‘Petty rules on nurses’ stations seem absurd and dangerous’

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. Factors that negatively affect skin health

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 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.

Plastic 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).

The 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).

Box 2 outlines the general principles of bed bathing.

Box 2. General principles of bed bathing

Source: Ersser et al (2005); Dougherty and Lister (2015)

Tagged with: Assessment skills: personal care Coronavirus zone: essential clinical skills Newly qualified nurses: practical procedures

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