CHCISC301A CHCISC301A

Provide support to meet personal Provide support to meet personal

care needs care needs

Personal HygienePersonal Hygiene

Consider….Consider….

• What is “normal” hygiene?What is “normal” hygiene?

• What does What does your your hygiene routine include?hygiene routine include?

• How may values and beliefs related to How may values and beliefs related to hygiene differ?hygiene differ?

• How do you feel aboutHow do you feel about supporting peoples supporting peoples hygiene needs?hygiene needs?

ADL’s associated with meeting a ADL’s associated with meeting a client’s hygiene needsclient’s hygiene needs

• Maintaining safe environmentMaintaining safe environment• CommunicatingCommunicating• EliminatingEliminating• Maintaining body temperatureMaintaining body temperature• Personal cleansing and dressingPersonal cleansing and dressing• MobilityMobility• Nutrition and hydrationNutrition and hydration• Self esteem and expressing sexualitySelf esteem and expressing sexuality• ComfortComfort• Grooming – including facial shave, hair, make upGrooming – including facial shave, hair, make up

Purposes of Hygiene / BathingPurposes of Hygiene / Bathing

• Cleansing the skin – to minimise skin Cleansing the skin – to minimise skin irritation by removing perspiration, some irritation by removing perspiration, some bacteria and dead skin cellsbacteria and dead skin cells

• Reduction of body odoursReduction of body odours

• Stimulation of circulation, through use of Stimulation of circulation, through use of warm water and touch – perhaps also to warm water and touch – perhaps also to reduce pain and muscle spasmreduce pain and muscle spasm

• Improved self-image and promotion of Improved self-image and promotion of relaxation – a feeling of comfort and being relaxation – a feeling of comfort and being refreshedrefreshed

• As a source of activity – involving position As a source of activity – involving position change, mobilisation and movement of the change, mobilisation and movement of the extremities, which may help to maintain extremities, which may help to maintain limb and joint functionlimb and joint function

Activity Activity

• Research a culture (not your own culture) Research a culture (not your own culture) Prepare a five minute presentation which Prepare a five minute presentation which you will post to the forum.you will post to the forum.

• Include in your presentation features of Include in your presentation features of that culture which may affect the way you that culture which may affect the way you deliver personal care – consider male / deliver personal care – consider male / female relationships, religion, nutritional female relationships, religion, nutritional requirements, cultural occasions etc. requirements, cultural occasions etc.

Neglect of Personal HygieneNeglect of Personal Hygiene

• SKINSKIN - growth of bacteria and fungi - growth of bacteria and fungi

- unpleasant body odour- unpleasant body odour

- increased incidence of skin infections- increased incidence of skin infections

• HAIRHAIR - becomes greasy - becomes greasy

- scalp encrusts = irritation/itchy- scalp encrusts = irritation/itchy

- scratching = broken skin- scratching = broken skin

• NAILSNAILS -- dirty = increased bacteriadirty = increased bacteria

- ingrown = infection and pain- ingrown = infection and pain

• MOUTHMOUTH - - unpleasant taste and halitosisunpleasant taste and halitosis

- dental decay, unhealthy gums - dental decay, unhealthy gums and and

mucous membranesmucous membranes

• EYESEYES - - accumulated secretions = accumulated secretions =

discomfort, and infection riskdiscomfort, and infection risk

• EARS EARS -- accumulated dirt and wax = accumulated dirt and wax = discomfort, and perhaps hearing lossdiscomfort, and perhaps hearing loss• NOSENOSE - crusting of nasal secretions = - crusting of nasal secretions = increased infection riskincreased infection risk• PERINEAL SECRETIONSPERINEAL SECRETIONS – excessive – excessive

vaginal, penile or secretions related to vaginal, penile or secretions related to incontinence = irritation and possible incontinence = irritation and possible InfectionInfection

• UMBILICUSUMBILICUS – accumulated powder etc = – accumulated powder etc = infection, irritation, rashinfection, irritation, rash

Factors influencing individual Factors influencing individual hygiene practiceshygiene practices

• Body imageBody image

• Social practicesSocial practices

• Socio-economic statusSocio-economic status

• Knowledge about the importance of Knowledge about the importance of hygienehygiene

• Cultural variablesCultural variables

• Personal preferencesPersonal preferences

• Stage of development across lifespanStage of development across lifespan

• Level of independence – physical and Level of independence – physical and emotional state, motivationemotional state, motivation

• Availability, facilities, environmentAvailability, facilities, environment

PrinciplesPrinciples

• Thorough physical and functional Thorough physical and functional assessmentassessment

• Provision of safety, privacy and comfortProvision of safety, privacy and comfort

• Prevention of the spread of cross-infectionPrevention of the spread of cross-infection

Hygiene CareHygiene Care

Regardless of the type of hygiene a clientRegardless of the type of hygiene a clientundergoes, the carer needs to :undergoes, the carer needs to :• Provide privacyProvide privacy – close doors & drapes, – close doors & drapes,

pull screens, expose only body areas pull screens, expose only body areas being bathedbeing bathed

• Maintain safetyMaintain safety – water temp, no slips, – water temp, no slips, side rails, brakes, don’t leave unattended if side rails, brakes, don’t leave unattended if not safe to do sonot safe to do so

• Maintain warmthMaintain warmth – room warm, prevent – room warm, prevent chilling, control drafts, avoid prolonged wet chilling, control drafts, avoid prolonged wet skin, keep covered as possibleskin, keep covered as possible

• Promote independencePromote independence – encourage – encourage participation, but still conserve energyparticipation, but still conserve energy

• Anticipate needsAnticipate needs – all equipment – all equipment available, and prepare for extrasavailable, and prepare for extras

PreparationPreparation

• Read the Care PlanRead the Care Plan• Introduce selfIntroduce self• Explain what you are going to do Explain what you are going to do • Choice of clothingChoice of clothing• Prepare areaPrepare area

TemperatureTemperatureToiletriesToiletriesClothingClothingAidsAids

ShoweringShowering

• Assist to bathroom

• Offer toilet facilities

• Turn on taps and adjust temperature

• Assist the client/resident to undress

• Check if client/resident wants hair washed & when (first or last in showering routine)

Activity Activity

• Read the case studyRead the case study• Eliza’s care plan states:Eliza’s care plan states:Showering: Showering: Likes the bathroom warmed. Prefers to go to the Likes the bathroom warmed. Prefers to go to the

bathroom with just her dressing gown on. Prefers bathroom with just her dressing gown on. Prefers to sit and wash herself. Needs prompting. Likes to sit and wash herself. Needs prompting. Likes to have back and legs washed and dried. to have back and legs washed and dried.

Dressing: Dressing: Likes to choose her own clothes but may need Likes to choose her own clothes but may need

prompting re appropriate clothing for climatic prompting re appropriate clothing for climatic conditions. Prefers to dress in her room again conditions. Prefers to dress in her room again just using her dressing gown from the bathroom. just using her dressing gown from the bathroom. Can dress herself.Can dress herself.

Activity (cont)Activity (cont)

Answer the questions:Answer the questions:• Write the dialogue that you will have with Eliza Write the dialogue that you will have with Eliza

when you first greet her prior to showering.when you first greet her prior to showering.

• What might you prepare prior to suggesting What might you prepare prior to suggesting Eliza undress. Include some dialogue that you Eliza undress. Include some dialogue that you will have with Eliza. will have with Eliza.

• List the things Eliza can do for herself. List the things Eliza can do for herself.

Aids and Equipment Aids and Equipment

• Utilise aids – rails, shower chair etc

• Assist into shower

• Ask client/resident if they like to use soap on face

• Encourage and prompt to highest level of independence

• Wash from head to toe at front of body• Check skin folds, umbilicus, between

toes, nails, armpits for excoriations & cleanliness

• Omit perineal area until last • Wash back

• Wash perineum, groin & buttocks area last (use gloves) – encourage client to do this

• Discard washer• Dry client/resident thoroughly, again

paying attention to skin folds etc• Apply creams, powders as necessary

and as requested• Dress client/resident. Ensure clothing

age, activity & weather appropriate. Encourage client choice of clothing

ObservationsObservations

• SkinSkin

• HairHair

• AbilitiesAbilities

• Changes in capabilitiesChanges in capabilities

• Clothing Clothing

• SafetySafety

Reporting, Reporting, Respect & DignityRespect & Dignity

• Report & Record any changesReport & Record any changes

• Dignity, self esteem and respect is Dignity, self esteem and respect is maintained at maintained at allall times times

Clothing and DressingClothing and Dressing

• Encourage choices as ableEncourage choices as able

• Provision of suitable clothing – clean and Provision of suitable clothing – clean and dry, appropriate warmth/coolness, no dry, appropriate warmth/coolness, no friction, rubbing or tight bandsfriction, rubbing or tight bands

• Provision of appropriate footwear, which is Provision of appropriate footwear, which is safe and comfortablesafe and comfortable

• Care of personal clothingCare of personal clothing

• Energy conservation when dressingEnergy conservation when dressing

• Check re order of layers, especially Check re order of layers, especially underclothesunderclothes

• Assist dressing gently if required – Assist dressing gently if required – affected arm or leg into a garment first, affected arm or leg into a garment first, and out lastand out last

Additional Hygiene ActivitiesAdditional Hygiene Activities

• Hair care, facial shavingHair care, facial shaving

• Mouth care – brushing, mouth washMouth care – brushing, mouth wash

• Eye careEye care

• Ear and nasal careEar and nasal care

• Glasses and hearing aides – clean and working Glasses and hearing aides – clean and working

• Make-up application and removal ofMake-up application and removal of

• Elimination and perineal careElimination and perineal care

Eye CareEye Care

• Extremely important to clean clients eyes if Extremely important to clean clients eyes if unable to do sounable to do so

• Clean gently with face washer Clean gently with face washer • If crusted sometimes need to moisten area If crusted sometimes need to moisten area

with water/saline firstwith water/saline first• GENTLY wipe from inside of eye outGENTLY wipe from inside of eye out• Document and report pain, discharge , Document and report pain, discharge ,

itchiness of eyesitchiness of eyes

Ageing & the MouthAgeing & the Mouth

• Many clients > 65 y have no natural teethMany clients > 65 y have no natural teeth• Membranes in mouth weaken Membranes in mouth weaken make it more prone to infectionmake it more prone to infection• Plates/dentures fit incorrectlyPlates/dentures fit incorrectly• Weaker jaw muscles and bone shrinkage Weaker jaw muscles and bone shrinkage

increase work of chewing, increased increase work of chewing, increased fatigue when eatingfatigue when eating

• Decrease in saliva - dry mouthDecrease in saliva - dry mouth

Oral HygieneOral Hygiene

• Maintains mouth, teeth, gums and lipsMaintains mouth, teeth, gums and lips

• Brushing teeth removes food particles, Brushing teeth removes food particles, plaque and bacteriaplaque and bacteria

• Massages gums and relieves discomfortMassages gums and relieves discomfort

• Flossing further helps removal of plaque Flossing further helps removal of plaque and tartar, reducing gingivitis and infectionand tartar, reducing gingivitis and infection

• Enhances well being, stimulates appetiteEnhances well being, stimulates appetite

BrushingBrushing

• Ideally 4x per day, but usually BDIdeally 4x per day, but usually BD

• Straight handled toothbrush - larger Straight handled toothbrush - larger handle or double sided brushhandle or double sided brush

• New toothbrush 3/12 or after coldNew toothbrush 3/12 or after cold

• Use fluoride toothpasteUse fluoride toothpaste

• Rinse after brushingRinse after brushing

Do’s & Don'tsDo’s & Don'ts

• DO encourage the client to brush their DO encourage the client to brush their own teeth/denturesown teeth/dentures

• DO ensure correct technique is used to DO ensure correct technique is used to prevent problemsprevent problems

• DON’T take over from the clientDON’T take over from the client

• DON’T brush/floss too vigorously to the DON’T brush/floss too vigorously to the gum linegum line

DenturesDentures

• Need regular cleaning to avoid gingival Need regular cleaning to avoid gingival infection or irritationinfection or irritation

• Are personal property and need to be Are personal property and need to be handled carefullyhandled carefully

• Should be removed at night to rest gumsShould be removed at night to rest gums

• Keep wet when out of mouthKeep wet when out of mouth

to prevent warpingto prevent warping

Dentures Dentures cont.cont.

• Store in LABELLED cup near clientStore in LABELLED cup near client

• Discourage removal and wrapping in Discourage removal and wrapping in

tissue/serviette - easily thrown outtissue/serviette - easily thrown out

Brushing Teeth - Brushing Teeth - the stepsthe steps

Equipment needed:Equipment needed:

• Soft bristled toothbrushSoft bristled toothbrush

• Non abrasive toothbrushNon abrasive toothbrush

• Dental floss (if available)Dental floss (if available)

• Glass with waterGlass with water

• BasinBasin

• TowelTowel

• GlovesGloves

Brushing Teeth - Brushing Teeth - the stepsthe steps

• Wash hands and apply glovesWash hands and apply gloves

• Inspect mouthInspect mouth

• Assess client’s ability to brush own teethAssess client’s ability to brush own teeth

• Prepare equipment - easy reachPrepare equipment - easy reach

• Place towel over client’s chestPlace towel over client’s chest

• Apply toothpaste to brush - wet with waterApply toothpaste to brush - wet with water

Brushing Teeth - Brushing Teeth - the stepsthe steps

• Brush inner and outer surfaces of upper Brush inner and outer surfaces of upper and lower teeth from gum to crown of and lower teeth from gum to crown of toothtooth

• Then brush biting surfaces of teeth with Then brush biting surfaces of teeth with toothbrush in back and forth motiontoothbrush in back and forth motion

• Hold bristles at 45 deg angle to gum line - Hold bristles at 45 deg angle to gum line - ensure tips of bristle rest against and ensure tips of bristle rest against and penetrate under gum linepenetrate under gum line

Brushing Teeth - Brushing Teeth - the stepsthe steps

• Brush over surface of the tongue (gently Brush over surface of the tongue (gently and not too far)and not too far)

• Allow client to rinse mouth swishing water Allow client to rinse mouth swishing water across all tooth surfaces, spitting into across all tooth surfaces, spitting into basinbasin

• Gargle mouthwash (if used)Gargle mouthwash (if used)

• Wipe client’s mouthWipe client’s mouth

Brushing teeth - Brushing teeth - the stepsthe steps

• Floss (if required)Floss (if required)

• Assist client to comfortable position and Assist client to comfortable position and clear up equipmentclear up equipment

• Remove gloves and wash handsRemove gloves and wash hands

• DocumentDocument

Activity Activity

• Work with a partner and following the Work with a partner and following the instructions brush the other person’s instructions brush the other person’s teethteeth

• Swap rolesSwap roles

• Write up how you felt in each of the Write up how you felt in each of the rolesroles

• Repeat the task asking your partner Repeat the task asking your partner not to cooperate with you.not to cooperate with you.

Cleaning Dentures - Cleaning Dentures - the stepsthe steps

Equipment required:Equipment required:

• Soft toothbrushSoft toothbrush

• Denture toothbrushDenture toothbrush

• Sink / toothmug Sink / toothmug

• Denture toothpaste/soap & waterDenture toothpaste/soap & water

• Face washerFace washer

• Denture cup/holderDenture cup/holder

• GlovesGloves

Cleaning Dentures - Cleaning Dentures - the stepsthe steps

• Fill basin with waterFill basin with water• Remove dentures - ask client to doRemove dentures - ask client to do• Grasp upper plate at front with index finger and Grasp upper plate at front with index finger and

thumb and pull downwardthumb and pull downward• Grasp bottom plate and rotate on one side Grasp bottom plate and rotate on one side

downward and remove from mouthdownward and remove from mouth• Inspect mouthInspect mouth• Place dentures in sink/container (cloth in sink to Place dentures in sink/container (cloth in sink to

prevent breakage)prevent breakage)

Cleaning Dentures - Cleaning Dentures - the stepsthe steps

• Apply toothpaste to denture and brush Apply toothpaste to denture and brush surfacessurfaces

• Hold dentures closeHold dentures close

to waterto water

• Brush horizontally overBrush horizontally over

biting surfacesbiting surfaces

• Short strokes for inner surfacesShort strokes for inner surfaces

Cleaning Dentures - Cleaning Dentures - the stepsthe steps

• Clean undersurfaces as wellClean undersurfaces as well

• GENTLY rub over gumsGENTLY rub over gums

• Rinse in tepid waterRinse in tepid water

• Return dentures to Return dentures to

client or store inclient or store in

tepid water in denturetepid water in denture

cupcup

Mouth care for debilitated clientsMouth care for debilitated clients

• Position client on their side - explainPosition client on their side - explain

• Arrange towel over chestArrange towel over chest

• Pull curtain/privacyPull curtain/privacy

• Raise bed up to protect youRaise bed up to protect you

• Wash hands, don glovesWash hands, don gloves

• Clean mouth using premoistened sponge stick - Clean mouth using premoistened sponge stick - chewing and inner surfaces first then roof of chewing and inner surfaces first then roof of mouth, gums and cheeksmouth, gums and cheeks

Mouth care for debilitated clientsMouth care for debilitated clients

• May need more than one swabMay need more than one swab

• Apply a thin layer of water soluble gel to lipsApply a thin layer of water soluble gel to lips

• Inspect mouth for disease/infectionInspect mouth for disease/infection

• Remove gloves and disposeRemove gloves and dispose

• Reposition client comfortablyReposition client comfortably

• Leave area clean and tidy Leave area clean and tidy

• DocumentDocument