Cost-consequence analysis of ‘‘washing without water’’ for nursing home residents: A cluster randomized trial

Background: no-rinse disposable wash gloves are increasingly implemented in health care to replace traditional soap and water bed baths without proper evaluation of (cost) effectiveness.Objectives: to compare bed baths for effects on skin integrity and resistance against bathing and costs.Design: cluster randomized trial.Setting: fifty six nursing home wards in the Netherlands.Participants: five hundred adult care-dependent residents and 275 nurses from nursing home wards.Methods: the experimental condition ‘washing without water’ consists of a bed bath with disposable wash gloves made of non-woven waffled fibers, saturated with a no-rinse, quickly vaporizing skin cleaning and caring lotion. The control condition is a traditional bed bath using soap, water, washcloths and towels. Both conditions were continued for 6 weeks. Outcome measures were prevalence of skin damage distinguished in two levels of severity: any skin abnormality/lesion and significant skin lesions. Additional outcomes: resistance during bed baths, costs.Results: any skin abnormalities/lesions over time decreased slightly in the experimental group, and increased slightly in the control group, resulting in 72.7% vs 77.6% of residents having any skin abnormalities/lesions after 6 weeks, respectively (p = 0.04). There were no differences in significant skin lesions or resistance after 6 weeks. Mean costs for bed baths during 6 weeks per resident were estimated at €218.30 (95%CI 150.52–286.08) in the experimental group and €232.20 (95%CI: 203.80–260.60) in the control group (difference €13.90 (95%CI: ?25.61–53.42).Conclusion: washing without water mildly protects from skin abnormalities/lesions, costs for preparing and performing bed baths do not differ from costs for traditional bed bathing. Thus, washing without water can be considered the more efficient alternative