FMV Groven, SMG Zwakhalen, G Odekerken-Schröder, EJT Joosten, JPH Hamers

How does washing without water perform compared to the traditional bed bath: a systematic review

BMC Geriatrics 2017, 17: 31

Abstract
Background 

For immobile patients, a body wash in bed is sometimes the only bathing option. Traditionally, the bed bath is performed with water and soap. However, alternatives are increasingly used in health care. Washing without water is one such alternative that has been claimed to offer several advantages, such as improved hygiene and skin condition. This systematic review aims to provide a comprehensive overview of the evidence on outcomes of the washing without water concept compared to the traditional bed bath.

Methods 
Controlled trials about washing without water outcomes published after 1994 were collected by means of a systematic literature search in CINAHL, Embase, MEDLINE, and PUBMED at the 25th of February, 2016.

Additionally, references and citations were searched and experts contacted. Studies were eligible if (1) the study designs included outcomes of washing without water products developed for the full body wash compared to the traditional bed bath, and (2) they were controlled trials. Two researchers independently used a standardized quality checklist to assess the methodological quality of the eligible studies. Finally, outcomes were categorized in (1) physiological outcomes related to hygiene and skin condition, (2) stakeholder-related outcomes, and (3) organizational outcomes in the data synthesis.

Results 
Out of 33 potentially relevant articles subjected to full text screening, six studies met the eligibility criteria. Only two studies (of the same research group) were considered of high quality. The results of these high quality studies show that washing without water performed better than the traditional bed bath regarding skin abnormalities and bathing completeness. No differences between washing without water and the traditional bed bath were found for outcomes related to significant skin lesions, resistance during bathing and costs in the studies of high quality.

Conclusions 
There is limited moderate to high quality evidence that washing without water is not inferior to the traditional bed bath. Future research on washing without water is needed and should pay special attention to costs, hygiene, and to stakeholder-related outcomes, such as experiences and value perceptions of patients, nursing staff and family.

C Pallotto, M Fiorio, V De Angelis, A Ripoli, E Franciosini, L Quondam Girolamo, F Volpi, P Lorio, D Francisci, C.Tascini, F Baldelli

Daily bathing with 4% chlorhexidine gluconate in intensive caresettings: a randomized controlled trial

Clinical Microbiology and Infection 2019, 25 : 705-710  

Objectives
Objectives To investigate whether daily bathing with a soap-like solution of 4% chlorhexidine (CHG) followed by water rinsing (CHGwr) would decrease the incidence of hospital-acquired infections (HAI) in intensive care settings.

Methods
Randomized, controlled trial; infectious diseases specialists were blinded to the intervention status. All patients admitted to the Intensive Care Unit (ICU) and to the Post-operative Cardiosurgical Intensive Care Unit (PC-ICU) of the University Hospital of Perugia were enrolled and randomized to the intervention arm (daily bathing with 4% CHGwr) or to the control arm (daily bathing with standard soap). The incidence rate of acquisition of HAI was compared between the two arms as primary outcome. We also evaluated the incidence of bloodstream infections (BSI), central-line-associated BSI (CLABSI), ventilator-associated pneumonia (VAP) and catheter-associated urinary tract infections (CAUTI), and 4% CHGwr safety.

Results
In all, 449 individuals were enrolled, 226 in treatment arm and 223 in control arm. Thirty-four individuals of the 226 (15%) and 57 (25.6%) suffered from at least an HAI in the intervention and control arms, respectively (p 0.008); 23.2 and 40.9 infections/1000 patient-days were detected in the intervention arm and control arm, respectively (p 0.037). The incidence of all bloodstream infections (BSI plus CABSI) was significantly reduced in the intervention arm (9.2 versus 22.6 infections/1000 patient-days, p0.027); no differences were observed in the mortality between the two arms.

Conclusions
Daily bathing with 4% CHGwr significantly reduced HAI incidence in intensive care settings. 

FMV Groven, SMG. Zwakhalen, G Odekerken-Schröder, F Tan, JPH Hamers 

The effect of washing without water versus water and soap in nursing students 

J Clin Nurs 2021, 30 : 2234–2245,

Abstract
Aims and objectives
To compare the washing without water method with the water and soap method regarding comfort perceptions of the bed bath.

Background 
Bathing affects nurses’ and care recipients’ comfort. Bedridden care recipients can be bathed in bed with water and soap or with washing without water products. Little is known about the differences between these two bed bath methods regarding comfort perceptions among care recipients and nurses.

Design 
Crossover randomised laboratory-controlled trial, conducted from March2018–November 2019, according to the CONSORT guidelines.

Methods 
Nursing students were randomly allocated roles as a patient (who received both types of bed baths) or a nurse (who provided both types of bed baths). Also,the order in which the bed baths were received/provided was randomised. A total of 97 students were included in the analysis. Student patients filled out the Patient Evaluation of Emotional Comfort Experienced (PEECE) scale to measure emotional comfort and a single-item question on physical comfort after each bed bath. Student nurses filled out the Physical Demands scale after each bed bath to measure their physical comfort perceptions.

Results 
No differences were found between the two bed bathing methods regarding student patients’ emotional or physical comfort levels. Among student nurses, the washing without water method was less physically demanding than the water and soap method.

Conclusions
Taking into account time-efficiency and physical comfort for nurses, washing without water seems to be a valuable alternative to water and soap from a care recipient comfort perspective, which should be assessed in a clinical setting in future research.

Relevance to clinical practice
The washing without water method is less physicallydemanding for nurses and takes less time. It does not have a detrimental effect on care recipients’ emotional and physical comfort

L Schoonhoven, BGI Van Gaal, S Teerenstra, E Adang, C van der Vleuten, Th van Achterberg

Cost-consequence analysis of ‘‘washing without water’’ for nursing home residents: A cluster randomized trial

International Journal of Nursing Studies 2015,  52 : 112–120

Abstract
Background 
No-rinse disposable wash gloves are increasingly implemented in health care to replace traditional soap and water bed baths without proper evaluation of (cost) effectiveness.  

Objectives 
To compare bed baths for effects on skin integrity and resistance against bathing and costs. Design: Cluster randomized trial.

Setting
Fifty six nursing home wards in the Netherlands. 

Participants
Five hundred adult care-dependent residents and 275 nurses from nursing home wards. 

Methods
The experimental condition ‘washing without water’ consists of a bed bath with disposable wash gloves made of non-woven waffled fibers, saturated with a no-rinse, quickly vaporizing skin cleaning and caring lotion. The control condition is a traditional bed bath using soap, water, washcloths and towels. Both conditions were continued for 6 weeks. Outcome measures were prevalence of skin damage distinguished in two levels of severity: any skin abnormality/lesion and significant skin lesions. Additional outcomes: resistance during bed baths, costs.

Results
Any skin abnormalities/lesions over time decreased slightly in the experimental group, and increased slightly in the control group, resulting in 72.7% vs 77.6% of residents having any skin abnormalities/lesions after 6 weeks, respectively (p = 0.04). There were no differences in significant skin lesions or resistance after 6 weeks. Mean costs for bed baths during 6 weeks per resident were estimated at s218.30 (95%CI 150.52–286.08) in the experimental group and s232.20 (95%CI: 203.80–260.60) in the control group (difference s13.90 (95%CI: 25.61–53.42). 

D D’alessandro, P Tedesco, A Rebecchi, S Capolongo

Water use and water saving in Italian hospitals. A preliminary investigation.

Ann Ist Super Sanita 2016, 52 (1) : 56-62 

Abstract
Aim
The aim of this work is to investigate about water use, wastage, saving and reuse in hospitals.

Methods
An anonymous ad hoc questionnaire was tested in a sample of 36 public hospitals in Lombardy region (21% of total public hospitals). Daily water consumption reported is on average equal to 481m3, ranging from 30 to 2280 m3. There is a strong corrolation between water consumption and number of hospital beds (p < 0.005). In 33 hospitals (92%) water consumption is measured and, among them, in about 48% more than one flow meter is installed : 86% consider “important” the reduction of water consumption and about 55% recognized that wastewater could be minimized within the structures.

Discussion
There is a consensus about the need to train health personnel and to implement technical measures to improve the water resources management, but initiatives to raise knowledge and awareness of health personnel have been promoted only in 10% of hospitals.

Results 
Results show not only a lack of awareness regarding water use and saving among the personnel in general, but also among heads of the hospitals technical office and energy managers as well. For this reason, i twill be of interest to carry out this investigation at national level and also to develop recommendations to support and promote a save reuse of water in all the hospitals.

JWM Agar, A Perkins, A Tjipto

Solar-Assisted Hemodialysis  

Clin J Am Soc Nephrol 2012, 7 (2) : 310 – 314

Background and objectives
Hemodialysis resource use—especially water and power, smarter processing and reuse of postdialysis waste, and improved ecosensitive building design, insulation, and space use—all need much closer attention. Regarding power, as supply diminishes and costs rise, alternative power augmentation for dialysis services becomes attractive. The first 12 months of a solar-assisted dialysis program in southeastern Australia is reported.

Design, setting, participants, & measurements
A 24-m2, 3-kWh rated solar array and inverter—total cost of A$16,219—has solar-assisted the dialysis-related power needs of a four-chair home hemodialysis training service. All array-created, grid-donated power and all grid-drawn power to the four hemodialysis machines and minireverse osmosis plant pairings are separately metered. After the grid-drawn and array-generated kilowatt hours have been billed and reimbursed at their respective commercial rates, financial viability, including capital repayment, can be assessed.

Results
From July of 2010 to July of 2011, the four combined equipment pairings used 4166.5 kWh, 9% more than the array-generated 3811.0 kWh. Power consumption at 26.7 c/kWh cost A$1145.79. Array-generated power reimbursements at 23.5 c/kWh were A$895.59. Power costs were, thus, reduced by 76.5%. As new reimbursement rates (60 c/kWh) take effect, system reimbursements will more than double, allowing both free power and potential capital pay down over 7.7 years. With expected array life of ∼30 years, free power and an income stream should accrue in the second and third operative decades.

Conclusions
Solar-assisted power is feasible and cost-effective. Dialysis services should assess their local solar conditions and determine whether this ecosensitive power option might suit their circumstance.

MB Hmida, T Mechichi, GB Piccoli, M Ksibi

Water implications in dialysis therapy, treats and opportunities to reduce water consumption : a call for the planet  

Kidney International 2023, 104 : 46 – 52

Water is a dwindling natural resource and potable water is wrongly considered as a limited resource. Dialysis, particularly hemodialysis, is a water hungry treatment that impacts the environment. The global annual water use of hemodialysis is approximately 265 million m3/yr. In this reference estimate, two-thirds of this water is represented by reverse osmosis reject water discharged into the drain. In this review, we would like to draw attention to the complexity and importance of water saving in hemodialysis. We propose that circular water management may comply with the “3R” concept : reduce (reduce dialysis need, reduce dialysate flow, and optimize reverse osmosis performance), reuse (reuse wastewater as potable water), and recycle (dialysis effluence for agriculture and aquaponic use).

Awareness and sustainability should be integrated to create positive behaviors. Effective communication is crucial for water savings because local perspectives may lead to global opportunities. Besides the positive environmental impacts, planet friendly alternative may have significant financial returns. Innovative policies based on the transition of linear to circular water management may lead to a paradigm shift and establish a sustainable water management model. This review seeks to support policymakers in making informed decisions about water use, avoiding wasting, and finding solutions that may be planet friendly and patient friendly in dialysis, especially in hemodialysis treatments.

Mia Vande Putte

De l’hygiène à la prévention des infections – manuel pour les infirmiers et les sages-femmes

Département Hygiène Hospitalière de l’UZ Leuven

Contenu

L’hygiène et la prévention des infections sont des éléments fondamentaux de la prestation de soins de santé professionnels. Une bonne compréhension de toutes les sources d’infection et des voies de transmission est donc cruciale pour prévenir et endiguer les contaminations.

 Ce manuel de référence destiné aux infirmières et aux sages-femmes explique de manière didactique tous les aspects de l’hygiène et de la prévention des infections pour les praticiens des soins primaires et les praticiens spécialisés dans les soins aigus, les soins chroniques et les soins à domicile.

 Les thèmes suivants sont abordés en détail : hygiène des mains ; nettoyage, désinfection et stérilisation des surfaces, du matériel, des instruments et des tissus vivants ; mesures de précaution et d’isolement générales, en particulier pour le MRSA et les micro-organismes hautement résistants, Clostridioides difficile et Covid-19 ; infections des voies urinaires ; infections des plaies ; infections sanguines ; infections des voies respiratoires ; nutrition ; linge ; élimination des déchets ; consignation des infections nosocomiales, des care bundles (ensembles de pratiques cliniques), de la sécurité des patients et des erreurs, incidents et quasi-accidents ; sécurité et services de santé dans les établissements de soins de santé. Chaque thème couvre différents piliers de la qualité des soins, tels que les équipements appropriés et l’évaluation des procédures.

 La structure didactique de cette édition en fait un manuel idéal pour l’ensemble des cours de soins infirmiers. En outre, il s’agit d’un ouvrage de référence utile pour tout prestataire de soins de santé. Cette édition révisée tient compte des nouveaux points de vue exprimés dans la littérature jusqu’en 2023 et de leurs implications pour la pratique.

 Mia Vande Putte a travaillé au département d’hygiène hospitalière de l’UZ Leuven et a dispensé des formations sur la prévention des infections nosocomiales à la KU Leuven et à la NVKVV. En tant qu’experte auprès du Conseil supérieur de la santé du SPF Santé, Sécurité de la chaîne alimentaire et Environnement, elle contribue aux recommandations nationales sur la prévention des infections dans les soins de santé.

 Pour en savoir plus : https://shop.acco.be/nl-be/items/9789464674552/De-l-hygi-ne—la-pr-vention-des-infections