NEW YORK NURSE: April 2009
by Wendy C. Budin, PhD, RN-BC, Director Of Nursing Research, Nyu Langone Medical Center
The results of a prospective, multi-center study recently published in the American Journal of Critical Care indicated patients’ bath basins are a potential source of infection.
Johnson, Lineweaver, and Maze (2009) reported the finding of their study conducted at three acute care hospitals. The purpose of the study was to identify and quantify bacteria in patients’ bath basins and evaluate the basins as a possible reservoir for bacterial colonization and a risk factor for subsequent hospital-acquired infection.
Hospital-acquired infections (HAIs) affect millions of patients in the United States, resulting in an annual healthcare cost of more than $6.5 billion (Stone, Braccia, & Larson, 2005). As regulations, legislation, and changing payment structures increase the pressure to eliminate HAIs, healthcare facilities are looking more closely at a variety of potential sources of contamination. There is growing evidence to support the presence of microbial colonization on a patient’s skin (Larson, McGinley, Foglia, Talbot, & Leyden, 1986), facility water supplies (Exner, Kramer, Lajoie, Gebel, Engelhart, & Hartemann, 2005), and a variety of environmental surfaces, including the commonly used disposable bath basin.
The most recent research posed the question, “Can patients’ bath basins harbor microorganisms that are potential sources of hospital-acquired infection, even after the removal of the possible contaminated water?” Sterile culture sponges were used to obtain samples from 92 bath basins, including those from three intensive care units (cardiac care, surgical intensive care, and medical intensive care) and a rehabilitation unit.
The sampling was limited to basins used at least twice for whole-body bathing of patients hospitalized for 48 hours or longer. The basins were tested at least two hours after the bath water had been emptied and the basins had been allowed to dry. Bath basins were not cleaned with any substance after patients were bathed. Once the culture sponges were obtained, they were sent to an outside microbiological testing laboratory for analysis.
Results indicated that some form of bacteria grew in 98% of the samples (90 sponges). The organisms with the highest positive rates of growth were enterococci (54%), gram-negative organisms (32%), Staphylococcus aureus (23%), vancomycin-resistant enterococci (13%), methicillin-resistant Staphylococcus aureus (8%), Pseudomonas aeruginosa (5%), Candida albicans (3%), and Escherichia coli (2%).
The authors concluded that bath basins indeed were a reservoir for bacteria and that further studies of their connection to HAI are needed. Increased awareness of the infectious potential of bath basins is also warranted, especially for patients in high-risk groups.
Although the healthcare industry has made some progress toward addressing the problem of HAI, hospitals and clinicians need to explore all potential sources of contamination if they are to get this major cause of morbidity and mortality under control. This study suggests that patient bath basins can spread harmful bacteria during bathing. In addition, the authors suggest that reusable washcloths can spread harmful bacteria during bathing when bacteria are transferred to the basin and then returned to the patient. Patients who have surgical wounds or skin breakdown are especially prone to infection from bath water.
The results of this study challenge nurses to develop and implement bathing protocols that address the potential for exposure to pathogens during bed baths. The most obvious and simple step to reduce a patient’s exposure to these potential sources of infection is to find methods for bathing patients in the hospital that do not use a bath basin. One suggestion is to use prepackaged bathing supplies instead of a water-filled bath basin. The researchers also recommend that rough, reusable towels be avoided because they produce mechanical friction that releases skin flora and potentially harmful microorganisms into the water and back onto the skin.
Exner, M., Kramer, A., Lajoie, L., Gebel, J., Engelhart, S., Hartemann, P. (2005). Prevention and control of health care-associated waterborne infections in health care facilities. American Journal of Infection Control. June:33(5 suppl):S26-S40.
Johnson, D., Lineweaver, L., Maze, L. (2009). Patients’ bath basins as potential sources of infection: A multicenter sampling study. American Journal of Critical Care. 18(1), 31-38.
Larson, E.L., McGinley, K.J., Foglia, A.R., Talbot, G.H., Leyden, J.J. (1986) Composition and antimicrobic resistance of skin flora in hospitalized and healthy adults. Journal of Clinical Microbiology. 23, 604-608.
Stone, P.W., Braccia, D., Larson, E. (2005). Systematic review of economic analyses of health care-associated infections. American Journal of Infection Control. 33:501-509.