JRSM >
Volume 97, Number 5 >
Pp. 235-237
Department of Elderly Medicine, St James's University Hospital, Beckett Street, Leeds LS9 7TF, UK
Correspondence to: Dr Andy Monro
E-mail:
amonro{at}doctors.org.uk
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There have been some improvements, particularly in the provision of bath hoists, adapted taps, alarm call systems, shower seats and wheelchair access to bathrooms. But many basic problems remain—absent locks and signs, inadequate heating, poor standards of privacy, insufficient bath aids, wet floors, and the inappropriate use of bathrooms as store rooms.
The overall condition of hospital bathrooms and showers remains unsatisfactory. Too many hospital bathrooms are austere, cold, smelly and poorly maintained.
| INTRODUCTION |
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The last detailed survey of bathing facilities in a UK hospital was over 20 years ago.4 Conducted in the same region as the present study but at a different hospital, it revealed a generally poor standard of inpatient washing, bathing and toilet facilities, with insufficient equipment, especially bathing aids. It also highlighted poor access and inadequate adaptations for wheelchair users. The authors made recommendations for improvements.
Two large UK multicentre hospital surveys5,6 yielded comparable findings. The King's Fund questionnaire of patients in ten hospitals indicated that no patient was happy with the number of bathrooms or washbasins and that most were critical of standards of cleanliness. The Health Advisory Service survey of eight English hospitals commented on the poverty of the physical environment and shortcomings in bathroom cleanliness, access, equipment, upkeep, comfort, and privacy. We have looked at hospital bathing, washing and showering facilities to see if matters have improved.
| METHOD |
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| RESULTS |
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General features
All bathrooms and showers had a functioning alarm call system.
On 9 of the wards, there was no sign on the bathroom or shower door indicating the room's use. On 5 wards there was no lock on the bathroom or shower door. On 9 wards, the bathroom or shower room lacked privacy: for example, having only a small curtain or ‘concertina’ door separating the shower from the open ward; bathroom doors with large ‘peep holes’ or with large ‘see-through’ glass panels covered only by a small curtain. In one case, a paper towel was taped across the glass panel in place of a curtain. In another ward the bathroom was being used simultaneously as a toilet, with two patients using the room at one time (one in the bath, one on the toilet), separated only by a curtain.
The width of all bathroom doorways was above the minimum recommended (80 cm) to allow access for a wheelchair. However, on 13 (28%) wards, doorway width was less than 93 cm, the preferred width for wheelchair access. 8 wards had no heating in the bathroom. On 3 wards the light switch was too high to be accessible for someone seated or in a wheelchair.
In most bathrooms and shower rooms the decor was plain, uninspiring blue or green gloss paint (‘like a bad campsite washroom’ was one nurse's comment). At the time of inspection, bathrooms or shower rooms on 12 wards were considered unclean on subjective inspection. A recurrent finding was that the room smelled of urine. In some, the floor was wet and potentially hazardous. The standard arrangement was for one of the domestic staff to clean the bathroom and shower once daily. At all other times—and between baths and showers—this responsibility fell to the ward nurses.
Bathtubs and bath aids
The number of bathtubs per patient varied from 1 in 6 to 1 in 28. All wards
had at least one bath, most had two. 12 wards had baths that were not
free-standing, so carers were unable to get around both sides (though most of
these wards also had another bath which was free-standing). Two free-standing
baths had a shower obscuring one side, which blocked access for carers.
45 of 46 wards had a bath hoist (ambulift), 19 (41%) had bath rails, 10 (22%) had a bath seat, 20 (4%) had non-slip mats (now less favoured because of the theoretical risk of infection spread), 2 (4%) had a bath board. 19 (41%) had ‘easy to use’ or adapted taps (i.e. easier to turn on and off for patients with dexterity problems). 6 bathrooms also contained a bidet; few of these worked and all were unused. Most bathrooms were cluttered—sometimes almost full—with non-bathroom-essential ward objects such as mattresses, commodes, and weighing machines. In some cases, these impeded access to the bath.
Showers
Most wards had two separate showers, 16 had only one. 10% (7/73) of showers
were either broken or not working. A recurring problem was water seeping under
the door into the main ward, in one case dripping down through the ceiling to
the floor below. Some of these had been awaiting repair for several months
with no obvious indication that this would occur in the near future. This was
a source of frustration to the nursing staff.
Only 33 (72%) wards had showers that were accessible to wheelchair users. Some had a large step up to the shower, others were too cramped, making manoeuvrability impossible. 82% (60/73) of showers had a shower seat, generally a simple plastic chair borrowed from the main ward.
Washbasins
Most washbasins were of a suitable height for those needing to sit and
wash, and legroom was adequate. Taps were adapted or easy to use on 34 (72%)
wards. 11% (10/90) of bathrooms had no mirror and 39% (31/80) of mirrors were
> 130 cm off the ground (not easily accessible for someone seated or in a
wheelchair).
| DISCUSSION |
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It is of concern that many of our findings are similar to those of the King's Fund patient survey performed in 1966.5 The Department of Health survey in 19986 raised similar criticisms, and made many recommendations for action to be taken. However, in the hospitals that we studied we found little evidence of improvement. Overall, there were few changes from the situation encountered more than 35 years ago.
These findings should be placed in context. On most wards, facilities for washing and bathing were adequate and there were several other positive findings. For example, all rooms had functioning alarm call systems and light switches that worked. With one exception, all wards had a bath hoist, the most important bathroom aid for disabled patients. But many shortcomings persist. Few wards had a full set of simple bath aids. Mirrors should be lowered or enlarged to make washing, shaving and grooming easier for those who need to sit for this activity. All taps should be adapted for easier use. Wheelchair access to showers should be improved. Repairs to broken bath and showering equipment could be done much more quickly. More consideration might also be given to improving the decor, privacy, cleanliness, and general environment of these rooms, helping to make washing and bathing a more dignified, pleasurable and relaxing experience for all involved.
There is limited space on hospital wards, and bathrooms are commonly used inappropriately as store rooms. There should be alternative areas to store ward equipment, freeing the bathrooms for their proper use. Having to share the same bathroom with another person (fortunately, only one instance seen) is particularly unsatisfactory.
The recommended standards for disabled people using hospital say little about bathrooms and showers.7 Measures to improve overall quality of care, privacy, and facilities in hospital are in the National Service Framework for Older People8 but at present there are no comprehensive guidelines or national standards. Most of the improvements required would be inexpensive. Hospital managers, doctors, and modern matrons should focus on these important deficiencies in the bathing facilities of most hospital wards. Perhaps a designated member of staff (such as an occupational therapist) could ensure that washing and bathing facilities are adequate and act as patient advocate. It might be a good idea to make bathroom standards a key factor in government star ratings of hospitals. The aim should be to provide bathing facilities that we would be happy to use ourselves.
| Acknowledgments |
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