Comparison of two washing methods for bed baths152: Soap and water or disposable wet wipes – A mixed methods study

Introduction and background:
Bed baths are offered to hospital-admitted patients if they cannot get out of bed during admission. Besides ensuring the patients’ personal hygiene, bed baths have many advantages and can be crucial to patients’ quality of life. Soap and water (SAW) have gradually been replaced by a more widespread use of disposable wet wipes (DWW). In Denmark, the two methods are both recommended. Still, the evidence for the use of both methods is sparsely elucidated. Knowledge and evidence about SAW and DWW are important elements in nursing staff’s clinical decision-making (CDM) regarding choice of washing method for a bed bath. In particular, three factors are relevant in the choice of washing method for bed baths: evidence for the effectiveness of SAW and DWW to remove microorganisms (MOs) on the skin, the patients’ perspective on the use of SAW and DWW for bed baths, and knowledge about cost. This PhD aimed to address these factors by investigating the use of SAW and DWW for bed baths, using both qualitative and quantitative methods.
Aim:
The overall aim of this PhD study was to provide new insights into the use of SAW and DWW for bed bath and thereby contribute to increased quality of CDM regarding bed bath practices for bedridden patients.
Methods:
The PhD study was based on a mixed methods research design that included three individual studies. In study I, a block-randomized cross-over design was employed to compare the efficacy of SAW and DWW to remove microorganisms (MOs) on the skin. Skin swabs from the groin and perineum of 72 admitted patients before and after washing with SAW and DWW, respectively, were microbiologically analysed and compared. In study II, qualitative interviews were conducted with 16 hospitalized, bedridden patients who had received bed baths with both SAW and DWW. The aim was to explore the patients’ perspectives on the use of SAW and DWW for bed baths. Study III was a scoping review, which aimed to identify relevant operating and capital costs in previously published cost analyses for bed bath washing methods. The mixed methods findings and results were integrated through narrative weaving.
Results:
In study I, no significant difference in the effectiveness of the two washing methods to reduce the amounts of MOs in the groin and perineum was found, but the total number of MO species was significantly reduced after washing with both methods. Furthermore, new types of MO species appeared after washing, regardless of which method was used. The patients in sub-study II preferred SAW to DWW, since it gave a sense of cleanliness, which was considered essential in social relations. In specific situations, DWW were preferred, for example, to freshen up. Washing the face and hands was thought to require special care, and hands should be washed at least once a day. Although patients would like to have the opportunity to be involved in the decision regarding choice of washing method, for them the important thing was to be washed. Study III identified a lack of transparency and structure in nine published cost analyses for washing methods, which makes it unclear whether there is a real difference in the costs between SAW and DWW. Despite this, the literature shows that DWW requires less time than the use of SAW. Relevant running costs, capital costs and consequences of washing methods were identified for SAW and DWW. The themes of integrated findings were: “Shared clinical decision-making regarding choice of washing method for bed bath”, “Freshening up or feeling really clean” and “Cleanliness in social relations”.
Conclusion:
Effectiveness of washing methods, the individual patients’ preferences and costs are important perspectives to consider in the shared clinical decision of washing methods for bed baths. Overall, the patients would like to have the opportunity to be involved in the clinical decision regarding choice of washing method for bed baths. However, the most important thing, in their opinion, was to be washed.
SAW was preferred for bed baths and handwashing and DWW was preferred in specific situations. The patients distinguished between “freshening up” and being “really washed” and cleanliness was essential in social relationships. There was no difference in the effectiveness of the two washing methods to remove MOs and it is unclear if there is a difference in the cost between SAW and DWW. Although the use of DWW seem to require less time than the use of SAW.