Microbiological efficacy and skin tolerance of commonly used nonantiseptic inpatient bathing practices in non-ICU settings: A systematic review

Abstract

Background: Nonantiseptic bathing practices among inpatients and residents of nursing homes vary in terms of frequency, bathing type and product. We performed a systematic review to compare the efficacy of different bathing practices in reducing skin colonization, health care-associated infections (HAI) or their impact on skin integrity.

Methods: We searched Medline and Embase up until February 2018 testing a combination of terms for 3 concepts: (1) personal hygiene, (2) inpatients, (3) skin colonization, integrity or HAIs. Studies set in ICUs or including children were excluded. This review was registered in PROSPERO: CRD42018091639.

Results: Seven studies were included. No statistically significant impact in terms of reduced skin colonization was described irrespective of bathing product, type or frequency except for a reduced burden of C difficile on the skin of infected patients after showering compared to bathing. One study addressing impact on HAI did not detect a significant difference when a waterless no-rinse product was used. Integrity of the skin was better preserved by no-rinse products.

Conclusions: No study described a statistically significant reduction of bacterial skin colonization or incidence of HAI after bathing hospitalized patients with nonantiseptic products. However, waterless no-rinse products were associated with less skin damage in most studies.

Keywords: Colonization; Inpatients; Nosocomial infection; Skin; Washing.