Minimum wiping pressure and number of wipes that can remove dirt during bed baths using disposable towels: a multi-study approach

Abstract

Background: Friction irritation by wiping increases the risk of skin problems. In bed baths with cotton towels, wiping three times with weak pressure (10-20 mmHg ≈ 1333-2666 Pa) can remove dirt while maintaining skin barrier function. However, few studies have examined the appropriate frictional irritation with disposable towels. This study aimed to analyse the wiping pressure and number of wipes currently applied by nurses when using disposable towels during bed baths and propose the minimum values for removing dirt from the skin.

Methods: This multi-study approach consisted of cross-sectional and crossover design components. In Study 1, 101 nurses in two hospitals were observed by recording the wiping pressure and number of wipes when using both disposable (nonwoven) and cotton (woven) towels. Wiping pressure and number of wipes by towel materials were analysed using a linear mixed model. In Study 2, 50 adults received oily and aqueous dirt on their forearms, which were wiped six-times with disposable towels, applying randomly assigned pressure categories. We used colour image analysis and a linear mixed model to estimate the dirt removal rate for each combination of wiping pressure and number of wipes.

Results: Study 1 showed that although wiping pressure did not differ by towel material, the number of wipes was significantly higher for disposable wipes than cotton wipes. Approximately 5% of nurses applied strong wiping pressure or wiped too often. In Study 2, wiping three times with disposable towels at least 5-10 mmHg achieved dirt removal rates of ≥80%.

Conclusions: Some nurses excessively wiped using disposable towels, which might cause skin problems. However, excessive wiping is not required to adequately remove dirt, regardless of the towel material used in various clinical situations. We recommend wiping at 10-20 mmHg of pressure (just like stroking gently) at least three times to improve the quality of bed baths. These findings highlight the need to develop skin-friendly bed bath educational programmes, particularly using appropriate frictional irritation to reduce the risk of skin problems.

Keywords: Baths; Bed baths; Cross-sectional studies; Disposable wipes; Hygiene; Nursing care; Quasi-experimental studies; Skin care.

Fig. 1

Disposable towel used in this study

Fig. 2

Box plots indicating distributions of wiping pressure and number of wipes by towel materials. Notes: Box plots of (A) wiping pressure (WP) and (B) number of wipes (NW) by towel materials. The median is denoted by the line within the box; 25th percentile, bottom border of box; 75th percentile, top border of box; variability outside the interquartile range, whiskers; and outside values, dots. The nurses applied WP and NW based on three classifications: ordinary (WP and NW applied in daily bed baths); weak (WP and NW for patients with vulnerable skin); and strong (WP and NW for patients with heavily contaminated skin). See Additional file 3 for details of statistical information; Interaction and main effect were analysed in a linear mixed model for two-way repeated-measures ANOVA (Effect size was calculated as partial η²); Wilcoxon signed-rank test showed that the number of wipes using disposable towel was significantly more often than that of cotton towel under the strong (a, P < .001) and ordinary (b, P = .018) condition. c, approximately 15% of the nurses performed patting only in the weak condition (Cotton towel; n = 84)

Fig. 3

Least squares means (LSMs) of skin dirt removal rate by wiping using disposable towel. Notes: LSMs of removal rate for (A) oily dirt and (B) aqueous dirt by categories of wiping pressures or number of wipes (n = 50); In the digital image colour analysis, a dirt removal of rate ≥80% can be considered as a sufficient dirt removal. The circles indicate the LSMs as determined by a linear mixed model as a function of the combination of wiping pressure and number of wipes; The error bars indicate the 95% confidence interval; The wiping pressure (WP: mmHg) is classified into four categories represented by the numbers on the x-axis;1, 5≤WP<10; 2, 10≤WP<20; 3, 20≤WP<30; 4, 30≤WP<40

Fig. 4

Nurses who performed the minimal effective wiping pressure and number of wipes during disposable wipes. Notes: Group A (n = 14), the group of nurses who performed the minimal effective wiping pressure and number of wipes (i.e., wiping three times at 5–10 or 10–20 mmHg); Group B (n = 12), the group of nurses who wiped three times at 20 or more mmHg; and Group C (n = 75), the group of nurses who wiped four or more times