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aily bathing is customary in our society. But as we age, our skin becomes more vulnerable, and alternatives to the tradition of daily soap-and-water baths must be sought to preserve the integrity of our skin. Add a decrease in motor skills and mobility issues to that vulnerability, and the need for alternative bathing methods and products increases.
       Appropriate bathing is a concern for all nursing staff. Most importantly, caregivers need to know what type of bath to give and what type of products to use for which patients. Challenges presented by physical, mental, or skin health conditions dictate which modes of bathing are inappropriate or prohibitive. Appropriate bathing increases a facility's overall quality of care, improves efficiency, and reduces costs. This article will identify the types of baths that are typically given, discuss the benefits of each type of bath, and define appropriate bathing.

Patient Bathing: What are Your Options?
       Each bathing option--shower and tub bathing, basin bathing, and bed bathing (waterless bathing)--has its own benefits. These benefits may include limited supply waste, staff time efficiency, and better infection control. Following are the benefits and drawbacks of each bathing option.
       Shower and tub bathing. Shower or tub bathing is the most common bathing option and the most acceptable, as long as the patient is physically and psychologically capable of using a shower or tub. This option helps in promoting resident independent activities of daily living and self care. Another benefit to shower or tub bathing is there are lower linen costs associated with this bathing option. In addition, there is no need for a basin and ancillary supplies.
       Soap choice in shower or tub bathing should be a concern for the clinician, as most soaps alter the pH of skin.1 In a shower or tub bath, the patient generally uses traditional rinse-off products, such as regular bar soap. In addition to potentially drying the skin, bar soaps can be a breeding ground for bacteria.1 Other options for product use should be sought by the clinician. The preferred product for routine bathing would be a liquid, nonantimicrobial cleanser that is neutral in pH.1 A product with a moisturizer is beneficial.
       In addition to the threat of contamination from traditional bar soaps, another disadvantage to tub and shower bathing is the risk of contamination through the showers and tubs themselves. Showers and tubs can harbor harmful bacteria that can be a danger to the patients and can be transmitted to the clinician as well.
       Basin bathing. Basin bathing is an effective cleaning method when shower bathing is not an option. Basin bathing is an option for the patient who has some sensory impairment yet is able to assist in the bathing process. Additionally, the basin bath can be part of a rehabilitation program that assists the patient to become more independent.
       If the patient is not rinsed completely, soap may remain on the skin. Since difficulty in rinsing is a drawback to the basin bath method, concentrated bathing products may be used in diluted form for ease of use as a no rinse.
       Much like shower and tub bathing, basin bathing has similar risks of contamination and harm to both the patient and the healthcare worker if the the proper steps of sanitization are not completed.
       Bed bath or bag bath. The bed bath is a water-free bathing system that generally consists of eight prepackaged disposable cloths that contain both cleanser and moisturizer. One cloth is used for each body area in a specific sequence, from neck and facial area to buttocks and perineal area. This type of bath saves nursing time and reduces the need for additional linens and supplies (i.e., basin, towels, etc.). Since this bath contains both cleanser and emollients to moisturize the skin, this bath can be less irritating to the skin than bar soap. This bath is the ideal bathing option for bed-bound patients where mobility is an issue and sensory impaired patients for whom tub or shower bathing would be traumatic. A benefit of this bathing system is the cloths can be heated in a microwave or warmer prior to usage, thus the patient's warmth will be sustained longer than in a tub bath, where the water gradually cools. The bed bath is convenient but not appropriate for every occasion.
       A patient's condition determines the most appropriate bathing option and product combination. Table 1 illustrates the bathing options that may be appropriate for patients with mobility restraints.

What to Look for in a Bathing Product
       Choosing the appropriate products for each bathing situation is as important as the type of bath.
       Bathing cloths, such as Aloe Vesta® Bathing Cloths, are a convenient, no-rinse system that cleanses and moisturizes. Easy-to-use bathing cloths are rinse free, disposable, and generally made of thick, soft, premium-grade rayon/polyester blend. Look for a bathing cloth that contains aloe vera to moisturize and condition skin along with dimethicone and botanical extracts.
       Antimicrobial and harsh cleansers can contribute to dryness, irritation, or tearing of thin, elderly, or fragile skin. Body wash and shampoo--ideal products for routine tub bathing and shampooing--should be gentle and soothing to fragile, dry skin. Look for a body wash and shampoo that are formulated with natural ingredients and protein-rich emollients that moisturize, condition, and restore moisture to the skin. An example of such product is the Aloe Vesta® 2-in-1 Body Wash & Shampoo.
       Cleansing foams, such as the Aloe Vesta® 3-n-1 Cleansing Foam, are convenient, no-rinse, extra-gentle cleansers. The high-foaming, nonaerosol, ready-to-use cleansing foam can be used for all-over body cleansing. Foams are ideal for use on the perineum, body, and hair. Cleansing foams eliminate the need for shampoo caps, incontinence products, or microwaves.
       Another option is concentrated formulations, such as the Septi-Soft® Concentrate, which is a natural oil-based soap formulated with natural surfactants, botanicals, and conditioners to clean away dirt and oils while improving the skin's natural moisture balance. Septi-Soft® Concentrate also helps to reduce body odor. Concentrated products are useful in no-rinse bed bathing and shampooing and offer an economical no-rinse bathing option.
       Aloe Vesta® and Septi-Soft® are registered trademarks of E.R. Squibb & Sons, L.L.C.

A Guide to Appropriate Bathing
       Appropriate bathing entails using only the highest quality, clinically proven products. In addition, appropriate bathing means providing each patient with the appropriate bath at the appropriate time and selecting the most appropriate and cost-efficient product for each bathing occasion. When deciding which bath is appropriate, take into consideration the patient's mobility level, sensory health, and skin health (see Table 1).
       In addition to the social, health, and comfort2 benefits to the patient, bathing allows the clinician to inspect the skin regularly. Proactive skin management goes hand in hand with appropriate bathing. There are three steps to skin management: regular cleansing, inspection, and protection. When we cleanse the skin, we remove soils, dead skin cells, perspiration, and surface bacteria. Inspecting the skin ensures early intervention and avoids serious future problems. Protection improves skin hydration and elasticity.