The effectiveness of bed bathing practices on skin integrity and hospital-acquired infections among adult patients: A systematic review protocol

Review question/objective: The objective of this systematic review is to identify, appraise and synthesize the best available evidence on the effectiveness of bed bathing practices on skin integrity and hospital-acquired infection (HAI) among adult patients. More specifically, the review question is: What is the effectiveness of traditional towel bed bath practice compared to other innovate bed bath practices on maintaining skin integrity, skin barrier function and reduction of pathogen microbial counts on skin among adult patients in all settings? Inclusion criteria: Types of participants: This review will consider studies that include patients over the age of 18 with no upper age limit, regardless of ethnicity and gender, in all hospital wards. Patients with skin allergies, visible damage to their skin, a chronic skin condition (e.g., eczema, or dermatitis), sensitive skin, or pre-existing medical conditions known to affect the dermal vasculature (e.g., diabetes) will be excluded. Types of intervention(s): This review will consider studies that evaluate bed bath practices performed by healthcare staff, in particular nurses. Intervention: The intervention of interest is innovate bed bath practices, including all bag bath interventions, not limited to any specific type or brand. For the purpose of this systematic review, bag bath interventions include bathing patients with pre-packaged disposal washcloths by use of a different cloth to wash each part of the patient's body. The washcloths typically comprise rayon/polyester cloth pre-moistened with an evaporating no-rinse cleanser and emollients. Comparator: The comparator is the traditional bed bath (towel bed bath) intervention, regardless of type and frequency. For the purposes of this systematic review, traditional bed bath refers to a practice using one new washcloth for each body part and the equipment includes a washbasin, water, towel, washcloths and soap. Types of outcomes: This review will consider studies that include the following outcome measures: Primary outcome: •Hospital-acquired infections defined as infections that becomes evident 48 hours after admission and are measured through surveillance of infection rates. Secondary outcome: •Skin microbiology measured by pathogen microbial counts on skin. •Skin barrier function and skin integrity measured by skin flakes, skin dryness, water vapour pressure gradient and skin pH.