1. Annual compulsory education
Bathing safety
Annual compulsory education

2. 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

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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.

10. 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

11. 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

12. 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

13. 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

14. 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

15. 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.

16. 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.

17. 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.

18. 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.

19. 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

20. 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

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

22. 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. .

23. 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

24. 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

25. 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

26. 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