A patient-centric approach to bed bathing

Abstract

The ability to use best practice approaches for care and personal hygiene purposes extends to one of the fundamental aspects of nursing – bed washing a patient. However routine it might seem, a patient-centric approach should always be adopted for what is an intimate and intrusive procedure. This article will examine the benefits of disposable wipes when bathing patients confined to bed in a care setting, comparing the experience with the more traditional method of soap and water. The article will focus on patient choice and comfort, personal hygiene aspects, as well as the time benefits to nurses performing routine care.

Citation: Eaton D (2024) A patient-centric approach to bed bathing. Nursing Times [online] 120: 3.

Author: Denise Eaton is senior clinical editor, Nursing Times.

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Introduction

Bed baths serve a number of needs for patients who are unable to undertake more conventional forms of washing, including maintaining personal hygiene and promoting psychological wellbeing (Konya et al, 2021). Assisting someone with their personal hygiene needs is a fundamental nursing activity that, according to Groven et al (2017), relates to both quality of care and quality of life. To be able to support the hygiene needs of a patient is considered a core function that all newly registered nurses should be able to aptly demonstrate in order to meet proficiency outcomes (Nursing and Midwifery Council, 2018).

Such an intimate procedure should allow the nurse protected time to interact with their patient and enhance the patient-nurse relationship, but it should also present a valuable opportunity for a holistic assessment to be carried out without interruption. It also allows time to address any concerns patients may harbour, and provides a valuable opportunity to assess and monitor skin integrity (Lawton and Shepherd, 2019).

In all circumstances, the patient’s preferences should be considered and Vege et al (2019) recommend shared decision making between patient and practitioner whenever bed baths are deemed necessary, with preferences expressed by the patient, where possible, incorporated into the procedure (Fig 1).

With patient reliance upon intimate care being the aspect of care that is most reported as undignifying (Ekpenyong et al, 2021), nurses must consider ways in which to mitigate such negative concerns. Lawton and Shepherd (2019) state that offering patients the chance to participate in this routine can help to maintain a patient’s self-esteem and dignity, as well as contribute towards maintaining their independence. Care considered to be dignified can also help improve patient recovery while, conversely, undignified care can lead to feelings of worthlessness and depression (Ekpenyong et al, 2021).

According to Groven et al (2019), bed-bound patients often perceive bed baths as having a negative impact on both physical and emotional comfort, with the standard soap and water in a bowl approach considered embarrassing and uncomfortable, not to mention physically demanding for the nurse and patient.

In one study cited by Groven et al (2019), most patients maintained they would rather replace the soap and water method with washing without water. Regardless, most bed-bound patients are still cleaned with soap and water (Groven et al, 2019), even though patient choice should always be factored into the routine care procedure, and nurses should recognise that bed-bound patients have varying preferences (Vege et al, 2019).

“Patients living with dementia, particularly in the advanced stages, may find traditional bathing methods and hair washing a confusing and threatening experience”

It is also worth considering that patients living with dementia, particularly in the advanced stages, may find traditional bathing methods and hair washing a confusing and threatening experience. Perception problems leave those affected unable to distinguish depth, making it scary to step into the water. They may also be unable to see water in the same way as before, so may experience hair washing as being hit on the head by an almost invisible force (Alzheimer’s Association, nd; Independent Living, nd).

The Conti® brand, owned by Vernacare, benefits from 40 years of research and experience developing and manufacturing hygiene solutions for the care sector and its Waterless Bathing range offers a selection of products created especially for assisted bathing. Among them is an effective solution for hair washing without water. A pre-impregnated shampoo cap activates a unique blend of cleansers and conditioners through a gentle massaging action, which releases a rinse formulation into the hair. The hydrophilic fabric absorbs oil and dirt from the hair, keeping it fully contained within the shampoo cap. There is no rinsing involved throughout the easy-to-use process, offering a completely rinse-free hair wash (Fig 2).

Cleansing and conditioning washcloths and wash mitts complete the Conti® Waterless Bathing range with both cloths and mitts created using a unique pH-balanced formula to promote clean, soft and healthy skin. Products are designed for optimal ease of use and comfort for the patient with a quick-drying action avoiding the need for towel drying or excessive rubbing, helping to maintain the skin’s integrity.

The ‘bag bath’ concept was introduced as an alternative to washing with soap and water in 1990, initially as a method to address shortcomings related to skin integrity and hygiene, and involved non-disposable washcloths placed in a bag together with a cleansing fluid diluted in water (Groven et al, 2017). Pre-packed disposable wipes evolved from this concept a few years later and offered a viable alternative to the traditional bed bathing method of using soap and water, with the further development of products now providing a more convenient way of delivering hygiene care.

An experimental study by Tai et al (2021) examined both methods of bathing critically ill patients, comparing, among other things, the length of time taken to carry out a full body wash and the cost involved. Results from the research demonstrated a statistically significant difference in the time taken to complete a bed wash, with the mean bath duration for disposable wipes at 23.8 minutes against 34.4 minutes for the soap and water approach. And, although the cost of consumables was significantly higher for the method using disposable wipes, once laundry and nursing labour costs were taken into consideration – NHS England spent more than £224m on laundry and linen costs in 2021-22 (NHS Digital, 2022) – the overall cost of bed baths with disposable wipes was significantly lower than for the more traditional method (Tai et al, 2021). Such findings, along with other issues associated with soap and water washes, are highlighted by Vernacare (Fig 3).

According to Martin et al (2017), another advantage to removing wash bowls from the bedside is that it contributes to a reduction in healthcare-associated infections. One study found the simple act of eliminating soap and water from the bedside led to a statistically significant drop in healthcare-associated infections and the transfer of multi-drug resistant organisms, with the recommendation that all portable wash bowls be replaced with pre-packaged wipes for patient bathing (Martin et al, 2017).

Using pre-packaged wipes also provides a significant improvement in skin integrity, with conventional soap and wash bowl methods possibly contributing to skin deterioration owing to changes in skin pH, skin-drying effects of traditional cleansers and friction caused by washcloths (Martin et al, 2017). Wipes such as the Conti® range produced by Vernacare are manufactured to match the pH balance of the skin, with additional emollients to reduce irritation during cleansing. This helps maintain the integrity of the skin, helping to provide a natural barrier to potential infection. This and a list of other benefits can be found in Fig 4.

Vernacare’s Conti® wipes are made from sustainable plant-based materials. The UK-based manufacturing plant enables the production of larger flow-wrap packs with clip-lock lids – providing a viable alternative to plastic containers. Its bed bathing range offers a choice of supporting products, including a range of infection prevention products to support washing without water. As well as flushable wipes, there are also wipes specifically designed to be disposed of in a hospital macerator. Its Conti® products offer a range of skincare solutions that are designed to protect skin and minimise the risk of infection. Products help reduce healthcare-associated infections and outbreaks while also offering time-saving solutions for nurses.

Conclusion

Switching from the traditional wash bowl to waterless bathing for patients confined to bed offers better patient choice and an individualised approach to healthcare delivery. It helps eliminate fear and confusion for those living with dementia, contributes to a reduction in healthcare-associated infections, avoids costly laundry expenditure, saves nurses time at the bedside, improves skin integrity and comfort, and delivers better all-in-one care.