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Patients' Bath Basins as Potential Sources of Infection

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An article from The American Journal of Critical Care is reproduced at Medscape.com:

http://www.medscape.com/viewarticle/586213_1 (free registration required to view entire article)

I'll put the abstract in for those of you who don't subscribe to Medscape:

Background: Nosocomial infections are a marked burden on the US health care system and are linked to a high number of patient deaths.

Objective: To identify and quantify bacteria in patients' bath basins and evaluate the basins as a possible reservoir for bacterial colonization and a risk factor for subsequent hospital acquired infection.

Methods: In a prospective study at 3 acute care hospitals, 92 bath basins, including basins from 3 intensive care units, were evaluated. Sterile culture sponges were used to obtain samples from the basins. The culture sponges were sent to an outside laboratory, and qualitative and quantitative microbial tests were conducted and the results reported.

Results: Some form of bacteria grew in 98% of the samples (90 sponges), either by plating or on enrichment (95% confidence interval, 92%-99.7%). The organisms with the highest positive rates of growth on enrichment were enterococci (54%), gram-negative organisms (32%), Staphylococcus aureus (23%),vancomycin-resistant enterococci (13%), methicillin-resistant S aureus (8%), Pseudomonas aeruginosa (5%), Candida albicans(3%), and Escherichia coli (2%). Mean plate counts, in colonyforming units, were 10 187 for gram-negative organisms, 99 for E coli, 30 for P aeruginosa, 86 for S aureus, 207 for enterococci, and 31 for vancomycin-resistant enterococci.

Conclusions: Bath basins are a reservoir for bacteria and maybe a source of transmission of hospital-acquired infections. Increased awareness of bath basins as a possible source of transmission of hospital-acquired infections is needed, particularly for high-risk patients. (American Journal of Critical Care.2009;18:31-40)

WalkieTalkie, RN

Specializes in CVICU.

Doesn't really surprise me. We are doing a trial with Hibiclens baths right now to see if it cuts down on nosocomial infections. We are using Hibiclens straight out of the bottle followed by washing the patient off with damp wash cloths.

I was just thinking on this the other night at work.

SusanKathleen, RN

Specializes in Trauma/Burn ICU, Neuro ICU.

Interesting article. Thanks for posting it. We use "bag baths". Using a new, large plastic bag, we fill it with clean washcloths, and prep it with a bath solution and warm water, and tie it up. Then it's transported to the pt's room, and as we use each cloth, it is placed in the soiled linen bag. I wonder if this prevents some of the bath basin contamination?

did anyone think to culture the basins BEFORE they were used?

ayla2004, ASN, RN

Has 5 years experience.

we may be going to using disposable cardboard basins fr all patients, at present we use them for infection control.

Our basins are that yummy pepto pink color and of course these things grow..they come off of the patient in the bath! Perhaps each basin should be bleach/quatted between uses.

suzy253, RN

Specializes in Telemetry/Med Surg.

No doubt about it....I was thinking the same the other day.

ExpatHopeful, LPN, LVN

Specializes in Gastroenterology. Has 4 years experience.

We've been trialing disposable cardboard basins at my unit this last week for just this reason. Although in theory our plastic bath basins are cleaned between patients I doubt they are really being cleaned. So far people seem quite happy with the cardboard ones although one or two staff think they are wasteful. But in my opinion the costs are justified if it reduces infection rates. Thanks for posting this - think I will print it out for the staff room.

RN1982

Specializes in ICU/Critical Care.

We use those bath wipes that are heated in a microwave. We can use soap and water for bathes also but for ICU patients, the bath wipes are convienent especially for a quick clean up. I'm not sure how effective they are but I used them every now and then.

Asa patient, my doctor said he was not going to use antibiotics unless I showed s/s.I went through major abdominal surgery, hospitalized for two weeks and never received an antibiotic of an infection. Not, because, the cleaning was exceptional. I based it on one thing, every day i sprayed my room and bed and all the furniture with clorox spray. I believe the infection has risen,because we quit using bleach and started using alternative cleaning products. My opinion and I use it for every person I personally know that end up in the hospital and so for It has worked.

MaryAnn_RN

Specializes in ICU. Has 15 years experience.

We used to use plastic bowls that were sterilised at HSDU in between patients. The bowls were washed and dried thoroughly then stored upside down after we had used them. The cost of sterilising the bowls became an issue so now we now use the cardboard type bowls and they go in the sluicemaster once we have finished. They hold the water well BUT if you don't get a move on they begin to leak.

ayla2004, ASN, RN

Has 5 years experience.

on my first ward as a student the bowls where sterilised hsdu between pt but that was mainly a self caring ward so most pt went to the bathroom. the second medical used new plastic bowls for every pt. Every other ward has mulituse bowls bard the cardboard ones.

suni, BSN, RN

Specializes in med surg. Has 15 years experience.

I love when the CNA puts the toothbrush in the basin that they just used to clean the peri anal area.

ayla2004, ASN, RN

Has 5 years experience.

we use a cardboard "sick bowl" for oral care so that we don't use the wash bowl.

cruisin_woodward

Specializes in CT ICU, OR, Orthopedic.

We use those bath wipes that are heated in a microwave. We can use soap and water for bathes also but for ICU patients, the bath wipes are convienent especially for a quick clean up. I'm not sure how effective they are but I used them every now and then.

They make the most sense to me!!

Interesting article. Thanks for posting it. We use "bag baths". Using a new, large plastic bag, we fill it with clean washcloths, and prep it with a bath solution and warm water, and tie it up. Then it's transported to the pt's room, and as we use each cloth, it is placed in the soiled linen bag. I wonder if this prevents some of the bath basin contamination?

We use bath bags for most of our patients. Regular wash rags have been eliminated because they're considered a source of bacteria, so we use these dry disposable peri-wipes. I never thougth about the pink basins being contaminated, but I'll be more aware now.

wanderlust99

Specializes in ICU/PACU. Has 10 years experience.

I love when the CNA puts the toothbrush in the basin that they just used to clean the peri anal area.

Everything does tend to end up in the pink basin after the bath! At my current hospital they request we just use the wipes that you heat up. We have separate peri wipes & body wipes. They seem to work and my patients like them. They would rather us not do the old fashioned soap & water baths.

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