The Basinless Bath A Study on Skin Dryness and Patient Satisfaction

<strong>The</strong> <strong>Basinless</strong> <strong>Bath</strong>:A <strong>Study</strong> on SkinDryness and PatientSatisfactionJoyce Kron-Chalupa, RN, MSN, Teresa Benda, RN, Brenda Williams, RNIowa City Veterans Affairs Medical CenterOVERVIEWProper skin care provides comfort and preventsand treats skin breakdown. For older adults,skin care takes on particular importance becauseas people age the skin becomesmore susceptible to burns, bruising,xerosis (dry skin), pressuresores, shear type injuries anddelayed wound healing. It isestimated that 59% to 79% of theelderly have pruritic skinconditions.<strong>The</strong> AHCPR pressure ulcer preventionguideline states: Skinshould be cleansed at time ofsoiling and at routine intervals.<strong>The</strong> frequency of skin cleansingshould be individualizedaccording to need and/orpatient preference 1 .Nurses assume the major responsibilityfor skin and wound managementin most healthcare settings 2 .Administration of the daily bed bath is seen bymany nurses as one of their most important tasks(Webster, Bowman, Sutton, 1988) and a time tospend talking with the patient and/or assessing apatient’s condition. Choosing the appropriatebathing method is one way nurses can helpprevent skin problems.OBJECTIVEFirst, to compare the basinless bath to the traditionalbasin bath for effectiveness at improvingdry skin, patient satisfaction, nurse satisfactionand cost effectiveness.Second, to evaluate and choose abasinless bath product based on thefollowing criteria: packaging,warmth, cleansing solution, clinicalresearch, nurse satisfaction andpatient satisfaction.BASINLESS BATH VS.TRADITIONAL BASIN BATH<strong>The</strong> main concept behind the basinlessbath is the use of one washcloth per body part/extremity, thusavoiding cross contamination.Some products offer disposablewash cloths with a surfactant basedcleansing solution containing tissuefriendly emollients that help maintain moisture inthe skin. <strong>The</strong> solution quickly evaporates from theskin’s surface making towel drying unnecessary,thus avoiding further friction to the patient’s skin.Nursing time: 10 minutes.<strong>The</strong> traditional basin bath includes: basin, barsoap, water, wash cloths, towels and a moisturizinglotion. Nursing time: 20 to 30 minutes.

STUDYThis quasi-experimental study was performed todetermine if the basinless bath was as effective asthe traditional basin bath. Variables studied werepatient skin condition, patient satisfaction, nursesatisfaction and cost analysis. A sample of 60patients, requiring complete or partial bed baths,were selected from the Iowa City Veterans AffairsMedical Center on the Progressive Care Unit andthe Surgical Unit.A thorough skin assessment using a modifiedversion of the Skin Condition Data Form (SCDF)developed by Frantz and Kinney (1986) wasobtained prior to bathing 3 . Patients served astheir own controls with the right side of the bodyreceiving the experimental treatment (basinlessbath) and the left side of the body receiving thecontrol (traditional basin bath).Patients were bathed for three consecutive daysusing the experimental and control treatments.After the third bath, another skin assessment usingthe SCDF was performed.1.) Flaking:appearanceof dandrufflike flakeswhen fingersare lightlyrubbed overskin surface.2.) Scaling:fish like scales onthe skin’s surfacethat are easilyrubbed off withfingers.RESULTSFlakyScalyINSTRUMENT<strong>The</strong> Skin Condition Data Form (SCDF) wasselected as the assessment tool for this study.Frantz and Kinney (1986) developed this tool toanalyze the relationship between sebum contentand dry skin for subjects over the age of 65. In apilot study (Hardy, 1990) utilizing the SCDF inassessing the skin condition of 15 elderly longtermcare residents, analysis of the data obtainedsuggested that scaling and flaking were validindicators of dry skin 4 .<strong>The</strong> following summary shows statistical significanceof improved skin condition.Skin Condition After <strong>Bath</strong>ingBody Part <strong>Basinless</strong> <strong>Bath</strong> Traditional Basin <strong>Bath</strong>Upper arms - anteriorUpper arms - posteriorForearms - anteriorForearms - posteriorThighs - anteriorThighs - posterior.0001.0002.0001.0001.00024.00024.0008.0014.0001.0001.00012.00024Statistically significant(p

Patient SatisfactionStrongly Agree Disagree StronglyAgreeDisagree1. I felt clean after the basinless bath.2. Privacy was respected during the bath.3. <strong>The</strong> basinless bath was easy to use.4. My skin felt soft after the basinless bath.5. <strong>The</strong> bath I liked best was: <strong>Basinless</strong> <strong>Bath</strong> 97% Traditional Basin <strong>Bath</strong> 3%Nurse Satisfaction1. <strong>The</strong> basinless bath is easy to administer.2. <strong>The</strong> basinless bath technique saves me time.3. <strong>The</strong> patient is clean after the basinless bath.4. My hands felt soft after using the basinless bath.5. <strong>The</strong> patient was satisfied with the basinless bath.62% 38%58% 42%72% 28%67% 33%Strongly Agree Disagree StronglyAgreeDisagree87% 13%75% 25%68% 32%87% 13%72% 28%6. <strong>The</strong> bathing technique I liked best was: <strong>Basinless</strong> bath 100% Traditional Basin <strong>Bath</strong> 0%CONCLUSION<strong>The</strong> basinless bath not onlyimproved dry skin, but wasoverwhelmingly preferred byboth patients and nurses participatingin this study. <strong>The</strong>basinless bath was also foundto be a highly cost effectivealternative to the traditionalbasin bath. On average, thebasinless bath took 10 minutesto administer comparedto 21 minutes for the basinbath which decreased thelabor cost per bath by half.Cost Analysis Supplies Cost per <strong>Bath</strong>Traditional Basin <strong>Bath</strong><strong>Basinless</strong> <strong>Bath</strong>Basin - reusable ($2.06)Bar Soap<strong>Bath</strong> Oil (1/2 bottle)4 Washcloths ($.38ea.)2 Towels ($1.50ea.)Launder Washcloths (4oz.)Launder Towels (8oz.)Nursing TimeNursing Salary ($.24/minute)TotalProductNursing TimeNursing Salary ($.24/minute)Total--.08.95.12.30.26 (4 per bath).26 (2 per bath)21 minutes5.04$7.012.5010 minutes2.40$4.90Upon determining the effectivenessof the basinless bath,it was necessary to evaluateand select a basinless bathproduct. <strong>The</strong> Comfort <strong>Bath</strong>from Sage Products waschosen due to its insulatedpackaging that retainswarmth, effective cleansingsolution and moisturizingability. Patients and nursesunanimously preferred theComfort <strong>Bath</strong>.<strong>Basinless</strong> <strong>Bath</strong> Savings$2.11 per bathProductSelec tionCriteriaComfort <strong>Bath</strong> 1Bag <strong>Bath</strong> 2Septi-Soft 3 PackagingXWarmthXCleansingSolutionXXMoisturizingAbilityXClinicalResearchNurseSatisfactionXPatientSatisfactionX

REFERENCES1234U.S. Agency for Health Care Pressure Ulcers inAdults: Prediction and Prevention (AHCPR Pub. No.92-0047). Rockville, M.D., U.S. Department of Healthand Human Services, (1992).Frantz, R.A., and Gardner, S., (1996). ClinicalConcerns: Management of Dry Skin. Journal ofGerontological Nursing, 15-18.Frantz, R.A., and Kinney, C.N., (1986). Variable associatedwith skin dryness in the elderly. NursingResearch. 35, 98-100.Hardy, M., (1990). A Pilot <strong>Study</strong> of the Diagnosis andTreatment of Impaired Skin Integrity. NursingDiagnosis, 10-18.1Comfort <strong>Bath</strong> is a trademark of Sage Products Inc.2Bag <strong>Bath</strong> is a trademark of Incline Technologies, Inc.20060B3Septi-Soft ® is a registered trademark of ConvaTec