Effects of bed baths with weak wiping pressure using cotton and disposable towels on the skin barrier function of the lower limbs and forearms in older patients with heart disease: a quasi-experimental (crossover) study

Abstract

Background: Bed baths are commonly used to maintain skin hygiene in older hospitalized patients whose skin may be affected by disease, treatment, and aging. The effects of bed baths on the skin barrier function, particularly in the lower limbs, in older patients with heart disease who may have fragile skin remain unclear. This quasi-experimental (crossover) study investigated the effects of bed baths with weak wiping pressure using cotton and disposable towels on the skin barrier function of the lower limbs and forearms in older hospitalized patients with heart disease.

Methods: Thirty-three older hospitalized patients with heart disease were evaluated. Participants received two randomly ordered wipes (AB or BA): (A) bed baths of the lower limbs and forearms using disposable towels; and (B) bed baths of the lower limbs and forearms using cotton towels. Weak wiping pressure was used (10-20 mmHg). Skin barrier function was measured before, 15 min after, and the day after bed bath using transepidermal water loss (TEWL), stratum corneum hydration (SCH), and overall dry skin score (ODS). Mixed-effects models for repeated measures were used to compare the changes over time between the two types of bed baths.

Results: SCH and TEWL were lower in the lower limbs than in the forearms, while ODS was higher. An interaction for TEWL was observed in the lower limbs (F _[2,25] = 4.0, P = 0.030); however, TEWL did not differ significantly across time points or towel types. No interaction or main effects of time or towel type on lower limb SCH and forearm TEWL were noted. Only the main effect of time on forearm SCH was observed, which was significantly lower 15 min after the cotton towel bed bath than before (t = 3.2, P = 0.004, MD [95% CI]: - 3.5, - 0.8). ODS at baseline and the following day demonstrated no difference.

Conclusion: Changes in TEWL and SCH over time revealed that a single bed bath with weak wiping pressure did not cause sustained impairment of skin barrier function by the following day. However, transient SCH decreases, and limited intervention periods require further mechanistic investigation.

Trial registration: UMIN R000061354 (date of registration: March 3, 2024).

Keywords: Bed baths; Hygiene care; Lower limbs; Older patients; Skin care; Stratum corneum hydration; Transepidermal water loss.