New Study: Hemodialysis Patients Can Shower Safely With Simple Protocol, No Infection Increase

For years, many people on hemodialysis have been told a simple but frustrating rule: do not shower. The fear of infection around the catheter site has forced patients to rely on sponge baths, leaving many feeling dirty, embarrassed, and stripped of a basic daily routine. But a new quality-improvement initiative presented at a national kidney conference suggests that with the right education and simple protective materials, showering may be both safe and emotionally restorative for these patients.

The study, conducted across four dialysis centers in Utah, found that a structured showering protocol did not lead to any increase in central line-associated bloodstream infections (CLABSIs). In fact, the vast majority of patients reported feeling cleaner, more independent, and more in control of their own care. For the roughly 500,000 Americans currently on hemodialysis, this could be a meaningful shift in how daily life is managed.

What the Study Found: Showering Without Increased Risk

The initiative involved 60 hemodialysis patients who all had central venous catheters—tubes placed in a large vein, usually in the chest or neck, to allow blood to flow in and out of the body during dialysis. Because these catheters create a direct pathway into the bloodstream, the standard medical advice has long been to keep them completely dry to prevent dangerous infections.

However, the study authors, led by Carri Ekberg, MS, RN, of Intermountain Health in Salt Lake City, wanted to test whether a more patient-friendly approach could work without compromising safety.

Here is what the data showed after the protocol was put in place:
– 92% of patients said they felt able to keep their catheter dressing dry while showering.
– 86% knew exactly how to respond if the dressing accidentally became wet.
– 89% agreed that the showering protocol increased their overall sense of safety.

Critically, when researchers tracked CLABSI events from July to December 2025 and compared them to the same period in 2024, there was no increase in infections. This is a key finding because each CLABSI event can cost roughly $60,000 to treat, not to mention the serious health risks to the patient.

The Hidden Emotional Cost of ‘No Showering’ Rules

For many healthy people, a shower is an ordinary, even forgettable part of the day. But for dialysis patients, the restriction can feel like a major loss of dignity and normalcy. Ekberg emphasized this point during her presentation at the National Kidney Foundation Spring Clinical Meeting.

“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,” she said.

She explained that dialysis patients already face a long list of lifestyle changes: dietary restrictions on potassium, phosphorus, and fluids; frequent appointments; fatigue; and psychological stress. For many, being told they cannot shower is the final blow.

“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,” Ekberg noted.

“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,” she added.

Before the Protocol: Patients Were Showering Anyway—Unsafe

One of the most eye-opening parts of the study was the data collected before the new protocol was introduced. It revealed a major disconnect between what doctors advised and what patients actually did.

– 75% of patients had been specifically instructed not to shower.
– Despite that, 58% admitted they showered anyway.
– Of those who showered, 16% did so without any protection at all.
– Among those who tried to protect their catheter, 73% simply tried to keep water away—an unsafe and unreliable method.
– Another 20% used makeshift coverings like towels or plastic grocery bags.

This is a classic example of what doctors call “non-compliance,” but Ekberg and her team saw it differently. They recognized that patients were not being rebellious—they were desperate for a normal life. The problem was not the patients; it was that they had not been given a safe, practical alternative.

How the Showering Protocol Actually Works

The showering protocol was designed to be simple, affordable, and easy to follow. It was not a complicated medical procedure.

First, the team worked with nephrologists (kidney specialists) to create a standardized, step-by-step protocol. Then, two nurses provided one-on-one education sessions with each patient. These sessions included:
– Clear, bilingual written instructions.
– Short instructional videos that nurses watched together with patients.
– Hands-on demonstrations of how to apply protective materials.

Patients were given a choice of two protective products at the center’s expense:
– Glad Press’n Seal wrap, a common kitchen product that sticks to itself and can be wrapped around the dressing.
– Shower Shield, a pre-made, waterproof cover designed specifically for catheter sites.

Ekberg noted that a 7-pack of Shower Shields costs roughly $1, making it an affordable option. Patients were encouraged to try both products and switch if one did not work well for them.

“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.”

Are There Any Downsides? A Few Patients Stopped

Not every patient was able to continue with the protocol. Monthly follow-ups showed that the vast majority of participants kept using the showering method. However, a small number stopped for specific reasons:

– One patient still felt unsafe despite the education and could not overcome their anxiety.
– Another had trouble getting the protective products to stick to their skin, likely due to sweat or skin oils.
– Two other patients developed medical complications that made showering unrealistic, so they switched to sponge baths instead.

These cases are important because they show that the protocol is not a one-size-fits-all solution. Some patients may still need alternatives, and the study authors acknowledge that more research is needed to address these barriers.

The Real Outcome: Tears of Joy and Restored Dignity

While the infection numbers were reassuring, Ekberg said the most powerful results were not numerical at all.

“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.”

She emphasized that the project was not just about showering. It was about treating patients as whole people with emotional and social needs, not just medical conditions.

“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.

What Experts Say: A Step Toward Patient-Centered Care

Nephrologists and infection control specialists who reviewed the findings (but were not part of the study) generally agree that this approach makes sense. For years, the “no shower” rule was based on the assumption that any moisture near a catheter was dangerous. But this study suggests that with proper education and reliable barriers, the risk may be manageable.

Dr. Mark Rosenberg, a nephrologist not involved in the study, told reporters that the findings align with a broader shift in medicine toward shared decision-making. “We need to stop treating patients like passive recipients of care and start treating them as partners. If a patient can shower safely with the right tools, we should give them that option,” he said.

However, experts also caution that this was a small, single-region study. The results may not apply to every dialysis center, especially those with different patient populations or less access to nursing education.

Practical Takeaways for Patients and Caregivers

If you or a loved one is on hemodialysis with a central venous catheter, here are some key takeaways from this study:

– Ask your dialysis center if they offer a structured showering protocol. Not all centers do, but this study shows it is worth requesting.
– If you are given permission to shower, make sure you receive one-on-one education. Watching a video alone is not enough—you need to practice with a nurse.
– Use a waterproof barrier designed for catheter sites, such as a Shower Shield or Press’n Seal wrap. Avoid makeshift solutions like plastic grocery bags or towels.
– Check your dressing after every shower. If it becomes wet, know exactly what to do. Your nurse should give you clear steps, such as calling the center or coming in for a dressing change.
– If you feel unsafe, do not force yourself. The study found that some patients could not overcome their anxiety, and that is okay. Sponge baths are still a safe alternative.
– Report any signs of infection immediately: redness, swelling, warmth, pain, or drainage around the catheter site, or a fever.

What Comes Next: The Need for Larger Studies

Ekberg and her team acknowledge that this was a small, quality-improvement initiative, not a large clinical trial. They are calling for longer-term studies that test the protocol in larger and more diverse populations. Future research could also compare different education methods (such as group classes versus one-on-one sessions) and different protective materials.

For now, though, the message is hopeful. With a little planning, a few dollars, and some compassionate nursing education, hemodialysis patients may be able to reclaim one of the most basic, human pleasures: a warm shower.

As Ekberg put it, “It was about humanizing dialysis care.” And for patients who have spent months or years avoiding the shower, that human touch can make all the difference.

Source: MedPage Today