Nursing care for bed bath in patients with COVID-19: an integrative review

an integrative literature review. Five stages were followed for this research: research question elaboration (identification of the problem), search of studies in literature, study assessment, data analysis, and presentation of review. To search for primary studies, the VHL and SciELO databases were selected.

Results:

initially, 55 publications were found. After reading and analyzing the abstracts, the sample consisted of 15 studies.

Conclusion:

patients with the new coronavirus have specific care to perform a bed bath, oral, intimate and skin hygiene. It is important that professionals use adequate personal protective equipment, perform humanized care, continuously observing patients’ vital signs to avoid occurrence of adverse events, promoting patient safety.

Descriptors:
Coronavirus Infections; Nursing Care; Baths; Patients; Skin Care

Authors and year	Journal	Study objective	Study design	Sample	Results
Bastos SRB, Gonçalves FAF, Bueno BRM, et al, 2019(⁴4 Bastos SRB, Gonçalves FAF, Bueno BRM, SILVA GS, Ribeiro KRA, Brasil VV. The care-omitting behavior of the nursing team. JRFCO [Internet]. 2020 Feb 14[cited 2020 Jun 29];11(3):627-33. Available from: http://www.seer.unirio.br/index.php/cuidadofundamental/article/view/6634 http://www.seer.unirio.br/index.php/cuid... ).	Cuidado é Fundamental	Assess the process of performing BB and nursing care.	Cross-sectional study	The study was carried out in the ICU of a hospital/school, with eight nursing technicians.	The bath was performed automatically without prior communication, without considering the patient’s individuality and privacy, especially in those undergoing MV.
Ananias MANB, Cambraia AA, Calderaro DC, 2018(¹⁷17 Ananias MANB, Cambraia AA, Calderaro DC. Efeito da posição prona na mecânica respiratória e nas trocas gasosas em pacientes com SDRA grave. Rev Med Minas Gerais [Internet]. 2018 [cited 2020 Jun 29];28(suppl 5):e-S2805528. Available from: http://rmmg.org/artigo/detalhes/2460 http://rmmg.org/artigo/detalhes/2460... ).	Revista Medica Minas Gerais	Perform a retrospective analysis of the effects of the prone position on the respiratory mechanics and blood gas parameters of patients with ARDS who are critically admitted to the ICU.	Cross-sectional study	Seven patients over 18 years of age, with severe ARDS, who underwent MV in the prone position.	The prone position process was efficient and safe in this population.
Mendonça PK et al., 2018(¹⁸18 Mendonça PK, Loureiro MDR, Frota OP, Souza AS. Prevention of pressure injuries: actions prescribed by intensive care unit nurses. Texto Contexto Enferm [Internet]. 2018 [cited 2020 Jun 29];27(4):e4610017. Available from: https://www.scielo.br/pdf/tce/v27n4/en_0104-0707-tce-27-04-e4610017.pdf https://www.scielo.br/pdf/tce/v27n4/en_0... ).	Texto & Contexto - Enfermagem	Describe the main nursing actions prescribed by nurses in order to prevent PI and its occurrence in intensive care centers.	Cross-sectional study	104 adult participants from two hospital teaching institutions linked to the Unified Health System (Sistema Únicode Saúde) in the city of Campo Grande, Brazil.	The elaboration and implementation of protocols, monitoring of records and groups at higher risk are strategies that guide the prescription of appropriate preventive actions for PI.
Borges DL et al., 2020(¹⁵15 Dalmedico MM, Salas D, Oliveira AM, Baran FDP, Meardi JT, Santos MC. Efficacy of prone position in acute respiratory distress syndrome: overview of systematic reviews. Rev Esc Enferm USP. 2017;51:e03251. https://doi.org/10.1590/S1980-220X2016048803251 https://doi.org/10.1590/S1980-220X201604... ).	Associação Brasileira de Fisioterapia Cardiorrespiratória e Fisioterapia em Terapia Intensiva (ASSOBRAFIR)	Provide guidance on the use of the prone position in the treatment of ARF secondary to COVID-19.	Guideline	Patients in ICUs affected by COVID-19 who present ARDS.	ASSOBRAFIR requires careful indication of this positioning during the COVID-19 pandemic, especially in improvised ICUs, with reduced and untrained staff. In this sense, they reinforce the need for training of physiotherapists and multidisciplinary teams working in ICUs, so that they can safely use this resource.
Oliveira VM et al., 2016(¹⁹19 Oliveira VM, Piekala DM, Deponti GN, Batista DCR, Minossi SD, Chisté M, et al. Safe prone checklist: construction and implementation of a tool for performing the prone maneuver. Rev Bras Ter Intensiva [Internet]. 2017[cited 2020 Jun 29];29(2):131-41. Available from: https://www.scielo.br/pdf/rbti/v29n2/en_0103-507X-rbti-29-02-0131.pdf https://www.scielo.br/pdf/rbti/v29n2/en_... ).	Revista Brasileira de Terapia Intensiva	Build and implement an instrument (checklist) to improve care when maneuvering from the prone position.	Experience report	The study was carried out at the intensive care center of the Hospital de Clínicas de Porto Alegre, Rio Grande do Sul.	The application of the checklist in the prone maneuver provided reliability and safety when performing the procedure. Helpful for patient safety, however staff need training.
Maciel SSA, Bocchi SCM, 2006(²⁰20 Maciel SSA, Bocchi SCM. Compreendendo a lacuna entre a prática e a evolução técnico-científica do banho no leito. Rev Latino-Am Enfermagem[Internet]. 2006[cited 2020 Jun 29];14(2):233-42. Available from: https://www.scielo.br/pdf/rlae/v14n2/v14n2a13.pdf https://www.scielo.br/pdf/rlae/v14n2/v14... ).	Latino-Americana de Enfermagem	Understand the experience of the person dependent on nursing for BB and develop a theoretical method representative of this experience.	Qualitative study	Seventeen bedridden patients, aged between 26 and 82 years, admitted to clinical and surgical units of a university hospital and dependent on nursing for BB.	The study made it possible to understand the vision and experience of patients dependent on nursing care for BB as well as to develop and validate a practical theoretical model.
Duncan Maguire, 2020(¹⁰10 Maguire D. Oral and nasal decontamination for COVID-19 patients: more harm than good?. Anesth Analg[Internet]. 2020 [cited May 14];131(1):e26-e27. Available from: https://journals.lww.com/anesthesia-analgesia/Fulltext/2020/07000/Oral_and_Nasal_Decontamination_for_COVID_19.68.aspx https://journals.lww.com/anesthesia-anal... ).	Anesthesia & Analgesia Journal Publish Ahead of Print	Provide necessary guidance to anesthesiologists and other healthcare professionals in the perioperative period of patients with COVID-19 regarding infection control.	Cross-sectional study	Patients with suspected or confirmed COVID-19 in the perioperative period.	The application of nasal povidone iodine can induce sneezing, increasing the spread of aerosolized viral particles. Rinsing the mouth with chlorhexidine can also induce a cough (or at least sputum), which can also increase the risk of contamination.
Wang W et al., 2020(³3 Wang W, Xu Y, Gao R, Lu R, Han K, Wu G, et al. Detection of SARS-CoV-2 in Different Types of Clinical Specimens. JAMA [Internet]. 2020 [cited 2020 May 15];323(18):1843-4. Available from: https://jamanetwork.com/journals/jama/fullarticle/2762997 https://jamanetwork.com/journals/jama/fu... ).	JAMA	Investigate the biodistribution of SARS-CoV-2 between different tissues of patients hospitalized with COVID-19.	Cross-sectional study	1,070 samples were collected from 205 patients with COVID-19 in Hubei, Shandong and Beijing, China.	Four coronavirus positive fecal samples were cultured, implying that SARS-CoV-2 can be transmitted via the fecal route. Bronchoalveolar lavage fluid samples had the highest positive rates (93%), followed by sputum (72%). None of the 722 urine samples tested positive.
Silva et al., 2016(¹³13 Silva CJB, Silva MÉS, Reis FF, Miranda GCO, Santos L, Lima DVM. Bed bath for infarcted patients: crossover of the hydrothermal control 40ºC versus 42.5ºC. Online Braz J Nurs [Internet]. 2016 [cited Jun 29];15(3):341-50. Available from: http://www.objnursing.uff.br/index.php/nursing/article/view/4233/pdf_1 http://www.objnursing.uff.br/index.php/n... ).	Revista Brasileira de Enfermagem Online	Compare the repercussions of the water temperature of BB of infarcted patients on SpO2, HR and Axt.	Cross-sectional study	Carried out with 20 patients suffering from acute myocardial infarction.	SpO2 and Axt were higher after BB with hydrothermal control at 42.5ºC, when compared to BB with hydrothermal control at 40ºC
Taets, Figueiredo, 2016(¹⁴14 Taets GGC, Figueiredo NMA. A quase-experimental nursing study on pain in comatose patients. Rev Bras Enferm [Internet]. 2016 [cited Jun 29];69(5):927-932. Available from: https://www.scielo.br/pdf/reben/v69n5/en_0034-7167-reben-69-05-0927.pdf https://www.scielo.br/pdf/reben/v69n5/en... ).	Revista Brasileira de Enfermagem	Check if comatose patients feel pain during BB.	Cross-sectional study	Nineteen patients with a mean age of 61 years, in a municipal public hospital in the north of Rio de Janeiro.	The study showed a statistically significant increase in the level of substance P of patients studied during the nursing intervention, which demonstrates a high incidence of pain in participating patients.
Castellões, Silva, 2007(¹⁶16 Castellões TMFW, Silva LD. Guia de cuidados de enfermagem na prevenção da extubação acidental. Rev Bras Enferm [Internet]. 2007 [cited 2020 Jun 29];60(1):106-9. Available from: https://www.scielo.br/pdf/reben/v60n1/a21v60n1.pdf https://www.scielo.br/pdf/reben/v60n1/a2... ).	Revista Brasileira de Enfermagem	Present the experience of working with the help of a guide to prevent accidental extubation.	Observational study	Intubated patients submitted to BB, transport, exchange of fixation of the ventilatory device and change of position.	It is expected that the guide will contribute to increasingly reduce the incidence of accidental extubation and be able to safely provide assistance to patients.
Lopes JL et al., 2015(²¹21 Lopes JL, Barbosa DA, Nogueira-Martins LA, Barros ALBL. Nursing guidance on bed baths to reduce anxiety. Rev Bras Enferm [Internet]. 2015 [cited 2020 Jun 29];68(3):497-503. Available from: https://www.scielo.br/pdf/reben/v68n3/en_0034-7167-reben-68-03-0497.pdf https://www.scielo.br/pdf/reben/v68n3/en... ).	Revista Brasileira de Enfermagem	Assess the effectiveness of a nursing guidance protocol to reduce anxiety in patients with acute coronary syndrome undergoing BB.	Randomized clinical trial	Patients with acute coronary syndrome, admitted to coronary care units. Age > 18 years, both sexes, without pulmonary congestion.	The intervention group had a significantly greater reduction in anxiety when compared to the control group after the intervention, which demonstrates that the protocol is effective.
TM Cook, 2020(²2 Cook TM. Personal protective equipment during the coronavirus disease (COVID) 2019 pandemic: a narrative review. Anaesthesia [Internet]. 2020 [cited 2020 May 15];75(7):920-7. Available from: https://onlinelibrary.wiley.com/doi/epdf/10.1111/anae.15071 https://onlinelibrary.wiley.com/doi/epdf... ).	Anaesthesia	Emphasize the purpose of using PPE.	Review article	Healthcare teams and patients infected with the coronavirus.	For each type of transmission by COVID-19, different forms of protection/prevention of infection are defined.
Lôbo ABAP, 2018(²²22 Skewes SM. Skin care rituals that do more harm than good. Am J Nurs [Internet]. 1996 [cited 2020 Jun 29];96(10):33-5. Available from: https://insights.ovid.com/pubmed?pmid=8863646 https://insights.ovid.com/pubmed?pmid=88... ).	American Journal of Nursing	Investigate the hemodynamic repercussions during the performance of three types of BB: traditional at 42.5C°, with a vial of heated distilled water and with heated moistened wipes.	Clinical trial	Patients with severe heart disease bedridden in ICUs.	The data did not present any significant results that could be recommended as a suggestion for improvement or that would be harmful to patients. It is understood that any of the three types of baths can be satisfactory to patients and the choice must be made by patients.
Paulela DC, Bocchi SCM, Mondelli AL, Martin LC, Ssobrinho AR, 2018(¹²12 Paulela DC, Bocchi SCM, Mondelli AL, Martin LC, Sobrinho AR. Effectiveness of bag bath on microbial load: clinical trial. Acta Paul Enferm [Internet]. 2018 [cited Jun 29];31(1):7-16. Available from: https://www.scielo.br/pdf/ape/v31n1/en_0103-2100-ape-31-01-0007.pdf https://www.scielo.br/pdf/ape/v31n1/en_0... ).	Acta Paulista de Enfermagem	Assess the efficacy of disposable BB on the microbial load on the skin of hospitalized patients.	Randomized clinical trial	Composed of 55 patients randomly distributed into two groups: 28 in the control group and 27 in the intervention group (disposable handkerchief).	Microbial load in the intervention groups reduced, while that in the control group increased significantly. The efficacy of the product for a disposable bed bath was estimated at 90%, compared to 20% for conventional BB.

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[1] Corresponding author: Patrícia Rezende do Prado E-mail: patyrezendeprado@gmail.com