Bathing Policies

[umcRN, BSN, RN]

So this is probably a random topic but I am interested in bathing policies in other peds ICU's. I have worked in all three ICU's at my hospital and it varies between them, some for obvious reason but others i'm not sure. They are as follows:

NICU - Bath three nights a week, soap & water for bigger babies, sterile water for itty bits and micro's don't really get a bath but wiped down if they've got goobers, bed changes with baths and PRN and bigger babies can also have baths as needed

PICU - Bath every night but baths usually involve the "bath wipes" though some will use soap and water, bed changes with baths & PRN

CardiacICU - Bath every night but with the chlorahexadine wipes, soap and water is NOT to be used, EXCEPT on midsternal incisions. The only time the chlorahex wipes are not used are if the baby is premature, and soap and water may only be used on "fresh" newborns (aka those that might still have mommy goop ). This is where I am working full time now and the argument against soap and water (the johnsons & johnsons baby soap) is that is increases central line infections however the other ICU's aren't saying that and all three of our ICU's won some award for decreased central line infections. I understand not bathing a fresh open heart or a really sick kid - you wouldn't give a too intense bath in the other units either if the kid is really sick, but for kids that are there for a long time, no soap and water? Seems kind of crazy to me. Especially on stinky chronics!

Just wondering what other ICU's are doing.

[NotReady4PrimeTime, RN]

We don't actually have a "policy" but we are strongly discouraged from using soap and water for bathing any of our patients. The issue, we're told, is that the basins aren't completely decontaminable. We're supposed to use the bath wipes, which I will do occasionally. But I carry a bottle of Aveeno Baby Wash with me and prefer to use that on the chronics and some of the older kids with B.O. issues. (It has a very mild lavender scent - not perfumey so those jocks with the conked craniums won't be offended by it.) One of our intensivists has a dictum that NO fresh post op patient will be bathed - PERIOD. Not even those itty-bitties who come back just drenched in Soluprep to the point where you can almost feel their skin burning. Not even the traumas covered in gore that you'd like to just spruce up a bit before the parents come in. (I had him tell me once that the child with the progressive neuro disorder I was holding would die if I washed his hair - thick with cradle cap and smelling to high heaven.)

Now this all brings up some interesting thoughts. Since we went to the bath wipes, our mediastinitis rate has shot up. So has our CLABSI rate. And I would guess our CAUTI rate too.

[umcRN, BSN, RN]

I have also carried my own soap with me after being in the NICU so long, I just got used to it. I haven't been in this new unit long enough to know all the details but I have heard that in the last few months their midsternal infection rates have been increasing. It just drives me crazy that there is no good way to wash hair with those wipes and the CHG wipes leave a residue after a while. Now I have no issues washing a kiddo then wiping after with the CHG cloths especially around central line areas but no soap at all is driving me nuts!

And in my practice every kid I take care of starts their morning with a face wash, just how I am. I also think their parents feel like someone actually cares for their kids when their clean...that poor baby with the cradle cap! Ugh!

And I wonder how much stuff is growing in those plastic basins that isn't already growing on the kids anyways??

[Rookie12]

chlorhex wipes on anyone 2 months or older daily, if under 2 months soap and water daily. Might not happen on fresh post-ops mostly because people dont get to it as opposed to the surgeons saying no. Our CLABSI rates are also climbing...hmmmm

[umcRN, BSN, RN]

Interesting! Now I want to dig deeper into our MSI infection rates and see if they correlate to when we started using the wipes & no soap/water...:uhoh21:

[NicuGal, MSN, RN]

We have some new soap we use, I'll have to look up the name, but it can be used on anyone from baby to adult. Our micros only get sterile water if needed, no soap. We will use Sali-wipes on the chest and areas around where our lines are, heck we use those a lot lol We had to get rid of all our tubs and we have to pitch the basins every 3 days if used.

[DGNurse10]

We use soap and water on all of our patients as long as they are stable enough, baby wipes on those who are not. We are supposed to be starting using a Chlorahexadine cream as well. Our unit has not had a line infection in almost a year, so we're not really sure why they are adding the chlorahexadine when what we're doing is working, but supposedly it's evidence based practice.....

[nursesharky]

At my home PICU we were 440 days clabsi free and we did baths with soap and water every night. I never saw anyone use bath wipes (we actually did not even have bath wipes on the unit) only your standard baby wipes. The only children that did not receive a bath were the unstable ones. For some of our extended stay kiddos we would give them Hibiclens baths as directed by the physician, generally 1-3 times per week.

[Double-Helix, BSN, RN]

We do baths with soap and water every night and PRN. Exceptions are our critical kids who are intubated/vented and then we do baths less frequently, as they can tolerate.

We have a really strict central line care policy. We've been infection free for more than two years.

[umcRN, BSN, RN]

I wish we used soap and water! Ugh I hate those bath cloths. We have also noticed a sharp increase in our central line infections the past few months (in the CI), way more than I ever noticed in the NICU. Ugh!