Skin cleansing practices for older people: a systematic review

Aims and objectives. To locate, summarise and critically analyse current knowledge about skin hygiene practices for older people. Background. Maintaining personal hygiene for patients is one of the core elements of care in all fields of nursing. However, it is a subject that has been neglected in both research and education. Skin integrity is essential to the health and well-being of older people. Skin cleansing practices can contribute to the maintenance and promotion of skin integrity. It is therefore essential to have a robust evidence base for such practices. Design. Literature review by searches of the electronic databases Medline, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Academic Search Premier, psycINFO, Web of Science, SCOPUS and the Cochrane Library, using firstly key words and exclusion criteria, then citations and reference searches. An integrative review method was used. Studies included were alternative bathing protocol or bathing product interventions. Seven studies met the methodological requirements for inclusion. Conclusions. There is a significant lack of high-quality research studies to provide a framework for guiding evidence-based skin cleansing practice. Current guidance is based on clinical expertise rather than on robust trial evidence. A research agenda has been developed which may become the basis for developing evidence-based, best practice guidelines. Future research must move beyond descriptive studies to include more robust methods of investigation. The lack of intervention studies limits the practice-guiding implications that can be gained from the current body of research. Implications for practice. Skin cleansing is one of the cornerstones of nursing practice, however, in the absence of a robust evidence base most such care is currently based on 'custom and practice'. There is a need to conduct further research into cleansing practices that will maintain or enhance skin health and skin integrity.