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THE EVOLUTION OF THE BAG BATH®

THE EVOLUTION OF THE BAG BATH®. Florence Nightingale recognized the importance of hygiene to control the spread of infection . As a result , she initiated a daily patient bathing procedure which has remained virtually unchanged for over 150 years .

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THE EVOLUTION OF THE BAG BATH®

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  1. THE EVOLUTION OF THE BAG BATH® Florence Nightingalerecognized the importance of hygiene to control the spread of infection. As a result, sheinitiated a daily patient bathing procedure which has remainedvirtuallyunchanged for over 150 years. In 1990, Susan M. Skewes, RN, developed a theory-based alternative method of bathing whichwassubsequentlyredevelopedintowhat is nowknown as the Bag Bath®. After more thaneightyears of lecturing, teaching and sharing the clinical and economicadvantages of her technique, millions of people areenjoying the benefits of her bathingmethod.

  2. MYTH: "There´s nothing like soap and water" Weoftenhear....."There’snothinglikegoodold-fashioned soap and water!" Thiswidely held beliefdoes not stand up againstfact! Nursing and medical research cite the frequency of bathing and the use of non-therapeuticsoap to be a major risk factor putting the elderly at risk for dry skin (Gioella & Bevil, 1985). By examiningsoap and itseffecton the skin, wecanbetter understand whythismyth is false and why the Bag Bath® has established a new standard of practice.

  3. What is soap ? According to the earliestsources, soapwasinvented by the Mesopotamians more than 4000 yearsago. In itsbasic form, old-fashionedsoap is made by combining an alkali with a fat (often a vegetableoil) and water and usually has a pH levelanywhere from 7.0 to as high as 11 or 12. Soap is a powerfuldegreaserthatemulsifiesfats and removes lipids from the skin. Lipidsarefatsthat bind water; thus, lipidlossresults in skin dryness. The soap and waterbasinbathmakesrinsingdifficult, and soapoften remainson the skin, elevatingits pH . What's more, soapcandestroysebum. Soapused in routine patient bathingshouldbeliquid, non-antimicrobial, and neutral in pH, and must containmoisturizers.

  4. Soap and it´s effect on skin ! Nursing and medical research has foundthat the use of notherapeutic soap, likefrequentbaths, puts the elderly at risk for dry skin. Soap is a powerfuldegreaserthatemulsifiesfats and removeslipids which bind water, from the skin. Loss of theselipidsresults in skin dryness. Most soaps alter the pH of human skin, whichnormally ranges in adults from 4.5 and 5.5, and the skin's mild acidity is an effective antimicrobialbarrier. Additionally, as we age, our skin suffers a marked reduction in lipid substancescausing skin to becomeevendrier, flaky, pruritic and "at risk". It has beenestimatedthat59% to 75% of the elderly have pre-existingpruritic skin conditions (Eliopoulos, 1988; Franz & Kinney, 1986; Parnet 1985; Tinadall & Smith, 1963). Research alsosuggests an association between dry, flakyorscaling skin and the incidence of pressureulcers (Guralnik, Harris, White, et al, 1988).*

  5. Normal pH of the skin and how it is affected by soap Human skin is protected by a film barriercalled the acidmantle. Thisprotective film maintains a skin pH of 4.5 to 5.5 which is mildlyacidic. Sebum (oroil) is produced by hairfollicles and is pushed to the skin’ssurfacewhere it is forming the acidmantlewhich has bactericidal and fungicidalproperties. The dailysoap and water patient bath, and whensoap is not completelyrinsed from the skin, the pH is elevatedreducing the acid mantle’sability to fight offharmfulmicroorganisms. Soap, particularly in bar form, canbecome a haven for the growth of bacteria. In addition, a bar of soapcaneasilybecontaminatedwith Gram negative organisms (Gooch, 1989).

  6. The Alternative To Soap Instead of usingsoap, skin canbe just as effectively cleanedby usingsurfactants. A "surfactant" is a surface-active agent that is used to reduce the surface tension of waterallowing it to spread out and help cleanse an area of skin. In addition, as a wetting agent, mild surfactantsalsoremove contaminants from the skin without the damagingeffects of soap. Basedon research by George Rodeheaver, Ph.D., Director of Plastic Surgery Research at the University of Virginia School of Medicine, the surfactant F-68 waschosen to beused as the primarycleanser in the Bag Bath®. Dr. Rodeheaver, at a symposium onadvancedwoundcare in 1988, identified F-68 to be as tissue-friendly as normal saline. Theseresults, plus otherstudyresultssuggestedthatPluronicF-68 was a totallybio-compatiblesurfactantthatcouldbesafelyemployed as a cleanser.

  7. What kind of ingredients are used in the Bag Bath®? • The Bag Bath® uses a special blend of tissue-friendly, no-rinse • surfactantsthatcleanwithoutdamaging the protectiveacidmantle • of the skin. • Surfactantscleanse by reducingsurface tension between • skin and contaminantswithoutdamagingunderlyingtissue. • The solution alsocontains vitamin E and vitamin B5 thatacts as an • emollient/humectantthatattracts and trapsmoisture in the skin, • eliminating the need for extra lotions. • The Bag Bath® is uniquebecause it does not containsoap, • soap-basedcleansers, oralcohol. • Purified Water, - non – ionic Mild, clean • SurfaceActive Agent ( F68) Cleanser • Vitamin B5 ( Dexpanthenol ) Humectant • Vitamin E ( Tocopherol ) Nutrient/ antioxidant • PolyaminopropylBiguanidePreservative

  8. Purified Water, - non – ionic • The waterused in Bag Bath has undergone a cleaning • procedure and treated to benon-ionic. • Free of bacteria • Mild • Neutral to the skin • Most important !! • Because the water is non – ionic it will not remove the • veryimportantacidmantelon the skin. • - Acidmantel ( under normal conditions ) is effective as • an antimicrobialbarrier.

  9. Surface Active Agent ( F68) • Instead of usingsoap, skin can as effectivelybecleaned by using • surfactants. A surfaceactive agent that is used to reduce the • surface tension of waterallows it to spread out and clean an • area of the skin. • F68, a new skin and woundcleanserapproved by FDA. • Removescontaminants from the skin. • Tissuefriendly as saline. • Totallybiocompatible. • Most important !! • The non – ioniccleanserprevented the development • of infections • F68 cleans the skin withoutdamaging the protective • acidmantle of the skin. 1: Ann Emerg Med. 1980 Nov;9 (11): 572 - 6 [Pluronic F-68: a promosing new skin wound cleanser. Rodeheaver GT, Kurtz L, Kircher BJ, Edlich RF.2: Am J Surg. 1976 Jul; 132 (1): 67 – 74. [Pharmacokinetics of a new skin wound cleanser. Rodeheaver G, Turnbull V, Edgerton MT, Kurtz L, Edlich RF 3: Provided by High Tech Detergent Wisdom from the professionals; A collection of articles: Synthetic Surfactant or Soap

  10. Vitamin B5 ( Dexpanthenol ) • Dexpanthenol is used as humectant in Bag Bath, but has a lot of • otherbenefits, thatcanhelp to understand the importance of this • ingredient in Bag Bath. • Provitamins B 5 (dexpanthenol) is necessary in the processes of • reconstruction of epithelium, and has regenerative and • anti-inflammatoryproperties. • - A lot of studies show the positive effecton skin and woundconditions • Actslike a moisturizer • Reducing trans -epidermalwaterloss • Activation of fibroblastproliferation • Acceleratedre-epithelialization • Most important !! • Moisturize the fragile skin • Supports all skin and wound healing processes • Used in a lot of skin careproducts 1: Klin Monatsbl Augenheilkd. 1996 Aug-Sep;209(2-3):84-8. [Clinical study of the effectiveness of a dexpanthenol containing artificial tears solution (Siccaprotect) in treatment of dry eyes]Gobbels M, Gross D.2: Klin Oczna. 2003;105(3-4):175-8. [In Process Citation]Raczynska K, Iwaszkiewicz-Bilikiewicz B, Stozkowska W, Sadlak-Nowicka J.3: Am J Clin Dermatol. 2002;3(6):427-33. Topical use of dexpanthenol in skin disorders.Ebner F, Heller A, Rippke F, Tausch I.4: Arzneimittelforschung. 2000 Jul;50(7):659-63. Effect of topically applied dexpanthenol on epidermal barrier function and stratum corneum hydration. Results of a human in vivo study.Gehring W, Gloor M.

  11. Vitamin E ( Tocopherol ) • Since the discovery that vitamin E is the majorlipid soluble • Antioxidant in skin, it has been usedto treat almost every type of skin lesion and • has beenused frequently by the general population to treatburns, • surgical scars, and other wounds. • Tocopherols, ascorbatepolyphenols; All these compounds administered • topically by cosmetics or by oral route by diet supplements, have been • shown to exert an antioxidant/protective effect in skin or skin cells • Acts as an nutrient / antioxidant • Acts as lipidsoluble antioxidant • Most important !! • Vitamin E is the most important antioxidant in the body • that protects cell membranes • - Topical d-alpha-tocopherol can soothe dry, rough skin 1: Supplements For Healthy SkinNew Orleans LA, 25 February 2002; Speaking today at the American Academy of Dermatology's 2002 Annual Meeting in New Orleans, New York-based dermatologist Karen E. Burke, MD,

  12. Biguanide ( Cosmocil ) • Acts as a preservative and is widelyused ex: skin creams and • lotions, contactlens cleaning solutions. • It is a non harmfull and veryeffectivepreservative, and is compatible • with non – ionicsurfactants. • Highlyeffectivepreservative • Most important !! • Offering excellent skin mildness • Areusedsafely in contact lens solutions 6: Ophthalmic Res. 1994;26(3):129-36. Contact lens care solutions and corneal epithelial barrier function: a fluorophotometric study.. Boets EP, Kerkmeer MJ, van Best JA.Department of Ophthalmology, University Hospital Leiden, The Netherlands.

  13. What could be of importance to be afraid of ? • You have to considerrisks for bothyourself, your patient and • the environment, whenyoudecide the productsyouwant to use • in yourdailywork. • Ingredientsyou have to Whatare the risks: • becarefullabout: • EDTA - Skin irritation • - Irritatingmucusmembranes • - Bind heavy metals trapped in lake • Alcohol - Skin irritation • - Removes the acidmantle • Soap - Recedueson the skin • Most important !! • Youcan put yourself at risk • Youcan put your patient at risk • We have to takecare of the environment

  14. What could be of importance to focus on ? • BagBath is produced under the most modern an controlled • methodsknown. • Produced in cleanroom • FollowingcGMPstandards • Productionfacillity ISO 9001 certified • CE mark • SealGuaranty • Most important !! • Offering the most skin friendlyingredients • Wellprovedconcept • Neverseenallergicreactions

  15. Why use instead of a normal procedure ?

  16. What is a normal bed bath ? • Normally bed bathare given to patients thatare not able to do • Theirownbathingbecause of traumatic situations, severeillness, immobile status • or in such a status thatprecautions have to betaken. • These patients areoften in such a condition, thattheyare in verybigrisk of • gettinginfections, why the risk of crosscontamination is an issue. • Gentle handling of these patients areveryimportant as well. • - Painduringpositioning. • - Pain due to traumatic situation. • - Pain due to positioning of osteosyntheticmaterial. • - Nausea. • - Lung- and heartdeseases, that not allows the patient to move. • - a.s.o • Most important !! • - Reducedburden in manual handling by the caregiver: • - only single contactwitheachbody part

  17. What is a normally used for a bed bath ? • Roll table • 3 Towels ( body and genitals ) • Foam wash towels • Zinks ( body and genitals ) - Soap ( hard or fluent ) • Bedlinen ( spillage of water needs • more bedlinen ) • Time to find and prepare everything, including • to dispose after use. • To that you add the laundry of bedlinen, • towels and washing zinks.

  18. Environmental benefits By doing a traditional Bed Bath, you have to consider the amount of waste roductsthat can influence the environment: Traditionel bed bath: 3 towels 25 litre water. Cleaning 50 g soap. 20 g softner .m. Electricity, 3 kWh/kg. (+Transportation) Cleaning of 2 Zinks 35 litre water . (Bedpan boiler) 90 g soap. 10 g surfactant. Electricity, 0,9 kWh/vask. (low energy boiler) Polyuretan-cloth: 70 g PU. 6 g Polyethylen. Soap for body wash: 20 g. Water: 10 litre Lotion: 10 g.  _________________________________________________________ 90 g Rayon/polyester 60 g ingredience 6 g barrier film

  19. What is a normallyused for a bed bathwith? • Roll table • Microwave to warm the BagBath • if not heated in otherways • One package of Bag Bath • Less time to find and prepare everything, including to • dispose after use

  20. Expences for a normal BedBath Cost 2 washing zinks filled up with water (incl. cleaning / desinfection after use € 0,18 3 towels (incl. washing, logistics and depreciation) € 0,79 Washing cloths or PU foam cloths (incl. washing, logistics and depreciation) € 0,57 Soap (used in average ± 10 gram) € 0,08 Bodylotion (used in average ± 10 gram) € 0,10 Total material Cost € 1,72 Cost of employee (In average 30 minutes á € 25,- per hour. This is inclusive preparing and disposal, cleaning and washing the zinks € 12,50 Total BedBath Cost € 14,22 Expences for a Bag Bath® Kosten One package of Bag Bath® (Average price ) € 2,50 Heating in a microwave (average 45 seconds incl. depreciation) € 0,07 Storage cost warehouse (± € 250,- per ton en ± 200 gram per BagBath®) € 0,05 Total material Cost € 2,62 Cost of employee (In average 10 minutes á € 25,- per hour. This is inclusive preparing and disposal. € 4,33 Total Cost € 6,95 Normal Bed Bath 14,22 Bag Bath® € 6,95 Possible savings by using Do you know the cost of doing a bed bath ? Bedbath € 7,27

  21. Safe alternative • More skin friendly • Easier to handle • More cost effective Not Just A Bed Bath !

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