Hygiene 2

• Hygiene


  The science of health and its maintenance
• Personal hygiene


  The self-care by which people attend to functions like bathing, toileting, body hygiene, and grooming
• Hygiene is a highly personal matter determined by individual values and practices
• Hygiene involves care of the skin, feet, nails, oral and nasal cavities, teeth, hair, eyes, ears, and perineal-genital areas
• Early morning care


  Providing a urinal or bedpan, washing face and hands, and giving oral care as clients awaken
• Morning care


  Providing for elimination needs, a bath or shower, perineal care, back massages, and oral, nail, and hair care, often after breakfast
• Hour of sleep or PM care


  Providing for elimination needs, washing face and hands, giving oral care, and giving a back massage before clients retire for the night
• As-needed (prn) care


  Care provided as required by the client, e.g. more frequent bathing and change of clothes/linen for a diaphoretic client
• Skin


  • Protects underlying tissues from injury by preventing the passage of microorganisms
  • Regulates body temperature
  • Secretes sebum to soften, lubricate, and protect the skin
  • Transmits sensations through nerve receptors
  • Produces and absorbs vitamin D
• Sudoriferous (sweat) glands


  Glands present on all body surfaces except the lips and parts of the genitals, which produce sweat to cool the body through evaporation
• Sweat is made up of water, sodium, potassium, chloride, glucose, urea, and lactate
• Factors influencing individual hygienic practices

  • Culture
  • Religion
  • Environment
  • Developmental level
  • Health and energy
  • Personal preferences
• Nursing assessment of client's skin and hygienic practices

  • Nursing health history to determine skin care practices, self-care abilities, and past/current skin problems
  • Physical assessment of the skin
• Nursing history data enables incorporating client's needs and preferences in the plan of care
• Assessment of client's self-care abilities determines the amount of nursing assistance and type of bath needed
• Presence of past or current skin problems alerts the nurse to specific nursing interventions or referrals the client may require
• Functional levels for self-care activities


  • Completely independent
  • Requires use of equipment/device
  • Semi-dependent, requires help from another person
  • Moderately dependent, requires help from another person and equipment/device
  • Totally dependent, does not participate in activity
• Self-Care Deficit nursing diagnoses are used for clients with problems performing hygiene care
• Etiologies of Self-Care Deficits


  • Decreased or lack of motivation
  • Weakness or tiredness
  • Pain or discomfort
  • Perceptual or cognitive impairment
  • Inability to perceive body part or spatial relationship
  • Neuromuscular or musculoskeletal impairment
  • Medically imposed restriction
  • Therapeutic procedure restraining mobility
  • Severe anxiety
  • Environmental barriers
• Planning to assist a client with personal hygiene includes consideration of the client's personal preferences, health, and limitations; the best time to give the care; and the equipment, facilities, and personnel available
• Nursing interventions


  • Focus on hygienic measures
  • May point to other interventions that promote circulation, promote self-esteem, restore nutritional status, correct fluid deficits or excesses, or prevent problems associated with immobility
• Planning to assist a client with personal hygiene

  1. Consider the client's personal preferences, health, and limitations

  2. Consider the best time to give the care

  3. Consider the equipment, facilities, and personnel available
• Client's personal preferences


  About when and how to bathe, should be followed as long as they are compatible with the client's health and the equipment available
• Client's comfort level with the gender of the caregiver

  Hygienic care, particularly bathing, can be embarrassing and stressful to modest individuals
• Nurses must respect a person's modesty, whether male or female, and provide adequate privacy and sensitivity
• If possible, try to provide a caregiver of the same gender
• Nurses need to provide whatever assistance the client requires, either directly or by delegating this task to other nursing personnel
• Providing for continuity of care


  1. Assess the client's and family's abilities for care

  2. Determine the need for referrals and home health services

  3. Determine the client's learning needs
• Implementing


  1. Apply the general guidelines for skin care

  2. Provide one of the various types of baths available to clients
• Types of baths


  • Complete bed bath
  • Self-help bed bath
  • Partial bath (abbreviated bath)
  • Bag bath
  • Towel bath
  • Tub bath
  • Shower
• Water temperature for a bath


  Should feel comfortably warm to the client, generally 43°C to 46°C (110°F to 115°F)
• Therapeutic baths


  • Given for physical effects, such as to soothe irritated skin or to treat an area
  • Medications may be placed in the water
  • Client remains in the bath for a designated time, often 20 to 30 minutes
  • Bath temperature is generally 37.7°C to 46°C (100°F to 115°F) for adults and 40.5°C (105°F) for infants
• Bath basins can harbor microorganisms that are potential sources of hospital-acquired infections, even after the removal of the possibly contaminated water
• Study activities


  1. Collecting data on clients' demographics, length of stay, and bathing regimen

  2. Training nurses to maintain consistency in the sampling technique

  3. Swabbing of the basins at least 2 hours after client bathing, after the bath water had been emptied and the basins were allowed to air dry

  4. Using disposable basins for only one client
• The data collection resulted in findings of some form of bacterial growth in 98% of the bath basins
• Highest positive growth rates

  • 54% for enterococci
  • 32% for gram-negative organisms
  • 23% for Staphylococcus aureus
  • 13% for vancomycin-resistant enterococci (VRE)
• Nurses disposed of used bath water in hand washing sinks, which could result in contamination of the sink and surrounding area
• Bath basins were left out in the client's room and used as a storage basin, which could then contaminate the personal items stored in the basin
• If the basin wasn't being used for personal items, it was used to store items used for cleaning up incontinence and, thus, created another opportunity for cross contamination
• All the basins were stored upright instead of upside down, which allowed any droplets of water to pool at the bottom of the basin and create a biofilm to form, a source of bacterial contamination