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PRINCIPLES of HYGIENE

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HYGIENE INVOLVES:

Skin Mouth Teeth Hair Nails

Eyes Ears Nose Perineal Area Feet

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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

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

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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

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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

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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

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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

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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

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DEVELOPMENTAL LEVEL:ADOLESCENTS

Modesty essential Normal clothes, not gowns Involve patients in decision making

when appropriate No tampons in the hospital

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

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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

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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

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

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PURPOSE OF NURSE PROVIDED HYGIENE

Remove microorganisms Do physical assessment Improve circulation Improve self image/esteem Provide comfort

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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 8/2/2010

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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

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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

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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

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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

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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

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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

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SKIN

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

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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

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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

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

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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

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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!

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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

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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

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BACK RUB Purpose

Relaxation Circulation Pain relief

Assess skin integrity on back Assess all bony prominences Always done as part of good nursing care

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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

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NAIL CARE

Observe circulation; color, capillary refill time

Observe color, sensation, and movement (CSM)

Assess for rings too tight or too loose

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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

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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

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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

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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

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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

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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

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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

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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

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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?

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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

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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

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