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

Background The skin of older hospitalized patients is affected by disease, treatment, and aging. Bed baths are commonly used to maintain skin hygiene in these patients. However, the effects of bed baths on the skin barrier function of the lower limbs in older patients, who may have particularly fragile skin, remain unclear. This 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 in older hospitalized patients. Methods Thirty-three older hospitalized patients with heart disease participated in this quasi-experimental (crossover) study. 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 the 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 the time point or towel type on lower limb SCH and forearm TEWL were noted. Only the main effect of time on SCH of the forearms 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]: 0.8–3.5). ODS at baseline and the following day demonstrated no difference. Conclusion Regardless of the material used, bed baths of the lower limbs did not worsen the skin barrier function in older hospitalized patients when weak wiping pressure was applied. However, the lower limbs tend to be drier than the forearms, requiring maintenance of the skin barrier. Trial registration UMIN R000061354 (date of registration: March 3, 2024)