Hygiene

Is the science of health and its maintenance. It is the self-care by which people attend to such
functions as bathing, toileting, general body hygiene and grooming. It is a highly personal
matter determined by individual values and practices.

Hygienic Care

Early Morning Care

 is provided to clients as they awaken in the morning.

 consists of providing a urinal or bedpan to the client confined to bed, washing the face
and hands, and giving oral care.

Morning care

 is often provided after clients have breakfast

 may be provided before breakfast as well.
 includes providing for elimination needs, a bath or shower, perineal care, back
massages, and oral, nail, and hair care.
 Making the client’s bed is part of morning care.

Hour of sleep or PM care

 is provided to clients before they retire for the night.

 usually involves providing for elimination needs, washing face and hands, giving oral
care, and giving a back massage.

As-needed (prn) care

 is provided as required by the client. For example, a client who is diaphoretic (sweating
profusely) may need more frequent bathing and a change of clothes and linen.

Factors Influencing Individual Hygienic Practices

 Culture
 Religion
 Environment
 Developmental Level
 Health and Energy
 Personal Preferences

SKIN- largest organ of the body

 It transmits sensations through nerve receptors, which are sensitive to pain,

temperature, touch, and pressure.
 It protects underlying tissues from injury
 It regulates the body temperature.
 It produces and absorbs vitamin D in conjunction with ultraviolet rays from the sun.
SUDORIFEROUS (SWEAT) GLANDS

APOCRINE

 located largely in the axillae and anogenital areas

 begins to function at puberty
 odorless secretions but when decomposed or acted on by bacteria takes on a musky,
unpleasant odor.

ECCRINE

 more numerous than the apocrine glands

 are found chiefly on the palms of the hands, soles of the feet, and forehead.
 sweat produced cools the body through evaporation.

Sweat is made up of water, sodium, potassium, chloride, glucose, urea, and lactate.

Common Skin Problems

ABRASION - Superficial layers of the skin are scraped or rubbed away. Area is reddened and
may have localized bleeding or serous weeping.

EXCESSIVE DRYNESS- Skin can appear flaky and rough.

AMMONIA DERMATITIS (DIAPER RASH) - Caused by skin bacteria reacting with urea in
the urine. The skin becomes reddened and is sore.

ACNE- Inflammatory condition with papules and pustules.

ERYTHEMA - Redness associated with a variety of conditions, such as rashes, exposure to sun,
elevated body temperature.

HIRSUTISM- Excessive hair on a person’s body and face, particularly in women.

General Guidelines for Skincare

Intact, healthy skin is the body’s first line of defense.

The degree to which the skin protects the underlying tissues from injury depends on the
general health of the cells, the amount of subcutaneous tissue, and the dryness of the skin.

Moisture in contact with the skin for more than a short time can result in increased bacterial
growth and irritation.

Body odors are caused by resident skin bacteria acting on body secretions.

Skin sensitivity to irritation and injury varies among individuals and in accordance with their
health.

Agents used for skin care have selective actions and purposes.

BATHING

 removes accumulated oil, perspiration, dead skin cells, and some bacteria.
  stimulates circulation
 also produces a sense of well-being. It is refreshing and relaxing and frequently
improves morale, appearance, and self-respect.
 offers an excellent opportunity for the nurse to assess clients and opens the door for
establishing trust.

Categories of Baths

Cleansing

 Given chiefly for hygiene purposes and includes the following:

 Complete bed bath
 Self-help bed bath
 Bag Bath
 Towel bath
 Tub bath
 Sponge bath
 Shower

Therapeutic

 are given for physical effects, such as to soothe irritated skin or to treat an area (e.g.,
the perineum). A therapeutic bath is generally taken in a tub one third or one half full.
The client remains in the bath for a designated time, often 20 to 30 minutes.
 Adults: 37.7°C to 46°C (100°F to 115°F)
 Infants: 40.5°C (105°F)

Complete bed bath- The nurse washes the entire body of a dependent client in bed.

Self-help bed bath- Clients confined to bed are able to bathe themselves with help from the
nurse for washing the back and perhaps the feet.

Partial bath (abbreviated bath)- Only the parts of the client’s body that might cause
discomfort or odor, if neglected, are washed: the face, hands, axillae, perineal area, and back.

Bag bath- This bath is a commercially prepared product that contains 10 to 12 presoaked
disposable washcloths that contain no rinse cleanser solution.

Towel bath- The client is covered and kept warm throughout the bathing process by a bath
blanket. The nurse gradually replaces the bath blanket with a large towel that has been soaked
with warm water and no-rinse soap.

Tub bath- Tub baths are often preferred to bed baths because it is easier to wash and rinse in
a tub. Tubs are also used for therapeutic baths.

Shower- Many ambulatory clients are able to use shower facilities and require only minimal
assistance from the nurse. Long-term care settings are often given showers with the aid of a
shower chair.
HAIR CARE

Possible Problems

Dandruff

- Often accompanied by itching, dandruff appears as a diffuse scaling of the scalp

- In severe cases it involves the auditory canals and the eyebrows.

Hair Loss

Pediculosis (Lice)- Lice are parasitic insects that infest mammals. Infestation with lice is
called pediculosis. Hundreds of varieties of lice infest humans.

Three common kinds:

 Pediculus capitis (the head louse)

 Pediculus corporis (the body louse)
 Pediculus pubis (the crab louse)

Ticks- Small gray-brown parasites that bite into tissue and suck blood, ticks transmit several
diseases to people, in particular Rocky Mountain spotted fever, Lyme disease, and tularemia.

Scabies- is a contagious skin infestation by the itch mite. Burrows are short, wavy, brown or
black, threadlike lesions most commonly observed between the fingers, creases of the wrists
and elbows, beneath breast tissue, and in the groin area.

Hirsutism- The growth of excessive body hair.

Brushing has three major functions:

 It stimulates the circulation of blood in the scalp

 it distributes the oil along the hair shaft
 it helps to arrange the hair

Note: A brush with stiff bristles provides the best stimulation to blood circulation in the scalp.

Shampooing the Hair

Brushing and Combing the Hair

 Hair should be washed as often as needed.

 The client’s hair can be washed in the shower, while sitting on a chair in front of a sink,
in a stretcher or in bed.
 Water used for the shampoo should be 40.5°C (105°F) for an adult or child to be
comfortable and not injure the scalp.
 A commercial product, similar to the bag bath, called a “head bath” is another
approach.
EYE CARE

General Eye Care

 Cleanse the eyes from the inner canthus to the outer canthus. Use a new cotton
ball for each wipe to prevent contamination of the lacrimal ducts.
 Eyeglasses should be cleaned with warm water and soap; dried with soft tissue.
 Avoid rubbing the eyes. This may cause infection
 Maintain adequate lighting when reading.
 If dirt/foreign bodies get into the eyes, clean them with copious, clean, tepid water as
an emergency treatment.
 Schedule regular eye examinations, particularly after age 40, to detect problems such as
cataracts and glaucoma.

Eye Care for the Comatose Client

 Administer moist compresses to cover the eyes every 2 to 4 hours.

 Instill ophthalmic ointment or artificial tears into the lower lids as ordered.
 Clean the eyes with saline solution and cotton balls. Wipe from the inner to outer
canthus.
 If (-)corneal reflex keep the eyes moist with artificial tears and protect the eye with a
protective shield.
 Monitor the eyes for redness, exudate, or ulceration.

SHAVING

Using a Safety Razor to Shave Facial Hair

1. Wear gloves in case facial nicks occur and you come in contact with blood.

2. Apply shaving cream or soap and water to soften the bristles and make the skin more pliable.

3. Hold the skin taut, particularly around creases, to prevent cutting the skin.

4.Hold the razor so that the blade is at a 45-degree angle to the skin, and shave in short, firm
strokes in the direction of hair growth.

5. After shaving the entire area, wipe the client’s face with a wet washcloth to remove any
remaining shaving cream and hair.

6. Dry the face well, then apply aftershave lotion or powder as the client prefers.

7. To prevent irritating the skin, pat on the lotion with the fingers and avoid rubbing the face.

MOUTH CARE

Common Problems of the Mouth

 Glossitis (Inflammation of the tongue)

 Gingivitis (Inflammation of the gums)
  Halitosis ( Bad Breath)
 Cheilosis (Cracking of lips)
 Dental caries (Teeth have darkened areas)
 Periodontal disease (Gums appear spongy and bleeding)
 Stomatitis (Inflammation of the oral mucosa)
 Parotitis (Inflammation of the parotid salivary glands)
 Sordes (Accumulation of foul matter in the mouth)

Brushing and Flossing the Teeth

The mechanical action of brushing removes food particles that can harbor and incubate
bacteria. It also stimulates circulation in the gums, thus maintaining their healthy firmness.

SULCULAR TECHNIQUE: technique recommended for brushing teeth which removes plaque
and cleans under the gingival margins.

Guidelines for Oral Care

 Clean the biting surfaces by moving the brush back and forth
 over them in short strokes .
 Brushing the tongue gently removes bacteria and freshens breath. A coated tongue
may be caused by poor oral hygiene and low fluid intake.

. To floss the upper teeth, use your thumb and index finger to stretch the floss. Move the
floss up and down between the teeth.

. To floss the lower teeth, use your index fingers to stretch the floss.

Providing Special Oral Care for the Unconscious Client

 Position the unconscious client in a side-lying position, with the head of the bed lowered
(Rationale: In this position, the saliva automatically runs out by gravity rather than
being aspirated into the lungs. This position is chosen for the unconscious client
receiving mouth care.)
 Rinse the client’s mouth by drawing about 10 mL of water or alcohol-free mouthwash
into the syringe and injecting it gently into each side of the mouth.
 (Rationale: If the solution is injected with force, some of it may flow down the client’s
throat and be aspirated into the lungs.)
 Watch carefully to make sure that all the rinsing solution has run out of the mouth into
the basin. If not, suction the fluid from the mouth. (Rationale: Fluid remaining in the
mouth may be aspirated into the lungs)

Hand Hygiene- Hand hygiene is important in every setting, including hospitals. It is

considered one of the most effective infection prevention measures. It is important for both the
nurses’ and the clients’ hands to be cleansed at the following times to prevent the spread of
microorganisms: before eating, after using the bedpan or toilet, and after the hands have come
in contact with any body substances, such as sputum or drainage from a wound.
  In addition, health care workers should cleanse their hands before and after giving care
of any kind.
 For routine client care, vigorous hand washing under a stream of water for 15 to 20
seconds using granular soap, soap-filled sheets, or liquid soap at the beginning of the
nurse’s shift, when hands are visibly soiled, and after using the toilet is recommended
(WHO, 2009)

The CDC promotes the use of alcohol-based hand rubs (foam or gel) because:

• They kill bacteria more effectively and more quickly than hand washing with soap and water.

• They are less damaging to skin than soap and water, resulting in less dryness and irritation.

• They require less time than hand washing with soap and water.

• Bottles/dispensers can be placed at the point of care so they are more accessible.

ALCOHOL BASED HANDRUB

 Apply a palmful of product into cupped hand—enough to cover all surfaces of both
hands.
 Rub palms against palms.
 Interlace fingers palm to palm.
 Rub palms to back of hands.
 Rub all surfaces of each finger with opposite hand.
 Continue until product is dry—about 20 to 30 seconds

Stages of Infectious Process

Incubation Period - Extends from the entry of microorganisms into the body to the onset of
signs and symptoms.

Prodromal Period - Extends from the onset of non-specific signs and symptoms to the
appearance of specific signs and symptoms.

Illness Period- Specific signs and symptoms develop and become evident.

Convalescent Period - Signs and symptoms start to abate until the client returns to normal
state of health.

The Chain of Infection

1. Etiologic Agent (microorganism)

These may be bacteria, virus, fungi or parasites. The ability of the infectious agent to cause a
disease depends on its pathogenicity, virulence, invasiveness and specificity

2. Reservoir (source)

Humans (clients, visitors, health care personnel) Animals (insects, rats) Plants General
Environment (air, water, food, soil)

3. Portal of Exit from Reservoir

Respiratory Tract: droplets, sputum

Gastrointestinal Tract: vomitus, feces, saliva, drainage tubes.

Urinary Tract: urine, urethral catheters.

Reproductive Tract: semen, vaginal discharge

Blood: open wound, needle puncture site

4. Mode of Transmission

A. Contact Transmission. This may be direct or indirect contact:

Direct contact involves immediate and direct transfer from person to person (body surface -
to - body surface). Examples: healthcare personnel to clients during bathing, dressing changes,
insertion of tubes and catheters; direct transfer between two clients, with one acting as the
source and the other as the host.

Indirect contact occurs when a susceptible host is exposed to a contaminated object such as
dressing, needle, surgical instrument.

B. Droplet Transmission- This may be considered a type of contact transmission.

It occurs when mucous membrane of the nose, mouth, or conjunctiva are exposed to secretions
of an infected person who is coughing, sneezing, laughing, or talking, usually within a distance
of 3 feet.

C. Vehicle Transmission. This involves the transfer of microorganisms by way of vehicles or

contaminated items that transmit pathogens. Examples: food, water, milk, blood, eating
utensils, pillows, mattress.

D. Airborne Transmission. This occurs when fine particles are suspended in the air for
a .long time or when dust particles contain pathogens. Air current disperses microorganisms,
which can be inhaled or deposited on the skin of a susceptible host.

E. Vector-borne Transmission. Vectors can be biologic or mechanical.

Biologic vectors are animals, like rats, snails, mosquitos.

Mechanical vectors are inanimate objects that are infected with infected body fluids like
contaminated needles and syringes.

5. Portal of Entry

This permits the organism to gain entrance into the host.

Pathogens can enter susceptible hosts through body orifices such as the mouth, nose, ears,
eyes, vagina, rectum or urethra. Breaks in the skin or mucous membranes from wounds or
abrasions increase chance for organisms to enter hosts.

6. Susceptible Host
A host is a person who is at risk for infection; whose own body defense mechanisms, when
exposed, are unable to withstand the invasion of pathogens.

Examples: malnourished children, the elderly, the client with leukemia are immune -
compromised, and therefore, have propensity to develop numerous types of infection.

Nail Care

For nail care:

 Nail Cutter
 Nail File
 Hand Lotion or Mineral Oil
 Basin of Water

PODIATRISTS: consulted for clients with diabetes, peripheral vascular disease, long term
steroid therapy, and anticoagulant therapy.

The nail is cut or filed straight across beyond the end of the finger or toe (Figure 33–4 •). Avoid
trimming or digging into nails at the lateral corners. This predisposes the client to ingrown
toenails.

Foot Care

Common Foot Problems

CALLUS is a thickened portion of epidermis, a mass of keratotic material.

CORN is a keratosis caused by friction and pressure from a shoe

INGROWN TOENAIL the growing inward of the nail into the soft tissues around it, most often
results from improper nail trimming.

PLANTAR WARTS appears on the sole of the foot. These warts are caused by the papovavirus
hominis virus.

FISSURES (DEEP GROVES)

frequently occurs between the toes as a result of dryness and cracking of the skin

ATHLETE’S FOOT OR TINEA PEDIS(ringworm of the foot)

is caused by a fungus. The symptoms are scaling and cracking of the skin, particularly between
the toes.

General Guidelines for Foot Care

 Use warm water at about 40°C to 43°C (105°F to 110°F).

 Prolonged soaking is generally not recommended for clients with diabetes or individuals
with peripheral vascular disease.
 Wash the feet daily and dry them well specially the interdigital spaces.
 Use cream or lotion to moisten the skin and soften callouses.
 Use deodorant spray or foot powder to prevent or control unpleasant odor.
Perineal-Genital Care

Guidelines for Female Patients

 Position: Dorsal Recumbent;

 Drape the patient diagonally
 Use forceps to hold cotton balls for cleansing the perineum.
 Use anterior to posterior (front to back) stroke
 Use one cotton ball per stroke
 Cleanse with soap/antiseptic solution
 Rinse with copious amount of water
 Dry perineum thoroughly.

Guidelines for Male Patients

 Position: Supine
 Wear Clean Gloves
 Wash and dry the penis using firm strokes to prevent erection
 Use circular motion from the tip of the glans penis to the penile shaft
 Retract the prepuce (foreskin) if uncircumcised to remove smegma.
 Wash and dry the scrotum and buttocks

Bed Bath

Equipment needed:

 Basin with warm water (between 43-46C)

 Soap and soap dish
 Bath Blanket
 Two Bath Towels
 Washcloth
 Clean Gown or Clothes as needed
 Clean gloves, if appropriate (Presence of body fluids or open lesions)
 Personal hygiene articles (e.g., deodorant, lotion, creams)
 Shaving equipment
 Table for bathing equipment
 Laundry bag

Before bathing a client, determine:

 the purpose and type of bath

 self-care ability of the client
 any movement or positioning precautions
 other care the client may be receiving, such as physical therapy or x-rays
 client’s comfort level with being bathed by someone else
 necessary bath equipment and linens.

Wash the body parts as follows:

  Eyes, face, ears, neck
 Farther arm
 Nearer arm
 Hands
 Chest and abdomen
 Farther leg
 Nearer leg
 Feet
 Back and buttocks
 Perineum

Guidelines for Bed Bath

 Ensure client privacy

 Ensure a comfortable room temperature
 Encourage to void before start of the procedure to ensure comfort
 Position the bed at a comfortable working height. Lower the side rail on the side close to
you.
 Remove the patient’s gown and cover up to the shoulder with a top sheet.
 Use warm water.
 Make a Bath Mitt using a washcloth.
 Cleanse the eyes from the inner to the outer canthus.
 Use Firm strokes from distal to proximal areas to promote circulation by increasing
venous blood return.
 Expose, wash and dry one body part at a time.
 Do a back massage.
 Change patient gown.
 Do after-care of equipment
 Document

Back Massage

Types of Techniques

EFFLEURAGE Is a smooth, long stroke moving the hands up and down the back.

TAPOTEMENT The little finger side of each hand is used in a sharp hacking movement on the
back. Also called TAPPING.

PETRISSAGE Is a large pinch of the skin, subcutaneous tissue and muscle quickly done. Also
called KNEADING.

Guidelines for Back Rub/Massage

 Position: Prone or Side-Lying

 Expose back , shoulders, upper arms and sacral area.
 Wash hands in warm water.
 Pour lotion into palms.
 Massage sacral area with circular motions.
 Move up to shoulders over the scapula in smooth firm strokes.
 Continue to upper arms and iliac crest.
 Use petrissage over shoulders and gluteal area and tapotement up and down the spine.
 End massage with long, continuous, stroking movements.