The Impact of In-Bed Showers on Nosocomial Infection Rates in Long-Term Care Facilities

Healthcare personnel managing patient transfers, highlighting infection risk factors

The Impact of In-Bed Showers on Nosocomial Infection Rates in Long-Term Care Facilities

By Mario P. Cloutier, LIOMAR Medical

Canada’s long-term care crisis did not begin with COVID-19. It was revealed by it.

Between March 1, 2020 and August 15, 2021, over 56,000 residents and 22,000 staff in Canadian LTC and retirement homes were infected with COVID-19, resulting in more than 14,000 deaths (CIHI, 2021).

The hardest lesson from that period was not about a virus. It was about what happens when infection control breaks down in environments where bedridden, vulnerable patients cannot protect themselves.

Hygiene is one of the most direct and controllable factors in nosocomial infection prevention. How patients are bathed, whether they are transferred to shared facilities or kept safely in their rooms, determines their exposure to pathogens every single day.

This article examines the role of in-bed shower systems in reducing nosocomial infection rates in Canadian LTC facilities and CHSLDs, with real case data, Canadian statistics, and a focus on isolation ward protocols.

KEY TAKEAWAYS:

  • Over 56,000 Canadian LTC residents and staff were infected with COVID-19 between March 2020 and August 2021, resulting in more than 14,000 deaths (CIHI).
  • CHSLD Herron in Dorval, Quebec: 47 residents died in spring 2020. Investigators found residents with soiled beds, no hygiene care, and COVID-positive patients not properly separated.
  • In Ontario LTC homes, outbreaks identified late had a 10.3% secondary infection rate vs. 3.3% for outbreaks identified early (PMC, 2024).
  • Shared shower room surfaces in LTC facilities test positive for Staphylococci and MRSA contamination (University of Tennessee, 2024).
  • 23.1% of patients transferred from LTC facilities to hospitals carried MRSA colonization on admission (PMC, 2025).
  • In-bed shower systems eliminate the transfer need of bedridden persons to shared facilities, keeping hygiene interventions contained at the point of care.
  • The Wishower by LIOMAR Medical is designed for use in isolation environments and is compatible with all bed types including bariatric.

THE NOSOCOMIAL INFECTION CRISIS IN CANADIAN LONG-TERM CARE FACILITIES

Prevalence and Cost of Healthcare-Associated Infections in LTC

Nosocomial infections, also called healthcare-associated infections (HAIs), are infections patients acquire while receiving care in a healthcare setting.

In long-term care facilities, the conditions that drive nosocomial infections are structural. Residents are elderly, immunocompromised, and often bedridden. They share living spaces, common areas, and in many facilities, bathroom and shower facilities.

Between March 1, 2020, and August 15, 2021, over 56,000 residents and 22,000 staff in Canada’s LTC and retirement homes were infected with COVID-19, resulting in more than 14,000 deaths among staff and residents (CIHI, 2021).

The cost of HAIs in Canadian healthcare extends far beyond the pandemic. The Canadian Nosocomial Infection Surveillance Program (CNISP), established in 1994 and coordinated by the Public Health Agency of Canada, tracks HAIs across Canadian acute care hospitals.

MRSA bloodstream infections, C. difficile, and carbapenem-resistant organisms are all monitored annually because their burden on the system is substantial and ongoing.

How Patient Transfers Amplify Infection Risk

Every time a bedridden patient is moved, infection risk increases.

Transfer to a shared shower facility exposes the patient to surfaces used by other residents. Wheelchairs, stretchers and shower chair surfaces carry pathogens between uses even after cleaning. Staff hands, clothing, and equipment become vectors during the transfer process itself.

Numbers speak for themselves. Of 149,129 cases in LTCF residents during a study period, 3,748 cases were definite or probable hospital-associated infections discharged back to an LTCF, contributing to 431 potentially nosocomial-seeded outbreaks involving 4,521 resident cases and 1,335 deaths (PMC10728972).

The data is consistent: movement between environments carries infection. Keeping hygiene interventions at the bedside is not a convenience. It is an infection control strategy.

A CANADIAN CASE ON RECORD: CHSLD HERRON, DORVAL, QUEBEC (2020)

The outbreak at CHSLD Herron in Dorval, Quebec during the spring of 2020 is the most documented example of what happens when basic hygiene care collapses in a Canadian long-term care facility.

Between March 26 and April 16, 2020, at least 38 deaths were confirmed by the coroner’s office. During a particularly dark period from April 5 to 10, 23 people died in six days. The final death toll reached 47 residents.

When workers from the local health authority arrived at Herron on March 29, 2020, residents showing COVID-19 symptoms were not properly separated from other residents. Residents were left unfed and untended to, with full diapers and soiled beds.

Health-care workers described bedridden residents lying in sheets soiled with excrement all the way up to the neck because their adult diapers had not been changed.

A joint investigation by three Quebec health-care professional orders found “major shortcomings” prior to the health crisis that had “uncontrollable repercussions during the outbreak,” concluding that what happened at CHSLD Herron can be qualified as a disaster in the making.

The Herron case is not cited here as a cautionary tale about one facility. It is cited as evidence of what bedridden patients depend on when they cannot care for themselves: consistent, contained, dignified hygiene at the bedside.

An in-bed shower system like the Wishower represents exactly the kind of infrastructure that reduces the hygiene gap between adequate and inadequate care for bedridden patients who cannot leave their rooms.

ONTARIO LTC OUTBREAKS: THE COST OF LATE DETECTION

Across 632 SARS-CoV-2 outbreaks recorded in Ontario LTC homes from March to November 2020, outbreaks identified late had a secondary infection rate of 10.3% compared to 3.3% for outbreaks identified early. Mortality was also significantly higher: 3.2% in late-identified outbreaks versus 0.9% in early-identified outbreaks (PMC11484918, 2024).

The implication is direct: in LTC outbreaks, the speed of containment determines outcomes.

In Quebec alone, 2,501 outbreaks were recorded across 471 LTC facilities from May 2022 to September 2024, corresponding to 39,089 COVID-19 cases among residents and healthcare workers (Scientific Reports, 2025).

Containment depends on isolating infected residents quickly and maintaining hygiene without creating new transmission vectors. Transferring isolated residents to shared shower facilities undermines both objectives.

And as we saw previously, depriving them of proper hygiene is not a solution in itself…

infections hospital outbreak

ISOLATION PRECAUTIONS AND THE HYGIENE CHALLENGE

Patients in Isolation: When Leaving the Room Is Not an Option

When a resident tests positive for a communicable pathogen, whether COVID-19, MRSA, C. difficile, or influenza, they are placed under isolation precautions.

The core principle of isolation is simple: the patient stays in their room and their environment is controlled. Contact with shared surfaces, shared staff pathways, and shared equipment is minimized.

Therefore, a transfer to a shared shower facility violates this principle at the most basic level.Nontheless, tisolated patients are still often moved through a corridor, placed on a shower chair or trolley that has touched other surfaces, transported to a shared room, and returned. Every step in that process is a potential transmission event, for the patient , the healthcare workers and for every other resident they pass along the way.

Having an in-bed shower system as part of any isolation ward toolkit can resolve this entirely. The hygiene intervention stays in the room. – Shared surfaces are minimzed. The resident or patient gets a dignified, full shower experience, in spite of their condition.

Why Standard Hygiene Protocols Fall Short in Isolation Settings

Sponge baths are the default hygiene method for isolated patients in many Canadian LTC facilities. Not because they are the most effective option, but because they are perceived as the only option when a patient cannot leave their room.  It’s far from being a valued patient-centered experience….

Sponge baths do not provide the coverage, pathogen removal, or patient dignity of a shower. For patients in isolation who may spend days or weeks confined to their room, the cumulative hygiene deficit is clinically significant.

Point-of-care in-bed shower systems are the evidence-based alternative.

REAL-WORLD EVIDENCE: SHARED SHOWER FACILITIES AND INFECTION RISK

Staphylococci Contamination in LTC Shower Rooms

A point-prevalence study published in Antimicrobial Stewardship and Healthcare Epidemiology in 2025 (DOI: 10.1017/ash.2025.353) cultured 5 shared shower rooms in a long-term care facility.

The study found Staphylococci and MRSA contamination on multiple surfaces including the shower bench, faucet, floor drain, grab bar, and shower curtain.

These are the surfaces that every resident contacts during a shared shower visit. For immunocompromised residents, contact with MRSA-positive surfaces during bathing is a direct infection risk.

MRSA Transmission via Patient Transfer

A cross-sectional study examining patient transfers from LTC facilities to hospitals(PMC10882737, 2025) found that of 936 patients transferred from LTCFs, 23.1% had MRSA colonization on admission.

MRSA colonization travels with patients. It travels on their skin, their clothing, their wheelchairs, and the hands of the staff who move them.

Reducing unnecessary patient movement, including transfers to shared shower facilities, is a direct infection control measure that could save lives.

The Case for Point-of-Care Hygiene Solutions

Both studies point to the same conclusion: shared surfaces and patient movement are the primary vectors for pathogen transmission in LTC environments.

Point-of-care hygiene solutions, specifically in-bed shower systems, address both vectors simultaneously. The patient stays in their room. No shared surfaces are contacted. The hygiene intervention is fully contained.

HOW IN-BED SHOWER SYSTEMS REDUCE INFECTION RISK

Eliminating Transfer-Related Exposure

Every transfer to a shared shower facility is a series of pathogen exposure events: corridor surfaces, elevator buttons, shower room door handles, shower chairs, grab bars, and curtains.

In-bed shower systems eliminate every one of these exposure points. Hygiene happens at the bedside, in a contained environment, with the equipment that can be cleaned and managed within the resident’s/patient’s own room

infections hospital outbreak

Containment of Pathogens at the Point of Care

Traditional bathing methods spread contaminated water and organic material across multiple surfaces and environments.

In-bed shower systems contain the entire hygiene process within a waterproof liner beneath the patient, with water and waste managed within the contained system.

This containment model aligns directly with the principles of contact precautions and outbreak management protocols.

Supporting Infection Prevention Committee Protocols

Infection prevention committees in Canadian LTC facilities set the hygiene protocols that govern how patients are bathed, how equipment is cleaned, and how outbreaks are managed.

In-bed shower systems support these protocols rather than working around them. They produce documentable hygiene events at the bedside, require no shared facility coordination, and eliminate the patient movement that infection prevention committees work to minimize during outbreak periods.

WISHOWER: DESIGNED FOR SAFE HYGIENE IN ISOLATION ENVIRONMENTS

The Wishower by LIOMAR Medical is designed and manufactured in Montreal, Canada for the specific demands of institutional LTC environments, including isolation wards.

Self-Contained, Autonomous Operatio

The Wishower operates as a fully self-contained unit. It does not require connection to existing plumbing or shared water systems within the facility.

This autonomous operation means it can be deployed in any patient room, including isolation rooms, without infrastructure modification. The paradigm shift is simple: he hygienic care system  is brought to the patient. No longer does the bedbound person have to be brought to a shared bathing or showering area.

Compatible with Most Bed Types Including Bariatric

Our Bed shower system is compatible with most hospital beds and bariatric beds, accommodating the full range of residents in a Canadian LTC facility.

For bariatric patients in isolation, where transfer risk is both elevated and infection-relevant, this compatibility is particularly important.

Designed for Isolation Ward Deployment

The Wishower’s self-contained, autonomous design makes it purpose-suited for isolation ward use.

Key features for isolation environments include: no shared water supply connection required, contained grey-water  within the unit, no transfer of patients to shared facilities, compatible with full PPE workflows for caregivers, and easy-clean exterior surfaces.

For LTC facilities managing active outbreaks or housing high-risk residents under contact precautions, the Wishower provides a complete hygiene solution that does not compromise isolation protocols.

Member of the HealthPRO Canada Innovation Accelerator Network

LIOMAR Medical is a member of the HealthPRO Canada Innovation Accelerator program, connecting the Wishower with a national network of over 2,000 Canadian healthcare facilities.

This membership simplifies procurement validation for hospital and LTC group purchasing organizations across Canada.

WHAT INFECTION PREVENTION COMMITTEES SHOULD KNOW BEFORE CHOOSING A SOLUTION

Key Evaluation Criteria for an alternative Hygiene Method

When evaluating an alternative Hygiene Method for infection prevention purposes, committees should assess the following criteria.

Does the system eliminate patient transfer to shared facilities? Does it operate in a fully contained manner with no shared water supply? Can it be deployed in isolation rooms without infrastructure changes? Is the exterior surface cleanable with hospital-grade disinfectants? Does it produce a documentable hygiene event for infection control records? Could the alternative also help increase healthcare workers safety? (e.g. injuries, infections) Can the alternative deliver a high-value patient-centered experience?

The Wishower meets all seven criteria.

Integration with Existing Infection Control Workflows

Successful integration of a new hygiene system into existing LTC workflows requires three things: staff training on the system, clear protocol documentation for its use in isolation and non-isolation settings, and alignment with the facility’s existing cleaning and disinfection schedule.

LIOMAR Medical provides implementation support for all new Wishower installations, including staff training guidance and protocol documentation templates for infection control committees.

FREQUENTLY ASKED QUESTIONS

What are nosocomial infections and how are they prevented in LTC?

Nosocomial infections, also called healthcare-associated infections, are infections patients acquire while receiving care in a healthcare setting, not from their original condition.

Prevention in LTC settings includes strict hand hygiene, environmental cleaning, isolation protocols for infected residents, antimicrobial stewardship, and minimizing patient exposure to shared surfaces and environments. In-bed shower systems support prevention by eliminating shared shower facility use.

Can in-bed showers be used in isolation rooms?

Yes. The Wishower by LIOMAR Medical is designed for use in isolation rooms. Its autonomous, self-contained operation requires no connection to shared plumbing, no patient transfer, and no contact with shared surfaces. It is deployed directly in the patient’s room and operated within the isolation environment.

How does the Wishower help reduce infection transmission?

The Wishower eliminates the need of bedridden resident/patient transfers shared shower facilities, which is a primary transmission vector for nosocomial pathogens in LTC settings. It contains the entire hygiene process at the bedside, within a waterproof liner, with no shared surface contact. This point-of-care model aligns with contact precaution and outbreak management protocols.

Is the Wishower approved for use in Canadian healthcare facilities?

The Wishower is designed and manufactured in Montreal, Canada, to meet the regulatory requirements for healthcare equipment in Canada. LIOMAR Medical is a member of the HealthPRO Canada Innovation Accelerator program, providing institutional buyers with an additional layer of procurement credibility. Contact LIOMAR Medical at https://www.liomarmedical.com/contact/ for facility-specific procurement documentation.

BOOK A FREE WISHOWER DEMO FOR YOUR FACILITY

LIOMAR Medical offers free virtual demos for Canadian LTC facilities, CHSLDs, and hospitals evaluating the Wishower for infection prevention and isolation ward deployment.

See the system in operation, ask clinical questions, and receive a detailed proposal tailored to your facility’s infection control protocols and patient population.

Share:

More Posts

Enhance Patients Lives

Equip Your Facility With the Best in Patient Care

From bed showers to medical carts, LIOMAR Medical provides innovative equipment designed for long-term care, hospitals, and rehabilitation centres across Canada.

Get a Quote
Medication cart distirbuted in Montreal
Scroll to Top