added expense. As nursing students we spend a lot of time giving bed baths, and we think that disposable bathing cloths are the preferable option. They are so much easier to use and cut the time drastically. We think that even though cost is an issue, using disposable cloths could be beneficial in the long run. Patients' health will benefit and hospital expenses could decrease because infections could be reduced. This article is very eye opening and can help improve patient care. |
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Jaime Guy, Student University of Florida, Gina Mossali
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jme1120{at}ufl.edu Jaime Guy, et al.
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In reading this article, I began to think back to personal clinical experiences where I had to choose between different methods of bathing my patient. In the past, I was unaware that any significant differences between the bathing methods existed and went strictly by the patient’s preference. Now, when given the choice between using a bath basin or prepackaged bathing supplies, there will be no question about which to use. I am thankful to know that I will be choosing a method that could possibly protect my patient from new infections. |
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Kelley K. Novak, Student , Katie Boyle
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kelley22{at}ufl.edu Kelley K. Novak, et al.
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Indeed some type of disposable cleansing technique is a better alternative to the bath basin in reducing the risk of infecting a patient. However, when using these disposable wipes I have noticed that some employees like to use a combination of the wipes and the bath basin, soaking the wipes in water and using it to rinse them out. This defeats the whole purpose of using these prepackaged bathing supplies because it still uses the contaminated water and reuses a bath basin with potential bacteria growth. There needs to be an increased awareness of the proper technique of using these prepackaged supplies in order to reduce further contamination. |
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Courtney Chastain, Student UF College of Nursing, Jamie Rivers
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Jamieriv{at}ufl.edu Courtney Chastain, et al.
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As nursing students we learn about sources of contamination and how important it is to control the spread of hospital-acquired infections. Before reading this study we never viewed bath basins as a source of contamination. Now, when possible, we will use the option of disposable bath wipes over bath basins. We are also interested in how the data would have been altered if the researchers in this study had cultured incontinence materials and other objects that were placed in the basins. |
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Amanda Kurtz, Student , Alexandria Bishop
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akurtz88{at}gmail.com Amanda Kurtz, et al.
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As nursing students who have just recently learned and practiced the art of bed baths using a basin, this article changed our perspective on a traditionally taught skill. All of the common nursing practices mentioned in the article, including dumping used water down the sink, storing the basin upright, and keeping other hygiene materials in the basin are the norms of our practice. However, this article inspires us as students to employ alternative bathing methods whenever appropriate, and to explore new ways to make the bath basin more sanitary. Even though we still lack expertise, it has become glaringly obvious in our clinical experiences how common and critical hospital-acquired infections can be. The evidence provided from this study helps all nurses be more aware of this very serious problem. |
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Bobbie R Slone, student University of Florida, College of Nursing, Sarah A. White
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brslone{at}ufl.edu Bobbie R Slone, et al.
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This article provides some great evidence that the bath cloths we have been using in clinicals really are beneficial. Reading this article did make us uneasy, though. We were trained in bed baths to prepare for the real thing, and then were presented with this study that tells us these can actually be more harmful than helpful. It really has changed our view on how to give a bed bath, especially if the bath basins are the only items available. Both of us have become more aware of our method of bathing patients in bed since reading this article. It would have been helpful, however, to see the quantitative data relating to the culture growths taken from the sample sponges and what constituted a positive bacteria culture, such as whether there was a minimum amount of growth necessary before a culture would be considered positive. We did appreciate the inclusion of types of bacteria found. It really drove home the gravity of the information. |
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Meghan E Diamond, student University of Florida, Kristin A McDougal
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meg436{at}ufl.edu Meghan E Diamond, et al.
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As students we have had the opportunity to work at various hospitals as part of our clinical rotations. One of the sites used prepackaged bath wipes instead of traditional bath basins. This reduced the amount of time we had to spend preparing for baths, was less messy, and the wipes were not as rough on the patients’ skin as washcloths are. This article shows just one of the disadvantages of using bath basins. It is important to be aware of the potentially harmful effects of a practice that has been unquestioned for so long. A follow-up study would be important to further identify the benefits of using prepackaged bath wipes rather than traditional bath basins so that this may become the standard of care in all hospital settings. It may initially seem more cost effective to use soap, water, and reusable basins for bathing rather than commercially prepared bathing wipes. However, hospitals are responsible for paying the cost of nosocomial infections. Therefore it is ultimately less costly for hospitals to use bath wipes in order to reduce the transmission of bacteria while bathing patients. In addition, this research cites other studies that identify hospital tap water as a source of bacteria. Since the prepackaged wipes don’t require water, this can further reduce the possibility of spreading infection. As nursing students the article was eye opening and forces us to think about how standard nursing practices must be constantly evaluated and questioned so that we may provide the best care for our patients. |
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Liliana M. Mejia, Student, BSN University of Florida, Tiffany Chiu
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lili{at}ufl.edu Liliana M. Mejia, et al.
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This research is of great clinical significance as it raises the awareness that the very steps taken to clean a patient may actually be a medium for bacteria transmission. The alternative method of prepackaged baths suggested in the study has been proven to effectively reduce the amount of bacteria transmission related to bathing. In my clinical experience however, I’ve found that patients, especially elderly patients, do not feel thoroughly clean after using mere wipes to cleanse their skin. In addition, warm water can have a soothing effect that may be therapeutic for the patient. In nursing school, I was taught to allow my patients to soak their hands and feet in clean, warm water to help them relax and feel as if they had taken a bath. I have found that patients enjoy this and thank me for taking the time to do this. I was also taught to rinse the basins with hot water and wipe them with antiseptic wipes after bathing, which was not done in the study. Unfortunately and realistically, in the clinical setting these steps are skipped due to lack of time and large patient loads. This article is a call to action to nurses to develop and implement ways to reduce transmission of pathogens, which in the long run will decrease the incidence of nosocomial, infections saving time and money. As a result, it is worth investing in the extra steps to maximize outcomes and patient comfort. |
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Kelli D Gruss, Student UF College of Nursing, Cory C. Dowell
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kelli.gruss{at}gmail.com Kelli D Gruss, et al.
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As new nursing students, we were taught to do bed baths with soap and water, but were also introduced to the disposable baths at one of our clinical facilities. They save a lot of time and allow patients more autonomy, but a common complaint is that some patients do not actually feel clean after using these wipes. We have each experienced working with a patient who preferred to use an old-fashioned wash cloth and water instead of the prepackaged wipes. After being shaved one patient stated, “The wipes make me feel sticky.” Another patient said she needed a washcloth to clean her arm after trying the wipes because she felt “grimy.” Although we were taught to provide care a certain way, this article creates awareness that other techniques should be considered to help keep patients as healthy as possible. As new nurses, we feel it is our responsibility to implement new ways to do common tasks. While we are learning how to be nurses, we find ourselves constantly asking “Why?” This article promotes further questioning to improve patient care. |
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Lela V Wright, Nursing Student University of Florida College of Nursing, Judith Aimable
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Lela1{at}ufl.edu Lela V Wright, et al.
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Bath basins and prepackaged baths are both abundantly available on my postoperative floor. I have always preferred to use the bath basins because I felt it is the closest thing to a real bath that patients could experience. Recently, I even went as far as removing the prepackaged bath supplies out of a patient's room so they could primarily use the bath basin! After reading this article, I truly understand that as nurses it is our responsibility to protect the patient and prevent nosocomial infections. My practice methods have changed tremendously. Now I only use prepackaged baths and educate the patient, other nurses, and nursing assistants on the importance of using prepackaged baths or at least minimizing contaminants in bath basins. |
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Christine A Hagen, nursing student University of Florida, Lindsey Putnam
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hagenc{at}ufl.edu Christine A Hagen, et al.
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Before reading this article, I did not even realize what a risk factor bath basins were for creating infections in patients. I think most nurses overlook this fact. They do not worry about how dirty the basins are since they use soap and water to clean the patients. There are also many other objects nurses think about first as risk factors for infections before they think of bath basins. I think once nurses read this article, they will forever change the way they administer bed baths and will be more cautious about what kind of objects get stored in the basins, as well as how they clean the basin postbath. This article is a very good tool for helping to bring awareness to the different, yet unnoticed, ways that patients can acquire hospital infections. Hopefully this awareness will bring about ideas on how to prevent these basins from being risk factors. |
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Lauren A Sutton, student University of Florida, Katherine Einbecker
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laur828{at}ufl.edu Lauren A Sutton, et al.
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The problem addressed by this article is extremely relevant to nursing practice today. As student nurses we give numerous bed baths and have experience using bath basins, as well as the prepackaged bathing cloths. Not only are the prepackaged cloths more time effective, they are much easier to use, and from reading this article we know they lessen the microbial counts on patients. After reading about how much bacteria is left in the bath basins, the question arises of how we, in the medical field, could continue using them with patients. This study was extremely informative and interesting but leaves some unanswered questions about health care - associated infections and whether or not they are caused by the use of bath basins. The question of cross contamination between tap water and immunosuppressed patients is also one that needs further investigation. In all, this study should have a major effect on the health care field in regard to patient baths. The use of prepackaged bath cloths should be further explored, but based on these findings they should be used. |
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Nancy Elmann, Cardiac Surgery ICU nurse Hackensack University Medical Center
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nancyelmann{at}verizon.net Nancy Elmann
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I just wanted to thank Johnson, Lineweaver, and Maze for validating what we as nurses have known and for years, since our cries to the administrators have fallen on deaf ears. After this study was published, we have changed our practice by storing the basins empty and upside down to prevent the biofilm formation. I personally use Hibiclens in the basins when bathing my patients. We also started storing all the hygiene products in a ziplock bag. About 3 years ago our hospital withdrew the use of Comfort Baths in the ICUs due to cost restraints.This study brought awareness to the fact that preventing infection will, in the long run, save money for the hospital therefore comfort baths should be brought back for these immunocompromised patients. I hope to see more research conducted on this topic in the future directly comparing the bath basin with the comfort bath in the prevalence of Hospital Acquired Infection. |
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Abel A Rodriguez, Trauma Nurse
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Email Abel A Rodriguez
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As I read this article, I realized that as nurses we sometimes perform acts with good intentions, but the effects may be be harmful. Such is the case with bed baths and this article. We may be unknowingly contributing to the problem, rather than helping. I am very happy to have read this article and the information it provdes, and had a gut-wrenching feeling as I read it. My practice has forever been changed as a result of being aware of this problem. Although we might think we are practicing safe nursing by rinsing the basin, this may not be enough and we need to rethink the procedure and how we accomplish it. Thank you so much for the information! |
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