Comfort
®
Bath
Patient Hygiene and Skin
Assessment
Who is Sage?
Our goal is to promote a positive patient
hygiene intervention between
caregivers and patients
to achieve improved clinical outcomes,
and increase satisfaction.
Basinless Bathing is Growing
Used in over 1800 hospitals across the
country:
Patient Satisfaction…It’s a soft cloth & it’s warm
Nursing Satisfaction…Saves time, giving time back
Infection Control Aspects…Transient bacteria, cross
contamination, hospital tap water as a source, the basin,
CDC guidelines
Skin Assessment…Bathing is the best time to assess the
patient’s skin
Economical …Competitive with a basin bath
Employee and Patient Satisfaction
Correlation between the satisfaction of the nurse and the
satisfaction of their patient
•
•
•
Nurses expressed a clear and significant preference for
the disposable bath.1
Only 4% of patients feel clean and comfortable with the
current basin bath method for patient cleansing.2
Only 34% of nurses said they had enough RNs to provide
quality care and still fewer than 33% had enough staff to
get their work done.3
1.Larson et al, American Journal of Critical Care, Comparison of Traditional and Disposable Bed Baths in Critically Ill Patients, May 2004; Vol. 13, No. 3, pg.
235-2
2.Comfort Bath® Cleansing System from Sage Products vs. the Basin Bath: Patient Preference Study,
Barbara Skiba, RN, BSN
3. JCAHO, Health Care at the Crossroads: Strategies for addressing the evolving nursing crisis
Hospital
Washcloth
Basin
Vs.
Disposable
Washcloth
Sage
Patients’ Bath Basins As Potential Sources of
Infection: A Multicenter Sampling Study
Authors: Debra Johnson, RN, BSN, OCN, CIC; Lauri Lineweaver,
RN BSN, CCRN; and Lenora M. Maze, RN, MSN, CNRN
Publication: AJCC January 2009, Volume 18, No. 1
Objective: To identify and quantify bacteria in patients’
bath basins and evaluate the basins as a possible reservoir for
bacterial colonization and a risk factor for subsequent hospitalacquired infection
Background: Basins tested at 3 acute care hospitals
• Presbyterian Hospital New Mexico (453 beds)
• Wishard Health Services Indiana (319 beds)
• Westerly Hospital Rhode Island (125 beds)
• 92 basins from 3 ICU’s and a rehabilitation unit evaluated
Patients’ Bath Basins As Potential Sources of
Infection: A Multicenter Sampling Study
Results
• Bacteria grew in 98% of the samples!!
• Organisms with highest rates of growth:
–
–
–
–
–
Enterococci (54%)
Gram-negative organisms (32%)
Staphylococcus aureus (23%)
VRE (13%)
MRSA (8%)
• VRE and MRSA were cultured from bath basins of
patients who were not carriers
The Role of Interventional Patient Hygiene in Improving Clinical and
Economic Outcomes
Devin Carr, MSN, RN, ACNS-BC, CCRN, RRT and Richard Benoit, MSN, RN, CCRN
Advances in Skin and Wound Care. Vol. 22 NO.2 February 2009
Objective
Asses the efficacy of an evidence-based IPH protocol initiated at a
university hospital aimed at reducing the incidence of PrU’s and
impaired skin integrity
Methods
•
•
•
•
•
21-bed surgical intensive care unit at the Vanderbilt University Medical Center.
4 month study 2 Components: Staff education which sought to improve the
knowledge base of the non-licensed staff, and patient intervention component
which would improve communication of risk factors of PrUs to the registered
nurses
A pre and post intervention knowledge survey (clinical assessment forms) was
conducted to determine the success of the education
Implemented Comfort Bath with Skin Check and Shield Barrier cloths with Peri
Check
Educated around the Skin Check label and proper usage. Non-licensed staff
received instruction in observational skills and the facilities bathing and
incontinence management protocol
The Role of Interventional Patient Hygiene in Improving Clinical and
Economic Outcomes
Devin Carr, MSN, RN, ACNS-BC, CCRN, RRT and Richard Benoit, MSN, RN, CCRN
Advances in Skin and Wound Care. Vol. 22 NO.2 February 2009
Outcome
• Pressure ulcers decreased from 7.14% to 0%
• 100% of the staff were able to demonstrate adequate knowledge of
hospital protocol and procedure after the intervention
• Department manager confirmed by random sampling of the audit
tools that reported alterations in skin integrity was followed up by the
responsible RN
The Science of Comfort Bath
• High colony count found in bath water is similar to the
number of bacteria found in urine from patients with
UTIs1
• Bath water could serve as a high magnitude microbial
reservoir of potentially antibiotic resistant organisms.1
• The patient’s skin may harbor more gram negative
organisms once the basin bath is completed.2
1. Shannon et al, Journal of HealthCare Safety, Compliance & Infection Control, April 1999; Vol. 3, No. 4, pg. 180-184.
2. Susan M. Skewes, RN, ONC, RN Magazine. January 1994: 34-35.
The Science of Comfort Bath
Ruth Bryant
article from Ostomy/Wound Management, 2001
• Strong correlation between bathing and
skin integrity
(the body’s first line of defense)
• Current basin bath procedure can be
cumulatively detrimental to skin condition
and cause skin dryness and skin tears
• Bathing is the best time to inspect the skin
• Traditional bathing technique should be
re-examined
The Science of Comfort Bath
Elaine Larsen
study from American Journal of Critical Care, 2004
Nursing survey comparing traditional
bathing to disposable bath determined
disposable bath:
• Is more convenient and easier to use
• Cleans and moisturizes skin more effectively
• Is more comfortable for patient
• Requires fewer supplies
• Is less expensive
The Science of Comfort Bath
Angela Clark
article from Clinical Nurse Specialists, 2006
Looked at nosocomial infections and bath water:
• Hospital tap water most overlooked and
controllable source for nosocomial pathogens
• Transmission from drinking, bathing and items
rinsed with tap water causing a contaminated
environment
• Immunocompromised patients at
highest risk
• Recommendation is to keep
immunocompromised patient away from
hospital tap water
Contains strong supporting references (e.g., NJOM)
Functions of Patient Bathing
1. Health/Clinical
•
•
•
Cleanse and moisturize the skin
Reduce gross bacterial count
Complete full skin assessment /
monitoring
2. Social
•
•
Control patient odor
Provide patient well-being
3. Comfort
•
Provide sensory stimulation
Ruth Bryant, RN, MS, CWOCN; Bonnie Rolstad, RN, BA, CWOCN, Ostomy Wound Management 2001: 47(6), 18-27.
Is the Basin a Source of HAIs?
Persistence of Clinically Relevant
Bacteria on Dry Inanimate Surfaces
Type of bacterium
Duration of persistence (range)
Acinetobacter spp.
3 days to 5 months
Escherichia coli
1.5 hours – 16 months
Enterococcus spp. Inc. VRE and VSE
5 days – 4 months
Klebsiella spp.
2 hours to > 30 months
Pseudomonas aeruginosa
6 hours – 16 mths; on dry floor: 5 wks
Salmonella spp.
1 day
Serratia marcescens
3 days – 2 mths; on dry floor: 5 wks
Staphylococcus aureus, inc. MRSA
7 days – 7 months
BMC Infect Dis. 2006; 6: 130.
Published online 2006 August 16. doi: 10.1186/1471-2334-6-130.
O’Flynn, APIC, 06/07
Methods
• 25 dry patient bath basins were cultured
– 10 CCU & 15 Med Surg
– Basins were in rooms > 48 hours
– Used at least once
• ICP swabbed each basin with 2 swabs
• Samples were streaked on a 5% blood
agar Petri dish
O’Flynn – Tables and Graphs
McGuckin, APWCA, 4/07
•
•
•
•
•
18-month study, 14-bed ICU
23 additional UTI’s and $107K in cost
Both Larson and Vernon found . . .
Shannon = bath water - bacteria - UTIs
Clark = keep tap water away from . . .
Clearly, the basin should be
considered as a major source
of HAIs
Unmet Clinical Bathing Need?
Skin issues often go undetected 1
Proof
– P.U’s cost U.S. healthcare system $1.3 billion/year 2
– Skin breakdown: Top healthcare litigation
– P.U.’s cost average hospital $400,000 to $700,000/year 1
– Most stage I and stage II go unreported 1
– Nearly half of all P.U.’s develop in hospital 2
Result of Not Implementing a Skin Monitoring System
– Costs go up, patient and RN satisfaction go down, increased
risk for infection
Solution
– Bathing is the best time to assess the skin
1. Robinson C, et al., “Determining the efficacy of a pressure ulcer prevention program by collecting prevalence and incidence data: A unit-based effort, “
Ost/Wound Mgmt. 2003: 49 (5): 44-51. 2. Amulung Sr, Miller WL, Bosley LM, “The 1999 National Pressure Ulcer Prevalene Survey: A Benchmarking
Approach,”
Who’s providing the care?
Creating a Safety Net for Patients
• Employ consistently clean or sterile
products and processes
• Making good use of everyday supply items
• Utilize ALL team members
• Train caregivers to make frequent
observations
New Sage Bathing Product Objective
• Deliver warm, soothing cleansing and
moisturizing quickly to the patient
• Remove odor and bacteria;
stimulate tissue
• Complete a daily skin inspection or
assessment from head-to-toe
Why now?
New CMS Guidelines
• Hospitals will no longer
receive higher payments
for the additional costs
associated with treating
patients for certain HAIs
and medical errors.
– UTIs
– Pressure ulcers
• What role does bathing
have on these
outcomes?
Market Review - Bath
Bath Sales*
$37 M
Current Market Capture:
19.2%
Potential Bath Market
$192.7 M
Market Available: 80.8%
*Source: Inpatient admissions and LOS for US and Canada per 2006 HCUP Nationwide Inpatient Sample (NIS) and 2006 Canadian Institute for Health Information (CIHI). Rates calculated
on assumption of LOS shortened by first day (3.77 down from 4.77). Average bath package pricing of $1.21 per package, one package per bath. Bath Sales figures: Sage Sales from
September 2007 – August 2008
BASINLESS BATHING
WASH KITS: SKIN CARE
80%
70%
Annual 2011 Market
60%
50%
40%
30%
20%
10%
0%
76.3%
18.8%
* others include: Bard Medical/Incline Technologies, No-Rinse, Donovan Industries
2.5%
1.8%
.5%
<0.1%
each
nd
Source: GHX Trend Report (Dollars) 2 Quarter, 2011 Hospital;
Annual market represents last 4 quarters of data
2005 WOCN Survey Results
297 Surveys Received
3. At my facility, there is a need to improve
(check all that apply):
number of responses
200
160
155
138
100
120
90
80
40
0
46%
Frequency and/or
consistency of skin
assessment/
monitoring
34%
Method of skin
assessment/
monitoring
52%
Communication of
skin problems
between different
levels of caregivers
30%
No response
7/26/05
2005 WOCN Survey Results
297 Surveys Received
4. At my facility, patients at risk for skin breakdown receive a full skin
assessment (approximately):
142
number of responses
160
120
71
80
34
36
40
0
48%
Daily
6
2%
Every
other
day
8
3%
Every
third
day
11%
12%
Weekly
Not sure
24%
No
response
7/26/05
IHI’s 5-Million Lives
Getting Started Kit:
Prevent Pressure Ulcers
How-to-Guide
Six Essential Elements of
Pressure Ulcer Prevention
1. Conduct a Pressure Ulcer Admission
Assessment for All Patients
2. Reassess Risk for All Patients Daily
3. Inspect Skin Daily
4. Manage Moisture: Keep the Patient Dry
and Moisturize Skin
5. Optimize Nutrition and Hydration
6. Minimize Pressure
http://www.ihi.org/ihi
How-to Guide
Six Essential Elements of Pressure Ulcer Prevention
Inspect Skin Daily
Skin integrity may deteriorate in a matter of hours in
hospitalized patients. Because risk factors change
rapidly in acutely ill patients, daily skin inspection is
crucial. Patients identified as being at risk need a
daily inspection of all skin surfaces, “from head to
toe.” Special attention should be given to areas at
high risk for pressure ulcer development such as the
sacrum, back, buttocks, heels, and elbows. Ideally,
staff should incorporate a skin inspection into their
work, every time they assess the patient.
How-to Guide
Six Essential Elements of Pressure Ulcer Prevention
What processes can be put in place to
ensure daily inspection of the skin?
•
Adapt documentation tools to prompt daily skin
inspection, documentation of findings, and initiation of
prevention strategies as needed.
•
Educate all levels of staff to inspect the skin any time
they are assisting the patient, for example, when
assisting patient to the chair, moving from one area to
the other, and while bathing. Upon recognition of any
change in skin integrity, notify staff so that appropriate
interventions can be put in place.
The Case for Skin Monitoring
• JCAHO 2007 National Patient Safety Goals
– Goal: Improve the effectiveness of communication
among caregivers.
• Measure, assess and, if appropriate, take action to
improve the timeliness of reporting
• AHRQ Guidelines
– Regular skin assessment for early signs of
pressure injury.
– Keep in mind that those who are at significant risk
may develop Stage I ulcers in less than 2 hours on
a standard support surface.
• Mandatory reporting
• And now, IHI 5-Million Lives Campaign
Folk Dahl BA, Frantz R, “Prevention of pressure ulcers,” Iowa City (IA): Univ of Iowa Gerontological Nursing Interventions Research Center,
research Dissemination Care: 2002 May.
The Science of Comfort Bath
Bellin Hospital – IHI Poster, 2006
• Wanted to improve skin inspection and rapid
response to skin injury to decrease nosocomial PUs
• Clinicians conducted pre- and post-intervention
criteria (evaluation forms)
• Established bathing protocol with Skin Check
• Resulted in improved patient outcomes:
– PUs decreased from 18% to 5.88%
– There is a need for rapid and frequent inspection of skin
integrity
– Bathing with a monitoring tool facilitates this activity
How Skin Check™ Works
• Peel the skin monitoring
label off and set aside
• Bathe patient as normal –
assistant looks for skin
integrity issues
• If an issue is observed,
mark label
• Communicate to RN
responsible for that patient
Skin Check™ Program
Early Detection Means Early Protection
1.
Skin Protection
– Fortifying the skin
• Right solution – pH balanced
• Lotion and moisturizers to nourish the skin
• Soft cloth for gentle yet thorough cleaning
– More hygienic way to provide a bath – fewer
opportunities for recontamination of the skin1
2. Early Detection
– Observation of skin issues
– Communication of red skin issues
– Action
Larson EL, et al., : “Comparison of traditional and disposable bed baths in critically ill patients”, American Journal
Critical Care. 2004; 13(3): 235-241.
Bathing and Clinical Outcomes
Costs
Nursing
Satisfaction
Infection
Skin
Monitoring
Skin
Care
Time/Quality
Patient
Satisfaction
Comprehensive Bathing
Program Includes . . .
1. Protocol
2. Observation program
–
Assessment / Monitoring
3. Incorporate a bathing
system that best meets
the hospital’s clinical and
economic needs
Sage – The Only Company With:
• Clinical proof
• Skin assessment / monitoring tools
• Customized training and
In-service programs
• Product options
–
–
–
Three cloth thicknesses
Deodorant
Three, five, and eight packs
• Fully insulated packaging
• Hospital grade warmers
and microwaves
Sage is Fully Committed to:
• Achieving improved outcomes
– Implementation and compliance to PIP’s and
protocols
• Product innovation
– Skin Check, Exopheryl, Insulation, Tencel, etc.
• Helping you manage usage
Thank You For Your Time