This document provides information about supporting personal care needs, including hygiene practices and tasks. It discusses cultural factors that may impact care, activities of daily living related to hygiene, purposes of hygiene and bathing, and the effects of neglecting personal hygiene. Guidelines are provided for showering, oral hygiene, denture care, eye care, and mouth care for debilitated clients.

1. CHCISC301A Provide support to meet personal care needs

2. Personal Hygiene

3. Consider…. What is “normal” hygiene? What does your hygiene routine include? How may values and beliefs related to hygiene differ? How do you feel about supporting peoples hygiene needs?

4. ADL’s associated with meeting a client’s hygiene needs Maintaining safe environment Communicating Eliminating Maintaining body temperature Personal cleansing and dressing Mobility Nutrition and hydration Self esteem and expressing sexuality Comfort Grooming – including facial shave, hair, make up

5. Purposes of Hygiene / Bathing Cleansing the skin – to minimise skin irritation by removing perspiration, some bacteria and dead skin cells Reduction of body odours Stimulation of circulation, through use of warm water and touch – perhaps also to reduce pain and muscle spasm

6. Improved self-image and promotion of relaxation – a feeling of comfort and being refreshed As a source of activity – involving position change, mobilisation and movement of the extremities, which may help to maintain limb and joint function

7. Activity Research a culture (not your own culture) Prepare a five minute presentation which you will post to the forum. Include in your presentation features of that culture which may affect the way you deliver personal care – consider male / female relationships, religion, nutritional requirements, cultural occasions etc.

8. Neglect of Personal Hygiene SKIN - growth of bacteria and fungi - unpleasant body odour - increased incidence of skin infections HAIR - becomes greasy - scalp encrusts = irritation/itchy - scratching = broken skin

9. NAILS - dirty = increased bacteria - ingrown = infection and pain MOUTH - unpleasant taste and halitosis - dental decay, unhealthy gums and mucous membranes EYES - accumulated secretions = discomfort, and infection risk

10. EARS - accumulated dirt and wax = discomfort, and perhaps hearing loss NOSE - crusting of nasal secretions = increased infection risk PERINEAL SECRETIONS – excessive vaginal, penile or secretions related to incontinence = irritation and possible Infection UMBILICUS – accumulated powder etc = infection, irritation, rash

11. Factors influencing individual hygiene practices Body image Social practices Socio-economic status Knowledge about the importance of hygiene Cultural variables

12. Personal preferences Stage of development across lifespan Level of independence – physical and emotional state, motivation Availability, facilities, environment

13. Principles Thorough physical and functional assessment Provision of safety, privacy and comfort Prevention of the spread of cross-infection

14. Hygiene Care Regardless of the type of hygiene a client undergoes, the carer needs to : Provide privacy – close doors & drapes, pull screens, expose only body areas being bathed Maintain safety – water temp, no slips, side rails, brakes, don’t leave unattended if not safe to do so

15. Maintain warmth – room warm, prevent chilling, control drafts, avoid prolonged wet skin, keep covered as possible Promote independence – encourage participation, but still conserve energy Anticipate needs – all equipment available, and prepare for extras

16. Preparation Read the Care Plan Introduce self Explain what you are going to do Choice of clothing Prepare area Temperature Toiletries Clothing Aids

17. Showering Assist to bathroom Offer toilet facilities Turn on taps and adjust temperature Assist the client/resident to undress Check if client/resident wants hair washed & when (first or last in showering routine)

18. Activity Read the case study Eliza’s care plan states: Showering: Likes the bathroom warmed. Prefers to go to the bathroom with just her dressing gown on. Prefers to sit and wash herself. Needs prompting. Likes to have back and legs washed and dried. Dressing: Likes to choose her own clothes but may need prompting re appropriate clothing for climatic conditions. Prefers to dress in her room again just using her dressing gown from the bathroom. Can dress herself.

19. Activity (cont) Answer the questions: Write the dialogue that you will have with Eliza when you first greet her prior to showering. What might you prepare prior to suggesting Eliza undress. Include some dialogue that you will have with Eliza. List the things Eliza can do for herself.

20. Aids and Equipment Utilise aids – rails, shower chair etc Assist into shower

21. Ask client/resident if they like to use soap on face Encourage and prompt to highest level of independence Wash from head to toe at front of body Check skin folds, umbilicus, between toes, nails, armpits for excoriations & cleanliness Omit perineal area until last Wash back

22. Wash perineum, groin & buttocks area last (use gloves) – encourage client to do this Discard washer Dry client/resident thoroughly, again paying attention to skin folds etc Apply creams, powders as necessary and as requested Dress client/resident. Ensure clothing age, activity & weather appropriate. Encourage client choice of clothing

23. Observations Skin Hair Abilities Changes in capabilities Clothing Safety

24. Reporting, Respect & Dignity Report & Record any changes Dignity, self esteem and respect is maintained at all times

25. Clothing and Dressing Encourage choices as able Provision of suitable clothing – clean and dry, appropriate warmth/coolness, no friction, rubbing or tight bands Provision of appropriate footwear, which is safe and comfortable Care of personal clothing

26. Energy conservation when dressing Check re order of layers, especially underclothes Assist dressing gently if required – affected arm or leg into a garment first, and out last

27. Additional Hygiene Activities Hair care, facial shaving Mouth care – brushing, mouth wash Eye care Ear and nasal care Glasses and hearing aides – clean and working Make-up application and removal of Elimination and perineal care

28. Eye Care Extremely important to clean clients eyes if unable to do so Clean gently with face washer If crusted sometimes need to moisten area with water/saline first GENTLY wipe from inside of eye out Document and report pain, discharge , itchiness of eyes

29. Ageing & the Mouth Many clients > 65 y have no natural teeth Membranes in mouth weaken make it more prone to infection Plates/dentures fit incorrectly Weaker jaw muscles and bone shrinkage increase work of chewing, increased fatigue when eating Decrease in saliva - dry mouth

30. Oral Hygiene Maintains mouth, teeth, gums and lips Brushing teeth removes food particles, plaque and bacteria Massages gums and relieves discomfort Flossing further helps removal of plaque and tartar, reducing gingivitis and infection Enhances well being, stimulates appetite

31. Brushing Ideally 4x per day, but usually BD Straight handled toothbrush - larger handle or double sided brush New toothbrush 3/12 or after cold Use fluoride toothpaste Rinse after brushing

32. Do’s & Don'ts DO encourage the client to brush their own teeth/dentures DO ensure correct technique is used to prevent problems DON’T take over from the client DON’T brush/floss too vigorously to the gum line

33. Dentures Need regular cleaning to avoid gingival infection or irritation Are personal property and need to be handled carefully Should be removed at night to rest gums Keep wet when out of mouth to prevent warping

34. Dentures cont. Store in LABELLED cup near client Discourage removal and wrapping in tissue/serviette - easily thrown out

35. Brushing Teeth - the steps Equipment needed: Soft bristled toothbrush Non abrasive toothbrush Dental floss (if available) Glass with water Basin Towel Gloves

36. Brushing Teeth - the steps Wash hands and apply gloves Inspect mouth Assess client’s ability to brush own teeth Prepare equipment - easy reach Place towel over client’s chest Apply toothpaste to brush - wet with water

37. Brushing Teeth - the steps Brush inner and outer surfaces of upper and lower teeth from gum to crown of tooth Then brush biting surfaces of teeth with toothbrush in back and forth motion Hold bristles at 45 deg angle to gum line - ensure tips of bristle rest against and penetrate under gum line

38. Brushing Teeth - the steps Brush over surface of the tongue (gently and not too far) Allow client to rinse mouth swishing water across all tooth surfaces, spitting into basin Gargle mouthwash (if used) Wipe client’s mouth

39. Brushing teeth - the steps Floss (if required) Assist client to comfortable position and clear up equipment Remove gloves and wash hands Document

40. Activity Work with a partner and following the instructions brush the other person’s teeth Swap roles Write up how you felt in each of the roles Repeat the task asking your partner not to cooperate with you.

41. Cleaning Dentures - the steps Equipment required: Soft toothbrush Denture toothbrush Sink / toothmug Denture toothpaste/soap & water Face washer Denture cup/holder Gloves

42. Cleaning Dentures - the steps Fill basin with water Remove dentures - ask client to do Grasp upper plate at front with index finger and thumb and pull downward Grasp bottom plate and rotate on one side downward and remove from mouth Inspect mouth Place dentures in sink/container (cloth in sink to prevent breakage)

43. Cleaning Dentures - the steps Apply toothpaste to denture and brush surfaces Hold dentures close to water Brush horizontally over biting surfaces Short strokes for inner surfaces

44. Cleaning Dentures - the steps Clean undersurfaces as well GENTLY rub over gums Rinse in tepid water Return dentures to client or store in tepid water in denture cup

45. Mouth care for debilitated clients Position client on their side - explain Arrange towel over chest Pull curtain/privacy Raise bed up to protect you Wash hands, don gloves Clean mouth using premoistened sponge stick - chewing and inner surfaces first then roof of mouth, gums and cheeks

46. Mouth care for debilitated clients May need more than one swab Apply a thin layer of water soluble gel to lips Inspect mouth for disease/infection Remove gloves and dispose Reposition client comfortably Leave area clean and tidy Document