title: How does washing without water perform compared to the traditional bed bath: a systematic review.
abstract: For immobile patients, a body wash in bed is sometimes the only bathing option. Traditionally, the bed bath is performed with water and soap. However, alternatives are increasingly used in health care. Washing without water is one such alternative that has been claimed to offer several advantages, such as improved hygiene and skin condition. This systematic review aims to provide a comprehensive overview of the evidence on outcomes of the washing without water concept compared to the traditional bed bath.
  
  
  
  Controlled trials about washing without water outcomes published after 1994 were collected by means of a systematic literature search in CINAHL, Embase, MEDLINE, and PUBMED at the 25th of February, 2016. Additionally, references and citations were searched and experts contacted. Studies were eligible if (1) the study designs included outcomes of washing without water products developed for the full body wash compared to the traditional bed bath, and (2) they were controlled trials. Two researchers independently used a standardized quality checklist to assess the methodological quality of the eligible studies. Finally, outcomes were categorized in (1) physiological outcomes related to hygiene and skin condition, (2) stakeholder-related outcomes, and (3) organizational outcomes in the data synthesis.
  
  
  
  Out of 33 potentially relevant articles subjected to full text screening, six studies met the eligibility criteria. Only two studies (of the same research group) were considered of high quality. The results of these high quality studies show that washing without water performed better than the traditional bed bath regarding skin abnormalities and bathing completeness. No differences between washing without water and the traditional bed bath were found for outcomes related to significant skin lesions, resistance during bathing and costs in the studies of high quality.
  
  
  
  There is limited moderate to high quality evidence that washing without water is not inferior to the traditional bed bath. Future research on washing without water is needed and should pay special attention to costs, hygiene, and to stakeholder-related outcomes, such as experiences and value perceptions of patients, nursing staff and family.
authors.affiliation: Department of Health Services Research, School for Public Health and Primary Care (CAPHRI), Maastricht University, Duboisdomein 30, 6229 GT, Maastricht, The Netherlands. f.groven@maastrichtuniversity.nl.|Department of Health Services Research, School for Public Health and Primary Care (CAPHRI), Maastricht University, PO box 616, 6200 MD, Maastricht, The Netherlands. f.groven@maastrichtuniversity.nl.
authors.forename: Fabian M V
authors.identifier: 0000-0002-4990-0144
authors.initials: FM
authors.lastname: Groven
authors.affiliation: Department of Health Services Research, School for Public Health and Primary Care (CAPHRI), Maastricht University, Duboisdomein 30, 6229 GT, Maastricht, The Netherlands.
authors.forename: Sandra M G
authors.initials: SM
authors.lastname: Zwakhalen
authors.affiliation: Department of Marketing & Supply Chain Management, School of Business and Economics, Maastricht University, Tongersestraat 53, 6211 LM, Maastricht, The Netherlands.
authors.forename: Gaby
authors.initials: G
authors.lastname: Odekerken-Schröder
authors.affiliation: Arion Holding, Vouersweg 103, 6161 AG, Geleen, The Netherlands.
authors.forename: Erik J T
authors.initials: EJ
authors.lastname: Joosten
authors.affiliation: Department of Health Services Research, School for Public Health and Primary Care (CAPHRI), Maastricht University, Duboisdomein 30, 6229 GT, Maastricht, The Netherlands.
authors.forename: Jan P H
authors.initials: JP
authors.lastname: Hamers
mesh_terms: D001494:Baths / Q000379:methods / Q000592:standards; D006233:Persons with Disabilities; D006801:Humans; D006920:Hygiene / Q000592:standards*; D012499:Sanitation / Q000379:methods*; D012915:Soaps; D014867:Water
chemical_list: D012915:Soaps; D014867:Water
keywords: Bathing; Baths; Bed bath; Hygiene; Patient experiences; Review; Washing without water