title: The provision of patient personal hygiene in the intensive care unit: a descriptive exploratory study of bed-bathing practice.
abstract: OBJECTIVE
  The provision of the patient bed-bath is a fundamental nursing care activity yet few quantitative data and no qualitative data are available on registered nurses' (RNs) clinical practice in this domain in the intensive care unit (ICU). The aim of this study was to describe ICU RNs current practice with respect to the timing, frequency and duration of the patient bed-bath and the cleansing and emollient agents used.
  
  
  METHODS
  The study utilised a two-phase sequential explanatory mixed method design. Phase one used a questionnaire to survey RNs and phase two employed semi-structured focus group (FG) interviews with RNs. Data was collected over 28 days across four Australian metropolitan ICUs. Ethical approval was granted from the relevant hospital and university human research ethics committees. RNs were asked to complete a questionnaire following each episode of care (i.e. bed-bath) and then to attend one of three FG interviews: RNs with less than 2 years ICU experience; RNs with 2-5 years ICU experience; and RNs with greater than 5 years ICU experience.
  
  
  RESULTS
  During the 28-day study period the four ICUs had 77.25 beds open. In phase one a total of 539 questionnaires were returned, representing 30.5% of episodes of patient bed-baths (based on 1767 bed occupancy and one bed-bath per patient per day). In 349 bed-bath episodes 54.7% patients were mechanically ventilated. The bed-bath was given between 02.00 and 06.00h in 161 episodes (30%), took 15-30min to complete (n=195, 36.2%) and was completed within the last 8h in 304 episodes (56.8%). Cleansing agents used were predominantly pH balanced soap or liquid soap and water (n=379, 71%) in comparison to chlorhexidine impregnated sponges/cloths (n=86, 16.1%) or other agents such as pre-packaged washcloths (n=65, 12.2%). In 347 episodes (64.4%) emollients were not applied after the bed-bath. In phase two 12 FGs were conducted (three FGs at each ICU) with a total of 42 RN participants. Thematic analysis of FG transcripts across the three levels of RN ICU experience highlighted a transition of patient hygiene practice philosophy from shades of grey - falling in line for inexperienced clinicians to experienced clinicians concrete beliefs about patient bed-bath needs.
  
  
  CONCLUSIONS
  This study identified variation in process and products used in patient hygiene practices in four ICUs. Further study to improve patient outcomes is required to determine the appropriate timing of patient hygiene activities and cleansing agents used to improve skin integrity.
authors.affiliation: School of Nursing and Midwifery, Queensland University of Technology, Victoria Park Road, Kelvin Grove, QLD 4059, Australia. f.coyer@qut.edu.au
authors.forename: Fiona M
authors.initials: FM
authors.lastname: Coyer
authors.forename: Judy
authors.initials: J
authors.lastname: O'Sullivan
authors.forename: Nicola
authors.initials: N
authors.lastname: Cadman
mesh_terms: D001494:Baths / Q000451:nursing* / Q000706:statistics & numerical data; D004643:Emollients / Q000627:therapeutic use; D005260:Female; D017144:Focus Groups; D019538:Health Care Surveys; D006302:Health Services Research; D006801:Humans; D006920:Hygiene / Q000592:standards; D007362:Intensive Care Units / Q000458:organization & administration / Q000592:standards*; D024802:Nurse's Role; D009732:Nursing Care / Q000458:organization & administration / Q000592:standards*; D010043:Outcome and Process Assessment, Health Care
chemical_list: D004643:Emollients