A common question most patients with fever ask us is whether they can have their regular bath. If we say Yes, eyebrows are raised, seeking confirmation. It appears that there exists a lot of confusion about bathing in the presence of a febrile illness.
Fever, as everyone knows, is the elevation of the body temperature as a result of release of certain mediators in response to an infection/injury/insult. Fever is invariably accompanied by sweating, a feeling of being sick, lack of interest in work and loss of appetite etc. Fever being a manifestation of the body’s fight against an ‘enemy,’ as far as possible it should not be or need not be ‘treated’. However, when fever itself becomes a problem, as when it causes a lot of discomfort , induces vomiting or seizures, it must be brought down.
Bathing for a febrile patient should be viewed from two angles. One, bath as a treatment for reducing the elevated temperature and two, bath as a regular, cleansing act.
Tepid sponging is a time honoured and well known method of reducing the elevated temperature. Tepid sponging is useful as an immediate but transient measure in bringing down the temperature and it should always be supplemented with drugs like paracetamol for a longer antipyretic effect1. Studies have shown no significant differences in patient groups treated with antipyretics compared to those treated with placebo2 even with regard to outcome. There is no hard evidence to suggest that reduction of temperature by tepid sponging adversely affects the disease process. But tepid sponging is sometimes perceived as a discomfort, especially by children3,4 and it may not be ideal for patients under intensive care, as it may induce vasoconstriction and shivering5). As against tepid sponging, cold sponging can cause constriction of the cutaneous vessels and may even increase the core temperature. Therefore, tepid sponging (and not cold sponging) can be used as a method of reducing temperature, but it can cause some discomfort to the patients, specially children.
Coming to bathing as a regular, cleansing activity, it can be said that bathing with luke warm water need not be discouraged in febrile patients. To reduce the level of discomfort, they can be advised to have their bath whenever the temperature has settled down from its peak. Bathing with luke warm water will certainly help in reducing the stink of sweat and will give some freshness. Bathing at the height of fever, particularly with cold water, is probably not advisable. Also patients who are sick, bed ridden and elderly may be given a warm sponge bath and a regular bath or cold sponging is not advisable in these patients.
References:
Aksoylar S et al. Evaluation of sponging and antipyretic medication to reduce body temperature in febrile children. Acta Paediatr Jpn. 1997 Apr;39(2):215-7
Kramer MS et al. Risks and benefits of paracetamol antipyresis in young children with fever of presumed viral origin. Lancet 1991 Mar 9;337(8741):591-4
Corrard F. Thermal comfort and fever or research on how to feel better. Arch Paediatr 1999 Jan;6(1):93-6
Sharber J. The efficacy of tepid sponge bathing to reduce fever in young children Am J Emerg Med. 1997 Mar;15(2):188-92
Shackell S. Cooling hyperthermic and hyperpyrexic patients in intensive care. Nurs Crit Care 1996 Nov-Dec;1(6):278-82
