1. 1 PRINCIPLES of HYGIENE

2. 2 HYGIENE INVOLVES: Skin Mouth Teeth Hair Nails Eyes Ears Nose Perineal Area Feet

3. 3 HYGIENE Cleansing by nurse is part of historical giving of care The more ill the patient, the more skill needed in providing the hygiene care Cleansing skin is first line of defence against organisms Mucous membranes and gastric secretions also defend

4. 4 WHY A NURSING FUNCTION? Assessment Teaching Comfort Touch Relaxation Pain Relief Caring

5. 5 HYGIENE also includes: Cleansing of patient Bed making Room straightening Emptying garbage Removal of used supplies, dishes, flowers, newspapers, etc. Assessing patency of and cleansing equipment Placement of necessary supplies

6. 6 SOCIOCULTURAL FACTORS It is common to bathe daily; not all cultures do Economics is an influence Different cultures shave different body parts and hair on head differently Some cultures wear items not to be removed in bath examples: wigs, head-dressings, amulets, turbans, religious medals or shawls Male nurse only or female nurse only may be necessary for some cultures

7. 7 KNOWLEDGE LEVEL May need teaching regarding: Front to back perineal care Brushing gum line, not just teeth Special foot care for circulatory problems Skin inspections by dermatologist

8. 8 DEVELOPMENTAL LEVEL: YOUNG CHILDREN Children can drown in very little water NEVER LEAVE CHILDREN ALONE DURING BATHING NEVER ALLOW CHILDREN TO TURN THE TAPS ALWAYS CHECK TEMPERATURE OF BATH WATER BEFORE PUTTING CHILD IN

9. 9 DEVELOPMENTAL ISSUES: CHILDREN Children may have natural parents, stepparents, four sets of grandparents, all involved in care For decision making, some cultures must ask father, some must ask grandmother

10. 10 DEVELOPMENTAL LEVEL: ADOLESCENTS Modesty essential Normal clothes, not gowns Involve patients in decision making when appropriate No tampons in the hospital

11. 11 DEVELOPMENTAL LEVEL: OLDER ADULTS Heat insensitivity; can burn easily Foot care Skin very fragile Decreased strength Decreased stamina

12. 12 ISSUES YOU MAY FACE Personal space of patient Undress, examine, wash and groom stranger Incontinence can cause discomfort/embarrassment Sexuality may be an issue Take a break if uncomfortable; tell facilitator, preceptor Attraction? Ask for patient change

13. 13 PATIENT PREFERENCES Try to involve patient in care If too ill, we must do all Give control over soap, deodorant, mouthwash, nail length, water temperature Must work within time constraints Be very cautious with delegation of care to others Must carefully assess refusal of bathing; speak to facilitator, preceptor

14. 14 BATH REFUSAL What is real problem? Power issue? Fatigue? Visitors? Assessment Patient continent? Skin care? Level of exertion? Comfort education and negotiation

15. 15 PURPOSE OF NURSE PROVIDED HYGIENE Remove microorganisms Do physical assessment Improve circulation Improve self image/esteem Provide comfort

16. 16 NOSOCOMIAL INFECTION Also called iatrogenic Patient illness brought on simply by being in hospital 4,000,000 cases reported annually. That’s: 76,923 per week 10,958 per day 8 per minute Statistics from http://aje.oxfordjournals.org/cgi/content/abstract/121/2/159 viewed 8/2/2010http://aje.oxfordjournals.org/cgi/content/abstract/121/2/159

17. 17 REDUCING NOSOCOMIAL INFECTION Hands washed with antiseptic soap or friction or approved alcohol gel Short fingernails; artificial nails now being banned at a lot of sites Soiled linen kept off uniform Gloves If your are going to come into contact with blood or body fluid (e.g.if client has open or draining wound or is incontinent if nurse has skin breaks on hands No sharing supplies without proper sanitation

18. 18 SAFETY Electrical supplies must be checked by engineering department prior to use hair dryers electric shavers Bed raised to working height and lowered when finished Side rails up for patients requiring All spilled water immediately wiped up

19. 19 SHAVING Safety razor not used on certain patients Those on anticoagulant drugs Those with liver disease causing clotting disorders Confused patients Suicidal patients Use electric razor after engineer check

20. 20 SAFETY All patients will need attention to water temperature Patients with impaired level of consciousness will need special care gentle eye care frequent mouth care proper positioning care to bed linen

21. 21 FATIGUE AS A FACTOR Nurse’s job to monitor patient tolerance Respiratory response Heart rate Can patient tolerate being flat? Do they need orthopnea position? Confusion level Shower less taxing than bed bath May be easier on patient to be up in chair than rolled side to side

22. 22 TYPES OF HYGIENE Early a.m. care: Urinal/bedpan, wash hands and face, brush teeth Morning care: After breakfast, complete bath or shower, hair care, nail care, oral care, back rub, linen change Afternoon care: straighten linen, offer urinal/bedpan/commode, wash hands/face Evening care: Elimination, wash hands and face, oral care, linen straightening, back rub

23. 23 SKIN Regulates body temperature First line of defense against harm Antibacterial and antifungal Transmits sensations Signs of problems

24. 24 PATIENTS AT RISK FOR SKIN PROBLEMS Altered level of consciousness Altered nutrition Immobility Dehydration Altered sensation Secretions on skin Mechanical devices, casts, restraints Altered venous circulation

25. 25 NURSING INTERVENTIONS General health important Intact skin Caution in movement Don’t over bathe elderly Protein in diet Avoid periods of moisture Change frequently Dry carefully (pat do not rub) Rinse off soap well, or use shower gel

26. 26 NURSING ASSESSMENT WHILE BATHING Relationship Color and condition of skin Pain on movement Level of consciousness Injuries Scars Skin turgor Weight loss or gain

27. 27 SHOWERING Check orders and get report Organize your supplies first Keep covered when moving in hallway Keep heels from dragging on floor Keep curtains/doors closed Dry carefully Include oral care, shampoo, and shave Don’t leave alone in shower

28. 28 BED BATH Check orders (schedule; positioning) Check arm band Obtain report on patient Discuss plan with team Check availability of water, linen, hamper, gloves if needed Organize supplies prior to entering room Assess patient condition Does patient need pain medication? Will any treatments need to be done? Begin!

29. 29 GENERAL PRINCIPLES Nurse safety Patient safety Work within time constraints Allow privacy and dignity Only body part being washed is uncovered Curtain is closed Change water, washcloths, towels, linen as needed Call bell available

30. 30 PERINEAL CARE Professionalism always Not deferred in cases needing nursing assessment Female Always wipe front to back (urethra to rectum) Often have menses in hospital Use peripads - tampons are not ideal in hospital If large breasts, need to dry underneath carefully, may use powders to keep area dry Male Assess for circumcision If not, cleanse under foreskin and replace

31. 31 BACK RUB Purpose Relaxation Circulation Pain relief Assess skin integrity on back Assess all bony prominences Always done as part of good nursing care

32. 32 FOOT CARE Soak feet as part of bath Clean toes and toenails Teach as you go Range of motion of legs Feet of diabetic patients and patients with vascular disease are inspected carefully; Never cut toenails of these patients Many facilities have podiatrist visits

33. 33 NAIL CARE Observe circulation; color, capillary refill time Observe color, sensation, and movement (CSM) Assess for rings too tight or too loose

34. 34 MOUTH CARE Examine with gloves and light Use only water soluble lubricants Unconscious patient has no gag reflex, position on side for care May have accumulated debris in mouth called sordes Teach about brushing and flossing

35. 35 CARE OF DENTURES Assess for fit - loose, causing ulcers If removed, keep in covered cup with water Label cup with patient’s name Keep in bedside table Pad sink when cleaning (they break when dropped - trust me, I know!!) Use cool water

36. 36 HAIR CARE Hair is combed daily and shampooed as required (prn) Both wet and dry shampoo available Send to operating room or surgical procedure room with clean hair and body hair shaven when applicable

37. 37 EYE CARE Contact lenses usually stored in saline liquid; case labeled Also label and safeguard glasses in drawer Clean inner to outer canthus Never use cotton near eyes Treat each eye separately Eyes considered sterile

38. 38 EARS Allow nothing sharp in ears Hearing aids now miniscule in size – don’t lose! Label case Speak directly to patient’s face if hard of hearing

39. 39 BEDBATH Wash head to toe, front to back Physical assessment as you are washing; must also loosen and secure lines as moving and turning patient Change washcloths for different areas Change water if cold or soiled or very soapy Some put oil in bath water of elderly

40. 40 BEDBATH Change linen as needed Do range of motion as needed Do oral care, hair care, and give back rub Leave bed in low position, rails up, and call bell in place. Straighten room. Report and chart findings

41. 41 ASSESSING TUBES AND LINES Oxygen – stays on during bath, check connections, litres per minute, cleanliness of prongs or mask, water if humidified etc IV lines – look at IV site, rate and solution Urinary catheter – draining, unkinked, bag below bladder

42. 42 ASSESSING TUBES AND LINES Enteral tubes – in place, running or draining properly, or clamped properly Dressings – Clean and dry, drains properly working Does anything need to be emptied, changed or cleaned?

43. 43 BEDMAKING Make bed for patient comfort If incontinent, wash, rinse, dry and change linen Use aids to relieve pressure points heel, elbow protectors bed frame with trapeze frame to keep covers off feet special beds and mattresses Position as ordered

44. 44 NURSE SAFETY IN BEDMAKING Raise bed to working height Face patient Bend knees Conserve steps Don’t lift alone Side rails as ordered Lower bed and place call bell when leaving

45. 45 CHARTING How patient tolerated bath Any unusual findings What was done about findings Comparative progress Nursing care plan updated?