Apollo CEO Raymond Nass.

What are some of the major risks involved in bathing for nursing home residents?

Nass: The transfer and the lifting are the most obvious hazards for residents and staff alike when it comes to bathing. We have also learned that bathing is directly related to infection rates in a nursing home and to skin conditioning.

How great is the risk of bathing-related infection?

Nass: We have some compelling evidence that bathing could be responsible for almost half the nosocomial urinary tract and respiratory infections in a facility. In 1984, the Medical College of Pennsylvania collected water samples that showed a dramatic increase in bacteria levels during the average nursing home tub bath. Consider how many nursing home residents have been incontinent before being bathed, and how many have open sores, lesions, and skin conditions harboring bacteria, viruses, spores, and mold. These pathogens depart from a resident's body during a tub bath, creating a "bacteria soup" ready to infect.

What method did the Medical College researchers devise for decreasing the levels of bacteria in the bath water?

Nass: They arranged for a whirlpool motor on the bathtubs to send water through chambers housing germicidal ultraviolet light and continued recirculating it past the UV light until the end of the bath. Once the bacteria are exposed to this light, they're killed immediately.

How did Apollo Corp. adapt this technology in developing its Remedy system?

Nass: We built a prototype and took it down to an independent FDA/EPA-recognized laboratory and had in vitro tests done under controlled scientific conditions. They would first clean the sides of the tub, then fill it and put in measured amounts of specific types of bacteria. After starting the whirlpool, the lab measured the bacteria levels at two minutes, six minutes, and 10 minutes. In this controlled situation, the bacteria were killed within the first two minutes--98 percent of the bacteria was gone.

In the real world, where you have someone in the tub, bacteria continue to wash off the resident's body during the bath. But when you recirculate the bath water through the chambers housing UV--both in the in vitro tests and in our Beta Study--the levels of bacteria come down to the point where they are barely traceable after an actual bath.

What did the Beta Study involve?

Nass: The study involved 300 nursing home residents in several locations and included those who were showered bathed in a tub, or bathed at bedside. We asked the nursing homes involved to keep track of how and where people were bathed and to provide us with six months of nosocomial UTI and respiratory-infection records. Then we bathed these same people for another six months with our Remedy system. It's very consistent across the board in every one of the locations that UTIs and respiratory infections were reduced roughly 50 percent.

When you think about trying to kill bacteria to stop infection, there's no practical way to do it when you're bathing someone at the bedside or during showering, because this would involve chemicals that are hazardous to both the staff and the resident. The UV technology allows you to capture and isolate the bacteria and kill it before it infects.

How have you addressed transfer-safety issues while maintaining residents' dignity?

Nass: Our reports tell us that the most distasteful thing for residents is being hoisted high in the air--naked as a jaybird--to be placed over the side of the tub. We don't require lifting in any of our bathing systems. Our tubs have doors, so you enter and exit the tub when it's empty. The transfer device is a chair on a frame that rolls, and it permits dignity by virtue of the way the resident is placed in the tub. He or she goes into the tub backwards so the caregiver has a chance to maintain eye contact. Caregivers tell us that people with dementia are easily alarmed, and that eye contact throughout the bathing procedure is very important.

What advice do you have on maintaining skin integrity in nursing home residents?

Nass: Frequent bathing has been given a bum rap as being responsible for causing dry, parched, and cracking skin. That then leads to a decision to bathe people maybe once or twice a week at most. People should look at the labels on what they're using, because it's the inappropriate soaps and bath oils that will cause dry, pruritic skin conditions.

Apollo Corp., based in Somerset, Wis., manufactures whirlpool bathing equipment and liquid bathing products for the long term care market. Under the leadership of CEO Raymond Nass, Apollo developed the Remedy[R] bathing system, which uses a patented ultraviolet (UV) infection-control system introduced in 1994. Prior to joining Apollo, Nass was president of Joerns Health Care Inc., Somerset, Wis.