Chapter 9

1. Chapter 9 Tim Coney PATIENT HYGIENE

2. Introduction • This presentation examines patients’ personal hygiene needs and the ways in which they should be met. • Part 1 – Uniform Policy • Part 2 – Bathing a Patient • Part 3 – Bedbathing a Patient • Part 4 – Perineal Care • Part 5 – Patient Eye Care • Part 6 – Patient Nail Care • Part 7 – Patient Hair Care

3. PART 1: Uniforms

4. Uniforms • Wear the correct uniform without modifications, according to local policies • Always follow Health & Safety and Infection Control regulations with respect to uniforms and other items of protective clothing • Follow local policies with respect to wearing items of religious significance • Local policies may specify a ‘naked below the elbows’ approach • Use a fob watch • Keep fingernails short, clean and without polish or extensions • Keep hair up, tied back and off the collar

5. Additional Protective Clothing • Be aware of your local uniform policy and wear the supplied uniform without alterations or additions • Be aware of local policies on wearing, and the correct disposal of, additional protective clothing such as aprons, gloves and protective eye wear • Be aware of local policies regarding hand washing and the correct disposal of clinical waste

6. Female Uniform (example) • Dress or tunic, and navy blue trousers • Only accepted items of jewellery allowed (usually a plain wedding band and single plain stud ear rings - local policies apply) • Black tights, stockings or socks, black flat shoes which cover the majority of the foot, lace ups for good support, no tassels or decorations and no sandals or trainers

7. Male Uniform (example) • White tunic and navy blue trousers • Only accepted items of jewellery allowed (usually a plain wedding band and single plain stud earrings - local policies apply) • Black socks, black flat shoes which cover the majority of the foot, lace ups for good support, no tassels or decorations and no sandals or trainers.

8. PART 2: Bathing a Patient

9. Giving a Patient a Bath • Begin with a risk assessment and assess the patient to find out what they can do for themselves. • This is ideally a two nurse procedure. • Prepare the bathroom area and ensure all of the equipment needed and personal toiletries are available. • Obtain the patient’s consent. • Check the temperature of the room and water in the bath. • Ensure privacy at all times – prevent interruptions. • Do not leave the patient alone. • Encourage the patient to help themselves as much as possible.

10. Before starting this procedure, discuss with your mentor the need to wear any additional items of protective clothing and the disposal of any waste. Familiarise yourself with any colour coding for bags used for soiled laundry and for the disposal of waste, and be aware of the differences between domestic waste and clinical waste as these are managed differently by many local authorities. • Always check with the patient before using soap, particularly on their face. Ask if they would rather use an alternative skin cleanser. • Be aware that adding bath oil to the water will make the patient’s skin extremely slippery, which can be dangerous when they get out of the bath.

11. Alternative Approaches • Q. Patients may not want to have a bath at the time that it is convenient to the routine on the ward. How would you manage a patient who appears to be refusing to have a bath? • Q. What sort of specialist baths are available in the hospital setting to assist patients with mobility problems? • Q. Would showering be an option for some patients? • Q. How would you approach bathing a patient in their own home?

12. PART 3: Bedbathing a Patient

13. Bedbathing a Patient • This is a two nurse procedure. • Undertake a risk assessment . • Plan the procedure with the patient and gain their consent. • Offer the toilet, commode or bedpan before commencing. • Collect all of the equipment to avoid interruptions. • Ensure privacy, and prevent interruptions during the bed bath. • Wash hands and decide on the protective clothing to be worn – local policies apply. • Help the patient, but encourage their participation where possible. • On completion, clear the area, leave your patient comfortable, dispose of waste correctly according to local policies, report any issues of concern to your mentor and document procedure, then sign and ask your mentor to countersign.

14. Be aware of the different needs and wishes of patients, which may include cultural and religious matters and the use of specific cleansing products and routines. • Be aware of, and adhere to, the local policies for the correct disposal of waste and the distinction between clinical and domestic (non-clinical) waste. Also be aware of the different methods used to dispose of these materials.

15. PART 4: Perineal Care

16. Perineal Care • Correct positioning of the patient, gain consent and encourage their participation. • Consider the patient’s dignity, ensure privacy and drape the area with towels – no interruptions. • Use plain water at the correct temperature – soap is not recommended – (Potter and Perry, 2007). • Wear disposable apron and gloves. • Use disposable wipes if available. • Care not to contaminate female genitalia with faeces. • Care of scrotum and penis in male patients. • Catheter care if the patient is catheterised, following local policies.

17. PART 5: Patient Eye Care

18. Eye Care • See chapter 12 for a detailed description of eye care. • Eye care as part of routine hygiene is restricted to gentle swabbing with normal saline – see local policies. (Brooker and Nicol 2003) • Always swab from the inner to outer aspect, single use swabs.

19. Move from inner to outer eye

20. PART 6: Patient Nail Care

21. Nail Care • Nurses often get asked to undertake nail care as part of a routine bath or bed bath • Q. What would you do if an elderly patient asked you to trim their toenails? • Q. Why is regular nail care so important for patients?

22. PART 7: Patient Hair Care

23. Hair Care • Encourage self care with brushing and combing where possible. • For male shaving: • Encourage self care where possible, or a member of the family may want to assist with this activity. • Ascertain the preferred technique – wet shaving or using an electric shaver – and provide equipment and a mirror. • If your patient is unable to undertake this procedure for themselves shave according to the facial contours and against the direction of hair growth.