Reducing Risk Factors for CAUTI

With the CMS reimbursement mandates1, it is important to understand what is present on admission (POA) and prevent hospital-acquired infections (HAIs). Bathing provides staff an opportunity to observe any changes in the patient’s skin.

Basins used for bathing “frequently harbor pathogens associated with nosocomial infection.”2 By eliminating the basin, you also eliminate the bath water, which often contains a high bacteria count similar to the number in urine from patients with urinary tract infections (UTIs).3 Basin bathing is also a proven risk factor for catheter-associated urinary tract infections (CAUTIs).4 The Joint Commission recommends implementing “evidence-based practices to prevent indwelling catheter-associated urinary tract infections.”5 By eliminating the basin, your hospital can be following the Joint Commission’s recommendation.

Basin sampling has proved that the basin is a reservoir for bacteria, including S. aureus and the multi-drug resistant organisms (MDROs) methicillin-resistant S. aureus (MRSA) and vancomycin-resistant enterococci (VRE).2,6

This education section will help you address patient skin integrity issues, eliminate potential bath water contamination, and empower all levels of staff to observe and report changes during daily bathing. You can also find information about basin sampling to see what lives in your facility’s basins, from S. aureus to MRSA to VRE to C. diff.

These unique tools will help you assess current clinical practice, educate staff, customize and implement an evidence-based protocol, complete a performance improvement plan, and track progress on everything from skin breakdown, to staff compliance, to costs.

REFERENCE: 1. Federal Register, Vol. 72 No. 162, 2007 Aug. 47201-47205. 2. Marchaim D, et al., Hospital bath basins are frequently contaminated with multi-drug resistant human pathogens. Poster presented at SHEA 21st Annual Scientific Meeting, April 2011. 3. Shannon RJ, et al., J Healthcare Safety, Compliance & Infection Control. Apr 1999;3(4):180-4. 4.Stone S, et al., Removal of bath basins to reduce catheter-associated urinary tract infections. Poster presented at APIC 2010, New Orleans, LA, July 2010. 5. Joint Commission, National Patient Safety Goals, 2006. 6. Johnson D, Lineweaver, Maze L, Patients’™ bath basins as potential sources of infection: a multicenter sampling study, AJCC, Vol 18, No 1, Jan 2009.

Hospital bath basins are frequently contaminated with multidrug-resistant human pathogens
Marchaim D, Taylor AR, Hayakawa K, et al.
American Journal of Infection Control Aug 2012
Download article (PDF)

Patients’ Bath Basins as Potential Sources of Infection: A Multicenter Sampling Study 
Debra Johnson, Lauri Lineweaver, and Lenora M. Maze
American Journal of Critical Care Jan 2009;18(1):31-40.
View abstract 
View full text 
Download article (PDF) 

The hospital water supply as a source of nosocomial infections: a plea for action
Anaissie EJ, Penzak SR, Dignani MC
Myeloma and Transplantation Research Center, University of Arkansas for Medical Sciences, Little Rock AR.
Archives of Internal Medicine. Jul 8 2002;162(13):1483-92.
View abstract 
View full text 

Comparison of traditional and disposable bed baths in critically ill patients
Larson EL, Ciliberti T, Chantler C, Abraham J, Lazaro EM, Venturanza M, Pancholi P
American Journal of Critical Care. May 2004;13(3):235-41.
View abstract 
View full text 
Download authorized summary (PDF)

Comfort Bath® Cleansing System from Sage Products vs. the basin bath: patient preference
Skiba B, Chicago IL, 2000.
Download (PDF)

The basinless bath: A study on skin dryness and patient satisfaction
Kron-Chalupa J, Benda T, and Williams B
Iowa City Veterans Affairs Medical Center.
Download (PDF) 

Clinical Studies – Bath Water and Nosocomial Infection

Analysis of transmission pathways of Pseudomonas aeruginosa between patients and tap water outlets
Reuter S, Sigge A, Wiedeck H, Trautmann M
Departments of Medical Microbiology and Hygiene, University Hospital of Ulm, Germany.
Critical Care Medicine. Oct 2002;30(10):2222-8.
View abstract 

Bath Basin Elimination: Removing the bath basin to reduce catheter-associated urinary tract infection in critically ill patients
Cineas N, Beswick R, Vezina M
Poster presented at the American Association of Critical-Care Nurses National Teaching Institute May 16-19, 2016
Download poster (PDF)
Removal of Basin Baths to Reduce Catheter-Associated Urinary Tract Infections
Stone S, Chaffee D, Rowin K, Chasin M
Poster presented at the 37th Annual APIC Educational Conference July 11-15, 2010
Download poster (PDF)
Download handout (PDF)
Interventional Patient Hygiene (IPH): case study at the bedside
McGuckin M, Shubin A – University of Pennsylvania, Department of Physical Medicine & Rehab, Philadelphia, PA
Presented at the American Professional Wound Care Association National Conference, Philadelphia, PA, April 2007.
Download poster (PDF)
Hospital Bath Basins are Frequently Contaminated with Multi-Drug Resistant Human Pathogens
Marchaim D
Poster presented at the 21st Annual Scientific Meeting, April 1-3 2011
Download poster (PDF)
Download handout (PDF)
Patients’ Bath Basins: Friend or Foe
Johnson N
Poster presented at the Association for Professionals in Infection Control & Epidemiology (APIC), 2013
Download poster (PDF)
Unleashing the Positive Deviants at the Frontline: More than Just Sparking Change
Crump M, Bryce E, Ko S, Busto G
Poster presented at the Association for Professionals in Infection Control & Epidemiology (APIC), San Antonio, TX, June 2012
Download poster (PDF)
Good Bye, UTI! Removal of Traditional Basin Bathing Methods Leads to 78% Reduction in UTIs
Hamman H
Download poster (PDF)
Environmental Testing of Patient Bath Basins Drives Quality Improvement Efforts in the Prevention of Bacterial Cross-Contamination
Skelton L, Thomas K
Poster presented at the Association for Professionals in Infection Control & Epidemiology (APIC), Baltimore, MD, June 2011
Download poster (PDF)
Bugs be gone: identify potential source of HAIs, the basin
Lineweaver L, Hayes L, Stiesmeyer J, McCede L, Vollman K
Poster Presented at Institute for Healthcare Improvement (IHI), Orlando, FL, December 2007
Download poster (PDF)
Download handout (PDF)
Patient bath basins are a potential risk factor for HAIs in acute care
O’Flynn J Kosair Children’s Hospital
Poster presented at Association for Professionals in Infection Control and Epidemiology (APIC) June 2007.
Download poster (PDF)

What the Experts Say

Meatal Cleansing For the Foley Catheterized Patient

Hospital Tap Water and Basin Bath Water Contamination

SHEA/IDSA Practice Recommendation: Strategies to Prevent Catheter-Associated Urinary Tract Infections in Acute Care Hospitals: 2014 Update 

APIC Guide to Preventing Catheter-Associated Urinary Tract Infections, 2014
Download Guideline

Centers for Disease Control and Prevention. Guideline for Prevention of Catheter-Associated Urinary Tract Infections, 2009
Download Guideline

Joint Commission Clinical Care Improvement Strategies: Preventing Catheter-Associated Urinary Tract Infections, 2011
Order PDF book and Download sample pages (PDF)

Guidelines for environmental infection control in health-care facilities: recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee (HICPAC)
Sehulster L, Chinn RYW
Centers for Disease Control and Prevention. MMWR 2003;52 (No. RR-10):5,14.
Download water recommendations excerpt (PDF)
View full text

Basinless Bathing

Far more could be done to stop the deadly bacteria C. diff 
Peter Eisler USA Today
View full text

National average costs for traditional basin bathing
McNees, D. Claymore Consulting, St. Louis, MO 2002
Download report summary (PDF)

To flush or not to flush; disposable vs. basin bath?
Brown S
Healthcare Purchasing News. September 2004.
Download (PDF)

Bath Water and Nosocomial Infection

Legal and Ethical: Nosocomial Infections and Bath Water: Any Cause for Concern? 
Clark AP, John LD
Clinical Nurse Specialist. May-Jun 2006;20(3):119-23.
View abstract

Splish splash: what’s taking a bath in your hospital’s water system?
Roark J
Infection Control Today. Aug 2004;8(8):32-41.
View full text

Water: is it a breeding ground for bacteria in your facility? 
Burns S
Infection Control Today. Oct 2002;6(10).
View full text

Breaking the chain of infection
Pyrek KM
Infection Control Today. Jul 2002;6(7).
View full text

21-day Cumulative Irritancy Patch Test: Comfort Bath® Cleansing System
Scheman A, West DP
Northwestern University Department of Dermatology, Chicago IL, May/Jun 1998.
Download article

Parkland Memorial Hospital saves time and money with basinless bathing
Dallas, TX
Download article (PDF)

Prevalence of incontinence and associated skin injury in the acute care inpatient.
Junkin J, Selekof JL.
J Wound Ostomy Continence Nurs. 2007 May-Jun;34(3):260-9.
Download article (PDF)

A 3-in-1 Perineal Care Washcloth Impregnated With Dimethicone 3% Versus Water and pH Neutral Soap to Prevent and Treat Incontinence-Associated Dermatitis
Beeckman D, Verhaeghe S, Defloor T, Schoonhoven L, Vanderwee K
Download article (PDF)

The 1999 national pressure ulcer prevalence survey: a benchmarking approach
Amlung SR, Miller WL, Bosley LM
Advances in Skin & Wound Care. Nov/Dec 2001;14(6):297-301.
View abstract

Risk factors associated with having a pressure ulcer: a secondary data analysis
Maklebust J, Magnan MA
Advances in Wound Care. Nov 1994;7(6):25,27-8,31-4 passim.
View abstract

21-day Cumulative Irritancy Patch Test: Comfort Shield® Perineal Care Washcloths
West DP, Horn M
Northwestern University Department of Dermatology, Chicago IL, Jul/Aug 1999.
Download article (PDF)

Survey indicates lack of incontinence-related communication/knowledge
Ostomy/Wound Management. Dec 2005;51(12):22-3.
Survey conducted at the Wound Ostomy Continence Nurse Society 2005 annual conference by Sage Products Inc, Jun 2005.
View full text

Nursing opinion poll reveals pressure ulcer prevention not seen as a top priority 
Infection Control Today Online: Posted Jul 30 2004.
Poll conducted at the Wound Ostomy Continence Nurse Society 2004 annual conference by Sage Products Inc, Jun 2004.
View full text

Risk factors for pressure ulcers, WOUND NEWS: Wound Technology, Jan 22, 2002.
View full text