1. PERSONAL HUGIENE AND CLIENTS SAFETY

2. 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

3. 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.

4. 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

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

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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.

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

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

15. 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.

16. 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

17. 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

18. 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

19. 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

20. 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

21. 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

22. 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

23. 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

24. 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 deaths a year.
In England, more than cases of health care-associated infection lead to over 5000 deaths directly attributed to infection each year.
In Mexico, an estimated cases of health care-associated infection cause 32 deaths per 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.

26. 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

27. 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 html

28. 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

29. 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

30. 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

31. Your 5 moments for HAND HYGIENE

32. 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.

34. 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.

36. 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.

37. 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

38. 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.

40. 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

41. 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