What is the proper way to bathe a patient with varicella?

How to Bathe a Patient with Chickenpox

Patients with chickenpox can continue normal showering or bathing, keeping the skin clean while taking precautions to avoid touching lesions and practicing meticulous hand hygiene afterward. 1

Bathing Guidelines

Basic Bathing Approach

• Allow normal showering or bathing to continue during active chickenpox infection 1
• Keep the vaccination or lesion sites dry when possible, though routine bathing does not need to be completely avoided 1
• If lesions become wet during bathing, blot them dry gently with gauze and discard the gauze immediately into a biohazard container 1

Critical Infection Control Measures During Bathing

• Avoid touching the lesions directly while washing to prevent autoinoculation (self-spreading of the virus to other body areas) 1
• Consider using a waterproof dressing over lesions during bathing to decrease the risk of autoinoculation, though this is optional 1
• If a towel is used to dry lesion areas, it must be handled as contaminated material 1

Hand Hygiene - The Most Critical Step

The single most important measure is consistent hand hygiene with antimicrobial soap and water or alcohol-based hand rub (>60% alcohol) after any contact with lesions or bathing materials. 1

• Wash hands before and after bathing the patient 1
• Wash hands after any contact with the vaccination site, lesions, or materials that touched them 1
• Antimicrobial soap and water is preferred over plain soap 1
• Alcohol-based hand rub is acceptable when hands are not visibly soiled 1

Special Considerations for Caregivers

Personal Protective Equipment

• Wear gloves when handling materials contaminated with vesicular fluid from chickenpox lesions 1
• Change gloves and decontaminate hands between different body areas if providing bathing assistance 1
• Consider wearing a gown if splashing with contaminated water is anticipated 1

Environmental Precautions

• Varicella is transmitted through direct contact with vesicular fluid and through airborne aerosols from respiratory secretions 1
• The patient remains contagious from 1-2 days before rash onset until all lesions are crusted (typically 4-7 days after rash onset) 1
• Ensure adequate ventilation in the bathroom, as the virus can be aerosolized 1

Common Pitfalls to Avoid

• Do not use harsh soaps or scrub lesions vigorously, as this can cause secondary bacterial infection and increase viral spread 1
• Do not share towels, washcloths, or bathing materials with other household members 1
• Do not allow the patient to soak in a bathtub with other children, as this significantly increases transmission risk 1
• Never assume bathing with soap removes the infectious virus - hand hygiene and avoiding direct contact with lesions are far more important than the bathing itself 2

Post-Bath Care

• Dispose of any gauze used to dry lesions in a biohazard waste container or sealed plastic bag 1
• Launder towels and washcloths separately from other household items using hot water 1
• Clean bathroom surfaces that may have contacted vesicular fluid with appropriate disinfectant 1
• Ensure the patient's hands are washed thoroughly after bathing to prevent autoinoculation to eyes, mouth, or other body areas 1

High-Risk Populations Requiring Extra Caution

For immunocompromised patients, pregnant women, or neonates exposed to someone with active chickenpox:

• These individuals should avoid direct contact with the bathing patient entirely 3
• If exposure has occurred, Varicella-Zoster Immune Globulin (VZIG) should be administered within 96 hours 3
• Consider using sterile water for bathing in transplant or severely immunocompromised patients if there is concern about water contamination 1