Personal Bathing and Washing

There is a clear temporal relationship between improvement in general levels of cleanliness in society and improved health. Greene V.W. used historical and cross-cultural evidence and causal inference to associate personal hygiene with better health. However, the role of personal cleanliness in the control of infectious diseases over the past century is difficult to measure, since other factors have changed at the same time (e.g., improved public services, waste disposal, water supply, commercial food handling, and nutrition).

Studies of personal and domestic hygiene and its relationship to diarrhea in developing countries demonstrate the effectiveness of proper waste disposal, general sanitary conditions, and handwashing. However, aside from hand cleansing, specific evidence is lacking to link bathing or general skin cleansing with preventing infections. Part of the difficulty in demonstrating a causal association between general bathing or skin care and gastrointestinal infection is that interventions to reduce diarrheal disease have been multifaceted, often including health education, improved waste disposal, decontaminating the water supply, and general improvement in household sanitation as well as personal hygiene. Risk for diarrheal disease has also been linked to the level of parental education. Multiple influences complicate definition of the impact of any single intervention.

In 11 studies reviewed by Keswick et al., use of antimicrobial soaps was associated with substantial reductions in rates of superficial cutaneous infections. Another 15 experimental studies demonstrated a reduction in bacteria on the skin with use of antimicrobial soaps, but none assessed rates of infection as an outcome.

Extensive studies of showering and bathing conducted since the 1960s demonstrated that these activities increase dispersal of skin bacteria into the air and ambient environment, probably through breaking up and spreading of microcolonies on the skin surface and resultant contamination of surrounding squamous cells. These studies prompted a change in practice among surgical personnel, who are now generally discouraged from showering immediately before entering the operating room. Other investigators have shown that the skin microflora varies between persons but is remarkably consistent for each person over time. Even without bathing for many days, the flora remain qualitatively and quantitatively stable.

For surgical or other high-risk patients, showering with antiseptic agents has been tested for its effect on postoperative wound infection rates. Such agents, unlike plain soaps, reduce microbial counts on the skin. In some studies, antiseptic preoperative showers or baths have been associated with reduced postoperative infection rates, but in others, no differences were observed. Whole-body washing with chlorhexidine-containing detergent has been shown to reduce infections among neonates, but concerns about absorption and safety preclude this as a routine practice. Several studies have demonstrated substantial reductions in rates of acquisition of methicillin-resistant Staphylococcus aureus in surgical patients bathed with a triclosan-containing product. Hence, preoperative showering or bathing with an antiseptic may be justifiable in selected patient populations.

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Dr. Larson is professor of pharmaceutical and therapeutic research, The School of Nursing, and professor of epidemiology, Mailman School of Public Health, Columbia University. She is editor of the American Journal of Infection Control and former chair of the Healthcare Infection Control Practices Advisory Committee (HICPAC) and member of CDC's National Center for Infectious Diseases Board of Scientific Counselors.

Address for correspondence: Elaine Larson, Columbia University School of Nursing, 630 W. 168th St., New York, NY 10032, USA; fax: 212-305-0722; e-mail: ell23@columbia.edu

The source of this article is http://www.cdc.gov