Waterless perineal hygiene as a sustainable nursing intervention: a secondary analysis of a multicentre randomized controlled trial

Every day, nurses perform countless small acts of care that form the backbone of hospital life. Among these, cleaning a patient's most private areas is a routine necessity for those who cannot move on their own. For decades, the standard method has been simple: soap, water, and towels. This approach is familiar, trusted, and deeply embedded in hospital routines. Yet, as hospitals strive to become more sustainable, they are beginning to ask if these everyday habits leave a larger footprint than necessary. Sustainability in healthcare is not just about recycling bins or solar panels; it is about the resources consumed in the smallest moments of care. Water, energy, and disposable materials add up quickly when multiplied by thousands of patients and millions of procedures. The question is whether changing a routine task to save these resources might also change the quality of care, or if it is possible to do both: protect the patient and protect the environment.

A team of researchers in Italy set out to answer this question by looking closely at a specific alternative to the traditional soap-and-water method. They examined a system that uses pre-moistened wipes that require no water, no rinsing, and no drying towels. This "waterless" approach had been tested before for its ability to keep patients clean, but this new study went further. The researchers wanted to know if switching to this method could reduce the amount of money, water, and waste generated by hospitals without making the care any less effective. They conducted a large, careful comparison across four major hospitals in Northern Italy, observing hundreds of hygiene procedures performed on bedridden patients. The goal was to see if the waterless method could stand up to the traditional one not just in keeping patients clean, but in how it treated the hospital's resources.

The study involved nearly five hundred hygiene procedures, split almost evenly between the traditional soap-and-water method and the new waterless system. In the traditional group, nurses used water, cleansing solutions, and multiple disposable items like towels and pads. In the waterless group, they used a single pre-packaged wipe system. The researchers measured everything: how long the procedure took, how much water was used, how many items were thrown away, and how much it cost the hospital to perform each cleaning. They also checked the results of the cleaning by testing for bacteria to ensure the patients were being kept safe. The findings were clear and consistent. The waterless method used significantly fewer resources. It eliminated the need for water entirely, which also meant no energy was spent heating that water. The number of disposable items dropped from an average of nine per procedure down to six.

When the researchers calculated the costs, the difference was substantial. The traditional soap-and-water method cost the hospital nearly ten euros per procedure, driven largely by the price of materials and the time staff spent on the task. The waterless method cost less than eight euros per procedure. While the time it took to perform the cleaning was roughly the same for both methods, the waterless approach saved money on the supplies themselves. More importantly, the study found that the waterless method did not compromise the patient's health. In fact, the waterless wipes were slightly more effective at reducing bacteria than the traditional soap-and-water method. This means the hospital could save money and resources while actually improving the cleanliness of the care provided.

The impact of these savings becomes even more striking when looking at the bigger picture. The researchers estimated that if a typical hospital ward performed ten thousand of these cleanings in a year, switching to the waterless method would save ten thousand liters of water and prevent over a thousand kilograms of medical waste from being generated. For a large hospital, the annual savings in money could reach hundreds of thousands of euros. The study did not just look at the immediate cost of the wipes; it considered the entire process, including the water used, the energy to heat it, and the waste created. The waterless method removed the water and heating energy entirely and cut the waste by more than half. This suggests that the environmental benefit is not a side effect but a direct result of using fewer materials and less water.

One might wonder if such a simple change could really make a difference in a complex system like a hospital. The researchers addressed this by ensuring their study was rigorous. They compared the two methods side-by-side in real hospital settings with real patients and real staff. They did not rely on guesses or computer models; they measured the water used and weighed the waste produced. They also confirmed that the staff spent the same amount of time on both methods, proving that the savings came from efficiency in materials, not from rushing the work. The study also ruled out the idea that saving money or resources would mean cutting corners on care. The data showed that the waterless method was just as fast and actually better at reducing bacteria. This challenges the old assumption that being sustainable might require sacrificing quality or that high-quality care must always be resource-intensive.

The implications of this work extend beyond just one type of cleaning. It suggests that the way nurses make daily decisions about what supplies to use has a direct impact on the hospital's environmental footprint. For years, sustainability in healthcare has often been discussed as a separate goal, something to be added on top of regular work through special initiatives or policy changes. This study shows that sustainability can be built into the work itself. By choosing an evidence-based method that uses fewer resources, nurses can achieve better outcomes for the patient and the planet at the same time. The study does not claim that this is the only solution or that it works for every single task in a hospital. It does, however, provide strong proof that for this specific, common task, the waterless method is a superior choice. It is a cleaner, cheaper, and more sustainable way to care for patients.

The researchers concluded that integrating sustainability into the evaluation of nursing care is essential. When hospitals decide which methods to use, they should look at the total cost, including the environmental impact, not just the price tag on a box of supplies. This study demonstrates that it is possible to reduce the consumption of water and energy and the generation of waste without making the care any less effective. In fact, the care was more effective. The findings offer a practical path forward for hospitals that want to be more responsible with their resources. By adopting methods that are proven to work well and use less, healthcare systems can reduce their burden on the environment while continuing to provide the highest standard of care to their patients. The story of this research is a reminder that the most powerful changes often come from rethinking the simplest, most routine parts of our work.