Showering patients in the ICU

[mgoodger113]

My facility is building a brand new patient tower, the rooms will be larger and have more amenities for patients/families. One such amenity is that each room will have a shower. I work in the Neuro Shock Trauma ICU and in our current building none of our patient rooms have showers. We don't even have a unit shower, so the patients only receive bed baths until the transfer to a lower acuity of care. The good majority of our patients are too critically ill to shower, so it hasn't been an issue so far.

With this new building and showers being available to everyone, what kind of guidelines do you guys suggest be in place? Besides the very obvious concern for falls, I'm also worried about my less hemodynamically stable patients. Are there any other ICU nurses out there that can shed light on their hospital's policies? What are the absolute contraindications in your mind? I would assume things like need for vasopressors or dependence on a ventilator would be a no brainer, but what about central lines? Or surgical drains? Or chest tubes?

[NICU Guy, BSN, RN]

What are the absolute contraindications in your mind?

Being in the ICU. If you are well enough to shower independently, then you are well enough to be transferred to a floor with a shower. You have to take all of the EKG electrodes and pulse ox while they are in the shower. The facility is going to accept liability for an ICU patient unmonitored and unsupervised for 15-30 minutes while they are in the shower? Why not let them go down to the gift shop or cafeteria whenever they feel like it? They are only in the INTENSIVE CARE unit.

[mgoodger113]

I agree with you completely, unfortunately, my hospital does not. I am not allowed to take a patient off monitor to walk them in the hallway, so how is it okay to take them off monitor and let them spend 20 minutes in the shower? The fact that we will have in-room showers in the new building has a lot of the nurses on my unit freaking out.

I'm trying to help my administrators come up with a policy to keep patients and caregivers as safe as possible. It can be hard for some nurses to argue their case with particularly demanding or difficult patients, when the shower is 'just right there.'

I am going to suggest a policy that requires any patient wanting to use the shower must have a caregiver with them at all times and has to have an order from the doctor saying that they may be off monitor to shower. But I also wanted to include a list of absolute contraindications, such has central lines, surgical incisions, chest tubes, drains, etc.

It is much easier to get a pushy patient/family member to stop arguing for a shower when you can have a specific policy to refer them to.

[Wuzzie]

I'm wondering if they are including showers in order to be able to potentially flex the rooms or for future use if they are transitioned to regular rooms. What I mean by flexing is our cardiac center rooms are designed to keep the patient in the room from ICU to discharge. Our new ICU rooms have showers because they already anticipate building an even bigger ICU in the next 10 years and the current ICU will be used for something else. They aren't really intended for the ICU patient's. One thing you guys will need to determine is if you will allow family members to use them. I have to tell you, I stayed with a hospitalized friend in a strange city 24/7 for 6 days. The nurses nicely let me use the shower in her room and it was most appreciated. Either that or I was starting to get stinky and they were protecting themselves. LOL!

[MunoRN, RN]

You don't actually have to take patients off tele to shower, Phillips and other manufacturers make shower pouches specifically for showering with a tele box in use during the shower.

But for the most part no, we don't shower ICU patients, I've maybe showered an ICU patient about once a year. No showering with a central line, with the exception of an established tunneled catheter, or other central devices such as ECMO, VAD, etc. I've worked at places where the ceiling lift tracks go all the way into the shower where they can essentially be hosed off in the sling, but opportunities for that are very rare.