Annual compulsory education Bathing safety Annual compulsory education

Learning Objectives Increase your understanding of the safety issues associated with bathing & showering Increase your understanding of the bathing & showering procedures Increase your understanding of the acceptable temperature range, the procedure, & documentation associated with temperature taking Increase your understanding of the Brenda Strafford Foundation policies for bathing & showering Increase your understanding of the procedures for nail care

Bathing keynotes Purpose is to clean the skin, provide comfort, & promote circulation Complete tub bath or shower at least twice a week or as indicated on resident’s care plan Bathing too often or soaking in water for too long may lead to skin dryness & itching Always follow facility policy & resident’s care plan

Aging Process Changes: Skin dries, less elastic, wrinkles, fragile, tears, & bruises easily Fingernails & toenails thicken Perspire less & have decreased oil production Temperature regulation is less effective Less sensitive to heat, cold, pain, & pressure

Caution – Be aware Elderly individuals are at a much higher risk of scalding during bathing or showering Diabetics & individuals with circulatory problems are at an extreme risk

General Safety rules Tubs & showers must be cleaned & disinfected between each use as per facility policy Check that all safety aids such as handrails, shower seats, & hydraulic lifts are in good repair & proper working order Wipe up all water spilled on the floor immediately to prevent falls Ensure the room temperature is comfortable & area clutter free

General Safety rules continued… Wear gloves if possible if there is contact with open sores &/or bodily fluids Observe skin for changes. Report anything unusual to the RN/LPN Transport the resident to & from tub room Use good body mechanics to protect yourself & the resident Never leave a resident alone in the tub or tub room at any time

Bathing Special Attention Should Be Given: Between the legs Under the arms Under the breasts Under the scrotum Between the buttocks Around the anus For obese people, under the folds of skin Between toes

Filling the Tub – key notes The same staff is responsible for filling tub, testing the water, & bathing the resident Tub temperature must be between 38-43°C No resident should be placed in water over 43˚C Record the temperature on the tracking sheet after each temperature check Note: If the resident wishes to have bathe in a temperature lower than 38°C, in the tracking sheet you must document “as per resident’s request.” Inform RN/LPN & adjust care plan as necessary.

filling the tub Set tap at desired temperature between 38-43°C If internal tub temperature does not record between 38-43°C, do NOT use the tub – Alert others & Report to Maintenance 3. Turn on water – Check water temperature with portable thermometer (check 1) 4. Record temperature on Tub Cleaning & Temperature Tracking Sheet 5.Close drainage plug if temperature is safe 6. Once tub is full, swirl water around with your forearm to mix the water as the water temperature at the top may be different from the water temperature at the bottom

Procedure – Filling the tub continued 7. Check water temperature with portable thermometer until the temperature reading stays steady (check 2) 8. Record temperature on Tub Cleaning & Temperature Tracking Sheet 9. Right before placing the Resident in the water, have then physically check the water temperature. Also use your forearm to test the water temperature for at least 5 seconds (check 3) 10. Record temperature on Tub Cleaning & Temperature Tracking Sheet 11. Observe resident for any indication of discomfort

Hand Held Shower (TUB) When using the tub’s hand-held shower to wash a Resident’s hair &/or provide a bath: Use a controlled mixture of hot & cold water 2. Check water temperature using your forearm before directing the water stream at the Resident 3. Record temperature on Tub Cleaning & Temperature Tracking Sheet 4. Keep your free hand in the water stream as much as possible 5. Observe Resident for any indication of discomfort

Cleaning the tub Tubs must be cleaned between residents Staff must wear safety goggles & gloves during procedure Staff must be aware of specialized cleaning procedures for the different tubs in their facilities Once the tub has been cleaned, you must record that you have cleaned the tub on the Tub Cleaning &Temperature Tracking Sheet

Cleaning the tub Equipment: Procedure – Between each resident: Pre-diluted disinfectant cleanser, long handled scrub brush, protective gloves & goggles Procedure – Between each resident: Put on goggles & gloves Drain tub completely Rinse well with clean water then close the tub drain Lower chair lift into tub Spray tub surfaces & lifting devices with pre-diluted tub disinfectant Using brush, scrub tub & lifting device ( surfaces and underside) Leave disinfectant on equipment for 10 minutes using a timer Rinse all surfaces with fresh water including underside of chair lift Record cleaning on tub temperature & cleaning sheet

Providing a shower – key notes The same staff is responsible for testing the water & showering the resident Shower temperature must be between 38-43°C No resident should be showered in water over 43˚C Record the temperature on the tracking sheet after each temperature check Note: If the resident wishes to shower in a temperature lower than 38°C, in the tracking sheet you must document “as per resident’s request.” Inform RN/LPN & adjust care plan as necessary.

Providing a Shower Staff shall wear a plastic apron & rubber boots when providing a shower Turn on water using a controlled mixture of hot and cold 2. while the water is running, check the water temperature by using the hand held thermometer until the temperature is steady (Check1). Document on the Shower Temperature Log. 3. Assist Resident to the shower chair 4. Immediately prior to the resident entering the shower, staff places their own forearm in the water stream for at least 5 seconds to check the water temperature (Check 2). The acceptable temperature range is 38-43°C.

Providing a shower Continued 6. If not contra-indicated by resident’s health or other condition, invite resident to check the water temperature using their forearm (intact skin only) (Check 3) If water check is not performed by the resident, then staff again places their own forearm in the water stream for at least 5 seconds to check the water temperature (Check 3) 7. Observe and ask the resident, whenever possible, for any indication of discomfort related to the water temperature during the shower. 8. Record the date, time, initials of the resident, and temperature during the shower.

shower Water too Hot??? If the resident indicates that the temperature of the water is too hot: the resident shall be immediately removed from the shower & steps shall be taken to provide for their immediate comfort & safety b) notify the RN immediately c) the residents skin shall be assessed for any reddening d) the water temperature shall be measured and compared to the temperature checks 1, 2, and 3.

Caution – be aware If there is a difference in the 2 temperatures: Recheck the water temperature with the portable thermometer Report to the RN/LPN immediately DO NOT shower the Resident until the issue is resolved

Cleaning the shower Showers must be cleaned between residents Staff shall wear safety goggle & gloves during the procedure Spray disinfectant over surfaces of walls & shower chair Leave disinfectant to soak for 10 minutes Scrub surface of walls & shower chair with soft bristle brush Rinse all surfaces with fresh water Clean safety goggles with disinfectant - hang to dry

Cleaning the thermometer After each resident the portable thermometer must be cleaned using Cavi–Wipes

Special considerations Resident’s hair should be washed last & if it was not done recently at the Beauty Parlor Once the hair is washed, wrap a dry towel around the head to prevent the resident from feeling cold Ensure that the resident is well dried. Pat dry, DO NOT RUB the resident’s skin as it is fragile While drying the resident be sure to complete a skin assessment – alert RN/LPN & document in POC if there is reddened skin, open wounds, bruising, scratches, etc. .

Foot & Toenail Care Only simple nail care is to be performed by the HCA Nail care shall be provided weekly Perform nail care before the bath; as per the resident’s care plan Each Resident must have their own nail care equipment that is supplied by the family Used nail equipment must be cleaned & disinfected after use Diabetics & residents with circulatory problems have their foot care completed by the Podiatrist or RN with special training in this area

Foot Care Process Collect resident’s individual foot care equipment Before the resident’s bath examine nails carefully for evidence of slight discoloration &/or breaks in the skin report immediately to the RN/LPN Clip toe nails straight across Smooth rough edges of the nails with an emery board While resident is bathing, gently clean under toe nails

Foot Care Process Give special attention to drying between the toes Apply lotion sparingly as needed, ensuring that the area between & under the toes is left dry Clean/disinfect nail equipment & return to labelled bag Wash your hands

Bsf requirements All RNs, LPNs, & HCAs must complete the On-line Compulsory In-Service annually All HCAs must complete the hands on Competency in Bathing & Showering Procedures annually