Bed baths

[bryson.holbrook]

Our current hospital policy is to use wash cloths and chlorhexidine for bed baths. Some of the big hospitals in Utah are using a product that has wipes specified for certain areas of the body. I have been fighting incorporating this product. I think that if the sheets don't get wet then you haven't properly cleaned your patient.

How do you give bed baths? Any support for using these wipes? I think this is an attempt to sell us something with the benefit of people being lazy and giving subpar bed baths.

[Here.I.Stand, BSN, RN]

Our pts get a daily soap-and-water bath, FOLLOWED BY a rub-down with the CHG wipes. Our body wash and lotions are all CHG-compatible.

A few years ago I remember the manager saying that rubbing down with the wipes alone is NOT a "bath." And they're not... ew.

[MunoRN, RN]

While the good-ol-fashioned soapy water tub and washcloth technique is often preferred by staff as feeling more fulfilling, it's been shown to often do more harm than good. So if the goal is to satisfy our own sense of fulfillment in giving a bath that includes as much free-flowing water as possible, it's not better care.

[AceOfHearts<3]

We use the packaged CHG wipes for the most part. They are great when you need to quickly wipe the patient down (new admits, hemodynamically unstable, etc.). With that being said I don't think the wipes are enough at times. I love to take a bottle of CHG and/or soap and do an old fashioned bed bath with a basin then slather the skin (if appropriate) in lotion. I find this really makes the patient smell and feel better. It's important to not to forget moisturizing because CHG is very drying.

[JKL33]

I think this is an attempt to sell us something with the benefit of people being lazy and giving subpar bed baths.

Nah, it's just to make sure you get your a$$ back to your real job of data entry clerk as fast as possible.

And what are you talking about "subpar?" That's the new normal...in fact it's above par; superpar! It's probably more evidence-based to boot. I know of no nursing research articles peer-reviewed and published in the last 5 years with a first author as a nurse that prove anyone can get clean with soap and water. Is your "wet-sheets" theory evidence-based? Come on, man!

/mini rant over.

[Rocknurse, MSN, APRN, NP]

I'm in the ICU and I use a combination. If the patient has been regularly bathed I might just do a freshen up with the wipes, but if the patient is a sweaty mess and needs a full bed change, I'll get a basin with warm soapy water and bathe them properly. I usually clean the patient more than once a shift if they have a lot going on because they're lying there for weeks. I like the convenience of the wipes, but sometimes someone just needs a bath, including their hair washed.

[elizzyRN]

While the good-ol-fashioned soapy water tub and washcloth technique is often preferred by staff as feeling more fulfilling, it's been shown to often do more harm than good.

What is the harm that comes from soap and water baths? In my experience the wipes don't do as good of a job with bad odors as soap and water, and sometimes the wipes leave a sticky residue. I generally prefer to go with soap and water but I certainly don't want to be causing harm with it.

[AceOfHearts<3]

What is the harm that comes from soap and water baths? In my experience the wipes don't do as good of a job with bad odors as soap and water, and sometimes the wipes leave a sticky residue. I generally prefer to go with soap and water but I certainly don't want to be causing harm with it.

A daily bath with CHG has been shown to decrease the bacterial load on the skin and reduce HAIs. A bath with just soap and water isn't enough, especially in critically ill patients and patients with any type of central lines.

Effect of chlorhexidine bathing in preventing infections and reducing skin burden and environmental contamination: A review of the literature - ScienceDirect

Chlorhexidine gluconate use to prevent hospital acquired infections—a useful tool, not a panacea

[MunoRN, RN]

What is the harm that comes from soap and water baths? In my experience the wipes don't do as good of a job with bad odors as soap and water, and sometimes the wipes leave a sticky residue. I generally prefer to go with soap and water but I certainly don't want to be causing harm with it.

There are a number of studies on the subject, the common findings of all of these is that washcloth/basin baths are potentially harmful because they essentially redistribute bacteria from one area to another, even when washing dirtier areas last. This takes away one of the basic defenses against infection which is to keep bacteria isolated. One study looked at the bacterial load of the basin water mid-bath and found it had more pathogenic bacteria than what you'll find in the urine of a patient with a UTI. The washcloths themselves are also an issue, in healthy patients the exfoliating nature of washcloths are useful, but in patients at higher risk for infection the microabrasions caused by the washclothes increases the risk of cellulitis and other infections, and also creates a better habitat for pathogens which can then be distributed elsewhere during the next bath.

[mmc51264, BSN, MSN, RN]

we are in the process of changing from washcloth and soap & water to wipes, not necessarily CHG unless it is a pre-op bath.

[wondern, ASN]

Hmmm, I do always wonder where this washcloth may have been before. I'm thinking I might use the wipes as a washcloth with soap and water to get all the stIcky out now that I read all these ideas.

[tanwonsaur]

My facility gives us the choice of using either the wipes or a basin with soap and water. I personally like using the wipes but I can see the benefits of using soap and water as well. My facility in particular has very rough wash cloths, and I've found that they can cause some discomfort during bed baths. The wipes are a good time-saver as they have lotion, and they smell nice! We also have perineal bath wipes and non-rinse shower caps.

That being said, there are specific circumstances where I use one versus another. If the patient is really grimy, I use soap and water. If they are young and their hair is still thick and healthy, I roll up a towel under their neck, wrap a garbage bag under it, and lay their head back so that I can run water over it and lather and have the contents fall into the bag without making a mess. If the patient has been incontinent, I clean them with a cloth and soap and water first, then follow with the perineal wipes.

Like I said, I like them both for different reasons. :)