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Waterless versus soap-and-water perineal hygiene in fully dependent hospitalized patients: a multicenter randomized
Domenica Gazineo1, Giuseppe Pedrazzi2, Elisa Maria Bruno3
1Governo Clinico e Qualità, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; ANIPIO, Società Scientifica Nazionale degli Infermieri Specialisti del Rischio Infettivo - National Association of Nurses for the Prevention of Hospital Infections, Bologna, Italy.
Background:
This study evaluated the microbiological effectiveness and organizational impact of waterless perineal hygiene compared with traditional soap-and-water cleansing in fully dependent hospitalized patients, addressing a gap in evidence within acute care settings.
Methods:
This multicenter, randomized, open-label superiority trial was conducted in 10 medical and geriatric wards across four hospitals in Northern Italy. Fully dependent adult inpatients were randomized 1:1 to waterless hygiene or standard soap-and-water care. The primary outcome was the proportion of participants achieving a ≥90% reduction in microbial load between pre- and post-procedure perineal swabs. Secondary outcomes included procedure duration, patient and healthcare professional satisfaction, and agreement between evaluations.
Results:
A total of 468 participants were analyzed (239 control; 229 experimental). The experimental procedure achieved a higher proportion of ≥90% microbial reduction compared with standard care (47.2% vs 37.2%; p=0.030), corresponding to an absolute risk difference of 9.9% (95% CI 1.0-18.8) and a risk ratio of 1.27 (95% CI 1.02-1.57). Procedure duration was similar between groups (median 10 vs 11 minutes; p=0.311). Satisfaction was high in both groups, with more favorable perceptions of fragrance and overall hygiene in the experimental group.
Conclusions:
Waterless perineal hygiene demonstrated greater immediate microbiological cleansing effectiveness than standard soap-and-water hygiene without increasing procedure time. Further studies are needed to determine whether these microbiological findings translate into improved clinical outcomes, including healthcare-associated infections.