拋棄式擦澡巾提升重症病人床上擦澡成效之實證臨床應用

Using Disposable Bathing Wipes to Improve Bathing for Critically Ill Patients

10.6142/VGHN.201806_35(2).0004

楊麗瓊(Li-Chiung Yang)；王麒嘉(Qi-Jia Wang)；林俐君(Le-Gin Lin)；劉雅云(Ya-Yun Liu)；廖淑貞(Shu-Chen Liao)；鄒怡真(Yi-Chen Tsou)

拋棄式擦澡巾 ； 重症病人 ； 感染率 ； 成本效益 ； 滿意度 ； disposable bathing wipes ； critically ill patients ； infection rate ； cost-effective ； satisfaction

榮總護理

35卷2期（2018 / 06 / 01）

145 - 151

繁體中文

床上擦澡能夠協助重症病人維持身體清潔、舒適度及減少病源傳播。然傳統擦澡方式有重複使用毛巾、不適當儲放及無法晾乾等問題，本文探討以拋棄式擦澡巾執行重症病人床上擦澡之成效。文中以實證手法搜尋文獻，透過關鍵字於PubMed及MEDLINE資料庫搜尋系統性文獻回顧及隨機對照試驗文章，使用拋棄式擦澡工具取代傳統式擦澡毛巾，臨床運用期為2014年1月30日至2015年7月30日，對象為重症加護室的病人及護理師，以滿意度、護理工時、經濟效益及感染發生密度為成效指標。結果發現拋棄式擦澡巾的介入後，護病雙方均有高滿意度、擦澡時間平均節省22分鐘、護理人力成本平均節省92元/位、經濟效益方面比傳統床上擦澡節省10,773元、平均感染密度從千分之14.5降至千分之11.3。拋棄式擦澡巾能夠降低感染源、增加病人舒適感，讓護理師及病人有較高之滿意度，更能在成本效益中節省人力及物料成本。

Providing bed baths can help critically ill patients stay clean and comfortable. However, using the same basin for bathing may cause cross-contamination between different parts of the body. Preparing traditional bed baths also has notable labor costs. In addition, inappropriate storing of reusable washbasins and wet towels can lead to microbial biofilm formation, which increases the risk of infection for patients. Thus, questions of hygiene, comfort, and cross-contamination during bed bathing have become a concern in nursing practice. In this study, evidence-based practice was used to investigate the effect of using disposable bathing towels when bathing critical patients in order to evaluate the cost-effectiveness of such towels versus traditional bed bathing methods. Possible problems and solutions were identified be searching the PubMed and MEDLINE databases to identify related articles. According to studies, using disposable bath towels instead of traditional bed baths was more economical and contributed to higher satisfaction among nurses and patients as well as lower infection rates. Data collection was conducted from January 1, 2014 to July 30, 2015. The participants were critical patients in an intensive care unit and the nurses responsible for their care. The outcome was based on the number of multidrug resistant strains found towels as well as the cost effectiveness, required labor, and satisfaction levels. The findings revealed higher satisfaction levels among nurses and patients when using disposable bath towels, increasing from 31% to 100% in the nurses and up to 90% in the patients. These disposable bath towels reduced bathing times to an average of 13 minutes from an average of 35 minutes using traditional bed bathing methods. Moreover, the new disposable bath towel method provided savings of up to NT$90 per person for every bath. This would provide savings of NT$10,773.60 per person per year. In addition, the annual average infection rate was 11.3%, which was lower than the threshold (14.5%). In summary, using disposable bath towels for bed bathing significantly reduces infection and increases comfort and satisfaction while saving nursing labor and material costs.

1. Cassir, N.,Thomas, G.,Hraiech, S.,Brunet, J.,Fournier, P. E.,La, Scola, B.,Papazian, L.(2015).Chlorhexidine daily bathing: Impact on health care-associated infections caused by gram-negative bacteria.American Journal of Infection Control,43(6),640-643.
2. Chen, W.,Li, S.,Li, L.,Wu, X.,Zhanq, W.(2013).Effects of daily bathing with chlorhexidine and acquired infection of methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus: A Meta- analysis.Journal of Thoracic Disease,5(4),518-24.
3. Hocking, L.(2009).Structured evaluation and adoption of a waterless bathing system into an NHS Foundation Trust.Infection Prevention Society Annual Conference,Harrogate:
4. Johnson, D.,Lineweaver, L.,Maze, L. M.(2009).Patients' Bath Basins as Potential Sources of Infection: A Multicenter Sampling Study.American Journal of Critical Care,18(1),31-40.
5. Larson, E. L.,Ciliberti, T.,Chantler, C.,Abraham, J.,Lazaro, E. M.,Venturanza, M.,Pancholi, P.(2004).Comparison of traditional and disposable bed baths in critically ill patients.American Journal of Critical Care,13(3),235-241.
6. Massa, J.(2010).Improving efficiency, reducing infection, and enhancing experience.British Journal of Nursing,19(22),1408-1414.
7. Noddeskou, L. H.,Hemmingsen, L. E.,Hordam, B.(2015).Elderly patients' and nurses' assessment of traditional bed bath compared to prepacked single units -randomised controlled trial.Scandinavian Journal of Caring Sciences,29(2),347-352.
8. Oxford Centre for evidence based medicine (2005). Critical Appraisal Worksheets: Randomised Controlled Trials (RCT) Critical Appraisal Sheet. Retrieved from https://www.cebm.net/2014/06/criticalappraisal/
9. Oxford Centre for Evidence Based Medicine Levels of Evidence Working Group. (2012). The Oxford 2011 levels of evidence. Retrieved from http://www.cebm.net/index.aspx?o=5653
10. Strouse, A. C.(2015).Appraising the literature on bathing practices and atheter-associated urinary tract infection prevention.Urologic Nursing,35(1),11-17.
11. Timby, B. K.(2009).Fundamental nursing skills and concepts.Philadelphia:Lippincott Williams & Wilkins.
12. 黃萬翠、王復德(2016)。Chlorhexidine 濕巾擦澡對預防多重抗藥性菌移生及醫療照護相關感染之效益。感染控制雜誌，26(5)，222-224。
13. 羅如君、洪美娟、盛望徽(2016)。使用2%chlorhexidine 擦澡在減少症病患醫療照顧相關感染及預防多重抗藥性菌株移生的應用。感染控制雜誌，26(2)，58-64。

1. 戴佳惠,盧佳文,陳惠蘭,徐菡妤,尤麗瑜(2019)。比較床上沐浴方式對於重症病人體溫及心跳之影響：前驅試驗。志為護理-慈濟護理雜誌，18(6)，63-74。