Showering Protocol for Hemodialysis Patients Shows No Increased Infection Risk

A structured showering protocol helped hemodialysis patients feel better without compromising safety, a quality-improvement initiative found.

Conducted across four dialysis centers in Utah, the initiative involved two nurses who provided one-on-one education and protective materials to 60 patients with hemodialysis catheters. Equipped with the new education and materials, 92% of patients said they felt able to keep their dressing dry, 86% knew how to respond if the dressing became wet, and 89% agreed that the showering protocol increased their sense of safety.

Importantly, there also was no increase in central line-associated bloodstream infections (CLABSIs), reported Carri Ekberg, MS, RN, of Intermountain Health in Salt Lake City.

“Hemodialysis patients are typically told not to shower if they have a central venous catheter because of the infection risk, but from the patient perspective, it comes at a real cost,” Ekberg said at the National Kidney Foundation Spring Clinical Meeting.

“In addition to lifestyle changes and multiple dietary restrictions, [dialysis patients] also are dealing with a lot of psychological stress and change — and now we tell them that they can’t shower. A lot of times this is the straw that breaks the camel’s back,” she said.

“What we were hearing consistently from our patients was frustration and feeling the loss of something that was so normal for everyone else. And for many, showering wasn’t just about being clean, it was about dignity, independence, and well-being,” noted Ekberg.

Prior to the initiative, the data showed a disconnect between medical advice and patient behavior. Although 75% of patients had been specifically instructed not to shower, 58% admitted they did so anyway. Of those, 16% showered without any protection at all. Most who attempted to protect the site relied on unsafe strategies: 73% simply tried to keep water away from the catheter, while 20% used makeshift coverings like towels or plastic grocery bags.

The showering protocol wasn’t overly complicated, noted Ekberg.

First, the team established a standardized protocol alongside nephrologists, followed by one-on-one nursing education sessions. These included clear, bilingual written instructions and short instructional videos.

Patients were provided their choice of protection — Glad Press’n Seal wrap or Shower Shield — at the center’s expense. Ekberg noted that a 7-pack of Shower Shields cost roughly $1. Patients were shown how to apply the materials and encouraged to switch options if one did not work for them.

The protocol instructed patients to:

• Check for signs of infection and ensure the Tegaderm dressing was intact before showering
• Use a handheld shower head, if possible, and keep showers brief
• Avoid spraying water directly on the dressing
• Shower shortly before their dialysis appointment so that if a dressing did get wet, it could be changed immediately at the clinic

“Importantly, education wasn’t rushed or passive,” said Ekberg. “Nurses reviewed the materials with the patients, sat down and watched the videos with them, answered their questions, and made sure that the patients knew what to do and that they understood what to do if something went wrong, such as their dressing getting wet.”

CLABSI events — which can cost roughly $60,000 per occurrence — were monitored from July to December 2025 and were compared with the same period in 2024. Monthly follow-ups showed that the vast majority of participants continued to follow the protocol.

Of the few who stopped, one still felt unsafe despite the education, and another had trouble getting the products to adhere to their skin. Two others developed medical complications that made showering unrealistic and opted for sponge baths instead.

“The most important, powerful outcomes weren’t numerical,” she noted. “Patients told us that they felt clean again, they could wash their hair independently, and some cried happy tears because something so normal had been returned to them.”

“The project wasn’t just about showering, it was about dignity, trust, and recognizing patients are capable partners in their care. It was about humanizing dialysis care,” she added.

Ekberg called for longer-term studies to test the protocol in larger, more diverse populations and to compare different education methods and protective materials.

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