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Table 4 Results regarding washing without water outcomes

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

Study

Washing without water outcome

Sample population at end of study

Results

Gillis et al. (2015) [26]

Skin hydration (stratum corneum) at the leg, hand, and cheek

150 Residents in pre-test and post-test stages (108 in the intervention group and 42 in the control group)

The post minus pre skin hydration scores were higher for the intervention group (washing without water) compared to the control group (traditional bed bath) at the cheek (p = 0.02) showing a higher increase in skin hydration for this skin site in the intervention group.

van Achterberg et al. (2015) [25]

Bathing completeness

450 Residents (257 in the intervention group and 193 in the control group)

Bathing completeness was more often found in the intervention group (washing without water) (p < 0.0001). When all body parts were cleaned, bathing was considered complete.

Schoonhoven et al. (2015) [2]

Any skin abnormalities

450 Residents (257 in the intervention group and 193 in the control group)

There is a difference in prevalence of any skin abnormalities over time (p = 0.04). The number of skin abnormalities decreased in the intervention group (washing without water) and increased in the control group (traditional bed bath). Any skin abnormalities included bright red discoloration, erythema, white, green or yellow discoloration of the wound bed, atrophic and shiny skin, satellite lesions and kissing lesions, fissures, erosions, or ulcerations on the buttocks, eyes, neck, armpits, elbows, sub-mammary region, umbilicus, abdomen, groins, anal cleft, or the skin between the toes.

 

Significant skin lesions

450 Residents (257 in the intervention group and 193 in the control group)

There is no difference in the prevalence of significant skin lesions over time between the intervention group and the control group (p = 0.82). If the skin on the buttocks, or in any of the skin folds in the sub-mammary region, abdomen, groins, or the anal cleft was not intact, the severity of the skin damage was considered to be significant.

 

Nurse satisfaction

275 Nurses

Nurses gave an average grade of 7.5 (out of 10) for washing without water with a standard deviation of 1.2. 61% Of the nurses would replace water and soap bed baths with washing without water.

 

Resident satisfaction

55 Residents

Residents gave an average grade of 7.1 (out of 10) for washing without water with a standard deviation of 2.0. 94% Thought washing without water cleaned the skin sufficient or good and 83% felt at least sufficiently fresh after being washed with washing without water. 61% Would permanently replace water and soap bed baths with washing without water.

 

Resistance during bathing

450 Residents (257 in the intervention group and 193 in the control group)

There is no treatment by time interaction (p = 0.713). Resistance is observed by nurses and present if the resident: wards the nurse off, avoids the nurse’s touch, is restless, turns away, struggles with the nurse, or protests verbally.

 

Costs

206 Observations of traditional baths and 272 observations of washing without water

There is no difference in costs at a confidence interval of 0.95. The total average costs over a time period of 6 weeks was €218,30 for washing without water and €232,20 for the traditional bed bath. The costs related to the nursing time needed to clean up after a bed bath were excluded from the calculation.

Nøddeskou et al. (2015) [28]

Nurse satisfaction

Preferences of 6 nurses for 54 individual bed baths

Nurses had a preference for washing without water compared to the traditional bed bath (p < 0.01).

 

Costs

58 Observations of traditional baths and 58 observations of washing without water

The average total costs of a washing without water bed bath in Danish Krone was 106.25 (11.84 material costs and 94.41 costs related to the salary of the nurse) compared to 126.96 for the traditional bed bath (11.87 material costs and 115.09 costs related to the salary of the nurse). Costs related to the use of machinery and electricity were excluded from the calculation.

 

Time of a bed bath

58 Observations of traditional baths and 58 observations of washing without water

Less time was used during all stages of the bed bath (preparation, the bath itself, and cleaning up) and in total when washing without water was used compared to the traditional bed bath (p < 0.001 for all).

 

Quality score

58 Observations of traditional baths and 58 observations of washing without water

Eight quality factors of the bed bath were checked and rated on a Likert scale from 1 to 10. The quality factors included (1) gathering bathing equipment, (2) wearing gloves, (3) explaining procedure to patient, (4) checking patients’ well-being, (5) ensuring patients’ privacy, (6) avoiding recontamination of patients’ skin, (7) cleaning all body surfaces, and (8) disposing equipment without environmental contamination, The mean total quality score for washing without water was 8 (out of 10) compared to a mean quality score of 7.9 (out of 10) for the traditional bed bath.

Larson et al. (2004) [27]

Reduction in microbial counts from the umbilicus

29 Paired observations

There was no difference in the total bacterial counts between washing without water and the traditional bed bath (p = 0.47) after the bed bath, although the number of microbial counts increased in the washing without water group (p = 0.04).

 

Reduction in microbial counts from the groin

33 Paired observations

There was no difference in the total bacterial counts between washing without water and the traditional bed bath after the bed bath (p = 0.78).

 

Reduction in microbial counts of gram-negative bacteria from the groin

33 Paired observations

There was no difference in the total bacterial counts between washing without water and the traditional bed bath (p = 0.22) after the bed bath, although the number of gram-negative bacteria counts decreased in the traditional bed bath group (p = 0.04).

 

Nurse satisfaction

40 Nurses

Nurses preferred washing without water over the traditional bed bath on the items related to convenience, time-consumption, patient comfort, required supplies, and overall preference (p < 0.001 for all). The only item for which no preference was expressed was about which bath type is more likely to clean and moisturize the skin (p = 0.20).

 

Costs

44 Observations of traditional baths and 44 observations of washing without water

The total average costs were $18.15 for washing without water compared to $19.87 for the traditional bed bath. Costs related to the use of water, heating and sewage (in case of the traditional bed bath) were excluded from the calculation.

 

Time of a bed bath

43 Observations of traditional baths and 43 observations of washing without water

The mean bath time was 12.8 min for washing without water compared to 14.4 min for the traditional bed bath. The total time did not differ between the two types of bed baths (p = 0.08). The time needed for the preparation of the bed bath and for cleaning up after the bed bath were excluded from the calculation. Instead, nurses were asked to estimate the time needed to prepare a bed bath. Nurses (n = 40) estimated that this would take significantly less time when a washing without water product is used.

 

Quality score

43 Observations of traditional baths and 43 observations of washing without water

The total quality score was 5.88 for washing without water compared to 5.51 for the traditional bed bath (p = 0.25). The quality of the bed bath was assessed by checking eight quality items. The quality items included (1) gathering bathing equipment, (2) wearing gloves, (3) explaining procedure to patient, (4) checking patients’ comfort and safety, (5) ensuring patients’ privacy, (6) avoiding recontamination of patients’ skin, (7) cleaning all body surfaces, and (8) disposing equipment without environmental contamination, The bed bath received a score of one point for each item met, resulting in a maximum score of 8.

Sheppard and Brenner (2000) [29]

Skin dryness

30 Residents (16 in the intervention group and 14 in the control group)

The total skin condition differed between the two types of bed baths (p < 0.001). The total mean scores were stable in the control group (traditional bed bath) and improved over time in the intervention group (washing without water). More specifically, there was a difference between the groups in flaking (p < 0.001) and scaling (p = 0.001).

 

Nurse satisfaction

11 Nurses

91% Of the nurses (strongly) agreed that washing without water was easy to administer and that residents were satisfied with this type of bed bath. 73% Thought washing without water was better for the skin of the resident compared to the traditional bed bath. 70% Thought the resident’s skin was clean after the bed bath with washing without water. 73% Indicated that washing without water was a worthy alternative for the traditional bed bath.

 

Resident satisfaction

7 Residents of the intervention group (washing without water)

All (strongly) agreed that the product was easy to use and all liked the bathing technique. 86% Felt clean and indicated they had a softer skin after the bed bath with washing without water. 71% Indicated washing without water was a worthy alternative for the traditional bed bath.