J Hosp Infect. 2026 Oct 10:S0195-6701(26)00394-4. doi: 10.1016/j.jhin.2026.09.032. Online ahead of print.
ABSTRACT
BACKGROUND: This study evaluated the microbiological effectiveness and organizational impact of waterless perineal hygiene compared with traditional soap-and-water cleansing in fully dependent hospitalized patients, addressing a gap in evidence within acute care settings.
METHODS: This multicenter, randomized, open-label superiority trial was conducted in 10 medical and geriatric wards across four hospitals in Northern Italy. Fully dependent adult inpatients were randomized 1:1 to waterless hygiene or standard soap-and-water care. The primary outcome was the proportion of participants achieving a ≥90% reduction in microbial load between pre- and post-procedure perineal swabs. Secondary outcomes included procedure duration, patient and healthcare professional satisfaction, and agreement between evaluations.
RESULTS: A total of 468 participants were analyzed (239 control; 229 experimental). The experimental procedure achieved a higher proportion of ≥90% microbial reduction compared with standard care (47.2% vs 37.2%; p=0.030), corresponding to an absolute risk difference of 9.9% (95% CI 1.0-18.8) and a risk ratio of 1.27 (95% CI 1.02-1.57). Procedure duration was similar between groups (median 10 vs 11 minutes; p=0.311). Satisfaction was high in both groups, with more favorable perceptions of fragrance and overall hygiene in the experimental group.
CONCLUSIONS: Waterless perineal hygiene demonstrated greater immediate microbiological cleansing effectiveness than standard soap-and-water hygiene without increasing procedure time. Further studies are needed to determine whether these microbiological findings translate into improved clinical outcomes, including healthcare-associated infections.
PMID:42858852 | DOI:10.1016/j.jhin.2026.09.032