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Patients' Bath Basins May Serve as a Reservoir for Potential Sources of Infection
Abstract & Commentary
By Leslie A. Hoffman, RN, PhD, Department of Acute/Tertiary Care, School of Nursing, University of Pittsburgh, is Associate Editor for Critical Care Alert.
Dr. Hoffman reports no financial relationship to this field of study.
Synopsis: Some form of bacteria grew in 98% of samples cultured from patient bath basins obtained from three acute care hospitals, including basins from three ICUs.
Source: Johnson D, et al. Patients' bath basins as potential sources of infection: A multicenter sampling study. Am J Crit Care 2009;18:31-38, 41.
This study examined patients' bath basins as a possible reservoir for bacterial colonization and a risk factor for subsequent hospital-acquired infections. In a prospective study involving 3 acute care hospitals, 92 bath basins were evaluated including basins from 3 ICUs (cardiac care, surgical ICU, medical ICU). The basins cultured for the study were used at least twice for whole-body bathing of patients who were hospitalized for ≥ 48 hours (mean 6.9 days). Cultures were obtained by swabbing the basins after the bath water had been emptied and the basins were allowed to air dry for at least 2 hours after bathing.
Some form of bacteria grew in 98% of the samples. The organisms with the highest positive rates of growth were enterococci (54%), gram-negative organisms (32%), Staphylococcus aureus (23%), vancomycin-resistant enterococci (VRE, 13%), methicillin-resistant Staphylococcus aureus (MRSA, 8%), Pseudomonas aeruginosa (5%), Candida albicans (3%), and Escherichia coli (2%). Mean plate counts, in colony-forming units, were 10,187 for gram-negative organisms, 99 for E. coli, 30 for P. aeruginosa, 86 for S. aureus, 207 for enterococci, and 31 for VRE. Findings suggest that bath basins may be a reservoir for bacteria and, therefore, a potential source of transmission of hospital-acquired infections.
Findings of this study suggest that potentially harmful microorganisms are present in bath basins in acute and critical care settings. With 2 exceptions, all cultures grew some form of bacteria, including VRE and MRSA. As part of infection control precautions, all at-risk patients who were admitted to ICUs were screened for MRSA (nares) on admission and all tested negative. Therefore, positive cultures were obtained from basins used by patients who were not previously identified as carriers. The researchers noted that all of the basins sampled were stored upright, instead of upside down, a position that allowed any water remaining in the basin to pool at the bottom. In some units, multiple basins were stacked on top of each other and basins were used for storage of incontinence cleanup items and other patient supplies, a practice that potentially created additional opportunities for contamination. In addition, nurses disposed of used bath water in sinks used for hand-washing, a practice that could result in contamination of the sink and surrounding areas.
Health care facilities have taken numerous steps to prevent nosocomial infections, including disinfection procedures, contact precautions, and education regarding the importance of adhering to protocols for gloving and hand-washing between each patient visit. Findings of this study provide strong support for the use of prepackaged bath products as a means of reducing risk for nosocomial infection. With a properly used bath pack, the same washcloth is not used to bathe the entire body, thus reducing the potential of spreading bacteria from one body area to another. Bathing requires less time and the product contains a skin conditioner that avoids the drying effects of soap and water. Prior studies have reported lower microbial counts on patients' skin after a prepackaged bath, compared to a bath given with a bath basin, although the differences were not significant.