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A clean bathing area is a safe bathing area. Long-term care facilities know the importance of a clean facility and the dangers that micro-organisms can pose to residents. Since the bathing area is a shared environment where bacteria, viruses, and other pathogens can readily spread from one resident to another, it is especially important that it be cleaned and disinfected regularly and thoroughly. Here are some recommendations for cleaning your bathing area so that you can be confident that it is a safe place free from pathogens.

Have a written process and proper documentation

One of the challenges that LTC facilities face is the constant rotation of staff. Some may clean bathing areas better than others; some may do more while others do less. By having a written and documented process of disinfection of tubs and bathing areas, you will reduce the chances of something being forgotten or skipped. Since every staff member will follow the same guidelines and “sign off” on their work, the bathing area will stand a better chance of being cleaned the right way every time.

Be mindful of stagnant water

 The Centers for Medicare & Medicaid Services expects Medicare-certified healthcare facilities to have water management policies and procedures to reduce the risk of growth and spread of Legionella and other opportunistic pathogens in building water systems. An industry standard1 calling for the development and implementation of water management programs in large or complex building water systems to reduce the risk of Legionella was published in 2015 by American Society of Heating, Refrigerating, and Air Conditioning Engineers (ASHRAE). In 2016, the CDC and its partners developed a toolkit to facilitate the implementation of this ASHRAE Standard.

To pose a health risk, Legionella first has to grow (increase in numbers). Then it has to be aerosolized so people can breathe in small, contaminated water droplets. Legionella can grow in many parts of building water systems that are continually wet, and certain devices can then spread contaminated water droplets.

The prescribed use of most bathing systems and showers includes draining and cleaning and chemical disinfecting after each use. These steps address the risk of Legionella growth as outlined by the CDC. It should be noted, that the chemical disinfection step does not directly kill Legionella. However, chemical cleaning and disinfecting with appropriate products does address the development of biofilm, scale and sediment growth, all of which provide environments supportive of Legionella survival and growth.

If your building water management protocol includes periodic flushing of fixture water sources (sinks, showers, toilets, etc.), your bathing system should be a part of that protocol. This would be a preventative measure against stagnant water in building plumbing lines if your bathing system is used infrequently.

Residents may self-infect

Residents bring significant amounts of pathogens to their baths. The micro-organisms then circulate in the water and enter the body through any natural openings or a cut or wound. To help combat these types of infections, consider investing in a bathing system that incorporates UV water purification.  These systems use ultraviolet light to kill pathogens in the bath water.  A study by the medical college of Pennsylvania showed the tremendous amount of bacteria bathers bring to their own bath and proved the efficacy of UV light at purifying the bathwater.  In a clinical study by Apollo Corporation, long-term care residents bathed in bathing systems protected with the Remedy® Ultraviolet Water Purification System showed a 50% decrease in incidences of UTIs (Urinary Tract Infections) and a 35% descrease in respiratory infections.

Follow manufacturer guidelines

 It’s important to follow the recommended cleaning and disinfecting procedures from the tub manufacturer so that you can be confident that your staff’s procedures are effective. Some bathing systems have integrated cleaning and disinfecting systems that automatically mix the disinfectant concentrate with the appropriate amount of water.  So it is critical that you use cleaners and disinfectant that are of the right concentration for your bathing equipment.

In Summary

The health of your residents is top priority. It is essential that you do everything you can  to minimize the risk of disease and illness. It’s important to understand that bathing areas, shower rooms and restrooms have an increased risk to spread infections from one resident to another unless you take the necessary precautions. By having a detailed cleaning procedure, being mindful of areas where stagnant water may breed bacteria, and properly cleaning bathing equipment, your residents can enjoy a better and healthier quality of life.

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