PERSONAL HUGIENE AND CLIENTS SAFETY

BATHING Purpose of Bathing Cleansing the skin Removes perspiration, bacteria, which minimizes skin irritation and reduces chance of infection Stimulation of circulation Warm water and gentle strokes from distal to proximal increase circulation and promote venous return Improve self-image Promotes feeling of being refreshed, relaxed Reduction of body odors Especially in axillae and pubic areas Promotion of Range of Motion Movement of extremities while bathing

Nurse’s Advantage Provides opportunity to develop a meaningful nurse- patient relationship Provides opportunity for assessment of the patient including condition of patient, psychosocial and learning needs.

Before You Begin Bathing IT IS THE NURSES ROLE TO: Assess Your Patient GUIDELINES FOR BATHING Provide Privacy Maintain Safety Maintain warmth Promote the patient’s independence as much as possible

FACTORS AFFECTING PERSONAL HYGIENE Cultural / Religious Developmental Stage Mobility Emotional Physical Illness Personal Preference

TYPES OF BATHS CLEANSING BATHS Used to clean the patient Complete Bed Bath Nurse baths entire body of dependent patient in bed Self-Help Bath Patients confined to bed are able to bathe themselves with some help Partial Bath Parts of the body are washed by the patient and some by the nurse

Shower Used by ambulatory patients who require only minimal assistance Can be used with a shower chair Tub Bath Much easier for bathing and rinsing than in a bed Varies in style

Therapeutic Baths Medicated solutions may be used in bathing Bath used for treatment Usually requires a doctor’s order Medicated solutions may be used in bathing Range from warm water baths, cool water baths, cornstarch, oatmeal, Aveno, alcohol

BACK RUB May be performed after drying off the back during the bath. Position of Patient: Prone or side-lying Expose only the back, shoulders, upper arms. Cover remainder of body Lay towel alongside back Warm lotion in your hands—still explain that it may be cool and wet. Start in the sacral area, moving up the back. Massage in a circular motion over the scapula. Move upward to shoulders, massage over the scapula Continue in one smooth stroke to upper arms and laterally along side of back down to iliac crests. Do NOT allow your hands to leave the patient’s skin End by telling your patient that you are finished

Maintains the healthy state of the mouth Cleanses teeth of food particles, plaque, and bacteria Massages the gums Relieves discomfort from unpleasant odors and tastes. Refreshes the mouth and gives a sense of well-being and thus can stimulate appetite

ORAL HYGIENE Frequency Depends on the condition of the patient’s mouth. Some patient’s with dry mouth or lips need care every 2 hours. Usually done twice a day or after each meal Assistance Needed Does the patient need assistance to do oral care *The nurse can help patients maintain good oral hygiene by: 1. Teaching them correct techniques 2. Actually performing for weakened or disabled patients.

ORAL HYGIENE ASSESSMENT Abnormalities Loose or missing teeth Swelling and bleeding of gums Unusual mouth odor Pain or stinging in mouth structures

BRUSHING Major concerns are: Procedure for Conscious Patient: Thoroughness in cleansing Maintaining the condition of the oral mucosa. Procedure for Conscious Patient: Upright position

BRUSHING: UNCONSCIOUS PATIENT Safety is of utmost importance Prevent aspiration Positioning—lateral position with head turned to the side or side-lying. Position back of head on a pillow so that the face tips forward and fluid/ secretions will flow out of the mouth, not back into the throat. Place a bulb syringe or suction machine with suction equipment nearby. Yankuer end on suction device. Keeping the mouth open Use a padded tongue blade to open the patients mouth and separate the upper and lower teeth Never place your hand in the patient’s mouth or open with your fingers. Oral stimulation often causes the biting –down reflex and serious injuries can occur.

DENTURE CARE Clean dentures as frequently as natural teeth Dentures are the patient’s personal property and should be handled with care because they can be easily broken. Care: Remove before going to bed – allows gums to rest and prevents buildup of bacteria. Store in a labeled container covered with water or denture cleaner if available

PROCEDURE: Tips to remember: Use gauze squares or washcloth to grasp front of dentures to prevent from slipping Place wash cloth or paper towel in sink to line it while you are cleaning the dentures Work close to the bottom of the sink in case y ou drop them. Use tepid water

HAIR CARE A person’s appearance and feeling of well-being often depends on the way their hair looks and feels Major Goals in Hair Care Keeps hair clean and distributes oil evenly along the hair shaft Combing styles hair and prevents from tangling Assessment while brushing Scalp lesions, abrasions Dandruff Parasitic infestations Quality of hair Appearance

HAIR CARE: Shampooing Depends on: Personal preference of the patient, does not have to occur every day with hygiene Condition of the hair Ways to Shampoo If patient can get up and into a shower or sink, use a hand held nozzle If patient can not get up, place on stretcher and roll to a shower area If patient is unable to be moved, may shampoo in the bed “Shampoo in a Bag” or dry shampoos are available

SHAVING Improves self-esteem and emotional needs of the patient Usually done after the bath or shampoo Assessment: Skin for elevated moles, warts, Rashes, patchy skin lesions, or pustules

Provide Safety When using a razor blade, the skin must be softened to prevent pulling, scraping, or cutting Place a warm wash cloth over area and then apply some gel, cream, foam. Hold the razor at a 450 angle Pull the skin taut Shave in the direction of hair growth Safety Precautions Electric razors must be used in patients who are at risk for bleeding, confused, or depressed

PATIENT SAFETY Actions undertaken by individuals and organizations to protect health care recipients from being harmed by the effects of health care services. Methods of Protecting Patients From Harm Well structured systems Explicit processes Professional standards of practice Individual competence reviews

HEALTH CARE-ASSOCIATED INFECTIONS (HAI) According to WHO: HAI is also called “nosocomial”. HAI is defined as: an infection acquired in hospital by a patient who was admitted for a reason other than that infection. an infection occurring in a patient in a hospital or other health-care facility in whom the infection was not present or incubating at the time of admission. An infection acquired in hospital by a patient who was admitted for a reason other than that infection. An infection occurring in a patient in a hospital or other health-care facility in whom the infection was not present or incubating at the time of admission. This includes infections acquired in the hospital but appearing after discharge, and also occupational infections among staff of the facility

IMPACTS OF HEALTH CARE-ASSOCIATED INFECTIONS (HAI) HAI can: Increase patients’ suffering. Lead to permanent disability. Lead to death. Prolong hospital stay. Increase need for a higher level of care. Increase the costs to patients and hospitals. In the United States, 1 out of every 136 hospital patients becomes seriously ill as a result of acquiring an infection in hospital; this is equivalent to two million cases and about 80 000 deaths a year. In England, more than 100 000 cases of health care-associated infection lead to over 5000 deaths directly attributed to infection each year. In Mexico, an estimated 450 000 cases of health care-associated infection cause 32 deaths per 100 000 inhabitants each year. Health care-associated infections in England are estimated to cost £1 billion a year. In the United States, the estimate is between US$ 4.5 billion and US$ 5.7 billion per year. In Mexico, the annual cost approaches US$ 1.5 billion.

MAIN SOURCES OF INFECTION Person to person via hands of health-care providers, patients, and visitors Personal clothing and equipment (e.g. Stethoscopes, flashlights etc.) Environmental contamination Airborne transmission Hospital staff who are carriers Rare common-source outbreaks

REQUIRED SKILLS Apply universal precautions* Use personal protection methods Know what to do if exposed Encourage others to use universal precautions Report breaks in technique that increase patient risks Observe patients for signs and symptoms of infection * Universal precautions: "Universal precautions," as defined by CDC, are a set of precautions designed to prevent transmission of human immunodeficiency virus (HIV), hepatitis B virus (HBV), and other bloodborne pathogens when providing first aid or health care. Under universal precautions, blood and certain body fluids of all patients are considered potentially infectious for HIV, HBV and other bloodborne pathogens. Retrieved from CDC web site http://www.cdc.gov/ncidod/dhqp/bp_universal_precautions. html

MAIN ROUTES FOR INFECTIONS Urinary tract infections (UTI) Catheter-associated UTIs are the most frequent, accounting for about 35% of all HAI. Surgical infections: about 20% of all HAI Bloodstream infections associated with the use of an intravascular device: about 15% of all HAI Pneumonia associated with ventilators: about15% of HAI

PREVENTION THROUGH HANDWASHING Handwashing: the single most important intervention before and after patient contact. Required knowledge and skills: How to clean hands Rationale for choice of clean hand practice Techniques for hand hygiene Protect hands from contaminants Promote adherence to hand hygiene guidelines

Five moments for hand hygiene Before patient contact Before an aseptic task After body fluid exposure even if wearing gloves! After patient contact After contact with patient surroundings

Your 5 moments for HAND HYGIENE

HOW TO CLEAN HANDS Remove all wrist and hand jewelry. Cover cuts and abrasions with waterproof dressings. Keep fingernails short, clean, and free from nail polish.

EFFECTIVE HANDWASHING TECHNIQUE Wet hands under tepid running water Apply soap or antimicrobial preparation solution must have contact with whole surface area of hands vigorous rubbing of hands for 10–15 seconds especially tips of fingers, thumbs and areas between fingers Rinse completely Dry hands with good quality paper towel. Apply a palmful of product in cupped hand Rub hands palm to palm Right palm over left hand with interlaced fingers Palm to palm with fingers interlaced Backs of fingers to opposing palms with fingers intelocked Rub between thumb and forefinger Rotational rubbing, backwards and forwards with clasped fingers of right hand in left palm and vice versa Once dry your hands are safe.

PERSONAL PROTECTIVE EQUIPMENT Gloves, aprons, gowns, eye protection, and face masks Health care workers should wear a face mask, eye protection and a gown if there is the potential for blood or other bodily fluids to splash. Masks should be worn if an airborne infection is suspected or confirmed to protect an immune compromised patient.

GLOVES Gloves must be worn for: all invasive procedures contact with sterile sites contact with non-intact skin or mucous membranes all activities assessed as having a risk of exposure to blood, bodily fluids, secretions and excretions, and handling sharps or contaminated instruments. Hands should be washed before and after gloving

1. Gloves are now an everyday part of clinical practice 1. Gloves are now an everyday part of clinical practice. There are two main indicators for wearing gloves in the clinical setting: • to protect the hands from contamination with organic matter and micro-organisms; • to reduce the risk of transmitting microorganisms to both patients and staff. 2. Even if a student is required to wear gloves this does not replace the need for cleaning one’s hands. 3. Gloves must be worn for: - all invasive procedures; - contact with sterile sites; - contact with non-intact skin or mucous membranes; - all activities assessed as having a risk of exposure to blood, bodily fluids, secretions and excretions, and handling sharps or contaminated instruments. 4. Gloves should be worn only once and should be put on immediately before the care activity, removed immediately afterwards and changed between patients and pisodes of care; 5. Gloves must be disposed of as clinical waste and hands must be decontaminated by washing appropriately.

SAFE USE AND DISPOSAL OF SHARPS Keep handling to a minimum Do not recap needles; bend or break after use Discard each needle into a sharps container at the point of use Do not overload a bin if it is full Do not leave a sharp bin in the reach of children

Before contact with each and every patient: clean hands before touching a patient clean hands before an aseptic task After contact with each and every patient: clean hands after any risk of exposure to body fluids clean hands after actual patient contact clean hands after contact with patient surroundings