Bathing your loved one regularly is an important way to help keep their skin healthy. It can help prevent infections and it's a good time to check for sores or rashes. Bathing also helps your loved one feel fresh and clean. The amount of help your loved one needs when bathing depends on how well he or she can move. You may be caring for someone who has short-term trouble with self-care because they are recovering from an illness or a surgery. Or you may be taking care of an older person who has memory problems and can't remember how to bathe. Or you could be caring for someone who has a long-term inability to move, such as a person who is paralyzed. This person may need much more help when bathing. A person who has to stay in bed for a short time and who can move a little may be able to take a shower with some help once or twice a week. Or the person may prefer a partial bath at the sink or with a basin every day. A person who can't move well or who can't move at all needs a bed bath. This is often called a sponge bath, but washcloths are often used too. You can give a full bath in bed without getting the bed sheets wet. Younger people who have no problems with blood flow can bathe more often if they want to. For older adults, you can give a bed bath 2 or 3 times each week. Bathing more often may put the person at risk for skin problems, such as sores. Let your loved one clean himself or herself as much as possible. As you help to undress and bathe them, try to be as relaxed as possible. Bath time can be embarrassing for you and the person you're caring for. This may be especially true if you are caring for someone of the opposite sex. If you are calm and don't seem embarrassed, they may feel more comfortable. To get ready to give someone a bed bath, start by gathering materials. You will need:
Ask the person if the room is too warm or too cool, and change the temperature if needed. Make sure that the bed is high enough so that you don't hurt your back. If it is low, it is okay to put your knee on the bed to reach over and bathe the person. Place a waterproof mat or sheet under the person to keep the bed dry. And for privacy, make sure the door is shut and the blinds or drapes are closed. When you help someone bathe you may have a chance to check the skin for redness or sores. Pay special attention to areas with creases, such as beneath the breasts or in the folds on the stomach. Also look at the groin area and bony areas, such as the elbows and shoulders. Start by filling two basins with warm water. Use the first basin for soaping up a washcloth and wringing it out. Use the second to hold clean water for rinsing the soap off. Use the back of your hand to test the water to make sure it's not too hot. You don't have to wear gloves, but it might be a good idea if the person has been vomiting or has had diarrhea. And it's a good idea to wear a mask if you or the person has an illness that can spread, such as a cold or the flu.
When you are finished with the bath, apply an unscented body lotion to protect the skin and keep it from becoming dry. Don't put lotion on areas that can become moist, such as under the breasts or in the folds of the groin. Help the person as needed to finish dressing. Put away your supplies and wash your hands. American Red Cross. Assisting with personal cleanliness and grooming. In: American Red Cross. American Red Cross Nurse Assistant Training Textbook. 3rd ed. American National Red Cross; 2013:chap 13. Konya I, Nishiya K, Yano R. Effectiveness of bed bath methods for skin integrity, skin cleanliness and comfort enhancement in adults: A systematic review. Nurs Open. 2021;8(5): 2284-2300. doi.org/10.1002/nop2.836. Smith SF, Duell DJ, Martin BC, Gonzalez L, Aebersold M. Personal hygiene. In: Smith SF, Duell DJ, Martin BC, Gonzalez L, Aebersold M, eds. Clinical Nursing Skills: Basic to Advanced Skills. 9th ed. New York, NY: Pearson; 2017:chap 9. Timby BK. Assisting with basic needs. In: Timby BK, ed. Fundamentals of nursing skills and concepts. 11th ed. Philadelphia, PA: Wolters Kluwer Health: Lippincott Williams & Wilkens. 2017:unit 5.
Assisting patients with personal hygiene is a fundamental part of nursing care and provides an opportunity for nurses to carry out a holistic assessment of their patient
Good personal hygiene is essential for skin health but it also has an important role in maintaining self-esteem and quality of life. Supporting patients to maintain personal hygiene is a fundamental aspect of nursing care. This article outlines the procedure for bed bathing a patient. Citation: Lawton S, Shepherd E (2019) The underlying principles and procedure for bed bathing patients. Nursing Times [online]; 115: 5, 45-47. Authors: Sandra Lawton is nurse consultant dermatology, Rotherham Foundation Trust; Eileen Shepherd is clinical editor, Nursing Times.
Supporting patients to maintain their hygiene needs while they are in hospital is a fundamental aspect of nursing care, yet there is very little evidence to support practice (Coyer et al, 2011). Personal hygiene includes care of the:
Hygiene and skin care should be considered as one entity, as both have a potential impact on skin health and on patients’ comfort and wellbeing. Factors that have a negative effect on skin health include:
Box 1 lists other factors.
Box 1. Factors that negatively affect skin health
Source: Dougherty and Lister (2015) Helping patients to wash and dress is frequently delegated to junior staff, but time spent attending to a patient’s hygiene needs is a valuable opportunity for nurses to carry out a holistic assessment (Dougherty and Lister, 2015; Burns and Day, 2012). It also allows time to address any concerns patients have and provides a valuable opportunity to assess the condition of their skin. Patients will have their own values and practices relating to hygiene, which nurses need to consider when planning care. For example, some patients may bathe in the evening as it helps them settle for the night, while others may prefer to shower in the morning. Nurses should also discuss with patients any religious and cultural issues relating to personal care (Dougherty and Lister, 2015). For example, ideally, Muslim patients should be cared for by a nurse of the same gender (Rassool, 2015), and Hindus may wish to wash before prayer (Dougherty and Lister, 2015). As part of routine hygiene care, some patients may require urethral catheter care, mouth and denture care, footcare and eye care. These procedures are not covered in depth in this article. Bed bathing a patientBed bathing is not as effective as showering or bathing and should only be undertaken when there is no alternative (Dougherty and Lister, 2015). If a bed bath is required, it is important to offer patients the opportunity to participate in their own care, which helps to maintain their independence, self-esteem and dignity. Selecting appropriate equipmentPlastic wash bowls were routinely used in hospitals for bed bathing but they can easily become contaminated with micro-organisms responsible for healthcare-acquired infections (Marchaim et al, 2012). As such, single-use disposable bowls are now commonly used. All patient should have their own toiletries or be supplied with single-patient use items until their own toiletries can be brought into hospital. Soap can alter skin pH, leading to dryness and skin breakdown, so it is suggested that skin-cleansing emollient creams should be used (Cowdell et al, 2014). These should be prescribed for individual patients, and a spoon or spatula should be used to decant the product into a disposable pot to prevent contamination; emollients in tubes or pump containers reduce this risk. New supplies should be prescribed following treatment for a skin infection (Lawton, 2016). Reusable washcloths should be avoided as they can harbour bacteria. This is particularly important in patients who are immunocompromised or critically ill, or those whose skin integrity is compromised, for example, patients with burns (Dougherty and Lister, 2015). A relatively new development is pre-packaged cloths for bed bathing (commonly known as the bag bath), which do not require water. A systematic review comparing bag baths with traditional bed baths concluded that ‘washing’ without water may be an alternative to the traditional bed bath, although more research is required (Groven et al, 2017). Glove useThe World Health Organization (2009) stated that non-sterile gloves are not required routinely for washing and dressing patients. Nurses need to assess individual patients for risk of exposure to blood and body fluids (Royal College of Nursing, 2018) and be aware of local policies for glove use. Evidence suggests that patients may prefer nurses to wear gloves to provide intimate care (Loveday et al, 2014a), for example, washing genitalia. When gloves are required they must be single-use and be disposed of in accordance with local policy (Loveday et al, 2014b). Undertaking a bed bathBox 2 outlines the general principles of bed bathing.
Box 2. General principles of bed bathing
Source: Ersser et al (2005); Dougherty and Lister (2015)
Source: Peter Lamb Equipment needed
The procedure
Burns S, Day T (2012) A return to the basics: interventional patient hygiene (a call for papers). Intensive and Critical Care Nursing; 28: 4, 193-196. Cowdell F et al (2014) Hygiene and emollient interventions for maintaining skin integrity in older people in hospital and residential care settings (Protocol). Cochrane Database of Systematic Reviews; Issue 12: CD011377. Coyer FM et al (2011) The provision of patient personal hygiene in the intensive care unit: a descriptive exploratory study of bed-bathing practice. Australian Critical Care; 24: 3, 198-209. Dougherty L, Lister S (2015) The Royal Marsden Hospital Manual of Clinical Nursing Procedures. Oxford: Wiley-Blackwell. Ersser SJ et al (2005) A critical review of the inter-relationship between skin vulnerability and urinary incontinence and related nursing intervention. International Journal of Nursing Studies; 42: 7, 823-835. Ette L, Gretton M (2019) The significance of facial shaving as fundamental nursing care. Nursing Times; 115: 1, 40-42. Groven FM et al (2017) How does washing without water perform compared to the traditional bed bath: a systematic review. BMC Geriatrics; 17: 31. Lawton S (2016) Emollients and ageing skin: optimising effectiveness and safety. British Journal of Nursing; 25: 11, 596-598. Loveday H et al (2014a) Clinical glove use: healthcare workers’ actions and perceptions. Journal of Hospital Infection; 86: 2, 110-116. Loveday HP et al (2014b) epic3: National evidence-based guidelines for preventing healthcare-associated infections in NHS hospitals in England. Journal of Hospital Infection; 86: S1, S1-70. Marchaim D et al (2012) Hospital bath basins are frequently contaminated with multidrug-resistant human pathogens. American Journal of Infection Control; 40: 6, 562-564. Rassool GH (2015) Cultural competence in nursing Muslim patients. Nursing Times; 111: 14, 12-15. Royal College of Nursing (2018) Tools of the Trade: Guidance for Health Care Staff on Glove Use and the Prevention of Contact Dermatitis. World Health Organization (2009) WHO Guidelines on Hand Hygiene in Health Care. |