Showering and bathing practices in patients with central venous catheters: A Scoping Review Protocol

Currently, it is common practice for staff in outpatient hemodialysis facilities to instruct patients dialyzing with a central venous catheter (CVC) to refrain from showering. Moreover, these patients are frequently not provided with education on how to safely perform personal hygiene at home. This common practice is based on the belief that showering with a catheter is associated with a higher risk of bloodstream infections (BSIs). Despite this instruction and lack of education, many patients continue to shower/bathe. The Centers for Disease Control and Prevention (CDC) guidance for prevention of intravascular catheter-related infections states “showering should be permitted if precautions can be taken to reduce the likelihood of introducing organisms into the catheter (e.g., if the catheter and connecting device are protected with an impermeable cover during the shower).” Although CDC has published guidance stating that showering should be permitted if appropriate precautions are put in place, implementation of this guidance is rare, leading patients to receive conflicting messaging from their healthcare providers. Studies have shown that this reticence to support conventional showers or baths (i.e., allowing water to flow over area where catheter is located) in this population is due to a concern for increased risk of infection secondary to contact between water and the catheter and/or exit site. Notwithstanding, we know that many patients are showering and bathing via conventional means. Without the proper education, training, and materials, patients may not be using the appropriate infection prevention and control precautions to ensure their safety. The objective of this scoping review is to identify and describe the evidence on the safety of showering, bathing, and swimming among all adults with CVCs, including the potential risk of infection, as well as interventions, practices, and recommendations for preventing infections. The search strategy is not limited to patients receiving hemodialysis via a hemodialysis catheter due to a dearth of studies, however, results will be applicable to this population.