Personal Hygiene
Purpose and principles
Hygiene prevents infection, protects skin integrity and preserves dignity. Always explain, get consent, provide privacy with screens or a curtain, expose only the part being washed and keep the rest covered. Water should be 43-46 degrees Celsius, tested with the elbow, never with the hand alone.
Bed bath sequence
Face first (no soap near the eyes; clean from inner to outer canthus), then neck, ears, arms, chest, abdomen, legs, back and finally the perineal area with a separate cloth and fresh water. Change the water when it cools or becomes soiled, and inspect skin, rashes, redness over bony points and any wound at the same time. Dry thoroughly between skin folds.
Oral care
Brush teeth and gums, rinse, and check the mouth for ulcers or coating. For an unconscious patient: turn to the lateral position, use only a small amount of solution, give no water to swallow, use suction, and never force the mouth. Clean dentures over a basin of water, not over the sink, and remove them at night.
Other care
Hair combing, nail trimming straight across (diabetic patients need special care), shaving with a guard, eye care from inner to outer, ear cleaning without inserting objects, and back care with a gentle massage that avoids reddened pressure areas.
Pressure area care
At every turn inspect the sacrum, heels, hips, elbows and ears; keep skin clean and dry; use prescribed cushions and a two-hourly turning schedule; never massage a reddened area.
Worked example
An unconscious patient needs mouth care. The GDA turns him to the side, places a kidney tray below the chin, uses a small amount of chlorhexidine, suctions as needed and gives no water. Reasoning: lateral positioning and suction prevent aspiration, the main danger in this procedure.
Traps
Using water that is too hot, washing the eyes from outer to inner, forgetting perineal hygiene, and exposing the patient during care.