HYGIENE

Prepared by: Rowilyn B. Aduana, RN,RM

Hygiene
• Refers to conditions and practices that help to
maintain health and prevent the spread of
diseases.( WHO)
PERSONAL HYGIENE

•Refers to maintaining the body’s cleanliness.

• Patients in healthcare facilities have at least the same need for
hygiene measures in their daily lives as you do in yours. Indeed,
they may have considerably more because of perspiration from
fever, drainage from wounds, odor from emesis, and other
aspects of illness. Often however, they cannot attend to those
needs themselves without at least some help. It is the nurse’s
responsibility to provide patients with the opportunity for
hygiene and assisting them as needed.
ORAL CARE

• It is the brushing and flossing of the teeth

including the inspection of the mouth for dental
caries, gum problems, soft plaque deposits etc.
Purposes:
• To cleanse the teeth of food residue and
microorganisms.
• To prevent dental caries
• To refresh the mouth
• To improve the pleasure of eating
• To maintain or improve self – concept
Equipment:
1. Toothpaste/Toothbrush 9. Petroleum jelly or lip gloss
2. Face towel
3. Glass of water
4. Emesis basin
5. Floss
6. Mouthwash (optional)
7. Gloves
8. Glass for dentures
PROCEDURE:

1. Explain the procedure to the patient.

An explanation facilitates cooperation.

2.Bring the equipment to the bedside.

Organization facilitates the performance of task.
3.Wash your hands.
Handwashing prevents the spread of
microorganisms.

4.Provide privacy for the patient.

The patient may be embarrassed if cleansing involves
removal of dentures.
5.Assist the patient to a sitting position if permitted or help him turn
to one side.
A sitting or side-lying position prevents aspiration of fluids into the
lungs.

6.Place a bath towel across the chest. Raise the bed to a comfortable
working position.
The towel protects the patient from dampness. Raising the bed
promotes efficient body mechanics.
7.Encourage the patient to brush his/her own teeth or assist
if necessary.
The nurse should encourage the patient to exercise as
much independence as possible.

a. Moisten the toothbrush and apply toothpaste.

• Water softens the bristles.
 b. Place the brush at a 45 degree angle to the gum line
and brush from the gum line to the crown of each tooth.
Brush the outer and inner surfaces of the teeth. Brush
back and forth across the biting surface of each tooth.

• Brushing facilitates the removal of plaque and tartar.

Angling the brush permits cleansing of all surfaces of the
teeth.
 c. Brush the tongue gently with the toothbrush.
• This removes any coating that may be on the tongue.
Gentle motion does not stimulate the gag reflex.

d. Have the patient rinse vigorously with water and spit into
the emesis basin. Repeat until clear.
• Vigorous gargling helps remove loosened debris.
 e. Assist the patient to floss the teeth if necessary.
• Flossing aids in the removal of plaque and promotes
healthy gum tissue.

f. Offer mouthwash if patient prefers.

• Flavored mouthwash leaves a pleasant aftertaste. No
alcohol content to avoid dryness oral mucosa.
8Assist the patient with the removal and cleansing of
dentures if necessary.
Artificial dental devices can be more thoroughly cleaned
when removed from the mouth.

a. Apply gentle pressure with 4 x 4 gauze to grasp and

remove the upper denture plate. Place it immediately in a
denture cup. Lift the lower denture using a slight rocking
motion and place in the denture.
• A rocking motion breaks the suction between the denture
and gum. Using a 4 x 4 gauze prevents slippage and the
spread of microorganisms.
b. If the patient prefers, add denture cleanser to the cup with
water and follow the package direction for cleaning, or brush
all areas thoroughly with a toothbrush and toothpaste.

c. Rinse dentures thoroughly with water and return them to

the patient.
• Water aids the removal of debris and the cleansing agent.
d. Offer mouthwash if the patient prefers.
• A mouthwash leaves a pleasant aftertaste.

e. Apply petroleum jelly to the lips, if needed.

• Petroleum jelly prevents cracking and drying of the
lips.
9. Assists the patient to a safe and comfortable position.
10. Do after care of the equipment.
11.Wash your hands.
• Handwashing prevents the spread of microorganisms.
12.Record the procedure done and the patient’s responses.
• Charting provides accurate documentation of patient’s care.
Bath
• A bath for a patients confined to bed.
Purpose:

Cleans the skin and makes the client more

comfortable. It stimulates the circulation
and relaxes the client.
Types of bed bath
1. Complete Bed Bath
A bath given to weak and bedridden patients.

2. Partial Bed Bath

A bath given to a patient is not totally
dependent but is given a basin, soap and water
as well as any assistance needed to maintain
good hygiene.
COMPLETE BED BATH
Purposes:
• To refresh the client

• To stimulate circulation

• To exercise muscles and

joints
• To promote comfort and relaxation

• To improve self-concept

• To facilitate head to toe assessment

• To cleanse the body

General Instructions:

1.Ensure privacy. If in the ward, the bed should be screened; in

the private room the windows should be adjusted to ensure
privacy;

2.Bed bath should be given one hour before meals or one hour
after meals.

3.Always have everything ready before giving the bath.

4. If the patient is quite weak all assistance should be given to
free the patient from exertion.

5. Children should never be left alone while bath is going on.

6. Unnecessary exposure or chilling must be avoided.

7.Special attention must be given to regions behind the
ears, axilla, umbilicus, the pubis, groin, spaces between
fingers and toes and areas where two skin surfaces come
in contact.

8.During the bath, the patient must be observed for

objective signs such as rashes, swelling, discoloration,
pressure sores, discharges, abrasions, lice, burns, etc.
The findings should be recorded in the nurse’s notes and
reported to the physician if they seem important.
9. All treatment such as enema, douches or preparation for
fields of operation should be done before the bath so that
the patient will remain clean and undisturbed afterwards.

10.The nurse may usually work quickly but in a quiet,

soothing and unhurried fashion. Strokes should be smooth
and firm and ends of the washcloth should not be allowed
to dangle.
Equipments: a. Soap in a soap dish
b. Patients comb/hair brush
1.Bath blanket or large towel c. Powder/Lotion
2.Bath towels (2) d. Nail cutter
3.Washcloths (2) e. Two pitchers (one with
4.Clean gown or pajamas cold and the other one with
5.Clean linen hot water)
6.Basin for water
7.Pail for used water 11.Clean gloves
8.Bedpan or urinal
9.Laundry hamper or bag
10.Tray containing the ff:
Procedure:
1. Explain the procedure with the client and assess the
client’s ability to assist in bathing as well as with
personal hygiene preferences.

• This promotes reassurance and provides knowledge

about the procedure. Dialogue also encourages client
participation and allows for individualized nursing care.
2. Bring the necessary equipment to the bedside table or over
bed table.
• This conserves time and energy. Arranging items near makes
it convenient, and helps prevent stretching and twisting.

3. Close the curtains and close the door if possible.

• This ensures the client’s privacy and lessens the possibility of
loss of body heat during the bath.
4. Offer the bedpan or urinal
• Voiding or defeating before a bath lessens the
likelihood that the bath will be interrupted since the
warm bath water may stimulate the urge to void.

5.Wash your hands

• It deters the spread of microorganisms.
6. Raise the bed to working height.
• Having the bed in a high position prevents strain on the nurse’s
back

7.Lower the side rail near you and assist the client to the side of
the bed where you will work. Have the client lie on his back.
• Having the client positioned near the nurse and lowering the
side rail help prevent unnecessary stretching and twisting of
muscles on the part of the nurse.
8. Loosen top covers and place the bath blanket over the
client and then remove the top sheet while the client
holds the bath blanket in place. If linen is to be reused,
fold it over a chair. Place the soiled linen in a laundry bag.

• The client should not be exposed unnecessarily so that

the warmth may be maintained. If a bath blanket is not
available, the top sheet may be used in its place.
9.Assist the client with oral hygiene. This may be done after the
bath if the patient prefers it.
• Oral hygiene helps maintain the teeth and gums in good
condition. It also alleviates unpleasant odor and taste.
10. Remove the client’s gown keeping the bath blanket in place.
• Removing the clothing provides access during the bath. Covering
with a bath blanket maintains the warmth of the client.
• Note: If the client has an intravenous line,
remove the gown from the other arm first.
Lower the IV container and pass the gown over
the tubing and container. Hang the IVF and
check the dip rate.

• IV fluids must be maintained at the prescribed

rate.
11. Raise the side rail. Fill the basin with comfortable warm water (43 –
46 C). Test with your elbow. Change the water as necessary throughout
the bath. Lower the side rail closer to you when you return to the
bedside to begin the bath.
• Warm water is comfortable and relaxing for the client. It also
stimulates circulation and provides for more effective cleansing.

12. Lay a towel across the client’s chest and on top of the bath blanket.
• A towel prevents chilling and keeps the blanket dry.
13. Fold the wash cloth like a mitt.
• Having loose ends of a wash cloth drag across the
client’s skin is uncomfortable. Loose ends cool quickly
and will feel cold to the patient.

14. With wet washcloth (no soap), wipe the farther eye
from the inner to the outer part. Turn the cloth before
washing the other eye.
• Rinsing or turning the cloth prevents spread of the
organisms from one eye to the other.
15. Rinse the washcloth and bathe the client’s face, neck and ears
then pat dry. Avoid soap on the face if the client prefers.
• Soap can be drying and maybe avoided as a matter of personal
preference.

16. Expose the client’s far arm and place the towel lengthwise
under it. Using firm long stroke, soap, rinse and dry the arm and
axilla. Strokes should be from distal to proximal areas.
• The towel helps to keep the bed dry. Washing the far side first
eliminates contaminating a clean area once it is washed. Gentle
friction stimulate circulation and helps remove the dirt, oil and
organisms. Firm strokes from distal to proximal areas increase
venous blood return.
17. Place a folded towel on the bed next to the client’s hand
and put the hand in the basin. Soap, rinse and dry the hand.
• Placing the hand in the basin of water is comfortable and
relaxing for the client. It allows for a thorough washing of
the hand and between the finger, as well as facilitating
removal of debris from under the nails.

18. Do steps 16 & 17 to the nearer arm

19. Spread the towel across the client’s chest lower the bath
blanket to the umbilical area. Soap, rinse and dry the chest.
Keep the chest covered with a towel between the washing and
rinsing. Pay special attention to the skin folds under the female
client’s breasts.
• Spreading the towel across the client’s chest will avoid
unnecessary exposure and chilling. Dirt usually accumulates in
between skin folds.
20. Lower the bath blanket to cover the perineal area. Place
the towel over the client’s chest.
• Keeping the bath blanket and towel in place avoids exposure
and chilling.

21. Soap, rinse and dry the client’s abdomen. Carefully inspect
and cleanse the umbilical area and any abdominal fold or
creases.
• Skin fold areas may be sources of odor and skin breakdown if
not cleaned and dried properly.
22. Return the bath blanket to the original position and
expose the client’s far leg. Place the towel under the far
leg. Using firm long strokes, soap, rinse and dry the leg
from the ankle to the knee and knee to thigh to groin. Pay
particular attention to the back of the knee and the groin.

• The towel protects the linen and prevents the client from
feeling uncomfortable from a damp or wet bed. Dirt
usually accumulates in these areas.
23. Fold the towel in half near the foot part and place the
basin on the towel. Place the foot in the basin while
supporting the ankle and heel with your hand and the leg
with your arm. Soap, rinse and dry the foot paying particular
attention to the areas between the toes. Change the water.

• Supporting the foot and leg helps reduce strain and

discomfort for the client. Placing the foot in a basin of
water is comfortable and relaxing. It also allows for a
thorough cleaning of the foot, particularly in areas in
between the toes and under the toenails.
24. Do steps 22 & 23 to the other leg and foot.
25. Discard the washcloth and towel.
26.Assist the client to a prone or lying position. Position the
bath blanket and towel so as to expose only the client’s back
and buttocks.
• The bath blanket maintains warmth and privacy. Clean,
warm water prevents chilling and maintains the client’s
comfort.
27. Soap, rinse and dry the client’s back and the buttocks
areas. Pay particular attention to cleansing between the
gluteal folds and observe for redness or other indications of
skin breakdown in the sacral area.

• Fecal material near the anus can be a source of

microorganism. Prolonged pressure on the sacral area or
other bony prominences may compromise circulation and
lead to the development of decubitus ulcer.
28. If not contraindicated, give the client a backrub. Then
assist the client to lie on his back comfortably with the
towel lined along the side of the client.

• A back rub improves circulation to the tissues and aids in

relaxation. The towel along the side catches the excess
powder or lotion to protect the client from skin irritation.
29. Refill the basin with clean water.
• The wash cloth, towel and water are contaminated after
washing the gluteal area. Changing to clean supplies
decreases the spread of organisms from the anal area to
the genitals.
30. Lay a towel under the buttocks. Clean the perineal
area. If the client prefers to do it by himself, make a mitt
on his/her hand.
• Providing perineal self-care may decrease the
embarrassment of the client. Effective perineal care
reduces odor and decreases the chance of infection
through contamination
31. Help the client to a clean gown before attending to his/her
grooming needs. If with IVF, insert the arm with IVF first and
check the dip rate.
• A clean gown promotes the warmth and comfort of the
client.
• This facilitates ease in dressing.

32. Protect the pillow with towel and groom the client’s hair.
• Hair is lost during the process of combing. The towel collects
loose
33. Change the bed linen.
• Providing clean linen promotes medical asepsis and comfort
of the patient.

34. Assist the client to clean and trim fingernails or toenails if

necessary.
• After a bath, nails are soft thus making it easy to trim or
clean.
35. Remove all the equipment used including the soiled linen
and bring them to the utility room. Wash the used equipment
(if necessary) and return to its proper place.
• This makes the room/unit clean and tidy. Doing the after
care of the equipment used is the responsibility of a nurse or
(student nurse). Check IVF rate if maintained.

36. Wash your hands

• Handwashing deters the spread of microorganisms.
• 37. Document the procedure done and any unusual
observations.
• A careful record is important for planning and individualizing
the client’s care.

Note: For a right handed person, always stand at the right

side of the patient and for the left handed person, his left.
PERINEAL CARE
• It is the washing of the genital/anal
and areas with plain water or
medicated solution.
Purpose:

• To cleanse the area of secretions and

excretions
• To reduce unpleasant odors
• To prevent skin irritation and excoriation.
• To control the potential for infection
• To promote comfort
Procedure for Giving Perineal Care

Assessment

1. Determine the condition of the patient’s skin and

the extent of soiling of the perineal area.

2. Identify the patient’s capabilities for cooperation.

Planning

3. Plan the equipment that will be needed.

4. Decide whether you will need assistance.

5. Wash your hands. It has been shown that infection

can be transmitted through minor breaks in the skin.
•
Implementation

6. Explain what you are about to do. Use words that the
patient understands: “washing your genital area” or washing
between your legs”. Again, the patient may be embarrassed,
so proceed in a professional manner.

7. Select the appropriate equipment. The position of patient

and equipment used will vary with the type of patient
receiving the care. Gloves are used for all patients.
a. Postpartum or surgical patient

• Bedpan • Cotton Balls

• Diaper/ underpad • Forceps
• Basin • Basin
• Pitcher
• Tap water
• Rubber drawsheet
• Antiseptic solution
b. Nonsurgical patient

1.Bedpan
2.Waterproof pad
3.Basin of warm water-40C/104F
4.Mild soap or cleansing agent
8. Provide privacy.
9. Place rubber draw sheet under patient’s
buttocks.
10. For purposes of convenience and privacy,
place the patient in the dorsal recumbent
position and drape with a bath blanket.

11. Place the client on a bedpan in a dorsal

recumbent position.
12. Put on clean gloves and proceed as follows:
a. Postpartum or surgical patient:

• remove dressing or pads. After placing a waterproof pad

under the patient, position the bedpan. Pour tepid water over
the perineum.
Do not spread the labia.
• This may allow solution to enter the vagina and might cause
infection. Rinse with clear water. Using cotton balls or gauze,
wipe from anterior to posterior because wiping in this
direction lessens the possibility of contamination to the
urinary tract from the anal area. Always clean gently to
prevent pain and avoid pressure on sutures (stitches). Use
extra gauze squares or cotton balls, if needed, dispose after
use to prevent contamination. Replace any pads or dressing,
for infection control. Remove the bedpan, make any
necessary observations, and discard the contents.
b. Nonsurgical patient:
After placing a bedpan under the patient, wash the perineum,
using warm water and soap or antiseptic. Gently separate the
labia of the female patient as you clean, to remove secretions
and smegma (an odorous collection of desquamated epithelial
cells and mucus).In male patients apply antibacterial ointment
at meatus site. Clean the male patient beginning with the
penile head and moving downward along the shaft. Retract
the foreskin of the uncircumcised male gently to avoid causing
irritation or pain, so that the underlying tissue can be cleaned.
All patients should be rinsed, to remove soap residue, and
dried thoroughly. Replace the foreskin over head of the penis.
Remove the bedpan and make the patient comfortable.
c. Patient with a catheter:
Wash the perineal area thoroughly with soap and water.
Clean well around the entire insertion site. Rinse to
remove all soap residue and thus prevent irritation of
the mucosa. Make sure the urine collection bag is
always at a dependent position to avoid urine reflux.
13. Remove the client from the bedpan.
14. Turn to side and dry the anal area using toilet paper.
15. Remove the rubber drawsheet.
16. Replace bed linens and reposition the patient for
comfort.
17. Dispose of equipment into infectious waste.
18. Remove gloves and wash hands for infection
control.
Evaluation:
19. Check back with patient for feelings of
comfort.

Documentation:
20. Good perineal care is assumed as apart of
hygiene. Record any pertinent observations such
as residual redness or tenderness of the areas or
difficulties with performance.
THANK YOU FOR
LISTENING!!!