Hygenique™ Sitz Bath was designed by a nurse to promote wound healing, provide pain relief, and reduce surface contaminants in the perineal area.

Promotes Wound Healing

Hygenique™ Sitz Bath's continuous warm water cleansing therapy concentrates heat and stimulates blood flow to the perineal wound or episiotomy. This local hyperthermia increases subcutaneous perineal tissue temperature and oxygen tension, thus significantly promoting the wound healing process.

Urinary Tract Infection

Treatment: Promotes Wound Healing

Hygenique™ Sitz Bath's continuous warm water cleansing therapy concentrates heat and stimulates blood flow to the perineal wound. This local hyperthermia increases subcutaneous perineal tissue temperature and oxygen tension, thus significantly promoting the wound healing process.

(1) Local Heat Increases Blood Flow and Oxygen Tension in Wounds. Archives of SurgeEy, Rabkin, J.M. and Hunt, T.K. (1987), pages 122 (2), 221-225.

(2) Physical Modalities in Wound Management, Ultrasound, Pasopneumatic devices and Hydrotherapy. Ostomy Wound Management, McCulloch, J. (1995). 41(5),30-32, 34,36-37.

(3) Minimizingjactors that impair wound healing; a nursi . ng approach. Ostomy Wound Management, Krasner, D., vol. 41, pages 22-6, 28, 30.

(4) Wound healing. Advanced Dermatology Waldorf, H., 1995, vol. 10, pages 77-96; discussion 97. Department of Dermatology, Harvard Medical School, Boston, MA.

(5) Using Wound Care products to promote a healing environment. Critical Care NqE~jn North America. Maklebust, J., June 1996, vol. 8, pages 141-158.

(6) Perineal manifestations of HlV infection. Diseases Colon Rectum, Orkin, B.A-, April 1992, vol. 4, issue 35. Division of Colon and Rectal Surgery, (5porge Washington University Medical Center, Washington, D.C.

Pain Relief: Decreases Perineal Pain

Hygenique™ Sitz Bath provides a gentle, therapeutic cleansing and soak, as well as local hyperthermia to the perineal wound. The patient will feel a relaxation of the internal anal sphincter muscle, thus decreasing pain.

(1) Warm-Water Bath in Anorectal Conditions: The Thermosphincteric Reflex. Journal of Clinical GastroenterolozL Shafic. A. (1993). 16(4), 304-308.

(2) Anal sphincter complex; endoanal MR imaging of normal anatomy. Radiology Hussain, SM., Dec. 1995, vol. 197, pages 671-7. Department of Radiology, University Hospital Rotterdam.

(3) Anorectal disorders;five common causes ofpain, itching and bleeding. Postgraduate Medicine. Metcalf, A., Nov. 1995, vol. 98, pages 81-4, 87-9, 92-4. Department of Surgery, University of Iowa Hospitals and Clinics, Iowa City, Lk

Prevention: Reduces Surface Contaminants

Hygenique™ Sitz Bath's glycerin cartridge and warm water cleansing therapy gently debride loosely attached devitalized tissues; reduce surface contaminants such as residual blood, urine, and fecal matter; and provide a surfactant and emollient to help maintain the proper PH level without drying out the tissue.

(1) Bacterial vaginosis in pregnancy: an approach for the 1990's. Obstetrics & Qynecology Survey, 1995, vol. 50, pages 482-8. University of North Carolina, Department of Obstetrics and Gynecology, Chapel Hill, USA-

(2) Risk of preterm delivery in pregnant women with group B streptococcal urinary infections or urinary antibodies to group B streplococcal and E. coli antigens. British Journal Obstetrics Qynecology, McKenzie, H., Feb. 1994, vol. 101, pgs. 107-13. Department of Obstetrics and Gynecology, Ninewells Hospital, Dundee.

(3) Preterm labor. emerging role ofgenital tract infections. Infectious Agents Diseases Dec. 1995, Andrew, W.W., vol. 4, pages 196-211. Department of Obstetrics and Gynecology, University of Alabama at Birmingham.

(4) Effect of vaginalfluid on adherence of type I piliated Escherichia coli to epithelial cells. Journal of Infectious Disease, Gaffney, R-A, Dec. 1995, vol. 172, pages 1528-35. Department of Urology, Northwestern University Medical School, Chicago, IIL.

(5) Role of warm water bath in inducing micturition in postoperative urinary retention after anorectal operations. Urology International, Shafik, A., 1993, vol. 50, pages 213-7. Department of Surgery and Research, Faculty of Medicine, Cairo University, Egypt.

(6) Clinical and molecular epidemiology ofsporadic and clustered cases ofnosocomial Clostridium difficile diarrhea. American Journal Medicine Jan. 1996, Samore, M.11, vol. 100, pages 32-40, Division of Infectious Diseases, New England Deaconess Hospital, Harvard Medical School, Boston, MA.

 

 

 

 

 

 

 

 

 

 

COMPARISON OF PERSONAL

HYGIENE TECHNIQUES

A COMPARISON OF THE Hygenique Plus ^™ SITZ BATH / BIDET

SYSTEM TO A PERI-BOTTLE, BAG-TYPE SITZ BATH, AND PERSONAL

HYGIENE WIPES FOR PERINEAL CARE

Microbiology performed at:

PTI Technologies, Inc.

Newbury Park, California

Microbiologist: John A. Simonetti

Date of Report: July 14, 1997

Purpose of the Study

Vaginal infections often contain bacteria that are normal inhabitants of the intestinal tract. Some of the rnicro-organisms cited in literature most frequently are Escherichia coli (E. Coli) and group B Streptococcus. These pathogens have been indicated as one of the causes for urinary tract infections. By reducing the number of types of bacteria in the perineal region, the number of pathogens will also be reduced; and with thern, we believe that the probability for cross-contamination of the vaginal area with bacteria is also reduced. This study was undertaken to compare various hygiene practices for perineal care to see which is the most effective in reducing the number of bacteria in the perineal region.

Introduction

Different perineal cleaning techniques were used following bowel movements by a female test subject. Following the personal hygiene technique, the perineal area was then rinsed using a squirt bottle filled with a sterile solution containing nutrients to support the growth of bacteria (TSB). This "post hygiene" wash liquid was allowed to fall into a sterilized basin and was subsequently transferred to a sterile Erlenmeyer flask, removed to a laboratory, and evaluated for the presence of micro-organisms. The number of bacteria in the post-hygiene TSB wash signifies the efficacy of the personal hygiene step; that is, the lower the bacteria numbers in the post-hygiene wash liquid, the more effective the person hygiene technique.

Materials

QTY	Description
4	Flasks containing 250-ml sterile tryptic soy broth (TSB)
18	Sterile tryptic soy agar (TSA) Petri dishes
6	Sterile 500-ml -wide-mouth Erlenmeyer flasks for sample collection
6	0.2 micron membranes
1	Premoistened towelette (Tucks brand)
1	240-cc peri-bottle
1	HygeniqueTm Sitz Bath/Bidet
1	Conventional sitz bath (Futuro)
8	Test tubes containing 9.9-ml TSB for dilution
1	Incubator set at 37 degrees Celsius
1	Autoclave
1	Vortex
1	47-nim filter funnel with vacuum source
4	Sterile squirt bottles
4	Sterile containers for catching wash solution

 

1.0 Perineal Wash Procedures

After a bowel movement, the subject was instructed to perform one of the following procedures:

1.1 Wipe perineum from the front to the back with toilet paper.

1.2 Wipe perineurn from the front to the back with toilet paper. Follow with 250-ml of warm water applied from a peri-bottle.

1.3 Wipe perineum from the front to the back, with toilet paper. Follow with the use of a personal hygiene (Tucks) moistened towelette.

1.4 No toilet paper. Two minute warm water wash applied with Hygenique™ Sitz Bath.

2.0 Evaluation of Washed Perineal Area

After each of steps 1 - 4 above, a sterile wash bottle filled with a sterile TSB was used to spray the TSB over the perineal area; and the TSB wash was collected in a sterile plastic basin. The TSB wash was then transferred to a sterile screw cap Erlenmeyer flask and transferred to the laboratory. Samples from each of the steps above were evaluated for the presence of bacteria by using the following method:

2.1 100 - ml of the sample was filtered through a sterilizing grade membrane filter, and the filter was placed on the surface of the TSA in a Petri dish. The purpose of this collection method was to collect bacteria from a large volume of liquid in case the bacteria counts were very low. A 0.2 micrometer filter is capable of collecting all bacteria on its surface, and the cells are capable of growing into visible colonies suitable for counting purposes.

2.2. 1 - ml sample was removed from the sample container, plated directly on the surface of the TSA Petri dish, and spread using a sterile glass rod (standard spread plate technique). The purpose of this and following dilutions is to achieve countable quantities of bacteria, even if the levels are very high.

2.3 The original sample was diluted using a 100 - fold dilution in sterile TSB, and 0. 1 - ml was removed and plated as in step 2.2.

3.0 Sitz Bath

Water Sample

After a bowel movement, the subject was instructed to '%kripe the perineal area with toilet paper and perform one of the following procedures:

3.1 Hygenique™ Sitz Bath Sitz Bath / Bidet

3.2 Conventional bag-type sitz bath

After a ten-minute sitz bath, a water sample was removed and evaluated for bacterial contamination. See test results 3.1 and 3.2

Results

The results are listed in Table I and photographs of several of the sample dilutions in Figure 1. Wash procedures 1.1, 1.2, and 1.3 had very similar numbers of bacteria which were present in concentrations of approximately 3 x 10⁷. This data suggests that there is not much difference between the cleaning methods of toilet paper used alone, toilet paper used in conjunction with a peri-bottle, and toilet paper used in conjunction with a personal hygiene wipe (50% witch hazel). There was a very large reduction of bacteria, however, after the use of the Hygenique™ Sitz Bath ( see 1.4 ). The bacteria numbers were approximately 100 times less than writh the peri-bottle or personal hygiene wipe. This means that the quantity of bacteria was reduced, by the Hygenique™ Sitz Bath, not only two or three, or ten times, but over 100 times or two orders of magnitude.

Table 1: Bacteria Levels in TSB Rinse Liquid after Personal Hygiene

Wash Procedure	Number of Bacteria (Colony-Forrriing Units)
	Estimated Total Bacteria per: 100-ml TSB	0. 1 - ml Undiluted	0. 1 - ml 1/100 Dilution
1.1 Toilet paper only	30,000,000	TNTC	300
1.2 Toilet paper and peri-bottle	10,000,000	TNTC	100
1.3 Toilet paper and personal hygiene wipe	24,000,000	TNTC	240
1.4 Hygenique™ Sitz Bath only --no toilet paper	112,000	112	2
3.1 Hygenique™ Sitz Bath sitz water	0	0	0
3.2 Bag-type sitz water	1,000,000	TNTC	2

TNTC = too numerous to count

	Toilet Paper Only 0.1 ml perineal rinse liquid number of bacteria : TNTC ( estimated total bacteria 30,000,000 3 X 10 7 )
	Toilet Paper and Peri-Bottle 0.1 ml perineal rinse liquid Number of Bacteria : TNTC ( estimated total bacteria 10,000,000 or 1 X 10 7 )
	Bag-Type Sitz Bath water sample 0.1 ml perineal rinse liquid number of bacteria : TNTC ( estimated total bacteria 1,000,000 1 X 106)
	Toilet Paper and Personal Hygiene Wipe 0.1 ml perineal rinse liquid Number of Bacteria : TNTC ( estimated total bacteria 24,000,000 or 2.4 X 10 6 )
	Hygenique only no Toilet Paper 0.1 ml perineal rinse liquid number of bacteria : 112 ( estimated total bacteria 112,000 1.2 X 105)
	Hygenique Sitz bath Water Sample Number of Bacteria : 0 ( estimated total bacteria 0 )

 

NOTE:

Conclusion

Although these results only come from a single test subject, they show conclusively that some personal hygiene techniques are significantly more effective than others. Much of the logic for understanding the mechanisms of how Hygenique™ Sitz Bath works is simple common sense. The water mechanically removes debris and bacteria. The results show particularly that the Hygenique™ Sitz Bath is more effective than a peri-bottle, personal hygiene wipe ( 5 0% witch hazel ) and conventional sitz bath in removing microorganisms from the perineal area. A reduction in bacteria from this area reduces the probability of cross-infection to the vaginal area with enteric pathogens. Although this study did not differentiate between enteric and normal inhabitants of the skin, it does show that the total number of bacteria was reduced; and we hypothesize that enteric organisms as well non-nal flora would be reduced in numbers with the use of Hygenique™ Sitz Bath.

The Hygenique™ Sitz Bath Sitz Bath water was notable in that there was no detectable bacteria present ( 3. 1 ). This is likely due to the presence of chlorine in the tap water and that the water is constantly being replaced with new fresh clean water. The conventional sitz bath water, however, did contain a large number of bacteria; i.e., over a million. This discounts the fact that chlorinated water alone killed the bacteria in the Hygenique™ Sitz Bath Sitz Bath ( 3. 1 ); the replenished fresh water was probably responsible for the killing or removing of the microorganisms.

Bibliography: available upon request.

The following information will give the researcher an overview of some of the common practices that are currently being used in the treatment of perineal, trauma/care and their drawbacks to patient care/outcomes. As part of the discussion, we will introduce the new standard of care, the Hygenique Plus ^™ Sitz Bath/Bidet, a superior perineal cleansing and wound treatment system. With the information presented in this package, you will be better informed to make a decision based on medical, clinical, and laboratory testing when choosing a treatment system for perineal care.

1. Hygiene Wipes ( premoistened towelettes )

• Not eftective in removing a sufficient number of surface contaminants'.
• No reduction in perineal pain.
• Does not promote wound healing.
• Does not stimulate voiding.
• Does not meet the Standard of Care.

2. Community Sitz Bath (tub approx. 3x3 ft., water delivered to patient at a steady flow)

• There is a potential for cross contamination when using a community sitz bath, and the nurse must make sure that the bath is thoroughly disinfected before each use.
• Potential for vasodilation (since a larger portion of the patient's body is being heated).' Availability becomes a problem. If there are several patients in line for treatment, the patient may have to wait for treatment since most postpartum floors only have one or two sitz bath rooms.
• More nursing time used with the operation of a cornmunity sitz bath (disinfection, set-up, and nurse must monitor patient since dizziness and fainting are often associated with the use of this system).
• Patient's concerns over using a community sitz bath and privacy are a consideration. Patient cannot use this system upon discharge.

3. Peri-Bottle (squirt bottle, holds 240-cc)

• Not effective in removing a sufficient number of surface contaminants.
• Does not provide wound healing.
• Does not provide pain relief

4. Bag-Type Sitz Bath (plastic basin, hooks up to plastic bag holding approx. 2000-cc gravity feed 5 ft.)

• Potential for cross contamination; patient soaks in his or her own contaminants which could lead to urinary tract infection or other perineal infection.
• No method for removal of contaminants during treatment; i.e., blood, urine, fecal matter.
• Treatment time cannot be met due to the cooling of the bath water.
• A bag-type sitz bath cannot provide sufficient water flow for a wtirlpool treatment if the bag is placed 4.5 feet above the sitz bath. The maximum water pressure will only be about 1.5 psi of water pressure.
• More nursing time usedi in the operation of a bag-type sitz bath. Nurse must set up and remove the bag-type sitz for the patient.

5. Whirlpool Tubs (bathtubs with water jets to provide whirlpool action)

• Potential for cross contamination, urinary tract infection.
• Do not provide local concentrated heat to the perineal area; therefore, local hyperthermia is not achieved.
• Perineal pain is not reduced because of the inability to achieve local hyperthermia.
• Potential for vasodilation.
• Nursing time increases,with the use of whirlpool tubs (set-up time, nurse must monitor patient since dizziness and fainting are often associated with the use of this system).

6. lce Packs (ice or cold gel wrapped in sealed pouch)

• Do not remove surface contaminants.
• Are only prescribed for the first 12 hours post delivery.
• Do not promote wound healing.
• Do not stimulate voiding.

7. Anesthetic Sprays and Ointments (topical products containing an anesthetic)

• Do not remove surface contaminants.
• Do not promote wound healing.
• Do not stimulate voidina.

The Hygenique Plus ^™ personal whirlpool sitz bath/bidet system prevents cross-contamination and allows for treatment of perineal trauma such as postepisiotomy edema, hemorrhoids, and pain in the perineurn and anal areas both in the hospital and at home. This system easily connects to a single-spouted water faucet for home use or to a delivery system in the patient's room. Used as a whirlpool sitz bath, the unit provides continuous water-flow heat therapy at a constant temperature and relief for tender tissues. With the flow-through door, the unit may be used as a bidet for self-administered gentle cleansing. The Hygenique Plus ^™ is the only sitz bath system available that provides the patient with contaminant-free soaking.

Hygenique™ Sitz Bath's continuous warm water cleansing therapy concentrates heat and stimulates blood flow to the perineal wound. This local hyperthermia increases subcutaneous perineal tissue temperature and oxygen tension, thus significantly promoting the wound healing process.

Hygenique™ Sitz Bath provides a gentle, therapeutic cleansing and soak, as well as local hyperthern-~a to the perineal wound. The patient will feel a relaxation of the internal anal sphincter muscle, thus decreasing pain.

Hygenique™ Sitz Bath's glycerin cartridge and warm water cleansing therapy gently debride loosely attached devitalized tissues; reduce surface contaminants such as residual blood, urine, and fecal matter; and provide a surfactant and emollient to help maintain the proper pH level without drying out the tissue.

• reduces potential for infection by reducing surface contaminants
• provides surfactant and emollient during cleansing cycle
• debrides loosely attached devitalized tissue
• maintains proper pH level without drying out tissue
• provides gentle-cleansing
• provides local hyperthermia
• stimulates blood flow
• increases perineal tissue temperature
• increases oxygen tension o relaxes internal anal sphincter muscle, thus decreasing pain
• can be used in the hospital or at home
• requires less nursing time set up (patients can use product without the help of a nurse)
• no potential for cross contamination since each patient has his/her own sitz bath system
• local heat is delivered to perineal tissue, reducing the risk for vasodilation
• patient is not forced to wait in line for sitz-bath room and can maintain privacy
• patient can continue treatment at home with the take-home system

• Assess presence, location, and nature of perineal discomfort.

• Assess for hemorrhoids and institute measures to relieve pain. Hemorrhoids cause
discomfort and may interfere with elimination.

• The use of a bidet system for perineal cleansing helps prevent hand contamination and reduces the risk of cross contamination by the hands to other parts of the body.

• Ascension of microorganism into uterus
• Ineffective perineal care

The most common pathogens responsible for postpartum infections are those that inhabit the lower genital tract and bowel; however, pathogens may also be exogenous in nature. After birth, portads of entry for bacterial invasion include the placental site, the perineum, the episiotomy, an incision or laceration, the vagina~ the urinary tract, the breast, and the lymphatic system along the uterine veins. Common organisms include Streptococcus, Escherichia coli, Staphlococcus, Clostridia, Klebsiella, and Neisseria gonorrhoeae. Most infections are caused by a combination of anaerobic bacteria.

• Incomplete emptying of bladder
• Perineal swelling, discomfort
• Trauma to the bladder
• Inappropriate wiping technique

• Lacerations
• Trauma to perineum
• Episiotomy
• Handling of breasts, breast-feeding

• The use of a bidet system for perineal cleansing helps prevent hand contamination and reduces the risk of cross contamination by the hands to other parts of the body.

Hygenique™ Sitz Bath Applications - For Diagnoses and Procedures of the Perineum

• Episiotomies
• Fissures
• Perineal abscesses
• Anal lesions
• Vaginectomies
• Fistulas
• Hemorrhoidectomies
• Vaginal tears/trauma
• Episiotomies
• Itching
• Incisions
• Perineal trauma
• Hemorrhoids
• Burning
• Chronic diarrhea pain
• Pain from infections
• Perineal hematoma
• Puritius ani
• Perineal swelling
• Chronic diarrhea hygiene
• Reduces the risk of urinary-tract infections
• Incontinence
• Reduces potential for infection
• Reduces the risk for uterine infection (endometritis)
• Reduces potential for skin breakdown which can lead to infection for immune- suppressed patients

• Postpartum
• Gynecology
• Gastroenterology
• Infection Control
• AIDS Ward
• Radiation/Oncology
• Med-Surg
• Hospital-wide (voiding stimulation)

• Meet the Standard of Care
• Better Patient Outcomes
• Financial Outcomes
• Better Clinical Outcomes
• Improved Continuity of Care

The "standard of care" changes as health care and nursing research determine the effectiveness or ineffectiveness of approaches to care. Hospital policies and procedures set standards of care. The standard of care is expected to be based on the professional literature and reviewed at regular intervals so that they remain current.

(Nichols 1997; Zwelling 1997)

This technology assessment has included references from various technical publications, professional literature, textbooks, university studies, and laboratory testing. The information presented clearly shows the benefits that Hygenique Plus ^™ , the new standard of care, can have on patient care/outcomes.

Comparison of Hygenique Plus Sitz Bath Bidet to a peri-bottle, bag-type sitz bath and personal hygiene wipes for perineal care. Simonetti, J.A., July 1997, PTI Technologies, Newbury Park, CA.

Maternal-Newborn Nursing: 7heory and Practice. Nichols, F.H. and Zwelling, E., 1997. W.B. Saunders Company.

Local Heat Increases Blood Flaw and Oxygen Tension in Wounds. Archives of Surge1y Rabkin, J.M. and Hunt, T.K. (1987), pgs. 122 (2), 221-225.

Physical Modalities in Wound Management, Ntrasound, Vasopneumatic Devices and Hydrotherapy. Ostomy Wound Management, McCulloch, J. (1995), pgs. 41 (5)) 30-32, 34, 36-37.

Minimizing jactors that impair wound healing; a nursing approach. OstomyWound Management, Krasner, D., vol. 41, pgs. 22-6, 28, 30.

Wound healing. Advanced Dermatology, Waldorf, H., 1995, vol. 10, pgs. 77-96; discussion 97. Department of Dermatology, Harvard Medical School, Boston, MA.

Using Wound Care products to promote a healing environment. Critical Care Nursing North America, Maklebust, J., June 1996, vol. 8, pgs. 141-158.

Perineal manifestations of HIV infection. Diseases Colon Rectum, Orkin, B.A., April 1992, vol. 4, issue 35. Division of Colon and Rectal Surgery, George Washington University Medical Center, Washington, D.C.

Effect of vaginal fluid on adherence of type l piliated Escherichia coli to epithelial cells. Journal of Inffectious Diseases Gaffhey, R.A., Dec. 1995, vol. 172, pgs. 1528-35. Department of Urology, Northwestern University Medical School, Chicago, IL.

Role of warm water bath in inducing micturition in postoperative urinary retention after anorecial operations. Urology International, Shafik, A., 1993, vol. 50, pgs. 213 -7. Department of Surgery and Research, Faculty of Medicine, Cairo University, Egypt.

Clinical and molecular epidemiology of sporadic and clustered cases of nosocomial Clostridum difficile diarrhea American Journal Medicine, Jan. 1996, Samore, M.H., vol. 100, pgs. 32-40, Division of Infectious Diseases, New England Deaconess Hospital, Harvard Medical School, Boston, MA.

Warm-Water Bath in Anorectal Conditions: The Thermosphincteric Reflex. Journal of Clinical Gastroenterology Shafic, A. (1993). 16(4), 304-308.

Anal sphincter complex; endoanal MR imaging of normal anatomy. RadiologyHussain S.M., Dec 1995, vol. 197, pgs. 671-7. Department of Radiology, University Hospital Rotterdam.

Anorectal Disorders, five common causes of pain, itching and bleeding. Postgraduate Medicine. Metcalf, A., Nov. 1995, vol. 98, pgs. 81-4, 87-9, 92-4. Department of Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA.

The virulence of E. Coli strains isolated in urinary infections. Bacteriology Virology Parasitology & Epidemiology. David, E., Jan. 1993, vol. 41, pgs. 57-61.

Episiotomy and body image. Modern Midway, Sept. 1996, vol. 6, pgs. 18-19.

Factors related to perineal trauma in childbirth. Journal of Nurse Midwifery Jul.Aug. 1996, vol. 41, pg. 269.

An overview of urinary incontinence in adults: assessments and behavioral interventions. Clinical Nursing Specialty, Beckman, N.J., Sept. 1995, vol. 9, pgs. 241-7, 274.

Anorectal disorders. Emergency Medical Clinician North America, Janicke, D.M., vol. 14, pgs. 757-88. Department of Emergency Medicine, State University of New York at Buffalo, Millard Filhnore Hospital.

Anal Itching: Strategies to Stop the Scratching. Fleiss, P.M., M.D., Universily of Southern California School of Medicine.

NRS 414 Research Utilization. Rosenfeld, A. RN, PhD., 1994, University of Portland School of Nursing .