Drawing a safe bath

Resident bathing is much more than just a hygiene issue for long-term care facilities — it also encompasses risk management, best practices, infection control and is a critical resident satisfaction indicator.

As a result, it has gained importance in recent years as facilities strive to make bathing a comfortable, enjoyable and dignified experience for residents.

The process of transporting residents and engaging them in the bathing process is one of the most risk-critical functions a long-term care provider must face. Safety has become paramount in protecting the resident, caregiver and facility, bathing specialists say.

“Slips and falls by the caregiver bath aides, and dropped or falling residents are still the biggest safety hazard,” says Jim Novotne, senior president of MasterCare. “The most common mistakes are not following established procedures by the facility and manufacturer. Following facility procedures, such as keeping bathroom floors dry and keeping the bathing staff trained to follow the manufacturer’s procedures, is very important. The key is training and having proper modern bathing equipment.”

Growing attention placed on fall prevention, as well as overall resident safety and comfort, have brought the serious safety issues to the forefront, says Chris Stafford, president of Safeway Safety Step. While providers are placing more emphasis on creating a better bathing experience for residents, he says, “we have seen many circumstances of good intentions to provide a safer bathing experience go awry.”

Stafford points out that a “relatively simple thing”  like the placement of a grab bar can ultimately do more harm than good if the bar is inaccessible, misplaced, installed improperly or is not the right device. 

“Effective prevention begins with education on the options, proper placement and installation technique and how products can be effectively grouped to provide the highest degree of safety,” Stafford says.

Controlling bugs key
Another major safety concern — that is not infrequently overlooked — is infection control, bathing experts agree.

“Potential cross-contamination between baths is a hazard that is not often recognized,” Novotne says. “Buildup over time of organic materials that harbor harmful bacteria can occur inside of conventional, off-the-shelf whirlpool or hydro-massage air systems without surface check valves. This material, if not removed, can release at any time and contaminate the bath water.”

Self-infection for residents is one of the biggest risks of bathing, agrees David Anderson, national sales manager for Apollo Bath.

“During the bath, millions of pathogens are released into the water via tub surfaces and the residents themselves,” he explains. “Exposure to these germs can put them at serious risk of infections such as urinary tract and respiratory infections. Staff members also inhale these same bacteria due to the aerosol effect.”

Other safety hazards are related to time constraints, Anderson says, such as understaffing and aides “simply hurrying through the process.” That haste can lead to critical mistakes, he explains.

“With regard to both patient lifts and dedicated bathing system transfer units, protocol needs to be followed and not hurried,” he emphasizes. “What’s more, worn or improperly maintained equipment can pose a serious threat to both residents and staff. It is crucial that any equipment used for the transferring of residents is properly maintained.”

Biggest potential danger
Tracy Sumner, manager of marketing communications for Joerns, considers the lifting environment to be “the biggest hazard for caregivers and residents because there are many restrictive areas and hazardous obstacles to overcome in completing transfers.” Slick floors are common and other problem points include thresholds or transition spots that make it difficult to position or to move a lift. 

Staff members who embrace safe patient handling techniques are seeing benefits through reduced injuries of both themselves and the residents, Sumner says. 

“This is not limited to bathing areas but applies to all locations in the facility,” she says. “Reducing or eliminating injuries also improves morale at the facility, and the positives continue to build upon each other.” 
By and large, the commercial bathing industry has made “some significant innovations” in the design and production of products, Sumner believes.

“Materials for lifts are lighter weight, yet stronger,” she says. “Lifts are electrically operated as opposed to manual cranks or pumps; and improved materials and designs of lift slings are more comfortable, dry quickly and reduce the risk of injury to the resident. New products utilizing lightweight materials and ergonomic design considerations make lifts easier to use,” she explains. “When lifts are both available and easy to use, the staff will use the mechanical advantage and help to create a safer environment at the facility.”

Eye on standards
There are three basic quality and safety standards a hydro-bathing system must meet:

• Underwriters Laboratories’ 1795 Third Edition, the U.S. electrical safety standard for hydro-massage bath tubs and their intended use.
• American Society of Mechanical Engineers A112.19.15-2005, the U.S. standard for bathtubs and whirlpool bathtubs with pressure- sealed doors.
• American National Standards Institute Z124.1.2-2005, the U.S. standard for plastic bathtubs and shower units.

“To be assured that the system you are looking at meets these important standards, it must carry a mark from a nationally recognized laboratory such as Underwriters Laboratories or Edison Testing Laboratories certifying that it meets the above standards,” Novotne says. “Be careful, though, because some manufacturers will claim that their tub ‘meets’ whatever standard they are referencing. However, unless it has a label affixed to it, with a mark from a nationally recognized laboratory stating that it is certified as meeting the standards listed on the label, you in fact have no guarantee that it meets the referenced standard.”

Jim Bollinger, national sales manager for commercial and hospitality at Aquatic, adds that bathing safety codes and standards haven’t changed fundamentally since the 1991 passage of the Americans with Disabilities Act, which mandated that public and commercial facilities be accessible to everyone.

“However, modifications to ADA passed in 2010 have allowed bathware manufacturers to make some important improvements,” he says, giving the example of  Aquatic’s line of roll-in showers with half-inch thresholds, “which do a better job of retaining water in the units.” In the past, seats on roll-in and transfer showers had to extend to the shower compartment entry, he said, but now seats can be three inches back from the entry so the shower curtain “hangs within the shower unit instead of billowing out and allowing water to escape,” he says.

Dignified bathing
Along with working to make bath time safer for residents, long-term care providers also have focused on creating a more comfortable, dignified experience as well. Manufacturers say this has been one of the most positive cultural trends in the industry.

“The trend toward dignified bathing has made the overall bathing experience safer for residents,” Anderson agrees. “Years back, the primary means of getting residents in and out of a tub was to raise them up and over the side of the tub itself in a chair powered by hydraulics. This was not only frightening for the residents, but they could become agitated and combative, increasing the chances of falling out of the lift or injuring the caregiver.”

Apollo’s answer to this challenge was developing its Level Glide transfer system. Shaped like a wheelchair, the device allows residents to stay securely grounded during the entire bathing process, providing a safer and more dignified bath, Anderson says.

Along with the more dignified low-level transfers that modern door tubs allow, Novotne says there are several comfort amenities standard on select hydro massage bathing systems, including aromatherapy, with an array of available scents to enhance the experience.

The air-based hydro massage system has become standard, with heated air keeping the bath area warm and comfortable during the fill and drain procedures, he says, adding that some air-based hydro massage system tubs can be adjusted in “an infinite range of intensities” to suit a resident’s personal comfort level.

Aquatic has concentrated on aesthetics of bath products “so they have more of a residential and even a hospitality appearance, versus an institutional appearance that screams ‘handicap’ and for many carries a stigma,” Bollinger says. Aquatic designs include four-piece units with simulated tile and a decorative band of diagonal tile. Even grab bars have been given a makeover, he notes.

“The goal is to make the bathroom look more residential and luxurious while still including key safety features in bathing fixtures,” he says.