Hygiene and Handwashing Procedures

Hygiene

• Helps prevent the spread of microorganisms
• Serves as standard practice for patient care

Resources for Hand Hygiene

• Soap
• Warm running water
• Paper towels
• Alcohol-based hand sanitizer

Special Circumstances: Hand Hygiene Assessment

• Assess for cuts, open sores, or breaks in the skin around cuticles, including hangnails
• Cover injuries with appropriate dressing, wear gloves, or delegate assignment
• Assess fingernail length, artificial nails, or nail polish
• File nails and remove nail polish if present
• Assess for jewelry
• Remove jewelry; plain wedding bands can be thoroughly washed and dried
• Assess for watches or long sleeves
• Push watch and sleeves above the wrist if present
• Assess for presence of visible dirt or soiling
• Use soap and water to clean hands, otherwise use alcohol-based hand sanitizer

Handwashing During Procedures

• If hands touch any individual or surface, consider that contaminated
• Restart handwashing
• The body, clothing, and sink are considered contaminated
• If hands touch any surface when retrieving paper towels, this is considered contaminated
• Restart handwashing

Handwashing Procedure

• Introduce yourself and educate the patient regarding handwashing
• Use warm, not hot water
• Point the wrists, hands, and fingers downward, then apply soap
• Wash for 15-20 seconds
• Remember to use circular motions, and rinse from wrist to fingertip

Factors Influencing Hygiene

• Culture can influence hygiene practices
• Some cultures may not allow male nurses to perform peri care on female patients, and vice versa
• Bathing frequency varies across cultures, ranging from daily to weekly
• A beard in certain cultures indicates that a man is married
• Women of different cultures have varying preferences as to whether they shave their axilla and legs
• Environment, religion, developmental level, personal preferences, and diversity considerations also influence hygiene
• It is important to ask patients about their bathing routine and respect their wishes/beliefs

Normal & Abnormal Assessment Findings

• Assess skin before and during hygiene care
• Inquire about dry skin, rashes, skin changes, or sores before hygiene care
• Assess skin color, texture, warmth, and intactness during hygiene care
• Assess the hair
• Oilyness, matting, or tangling can indicate poor hair hygiene
• Broken or missing teeth, red gums, halitosis, and open sores indicate altered oral health and poor oral hygiene

Delegation of Hygiene Skills

• Collaborate with colleagues when a patient requires a caregiver of the same sex
• Involve family and friends in goal-setting if the patient needs assistance
• Consult physical and occupational therapists to assess motor abilities and activities of daily living

Types of Bathing

• Complete Bed Bath: For patients who are bedridden or totally dependent for care, nurses or UAPs wash the patient, can provide passive ROM exercises, and assess the skin before/during the bath
• Partial Bed Bath: Only part of the body is washed, some patients prefer to wash their hands and face before breakfast
• Sink Bath: Ambulatory patients may walk up to the sink and perform a sink bath, assistance with feet and back may still be needed, and assess that the patient is able to walk and wash independently
• Chair Shower: Long-term patients are washed in the shower while sitting in a chair, nurses/UAPs can wash physically dependent or cognitively impaired patients during it
• Shower: Use in rooms equipped with showers if they are strong enough to shower independently and a PCP order is required before using it

Bathing Considerations

• Ask if the patient wants to take a bath or shower
• Tell the patient what you will do before you do it
• Example: “Okay miss Doe now I am going to wash your face.”
• Assess skin thoroughly, identify skin tears and bruises, and document findings
• Elderly patients typically don’t need to shower everyday because of dry skin
• They will usually get a bath 2-3 times per week
• Be creative, especially with patients with dementia to get them to shower

Hair Care

• Shampooing a patient's hair and cleansing the scalp can increase comfort and can provide a sense of well-being.
• Some patients are weak or debilitated and cannot perform hair care so their hair becomes oily or matted
• Routinely brushing or combing during morning and evening care can help prevent tangling
• Pediculicidal shampoos are used sometimes if the patient has lice

Bed Making

• Routine hygiene care
• Prevents skin irritation
• Helps prevent the spread of infection
• Provides comfort and relaxation
• Reduces body odor
• Strengthens a general feeling of health and wellness.

Bed Making: UAP Delegation

• UAPs should report potential patient injury, medications found in bed linens, and difficulties performing the procedure

Special Circumstances

• Assess if diagnosis includes pain issues and consider medication before moving the patient if so
• Assess if the patient has positioning concerns and lower the head of the bed if so
• Assess if there are any musculoskeletal concerns and get assistance repositioning the patient as well checking positioning orders

Assesment of Linens

• Assess if dirty linens are wet and soiled
• Absorb additional moisture with extra sheet or towel
• Clean the mattress before applying new linens

Hearing Aids: Assessment

• Cleanliness
• Batteries charged and inserted correctly
• Battery compartment is shut
• Everything is intact
• Dials are clean and rotate easily
• Absence of static
• Volume should be on 1/3; slowly increase to 1/2
• Volume is properly adjusted so patient can hear a normal speaking voice 3 feet away

Hearing Aids: Whistling

• Improper fit
• Cerumen
• Fluid
• Improper insertion
• Volume too high

Hearing Aids: Precautions

• Avoid getting the device wet or exposing it to extreme temperatures
• Avoid spraying hairspray or perfume around the device
• Clean with a dry soft cloth

Hearing Aid Documentation

• Which ear requires the device
• Type of hearing aid and batteries required
• The procedure to turn on, adjust the volume, and change batteries
• Typical storage and cleaning instructions

Oral Care

• Provides comfort, removes plaque and bacteria, reduces tooth decay, and decreases halitosis
• Brush teeth and tongue
• Flossing
• Rinsing
• Cleaning dentures
• Brush teeth several times a day

Oral Care: Delegation

• Oral care may be delegated to UAP after initial assessment if no issues
• Coughing/Choking Symptoms: report to nurse
• Wounds: report to nurse
• Sores: report to nurse
• Irritations: report to nurse
• Lesions: report to nurse
• Bleeding: report to nurse
• Complaints of discomfort with/related to teeth: report to nurse
• Refusal or Discomfort related to denture wear: report to nurse
• Missing dentures: report to nurse
• Tooth Decay: report to nurse

Oral Care : Evidence Based Practice

• Shows diligent oral care provides patient comfort, reduced plaque build-up on teeth, and decreases the inflammation of the oral mucosa.
• Oral care should be performed twice daily and moisturizer should be applied to the lips afterwards

Oral Care

• Does the client have any anticoagulant therapy or any bleeding disorders?
• Use a soft bristled brush, and brush gently being sure to clean the teeth and gums
• If there is excessive bleeding notify PCP
• Is the client coughing or gagging during cleaning procedure?
• Remove any equipment from the mouth; assist the patient as needed; and document the occurrence.
• Ask the client if they are complaining about pain, sensitivity, or are other overt signs of cavities or teeth decay
• Advise Pt to notify PCP or dentist and document
• If a caregiver has been bitten during the procedure
• Stop the procedure; clean the wound; report and document the injury according to policy.
• Ensure the client completes their dental and cleaning procedure accordingly to their appropriate plan
• Check if a client is unable to remove their dentures
• Use a gentle side-to-side rocking motion to release suction, and remove dentures
• Check for cracks in the dentures, and if any are present notify PCP- DO NOT Reinsert

Eye/Nose care

• Eyes washed with plain water
• Wash inner to outer canthus, using different part of washcloth every time
• If patient has dry, crusty drainage around eyes- use saline

Foot Care

• Care offers comfort while preventing odors and skin breakdown
• Soak feet and hands if allowed Inspect feet if decreased feeling to lower extremities

Never soak patient's feet of those with

• Peripheral neuropathy
• Diabetics

Foot Care Purpose

• Routine hygiene care
• Removes buildup of secretions and oils
• Prevents odor
• Promotes circulation and blood flow
• Prevents infection
• Softens rough skin and calluses
• Comfort and relaxation

Foot Care

• Diabetics often seen by podiatrist
• Report sores, wounds, irritation, lesions, redness, or rashes
• Also report thick, yellowed, unusual nails

Neglecting proper nail care and trimming causes

• Trauma and scratches
• Infection Patient with PVD or CVD the feet may cause skin break down or infection

Pedeuculicides

• Especially important in independent, incontienent or those with catheters

Perineal care

• Wash from from to the back of perineal area
• Prevents infection breakdown
• Removes buildup of secretion
• Provides daily comfort

Delegation to UAP

• Report wounds lesions and irritation

Special circumstances

• Recent surgery? Do not delegate to UAP
• Retract foreskin is difficult, use soap/water
• Fecal incontience: Remove feces from the area then restart cleansing

Shaving

• Use E razor for clients using anticoagulants
• Shave way hair grows

Critical Thinking

• Is the ability to apply higher order, cognitive skills and disposition to deliberate action that is logical
• Nurse: think of how judgements and actions result in positive outcomes
• Clinical reasoning is the ability to focus and filter clinical data to recognize what is most and least important
• Clinical reasoning requires consideration of the context and concerns of Pt

Inductive Reasoning

• Uses specific factual details to make conclusion
• Inductive Reasoning Ex: Nurse recognizes the Pt had an indwelling catheter and their urine is cloudy
• Reason patient shows/has a UTI for those who have had a catheter

Deductive reasoning

• Involves validating a major theory to generate facts or details for patient.
• Observing that a Pt may have a suspected infection, and observing for elevated temp sign for proper diagnosis

Necessary Attributes for Critical Thinking

• Humility and admitting limitations
• Avoid ClosesMindedness"
• Being Bias

How to enhance critical thinking skills

• Active collaboration with others/Colleagues
• Emotional Intelligence and the ability to react to emotions to guide thought
• Intention application ( using knowledge) improves clinical problem solving
• Concept and Role mapping

Patient safety

• The methods to assess risk can be done by assessing electrical fire toxin stress and meds

In home care

• Safety assessment of the home to prevent fire issues
• DO NOT close stoves for heating
• Always have fire alarms and extinguishers
• Do not use ovens as for storing food
• For poisoning- ensure labelling storage away from original containers and from the reach of children
• Keep plants clear and far from reach of patients
• Keep fire arms locked and safely away
• Falls occur when inadvertently the patients body moves out of support
• Help with calls light safety
• Bed alarm
• Rail padding for seizures

Maintain the following during a Seizure

• Oxygen and keep suction at bedside
• Move things that may be sharp to the side after patient is turned on their side gently
• Ensure your patient is always looked at using properly maintained and always inspected Equipment

Body Mechanics

• Safe pt movement
• Assess patient ability
• Lift properly and avoid twisting and injuries

Transferring

• Gait belt is always wrapped under breast make sure 2 fingers underneath and always support the client do note Trapeze is good for patients who can bilaterally support themselves

Patients who need a trapeze

• Use the trapeze lift themselves mostly
• Ensure pt bilaterally can lift
• Transfer/slide- plastic like material that reduce friction
• Allows patients to move easily; good for nurses

Friction Reducing Sheet

• Reduce friction and shear
• Use per brand guideline

Log rolling

• Proper is 3 people, helps those with spine cord

Positionings

• Fowlers High 90°, normal 45°Semi 15 is good for breathing, meals and head inclined
• Do not Leave patients who are on supine for a long amount it me

Devices for mobility

• Walkers provide more supports such as those whom are recovering from leg injuries
• COAL” the canes of opposite abilities, the elbow and hips provide level placement and support
• Two finger width for support

Arm Crutches

• Used for longterm
• Must be properly fitted

Best use of restraints with Doctors Orders

• Restraints can't be PRN
• Must get family approval
• Check ADPIE, assessment, implementation
• ADPIE helps guide nursing care and steps
• The process to improve client diagnosis to care. The assessment is key.
• Subjective versus Objective” -what the patient express, feels rather than what is being seen.

Nursing Diagnosis

• Patient Assessment with signs and symptoms

Nursing and Planning

• Need to be aware of ABC’s
• Emergency intervention helps improve outcome

Evaluating the care

• Need the patient to improve with the goals and care
• Intervention” - education, culture, teaching Implementation is putting it all on effect Assess and evaluate goals to achieve outcome Pt must follow

Documentation

• Document all that is found
• Helps improve or avoid problems for the next shift