Yoğun Bakım Hastalarında Yıkama ve Silme Banyosunun Cilt Hijyeni ve Nem–Yağ Oranı Üzerine Etkisinin Karşılaştırılması: Yarı Deneysel Çalışma
Year 2025,
Volume: 29 Issue: 3, 194 - 206, 25.12.2025
Nurcan Tekinalp
,
Ayşe Demiray
Abstract
Amaç: Bu çalışma, yoğun bakım ünitesindeki (YBÜ) hastalarda yıkama ve silme banyolarının cilt hijyeni ve nem-yağ oranı üzerindeki etkilerini karşılaştırmayı amaçlamıştır.
Yöntem: Araştırma, yarı deneysel iki gruplu ön test–son test tasarımı ile gerçekleştirilmiştir. Çalışma, 25 Temmuz- 25 Aralık 2023 tarihleri arasında bir devlet hastanesinin yoğun bakım ünitesinde, toplam 68 hasta ile yürütülmüştür. Katılımcılar rastgele şekilde yıkama veya silme gruplarına atanmıştır. Veriler; Hasta Bilgi Formu, Tüm Vücut Cilt Hijyen Değerlendirme Formu ve Non-invaziv Biyoempedans Cilt Nem-Yağ Analiz Formu kullanılarak toplanmıştır. Yıkama grubuna 72 saatlik izlem süresinde bir kez yıkama banyosu uygulanırken, silme grubuna her 24 saatte bir silme işlemi yapılmıştır. Değerlendirmeler müdahale öncesinde ve sonrasında gerçekleştirilmiştir.
Bulgular: Müdahale öncesinde gruplar arasında cilt hijyeni ve nem-yağ oranı açısından anlamlı bir fark bulunmamıştır (P>,05). Müdahale sonrasında, yıkama grubunda saç, göz, kulak, burun, el, ayak ve tırnak hijyeninde iyileşme gözlenmiş; ancak koltuk altı ve perine hijyeninde anlamlı bir değişiklik saptanmamıştır (P>,05). Gruplar arasında cilt yağ oranı açısından anlamlı bir fark bulunmamıştır (P>,05); ancak yıkama grubunda cilt neminde azalma tespit edilmiştir (P<,05).
Sonuç: Yıkama banyoları, koltuk altı ve perine bölgesi hariç cilt hijyenini artırmıştır ancak silme banyolarıyla kıyaslandığında cilt nemini azaltmış, yağ oranında ise bir değişikliğe yol açmamıştır. Bu nedenle, yoğun bakım hastalarında banyo uygulamaları bireysel ihtiyaçlara göre planlanmalı, uygun durumlarda silme banyosu tercih edilmelidir.
Ethical Statement
Bu çalışma için etik komite onayı Bolu Abant İzzet Baysal Üniversitesi Klinik Araştırma Etik Kurulundan (Tarih: 23.05.2023, Sayı: 2023/131) alınmıştır.
Thanks
Çalışmaya katılan yoğun bakım hastalarına ve ailelerine, ayrıca çalışma boyunca değerli destek ve iş birlikleri için Bolu İzzet Baysal Devlet Hastanesi Merkez Birimi yönetimine en içten teşekkürlerimizi sunmak isteriz.
References
-
1. Roger M, Fullard N, Costello L, et al. Bioengineering the microanatomy of human skin. J Anat. 2019;234(4):438-455.
-
2. Vaughn AR, Clark AK, Sivamani RK, Shi VY. Natural oils for skin-barrier repair: ancient compounds now backed by modern science. Am J Clin Dermatol. 2018;19(1):103-117.
-
3. Kula BE, Hudson D, Sligl WI. Pseudomonas aeruginosa infection in intensive care: epidemiology, outcomes, and antimicrobial susceptibilities. J Assoc Med Microbiol Infect Dis Can. 2020;5(3):130-138.
-
4. Nascimento T, Inácio J, Guerreiro D, et al. Insights into Candida colonization in intensive care unit patients: a prospective multicenter study. J Fungi. 2024;10(6):378.
-
5. Sharara SL, Maragakis LL, Cosgrove SE. Decolonization of Staphylococcus aureus. Infect Dis Clin North Am. 2021;35(1):107-133.
-
6. Ture Yuce Z, Erdemir A. Infection control bundles for the prevention of hospital infections. Mediterr J Infect Microb Antimicro. 2016;5:8.
-
7. Alserehi H, Filippell M, Emerick M, et al. Chlorhexidine gluconate bathing practices and skin concentrations in intensive care unit patients. Am J Infect Control. 2018;46(2):226-228.
-
8. Cassir N, Papazian L, Fournier PE, Raoult D, La Scola B. Insights into bacterial colonization of intensive care patients’ skin: the effect of chlorhexidine daily bathing. Eur J Clin Microbiol Infect Dis. 2015;34(5):999-1004.
-
9. La D, Filippell FS, Johnson C, et al. Central-line–associated bloodstream infections in intensive care units before and after implementation of daily antiseptic bathing with chlorhexidine or octenidine: a post hoc analysis of a cluster-randomized controlled trial. Antimicrob Resist Infect Control. 2023;12(1):45.
-
10. Pallotto C, Fiorio M, De Angelis V, et al. Daily bathing with 4% chlorhexidine gluconate in intensive care settings: a randomized controlled trial. Clin Microbiol Infect. 2019;25(6):705-710.
-
11. Peixoto EAC, Poveda VB, Gnatta JR, Oliveira RA. Bathing with wipes impregnated with chlorhexidine gluconate to prevent central line-associated bloodstream infection in critically ill patients: a systematic review with meta-analysis. Am J Infect Control. 2024;52(1):1-10.
-
12. Viray MA, Morley JC, Coopersmith CM, Kollef MH, Fraser VJ, Warren DK. Daily bathing with chlorhexidine-based soap and the prevention of Staphylococcus aureus transmission and infection. Infect Control Hosp Epidemiol. 2014;35(3):243-250.
-
13. Alshahrani B, Middleton R, Rolls K, Sim J. Pressure injury prevalence in critical care settings: an observational pre-post intervention study. Nurs Open. 2024;11(2):e2110.
-
14. Çavuşoğlu A, Yeni K, İncekara H, Acun A, Polat Dünya C, Türek Z. Pressure ulcer prevalence in an intensive care unit: a retrospective study. JAREN. 2020;6(2):203-209.
-
15. Centers for Disease Control and Prevention (CDC). Hygiene-related diseases. Published June 15, 2022. Accessed March 7, 2024. Available from: https://www.cdc.gov/hygiene/disease/index.html
-
16. Smith SF, Duell DJ, Martin MJ. Clinical Nursing Skills. Pearson; 2014.
-
17. Treas LS, Wilkinson JM. Basic Nursing: Concepts, Skills, & Reasoning. F.A. Davis Company; 2014.
-
18. Hunter C. Hygiene. In: Fundamentals of Nursing. 6th ed. Mosby; 2017:299-313.
-
19. Uludağ S. Yoğun Bakım Hastalarında İki Banyo Yönteminin Yaşam Bulguları ve Oksijen Satürasyonu Üzerine Etkisi. Master’s thesis. Marmara University, Institute of Health Sciences; 2022.
-
20. Gillis K, Tency I, Roelant E, Laureys S, Devriendt H, Lips D. Skin hydration in nursing home residents using disposable bed baths. Geriatr Nurs. 2016;37(3):175-179.
-
21. Martin ET, Haider S, Palleschi M, et al. Bathing hospitalized dependent patients with prepackaged disposable washcloths instead of traditional bath basins: a case-crossover study. Am J Infect Control. 2017;45(9):990-994.
-
22. Eraydın Ş. Hijyen uygulamaları. In: Karagözoğlu Ş, Demiray A, Doğan P, eds. Temel Hemşirelik Uygulama İçin Esaslar. 1st ed. Nobel Tıp Kitabevleri; 2023:806.
-
23. Uludağ E. Hijyen uygulamaları. In: Kara Kaşıkçı M, Akın Palandöken E, eds. Temel Hemşirelik Esaslar, Kavramlar, İlkeler, Uygulamalar. 1st ed. İstanbul Tıp Kitabevi; 2021:115-135.
-
24. Peate I, Nair M. Fundamentals of Anatomy and Physiology for Student Nurses. Peker TV, Erbaş D, trans. eds. Palme Yayıncılık; 2014.
-
25. Aktümsek A. Anatomi ve Fizyoloji İnsan Biyolojisi. 11th ed. Nobel Akademik Yayıncılık; 2017.
-
26. Byrne AJ. Bioengineering and subjective approaches to the clinical evaluation of dry skin. Int J Cosmet Sci. 2010;32(6):410-421.
-
27. Ademola J, Frazier C, Kim SJ, Theaux C, Saudez X. Clinical evaluation of 40% urea and 12% ammonium lactate in the treatment of xerosis. Am J Clin Dermatol. 2002;3(3):217-222.
-
28. Ataseven Emeksiz T. Obez/Kilolu Çocuk ve Adolesanlarda Metabolik Hormonal ve Nutrisyonel Durumun Cilt Bariyer Fonksiyonlarına Etkisinin Biyoimpedans Yöntemiyle Araştırılması. Doctoral thesis. Ufuk University, Faculty of Medicine, Department of Pediatrics; 2021.
-
29. Dudzinski K, Dawgul M, Wawro B, Pijanowska D, Torbicz W. Skin impedance measurements by means of novel gold sensors fabricated by direct writing. Procedia Eng. 2015;120:134-140.
-
30. Kato A, Hamada M, Maruyama T, Maruyama Y, Hishida A. Pruritus and hydration state of stratum corneum in hemodialysis patients. Am J Nephrol. 2000;20(6):437-442.
-
31. Lenth RV. Statistical power calculations. J Anim Sci. 2007;85(13 Suppl):E24-E29.
-
32. Boutron I, Altman DG, Moher D, Schulz KF, Ravaud P; CONSORT NPT Group. CONSORT statement for randomized trials of nonpharmacologic treatments: a 2017 update and a CONSORT extension for nonpharmacologic trial abstracts. Ann Intern Med. 2017;167(1):40-47.
-
33. Brooks J, Cowdell F, Ersser SJ, Gardiner ED. Skin cleansing and emolliating for older people: a quasi-experimental pilot study. Int J Older People Nurs. 2017;12(3):e12145.
-
34. Hahnel E, Lichterfeld A, Blume-Peytavi U, Kottner J. The epidemiology of skin conditions in the aged: a systematic review. J Tissue Viability. 2017;26(1):20-28.
-
35. Cowdell F, Jadotte YT, Ersser SJ, et al. Hygiene and emollient interventions for maintaining skin integrity in older people in hospital and residential care settings. Cochrane Database Syst Rev. 2020;1(1):CD011377.
-
36. Groven FMV, Zwakhalen SMG, Odekerken-Schröder G, Joosten EJT, Hamers JPH. How does washing without water perform compared to the traditional bed bath: a systematic review. BMC Geriatr. 2017;17(1):31.
-
37. Konya I, Iwata H, Hayashi M, et al. Effectiveness of weak wiping pressure during bed baths in hospitalized older adults: a single-blind randomized crossover trial. Geriatr Nurs. 2021;42(6):1379-1387.
-
38. Lichterfeld-Kottner A, El Genedy M, Lahmann N, Blume-Peytavi U, Büscher A, Kottner J. Maintaining skin integrity in the aged: a systematic review. Int J Nurs Stud. 2020;103:103509.
Comparison of the Effect of Washing and Wiping Bath on Skin Hygiene and Moisture–Oil Ratio: A Quasi-Experimental Study
Year 2025,
Volume: 29 Issue: 3, 194 - 206, 25.12.2025
Nurcan Tekinalp
,
Ayşe Demiray
Abstract
Objective: This study aimed to compare the effects of washing and wiping baths on skin hygiene and the moisture-oil ratio in intensive care unit (ICU) patients.
Method: A quasi-experimental two-group pre-test/post-test design was used. The study was conducted with 68 ICU patients in a public hospital between July 25 and December 25, 2023. Participants were randomly assigned to either the washing bath group or the wiping bath group. Data were collected using the Patient Information Form, Whole-Body Skin Hygiene Assessment Form, and Non-invasive Bioimpedance Skin Moisture-Oil Analysis Form. The washing group received one washing bath during the 72-hour follow-up period, whereas the wiping group received wiping baths every 24 hours. Assessments were performed before and after the intervention.
Results: No significant differences were found between the groups in terms of skin hygiene or moisture–oil ratio before the intervention (P>.05). After the intervention, improvements were observed in hair, eye, ear, nose, hand, foot, and nail hygiene in the washing group; however, no significant changes were detected in axillary and perineal hygiene (P>.05). There were no significant differences between the groups regarding skin oil content (P>.05), whereas a significant decrease in skin moisture was observed in the washing group (P<.05).
Conclusion: Washing baths improved overall skin hygiene, except for the axillary and perineal areas; however, compared with wiping baths, they were associated with reduced skin moisture and no change in skin oil content. Therefore, bathing practices for intensive care patients should be individualized, and wiping baths may be preferred when appropriate.
Ethical Statement
The study protocol was approved by the Bolu Abant İzzet Baysal University Clinical Research Ethics Committee (date: 23.05.2023, decision no: 2023/131) and the Bolu Health Directorate (date: 18.07.2023, decision no: E-38244951-604.01.01-220068481). Throughout the study, patient privacy was maintained, and the principles of the Declaration of Helsinki were upheld.
Thanks
We would like to express our sincere gratitude to the intensive care patients and their families for their participation, as well as to the administration of Bolu İzzet Baysal State Hospital, Central Unit, for their valuable support and cooperation throughout the study
References
-
1. Roger M, Fullard N, Costello L, et al. Bioengineering the microanatomy of human skin. J Anat. 2019;234(4):438-455.
-
2. Vaughn AR, Clark AK, Sivamani RK, Shi VY. Natural oils for skin-barrier repair: ancient compounds now backed by modern science. Am J Clin Dermatol. 2018;19(1):103-117.
-
3. Kula BE, Hudson D, Sligl WI. Pseudomonas aeruginosa infection in intensive care: epidemiology, outcomes, and antimicrobial susceptibilities. J Assoc Med Microbiol Infect Dis Can. 2020;5(3):130-138.
-
4. Nascimento T, Inácio J, Guerreiro D, et al. Insights into Candida colonization in intensive care unit patients: a prospective multicenter study. J Fungi. 2024;10(6):378.
-
5. Sharara SL, Maragakis LL, Cosgrove SE. Decolonization of Staphylococcus aureus. Infect Dis Clin North Am. 2021;35(1):107-133.
-
6. Ture Yuce Z, Erdemir A. Infection control bundles for the prevention of hospital infections. Mediterr J Infect Microb Antimicro. 2016;5:8.
-
7. Alserehi H, Filippell M, Emerick M, et al. Chlorhexidine gluconate bathing practices and skin concentrations in intensive care unit patients. Am J Infect Control. 2018;46(2):226-228.
-
8. Cassir N, Papazian L, Fournier PE, Raoult D, La Scola B. Insights into bacterial colonization of intensive care patients’ skin: the effect of chlorhexidine daily bathing. Eur J Clin Microbiol Infect Dis. 2015;34(5):999-1004.
-
9. La D, Filippell FS, Johnson C, et al. Central-line–associated bloodstream infections in intensive care units before and after implementation of daily antiseptic bathing with chlorhexidine or octenidine: a post hoc analysis of a cluster-randomized controlled trial. Antimicrob Resist Infect Control. 2023;12(1):45.
-
10. Pallotto C, Fiorio M, De Angelis V, et al. Daily bathing with 4% chlorhexidine gluconate in intensive care settings: a randomized controlled trial. Clin Microbiol Infect. 2019;25(6):705-710.
-
11. Peixoto EAC, Poveda VB, Gnatta JR, Oliveira RA. Bathing with wipes impregnated with chlorhexidine gluconate to prevent central line-associated bloodstream infection in critically ill patients: a systematic review with meta-analysis. Am J Infect Control. 2024;52(1):1-10.
-
12. Viray MA, Morley JC, Coopersmith CM, Kollef MH, Fraser VJ, Warren DK. Daily bathing with chlorhexidine-based soap and the prevention of Staphylococcus aureus transmission and infection. Infect Control Hosp Epidemiol. 2014;35(3):243-250.
-
13. Alshahrani B, Middleton R, Rolls K, Sim J. Pressure injury prevalence in critical care settings: an observational pre-post intervention study. Nurs Open. 2024;11(2):e2110.
-
14. Çavuşoğlu A, Yeni K, İncekara H, Acun A, Polat Dünya C, Türek Z. Pressure ulcer prevalence in an intensive care unit: a retrospective study. JAREN. 2020;6(2):203-209.
-
15. Centers for Disease Control and Prevention (CDC). Hygiene-related diseases. Published June 15, 2022. Accessed March 7, 2024. Available from: https://www.cdc.gov/hygiene/disease/index.html
-
16. Smith SF, Duell DJ, Martin MJ. Clinical Nursing Skills. Pearson; 2014.
-
17. Treas LS, Wilkinson JM. Basic Nursing: Concepts, Skills, & Reasoning. F.A. Davis Company; 2014.
-
18. Hunter C. Hygiene. In: Fundamentals of Nursing. 6th ed. Mosby; 2017:299-313.
-
19. Uludağ S. Yoğun Bakım Hastalarında İki Banyo Yönteminin Yaşam Bulguları ve Oksijen Satürasyonu Üzerine Etkisi. Master’s thesis. Marmara University, Institute of Health Sciences; 2022.
-
20. Gillis K, Tency I, Roelant E, Laureys S, Devriendt H, Lips D. Skin hydration in nursing home residents using disposable bed baths. Geriatr Nurs. 2016;37(3):175-179.
-
21. Martin ET, Haider S, Palleschi M, et al. Bathing hospitalized dependent patients with prepackaged disposable washcloths instead of traditional bath basins: a case-crossover study. Am J Infect Control. 2017;45(9):990-994.
-
22. Eraydın Ş. Hijyen uygulamaları. In: Karagözoğlu Ş, Demiray A, Doğan P, eds. Temel Hemşirelik Uygulama İçin Esaslar. 1st ed. Nobel Tıp Kitabevleri; 2023:806.
-
23. Uludağ E. Hijyen uygulamaları. In: Kara Kaşıkçı M, Akın Palandöken E, eds. Temel Hemşirelik Esaslar, Kavramlar, İlkeler, Uygulamalar. 1st ed. İstanbul Tıp Kitabevi; 2021:115-135.
-
24. Peate I, Nair M. Fundamentals of Anatomy and Physiology for Student Nurses. Peker TV, Erbaş D, trans. eds. Palme Yayıncılık; 2014.
-
25. Aktümsek A. Anatomi ve Fizyoloji İnsan Biyolojisi. 11th ed. Nobel Akademik Yayıncılık; 2017.
-
26. Byrne AJ. Bioengineering and subjective approaches to the clinical evaluation of dry skin. Int J Cosmet Sci. 2010;32(6):410-421.
-
27. Ademola J, Frazier C, Kim SJ, Theaux C, Saudez X. Clinical evaluation of 40% urea and 12% ammonium lactate in the treatment of xerosis. Am J Clin Dermatol. 2002;3(3):217-222.
-
28. Ataseven Emeksiz T. Obez/Kilolu Çocuk ve Adolesanlarda Metabolik Hormonal ve Nutrisyonel Durumun Cilt Bariyer Fonksiyonlarına Etkisinin Biyoimpedans Yöntemiyle Araştırılması. Doctoral thesis. Ufuk University, Faculty of Medicine, Department of Pediatrics; 2021.
-
29. Dudzinski K, Dawgul M, Wawro B, Pijanowska D, Torbicz W. Skin impedance measurements by means of novel gold sensors fabricated by direct writing. Procedia Eng. 2015;120:134-140.
-
30. Kato A, Hamada M, Maruyama T, Maruyama Y, Hishida A. Pruritus and hydration state of stratum corneum in hemodialysis patients. Am J Nephrol. 2000;20(6):437-442.
-
31. Lenth RV. Statistical power calculations. J Anim Sci. 2007;85(13 Suppl):E24-E29.
-
32. Boutron I, Altman DG, Moher D, Schulz KF, Ravaud P; CONSORT NPT Group. CONSORT statement for randomized trials of nonpharmacologic treatments: a 2017 update and a CONSORT extension for nonpharmacologic trial abstracts. Ann Intern Med. 2017;167(1):40-47.
-
33. Brooks J, Cowdell F, Ersser SJ, Gardiner ED. Skin cleansing and emolliating for older people: a quasi-experimental pilot study. Int J Older People Nurs. 2017;12(3):e12145.
-
34. Hahnel E, Lichterfeld A, Blume-Peytavi U, Kottner J. The epidemiology of skin conditions in the aged: a systematic review. J Tissue Viability. 2017;26(1):20-28.
-
35. Cowdell F, Jadotte YT, Ersser SJ, et al. Hygiene and emollient interventions for maintaining skin integrity in older people in hospital and residential care settings. Cochrane Database Syst Rev. 2020;1(1):CD011377.
-
36. Groven FMV, Zwakhalen SMG, Odekerken-Schröder G, Joosten EJT, Hamers JPH. How does washing without water perform compared to the traditional bed bath: a systematic review. BMC Geriatr. 2017;17(1):31.
-
37. Konya I, Iwata H, Hayashi M, et al. Effectiveness of weak wiping pressure during bed baths in hospitalized older adults: a single-blind randomized crossover trial. Geriatr Nurs. 2021;42(6):1379-1387.
-
38. Lichterfeld-Kottner A, El Genedy M, Lahmann N, Blume-Peytavi U, Büscher A, Kottner J. Maintaining skin integrity in the aged: a systematic review. Int J Nurs Stud. 2020;103:103509.