Structured Showering Protocol Improved Confidence in Hemodialysis Patients Without Increasing Infection Risk: Study
USA: A quality-improvement initiative conducted across four outpatient dialysis centers in Utah found that a structured showering protocol enabled patients with hemodialysis central venous catheters to feel safer and more confident while maintaining infection safety.
After receiving individualized education and protective supplies from nurses, most participants reported that they were able to keep catheter dressings dry and understood how to respond if dressings became wet. Importantly, the protocol was not associated with an increase in central line-associated bloodstream infections (CLABSIs), supporting its feasibility and safety in routine dialysis care.
The findings were presented at the Spring Clinical Meetings 2026 by Chenlee Condie from Intermountain Health and colleagues.
Patients undergoing hemodialysis with tunneled central venous catheters are commonly advised to avoid showering due to infection concerns. However, researchers noted that these restrictions may negatively affect hygiene, quality of life, and patient satisfaction, with many patients continuing to shower using unsafe methods that could increase infection risk.
To address this issue, investigators developed a standardized showering protocol combined with patient education, aiming to improve patient satisfaction while maintaining low central line-associated bloodstream infection (CLABSI) rates. Given that each CLABSI event may cost nearly $60,000, the initiative also sought to reduce potential healthcare costs.
The quality-improvement project was conducted across four outpatient dialysis centers and included educational materials in English and Spanish, including written instructions and instructional videos on catheter care, dressing changes, and safe showering practices. Two trained hemodialysis nurses provided one-on-one education sessions to 60 patients with dialysis catheters.
Participants received protective supplies such as Press’n Seal wrap or ShowerShield coverings and were reassessed after approximately one month to evaluate recall of instructions, adherence to the protocol, confidence in showering safely, and patient satisfaction.
Key Findings:
- At baseline, 58% of patients reported showering despite being instructed not to do so.
- Among those showering, 16% did so without any catheter protection.
- Many patients relied on unsafe or unreliable protective methods such as towels, shirts, or simply attempting to keep water away from the catheter.
- Most participants expressed a strong desire to shower safely and were willing to follow a structured showering protocol.
- One month after education, nearly all participants accurately recalled the showering protocol.
- Most patients reported consistently covering their catheter while showering during follow-up.
- Patients demonstrated improved confidence in keeping catheter dressings dry and managing situations in which dressings became wet.
- The showering protocol did not lead to an increase in central line-associated bloodstream infection (CLABSI) events compared with the previous year.
- Participants also reported better emotional well-being, improved cleanliness, greater independence, and enhanced dignity after safely resuming showering.
The investigators concluded that incorporating a standardized showering protocol into routine dialysis catheter care education may improve patient experience and support safer self-care practices without compromising infection control.
Reference:
Collins, J., Molnar, A. O., Hae, R., Kosa, D., Moist, L., Zimmerman, D., & Lok, C. (2025). Patient and Health Care Provider Perspectives on Showering for Patients With Hemodialysis Central Venous Catheters: A Survey Study. American journal of kidney diseases: the official journal of the National Kidney Foundation, 85(5), 5
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