Troubled waters?

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Transfers should be easy for residents and staff, experts say.
Transfers should be easy for residents and staff, experts say.

In the perpetual quest to mitigate risk in assisted living facilities, one area that appears at the top of the concern list more frequently than others is bathing. Keeping the bathing area as safe and secure as possible in order to alleviate worries about resident falls or infections is an ongoing challenge at senior living communities.

Facilities with a higher ambulatory resident population have less to worry about, as those residents can bathe themselves privately in their rooms or apartments and staff typically doesn't have to be involved. But as assisted living continues to take in higher acuity residents from the skilled nursing sector, the bathing issue assumes greater importance. 

In fact, facility operators should be thinking about their demographics and occupancy levels over the next decade in order to determine future bath safety procedures, says David Anderson, national sales manager for Apollo Bath.

“If there is a centralized bathing area, it is important to not only consider the make-up of your current resident mix, but what you expect the profile to be five to ten years from now,” he says. “It does little good to purchase a bathing system for your current resident mix without considering the acuity levels of that population in the next decade.”

Consideration also should be given to the acuity levels of those residents who bathe themselves on their own right now, and how they would manage after a debilitating stroke or after undergoing an invasive medical procedure, Anderson says. 

“If they can no longer bathe themselves, a centralized system that meets their needs should be made available,” he says.

Fran Spidare, product development manager for safe patient handling at Invacare, says safety and comfort are not mutually exclusive in bathing.

“Many centers understand the importance of creating a relaxing bathing environment, balancing the time required for true hygiene with the time for relaxing in the physical and emotional warmth of the total environment,” she says. “Safety is a mindset and the consistent actions that go with it, including well-defined procedures for safe transfers, training for staff, preparations to making the area safe and assurance that the bathing area is a clean and inviting atmosphere.”

Safe transfers

The greatest risks involved with bathing focus on ensuring the safety of the resident transfer as well as slip, fall and burn prevention and keeping on top of infection control.

For transfers, the process of lifting and moving can cause stress, strain and injury for residents and staff members alike, Spidare says.

“Safe handling of residents involves a thorough assessment of the resident,” she says. “Lifting equipment must be used so that both the caregiver and resident remain safe during the transfer process. The more familiar caregivers are with the equipment and its proper use, the more at ease they can make the resident.”

Indeed, staff must operate transfer equipment according to manufacturer specifications, Anderson says. For heavier residents, bariatric equipment and special protocols should be followed. 

The key to transfers, whether from bed to wheelchair or wheelchair to bath, is leverage, adds Lee Penner, president of Penner Patient Care.

“If it's a weight-bearing transfer and the resident shifts during the move, the caregiver's body mechanics will fail if there is not proper leverage,” he says. “Employees get hurt more often than residents because of bad body mechanics and lack of leverage.”

A low entry point to the bath is another advantage, as is an in-spa transfer device, Penner says.

Arden Olson, president of Accessible Systems, says the best way to minimize risk in transfers is to avoid transfers whenever possible.

“Our adjustable sink allows most non-ambulatory residents to remain in their wheelchairs for a shampoo service,” he says. “When the number of transfers is reduced, the opportunities for accidents and injuries is reduced.”

Danger areas

Slips and falls are more likely on wet surfaces, so keeping the floor as dry as possible is critical to a safe bathing environment, Spidare says.

“This relates to the design of the room — the floor should be slightly sloped to allow for good drainage,” she says. “Rubber mats should be used to provide traction and some slip resistance.”

Placing a non-slip rug in front of the tub is another effective slip prevention tactic, Anderson adds.

Burns are another concern and bathing suppliers recommend equipping each tub with an anti-scald mixing valve. These valves automatically control the flow of hot and cold water so the temperature does not fluctuate, which virtually eliminates the chances of residents being scalded by hot water, Anderson says.  

Given their potential for cross-contamination and germ fertility, bathing areas should always be on high alert for infection control, specialists say.

“Cross-contamination is always an issue,” says Anderson. “A bathing system equipped with a means to flush the lines with cleaner and disinfectant is needed and a means of purifying the water during the bath minimizes self-infection as well.”

To be sure, the bathing tub and its jet must be properly cleaned and disinfected every time between bathing cycles, Spidare says. 

“For tubs with pipes and tubing that circulate water from the tub, this is a difficult task,” she says. “Pipeless jet systems allow for much easier cleaning and disinfecting.”

Penner's spas have a dual disinfecting system that uses a sporicide that kills even the most stubborn pathogens, like clostridium difficile, Methicillin-resistant Staphylococcus aureus and Vancomycin-resistant enterococci.

“When the need arises, the sporicide is available in our system,” he says. “But in 95 percent of the cross-contamination cases, the problem is with a lack of diligence in cleaning the equipment according to the manufacturer's specifications.”

Bathing technology

Bathing manufacturers are constantly listening to their assisted living customers about the challenges with resident bathing and are incorporating that feedback into their technology. Regarding resident transfers, Apollo has developed the Level Glide Transfer System to eliminate hydraulic lifts.

“These lifts would hoist the resident high in the air so that the chair could swing around and over the tub so the resident could be lowered into the water — it is a means of transferring that is undignified for residents and unsafe for both residents and staff,” Anderson says.

Apollo also developed the Remedy Ultraviolet Water Purification System to address the “often ignored but very real issue of self-infection,” Anderson says. “Regardless of how well a bathing system was cleaned and disinfected between baths, the number of harmful bacteria skyrocket during a bath because the pathogens wash off the bather's body. Instead of bathing in whatever washes off one's body, the UV system continuously kills those bacteria. This results in lowered rates of infection; in fact, the system was clinically proven to reduce UTIs by 50 percent and respiratory infections by 35 percent.”

Invacare has introduced the SANIJET Pipeless technology to its tub line, Spidare says.

“Pipeless jet technology really improves the bathing experience because it allows clients to use whatever soap, shampoo or bath oil they like; it moves the water to relax the muscles, and it provides a truly clean bath because everything may be properly disinfected since there are no pipes in which dirty water can sit,” she says. 

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