1. Nursing Shortage Employee Satisfaction Compromised Skin Risk Management Patient Satisfaction Patient Safety Nursing Productivity Waterborne Infections Water Conservation Basin Contamination Basin Contamination Patient Care Quality Linen Management Any One of These Issues is a Good Reason to Use Comfort Bath ™ Any One of These Issues is a Good Reason to Use Comfort Bath ™

2. Add Them All Up for Your Hospital... + Compromised Skin + Patient Satisfaction + Employee Satisfaction + Waterborne Infections + Nursing Productivity + Basin Contamination + Compromised Skin + Patient Satisfaction + Employee Satisfaction + Waterborne Infections + Nursing Productivity + Basin Contamination And the Evidence is Overwhelming! +Risk Management +Patient Safety + Water Conservation + Nursing Shortage + Linen Management + Patient Care Quality +Risk Management +Patient Safety + Water Conservation + Nursing Shortage + Linen Management + Patient Care Quality

3. Nursing and Patient Satisfaction Traditional Basin Baths Consume Unnecessary Nursing Hours and Yield Low Satisfaction Scores  “In one survey of nurses describing their last shifts, 31% said their patients did not receive necessary skin care, 20% said patients did not receive oral care and 28% were not able to provide patients and their families with necessary education and instruction. 40% of nurses were not able to comfort or talk with their patients on their last shift.” - Joint Commission on Accreditation of Healthcare Organizations, “Healthcare at the Crossroads: Strategies for Addressing the Evolving Nursing Crisis” August 2002 Report  Traditional bathing can consume over 12,000 annual nursing (patient care) hours at a busy 250 bed hospital - Total Delivered Cost Analysis Database from U.S. Hospitals 1997-2002.  “…the odds of patient mortality increased by 7% for every additional patient in the average nurse’s workload... an increase from four to eight patients per nurse would be accompanied by 31% increases in mortality...” - Aiken, L.H. et al, Hospital Nurse Staffing and Patient Mortality, Nurse Burnout, and Job Dissatisfaction. Journal of the American Medical Association ( JAMA) Vol. 288 No. 16. October 23/30, 2002  ”Grumpy clinicians at the bedside can translate into high turnover, unhappy patients, and lower quality of care” - Huff, Charlotte, “Job Satisfaction: Why your job isn’t a bowl of cherries”, Nurseweeek, October 1997... throw the basin out WITH the bath water! The Proof:

4.  “Only 34% of nurses said they had enough RNs to provide quality care and still fewer than 33% had enough staff to get their work done.” - Joint Commission on Accreditation of Healthcare Organizations, “Healthcare at the Crossroads: Strategies for Addressing the Evolving Nursing Crisis” August 2002 report  “A traditional bed bath is always a mess. Water gets all over the sheets and blankets, the patients are uncovered, and they get cold and uncomfortable.” - Howe,L. “Bath in a Bag Gets High Marks From Patients, Staff” North Shore Health System Newsletter, New York November 2002  Only 4% of patients preferred the traditional basin bath method for patient cleansing. The majority did not feel clean or comfortable after the basin bath. - Comfort Bath™ Cleansing System vs. the Basin Bath: Patient Preference Study, Barbara Skiba, RN, BSN. 200 bed acute care hospital, Chicago, IL.  Only 3% of patients and 2% of nurses prefer basin baths over basinless bathing. - Patient and Nursing Satisfaction Evaluation Surveys. U.S. Hospitals, 1997 – 2002... throw the basin out WITH the bath water! The Proof: Nursing and Patient Satisfaction Traditional Basin Baths Consume Unnecessary Nursing Hours and Yield Low Satisfaction Scores

5. Nursing Satisfaction 0% of Nurses Prefer Basin Baths Nursing Satisfaction Strongly Agree AgreeDisagreeStrongly Disagree 1. The basinless bath is easy to administer. 87%13% 2. The basinless bath technique saves me time. 75%25% 3. The patient is clean after the basinless bath. 68%32% 4. The patients skin felt soft after the basinless bath. 87%13% 5. The patient was satisfied with the basinless bath. 72%28% 6. The bathing technique I like best was: Basinless Bath 100% Traditional Bath 0% 100% of Nurses Prefer Comfort Bath™ 100% of Nurses Prefer Comfort Bath™ Kron-Chalupa J, RN, MSN, Benda T, RN, Williams B., RN The Basinless Bath: A Study on Skin Dryness and Patient/Nurse Satisfaction. VA Medical Center, Iowa City, Iowa, 1998 Kron-Chalupa J, RN, MSN, Benda T, RN, Williams B., RN The Basinless Bath: A Study on Skin Dryness and Patient/Nurse Satisfaction. VA Medical Center, Iowa City, Iowa, 1998 Comfort Bath™... throw the basin out WITH the bath water! Basinless Bathing 8,000 Patient Care hours Gained Comfort Bath™ Basin Baths Annual Nursing Hours 12,000Patient Care Hours Consumed Delivers High Nursing Productivity 12,000 Hours 4,000 Hours

6. Compromised Skin Traditional Basin Baths May Be Doing More Harm Than Good  Traditional bathing techniques constitute one particular practice that may present considerable potential harm.” - Ruth Bryant, RN, MS, CWOCN; Bonnie Rolstad, RN, BA, CWOCN, Examining Threats to Skin Integrity,Ostomy Wound Management 2001:47(6), 18-27.  “ Basin bathing based on scores from the Skin Condition Data Form (SCDF) proved to cause significantly more dryness, scaling than a basinless bath product.” - Kron-Chalupa J, et al, Iowa City, VAMC, Iowa, The Basinless Bath: A study on skin dryness and patient/nurse satisfaction, VAMC  “ In addition, soaps decrease the natural skin lubricants, interfere with the water-holding capacity of the skin, thin the layers of the stratum corneum, and increase the skin pH. - Ruth Bryant, RN, MS, CWOCN; Bonnie Rolstad, RN, BA, CWOCN, Examining Threats to Skin Integrity, Ostomy Wound Management 2001: 47(6), 18-27.  “ Cleansing is the first step in skin protection. As mentioned earlier, bar soaps can harm skin by changing the pH to alkaline, making the skin more permeable to water-soluble irritants.” - Shannon ML, RN, Ed.D., and Lehman CA, RN, MSN, CRRN, “Protecting the Skin of the Elderly Patient in the ICU.” Critical Care Nursing Clinics of North America, Vol. 8, No. 1, March 1996.  “ Soap and a washcloth are fragile and/or damaged skin’s worst enemies.” - Friers SA, RN, BSN, CETN, “Breaking the cycle: The etiology of incontinence dermatitis and evaluating and using skin care products,” Ostomy/Wound Management, Vol. 42, No. 3, April 1996.... throw the basin out WITH the bath water! The Proof:

7. Comfort Bath™ “ Under double-blind conditions, the Comfort Bath™ Cleansing System formula and sodium chloride 0.9% solution (physiological saline) ranked as Class I materials…essentially no evidence of cumulative irritation under continuous reapplication and occlusion …” Dennis P. West, PhD, FCCP and Andrew Scheman, MD Northwestern University Department of Dermatology, Chicago, Illinois, May – June 1998... throw the basin out WITH the bath water! Basinless Bathing

8. Basin Contamination The Basin is Both a Reservoir and a Vehicle for Nosocomial Pathogens  “ High colony count found in bath water is similar to the number of bacteria found in urine from patients with UTIs.” - Shannon et al, Journal of HealthCare Safety, Compliance & Infection Control, April 1999; Vol. 3, No. 4, pg. 180-184.  “ Basins are used for multiple purposes such as emesis, incontinence clean-up, and bathing.” - William Rutula, PhD, David Weber, MD, Infection Control and Hospital Epidemiology, Volume 18(9), September 1997 editorial.  “ Bath water could serve as a high magnitude microbial reservoir of potentially antibiotic resistant organisms.” - Shannon et al, Journal of HealthCare Safety, Compliance & Infection Control, April 1999; Vol. 3, No. 4, pg. 180-184.  “A major question emerging from Dr. Reuter and colleagues’ study is how to limit the spread of pathogens from contaminated sinks (faucets) to patients.” - Bonton MJM, Weinstein RA, Transmission pathways of Pseudomonas aerugiuosa in intensive car units: Don’t go near the water. Critical Care Medicine, Vol. 30, No. 10, pp. 2384-5  “ The patient’s skin may harbor more gram negative organisms once the basin bath is completed.” - Susan M. Skewes, RN, ONC, Skin care rituals that do more harm than good, American Journal of Nursing, Vol. 96, No. 10.  “By the end of the bath, the water is a soup of soap and bacteria….Contaminated wash bowels (basins) have been implicated in an outbreak of infection.” - Ayliffe, GAJ “Nursing aspects of prevention of infection: aseptic and hygienic techniques” Hospital Acquired Infection: The Principles and Prevention Second Edition pp 58-59 The Proof:... throw the basin out WITH the bath water!

9. Comfort Bath™ Does not require basins 8 Individually dispensed washcloths Immediately discard washcloths in clear trash No contact with sinks and/or commodes No transport of contaminated basins & linens Does not require basins 8 Individually dispensed washcloths Immediately discard washcloths in clear trash No contact with sinks and/or commodes No transport of contaminated basins & linens... throw the basin out WITH the bath water! Basinless Bathing

10. Waterborne Infections Hospital Tap Water is a Major Source of Nosocomial Infections  “Although numerous hospital sources cause nosocomial outbreaks, perhaps the most overlooked, important and controllable source of nosocomial pathogens is hospital water.” - Anaissie, et al, Archives of Internal Medicine, July 8, 2002, Vol 162, No. 1, pp 1483-1492.  “Several investigators have suggested that gram-negative bacteria can pass to patients by employee’s hands contaminated during hand washing, presumably by splashing water droplets from the sink basins to hands.” - William Rutula, PhD, David Weber, MD, Infection Control and Hospital Epidemiology, Vol. 18(9), September 1997 editorial  “Dr. Reuter and co-workers report that in their intensive care unit, 35% of all cases of acquired colonization with Pseudomonas aeruginosa originated from contaminated tap water…” - Bonton MJM, Weinstein RA, Transmission pathways of Pseudomonas aerugiuosa in intensive car units: Don’t go near the water. Critical Care Medicine, Vol. 30, No. 10, pp. 2384-5  “...Contaminated water was used to wash pre-term infants, leading to the colonization of four infants and the death of a fifth from Stenotrophomas maltophilia. The outbreak was controlled by reinforcing hand disinfection, limiting use of tap water for hand washing and using sterile water to wash the pre-term babies.” - Verwey PE, Meis JFGM, Christmann V, Van der Bar, Melchers WJG, Hilderink BGM, et al. Nosocomial outbreak of colonization and infection with Strenotrophomas maltophilia in pre-term infants associated with contaminated tap-water. Epidemiology Infect 1998; 120: 251-6.. The Proof:... throw the basin out WITH the bath water!

11.  “The best advice is to eliminate water where possible. This will greatly decrease the chances of contamination. Replace all water- containing devices with those that do not require water to work, keep potentially contaminated water away from the patient, and include waterless hand products in your hand hygiene program. Prevent infection from potentially contaminated water.” - Burns SM, Water: Is it a breeding ground for bacteria in your facility?” Infection Control Today, October 2002  “Nosocomial infections caused by waterborne bacteria have been associated with serious morbidity and even mortality.. the annual mortality rate from waterborne Pseudomas aeruginosa in the U.S. is approximately 1400.” - Anaissie, et al, Archives of Internal Medicine, July 8, 2002, Vol. 162, No. 1 pp 1483-1492.  “…contamination of faucets with P. aerugenosa is an important source of endemic P. aeruginosa and that eradication of contaminants from these sources is nearly impossible.” - Bonton MJM, Weinstein, RA, Transmission pathways of Pseunomonas aerugiuosa in intensive care units: Don’t go near the water. Critical Care Medicine, Vol. 30, No. 10, pp. 2384-5. Waterborne Infections Hospital Tap Water is a Major Source of Nosocomial Infections The Proof:... throw the basin out WITH the bath water!

12. Comfort Bath™ Requires no hospital tap water Microwaved to an average temperature of 125 o F Uses only 6.75 oz. of purified water Tested under USP XXIV microbial limits Helps close the gap on waterborne pathogens Requires no hospital tap water Microwaved to an average temperature of 125 o F Uses only 6.75 oz. of purified water Tested under USP XXIV microbial limits Helps close the gap on waterborne pathogens... throw the basin out WITH the bath water! Basinless Bathing

13. The Unknown Costs Basin bath costs are buried in multiple budgets and consume significant hospital resources  In a statistically significant analysis of U.S. Hospitals, the average supply and laundry costs associated with basin baths was $1.85 and the average nursing labor cost was $5.71. - McNees, D., The McNees Report, Claymore Consulting, February 2003.  The traditional basin bath used a basin, bar soap, bath oil, 4 laundered washcloths and 2 towels, and hot water. The non-labor cost of the bath alone was over $2.00. - Kron-Chalupa J, et al, Iowa City, VAMC, Iowa, The Basinless Bath: A study on skin dryness and patient/nurse satisfaction, VAMC  “…the costs for the soap, lotion, two towels, three washcloths, and the laundry service, we arrived at a total of $2.01 per bed bath, plus $5.04 in nursing salary. “ -Wright, KL “Considering a New Product? Put it to a Test” RN Journal, December 1996 pp 21-23 A 250 bed hospital can consume a million gallons of hot water, over 100,000 pounds of laundry, thousands of dollars in disposable supplies and over 12,000 patient care hours just giving baths. - Total Delivered Cost Analysis, U.S. hospitals greater than 200 acute care beds, 1997-2002 The Proof:... throw the basin out WITH the bath water!

14.  Comfort Bath™ enabled this 500+ bed facility to reduce medical supply costs by $15,216 and eliminate four bathing related sku’s (lotion, soaps, and powders) in the process. - Insights TDC Outcomes Analysis, St. John’s Medical Center, Tulsa, OK 2001  This specialty hospital was able to trim their supply cost of traditional bathing items by over 80% after implementing Comfort Bath™. - Select Specialty Hospital of Western Michigan, Muskegon, Michigan, 2000  Over a three year period of using Comfort bath™, this 1000 bed teaching facility created 104,133 nursing hours and reallocated them to new patient care hours. That’s the equivalent of 15 full-time nurses/nursing technicians. - Baylor University Medical Center, Dallas, Texas, January 1999 to April 2002 The Proof:... throw the basin out WITH the bath water! The Unknown Costs Basin bath costs are buried in multiple budgets and consume significant hospital resources

15. Comfort Bath™ Effectively competes with the cost of a traditional basin bath Reduces the consumption of valuable hospital resources Helps meet key organizational goals: nursing morale and productivity, patient safety and patient satisfaction Effectively competes with the cost of a traditional basin bath Reduces the consumption of valuable hospital resources Helps meet key organizational goals: nursing morale and productivity, patient safety and patient satisfaction... throw the basin out WITH the bath water! Basinless Bathing

16. Comfort Bath™ $1.02 Laundry &Linens $.10 Water,Sewer,Energy $.83 Materials $.83 Materials Basin Bath Basin less Bath Source: - McNees, D., The McNees Report, Claymore Consulting, February 2003. $5.71 Nursing Time $1.75 $1.83 Nursing Time Effectively Competes with Cost Patient Bathing Costs Patient Satisfaction Only 4% prefer traditional basin baths 96% of Patients Prefer Comfort Bath™ 96% of Patients Prefer Comfort Bath™ Skiba B, RN, BSN, Patient Satisfaction Preference Study: Comfort Bath vs. The Basin Bath, 200 Bed Acute Care Hospital, Chicago, IL, 1997

17. “A good clinical outcome is a patient’s expectation, but it doesn’t necessarily affect their satisfaction… …The satisfaction comes when they are delighted with service they receive - the care and compassion, and timeliness of the service” Material Management in Health Care, January 2002

18.  Improves patient satisfaction  Increases nursing satisfaction  Creates thousands of patient care hours  Improves overall skin care  Reduces the risk of basinborne contamination  Eliminates exposure to waterborne pathogens  Meets CDC, NPUAP and APIC guidelines  Delivers a consistent standard of patient care Comfort Bath™ Basinless Bathing

19. It brings opportunities for your hospital… Comfort Bath ™ …to the surface Basinless Bathing