Date Presented 03/27/20
This study describes the impact of an educational intervention that promotes effective communication of patient hygiene routines among interdisciplinary teams. Results showed that the intervention group was two times more likely to bathe in the bathroom than in a chair or bed. Findings suggest that OT plays an integral role in the education of interprofessional team members on bathing procedures, particularly for those with limited mobility and independence.
Primary Author and Speaker: Megan Westendorf
Additional Authors and Speakers: Morgan Haak, Carissa Studer
Contributing Authors: Elizabeth Zubrenic, Natalie Fiore, Lauren Little, Kevin Pritchard
PURPOSE: According to the Agency for Healthcare Research and Quality (AHRQ), HAIs affect one out of every 20 patients in the hospital (Agency for Healthcare Research and Quality, 2018). Catheter associated urinary tract infection (CAUTI) is the most prevalent HAI andextends patient length of stay, reduces patient satisfaction, and increases hospital expenses. The AHRQ estimated that the number of CAUTIs increased by 36,000 between 2014 and 2016, resulting in an increase in costs by almost $5.1 million (Agency for Healthcare Research and Quality, 2018). Occupational therapy practitioners (OTs) should promote interdisciplinary collaboration to address often overlooked standards of hygiene care (Pritchard, Fisher, Rudnitsky, Ramirez, 2019). The standard of bathing care includes the use of running water; however, our hospital often implements basin bathing. The purpose of this study is to determine if the use of a standardized electronic communication tool would result in improved bathing practice as evidenced by an increased number of individuals bathing in less restrictive environments.
DESIGN: Participants in the prospective cohort study were adult acute care patients in an urban midwest academic medical center on the general surgical unit between the dates June 26, 2019 and September 26, 2019. Participants included all patients admitted to the general surgical unit who received an occupational therapy consult. No participants in this study were excluded. 124 individual participants were included.
METHOD: OTs provided interdisciplinary education to the patient care technicians, nursing manager, nursing education coordinator, and charge nurse for the floor. Education focused on the successful utilization of a customized interdisciplinary plan of care page where OTs document bathing recommendations. Finally, the interdisciplinary group defined a common documentation terminology for a patient’s level of independence and recommended bathing location. To address our primary research question, we used electronic health record (EHR) data from the intervention and control groups. The following variables were operationally defined and analyzed for our study: 1) level of independence (where this was taken from); 2) intervention and control groups; 3) bathing location, defined as bathroom, chair, or bed. We used SAS Studio 5.1 to conduct a multinomial logistic regression, which is appropriate for models in which the outcome is categorical. Independent variables included intervention or control group; covariates included: level of independence; and the outcome variables included bathing location (bathroom, chair, bed).
RESULTS: Findings from the multinomial logistic regression showed that patients in the intervention were 2.738 times more likely to bathe in the bathroom than the chair (95% CI 1.390-5.395). Independent patients were 2.114 times more likely to bathe in the bathroom than the chair (95% CI 1.035-4.317). We also tested the interaction between independence level and intervention group, which was not significant X2 (1, N=414)=0.62, p=.43.
CONCLUSION: Patients in the intervention group were significantly more likely to bathe in the bathroom than the chair. These results are important because patients who are generally independent and bathing in the chair with a basin are at risk of decreased mobility and substandard bathing practices. While this study did not directly address CAUTI incidence, transitioning bathing practices from the bedroom chair with a basin to using running water in the bathroom has implications for a case-control trial that would directly measure CAUTIs. OTs play an integral role in the education of interdisciplinary team members on translating the least restrictive bathing practices to a patient’s current level of function
References
Agency for Healthcare Research and Quality. (2018, June). AHRQ national scorecard on hospital-acquired conditions: Updated baseline rates and preliminary results 2014–2016. Retrieved from https://www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/pfp/ natlhacratereport-rebaselining2014-2016_0.pdf
Pritchard, K. T., Fisher, G., McGee Rudnitsky, K., & Ramirez, R. D. (2019). Health Policy Perspectives—Policy and payment changes create new opportunities for occupational therapy in acute care. American Journal of Occupational Therapy, 73, 7302109010. https://doi.org/10.5014/ ajot.2018.732002
Centers for Medicare and Medicaid Services. (2018c). Hospital-Acquired Condition Reduction Program. Retrieved from https://www.cms.gov/Medicare/ Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/HAC-Reduction-Program.html
