The Dirty Job of Keeping Clean: An Assessment of Current Bathing Practices at a Veterans Affairs Medical Center

Background:   The skin of hospitalized patients is an important source for transmission of healthcare associated pathogens such as Clostridium difficile, vancomycin-resistant Enterococcus (VRE), and methicillin-resistant Staphylococcus aureus (MRSA).  Bathing of patients may be a useful strategy to reduce the burden of pathogens on skin. However, very limited information is available on current bathing practices among hospitalized patients and on factors that might limit the ability of patients to bathe.

Objective: To test the hypothesis that factors such as decreased mobility and presence of invasive devices limit the ability of hospitalized patients and long-term care facility (LTCF) residents to perform adequate bathing.

Methods: We interviewed and reviewed medical records of a random sample of acute-care patients and LTCF residents at the Cleveland Veterans Affairs Medical Center to assess bathing practices. Multivariate logistic regression analysis was used to determine factors that limit the frequency of bathing and ability to shower.

Results: Of 238 patients interviewed, 126 (53%) were acute-care patients and 112 (47%) were LTCF residents. A total of 47% of acute-care and 87% of long-term care residents received bed-baths rather than showering. On logistic regression analysis, receiving bed-baths rather than showering was associated with being in contact precautions (OR 0.06, 95% CI [0.01-0.51]) and decreased mobility (for each 1 unit increase in mobility score, there was a 3-fold increase in likelihood of showering (OR 3, 95% CI [1.1-8]). Only 66 (28%) of acute-care patients and 22 (20%) of LTCF residents reported bathing daily either by bed-bath or shower. Increased Braden score and LTCF residence were associated with decreased frequency of bathing (overall regression adjusted R square = 0.22, P<0.001). In interviews, the most common factors that patients cited as limiting ability to bathe were decreased mobility, presence of devices, weakness, and pain.

Conclusions: The ability of hospitalized patients and LTCF residents to perform adequate bathing is limited by a variety of factors such as decreased mobility and presence of devices. Interventions are needed to improve the quality and frequency of bathing as a strategy to reduce the spread of healthcare-associated pathogens.