Patients hygiene care

Stoma care
Patients hygiene care
 Bedbathing a patient
 Washing a patient’s hair in bed
 Eye swabbing
 Contact lens removal: hard lenses
 Contact lens removal: soft lenses
 Mouth care
 Mouth care for the patient with dentures
 Usage of sleeper bad pan
 Usage of commode, assisting a patient
 Penile sheath application
 Personal hygiene
Personal hygiene is the self-care by which people attend to such
functions as bathing, toileting, general body hygiene and grooming.
Hygiene is a highly personal matter determined by individual values and
practices
 BED BATHING

• Bed bathing can help to maintain the hygiene needs of patients who

are bedridden as a result of acute illness or chronic debilitation
Soap
Wash cloths
Bath towel(s)
Wash basins
Clean gown
Bath blanket
Lotion for back rub

Wash your hands.

Explain procedure to recipient
Provide privacy
BED BATHING PROCEDURE
• Remove clothing
• Ask water temperature preference
• Do NOT use soap on the face
• Place towel under resident’s arm farthest from you. Wash with soapy washcloth from wrist to
shoulder.
• Fold bath blanket down to abdomen. Wash, rinse, and pat dry chest and abdomen
• Place towel across chest and fold blanket down to pubic area.
• If water is dirty, soapy, or cool, empty basin and refill with clean water.
• Place towel behind back on the bed. Wash, rinse, and pat dry neck, back, and buttocks first.
Complete care to rectal area from the back
• Assist resident to put on a clean gown
• Leave resident in a position of comfort and call light in place
 Skin care
• Some patients may have a long-term
need for personal care support
• Hygiene is a personal issue and everyone
will have their own individual
requirements and standards of
cleanliness
• Skin care is particularly important to
prevent the colonization of Gram-positive
and -negative micro-organisms on the
skin, which lead to healthcare-associated
infection
• Specific considerations for skin care: •
Frail and papery skin • Open wounds •
Intravenous devices and drains
 Methods of hair care
Washing the hair of a bed-bound Essential equipment • Disposable apron • Non-sterile gloves •
Comb and brush • Plastic sheet or pad • Two large towels •
patient can be challenging, but
Shampoo tray • Receptacle for the shampoo water, e.g. bucket
there are several ways to • Basin and jug • Shampoo and conditioner • Hair dryer if
manage this as follows. required • Washcloth or pad
• • Using a special bed tray water
aid.
• • Using an infl atable shampoo
basin.
• • Using a dry or no rinse
shampoo.
• • Using a no rinse shampoo cap
Methods of hair care
• Remove the pillows from under the patient’s head, lower or remove the bed head
• Place the plastic sheet under the patient’s head and tuck a bath towel around their
shoulders, bringing it towards their chest
• Fold the top bedding down to the waist and cover the upper part of the patient with a
towel
• Protect the patient’s eyes and ears
• Apply a small amount of shampoo to the hair and scalp and gently massage with your
fingertips
• Using fresh water from the basin, rinse the hair thoroughly/ Apply conditioner if desired
• Squeeze excess water from the hair into the shampoo tray before removal. Gently rub
hair dry with a towel Dry the patient’s face
• Remove any equipment and return the patient back to a comfortable position
Eye care
• Eye care is the Essential equipment Optional equipment
• Sterile dressing pack • Sterile/non-sterile
process of lint-free swabs powder-free gloves
assessing, cleaning • Sterile water for irrigation
• Light source
and/or irrigating
the eye, including
the instillation of
prescribed ocular
preparations
where applicable
Eye Swabbing Procedure
• Always treat the uninfected or uninflamed
eye first.
• Always bathe lids with the eyes closed first.
• Ask the patient to look up and, using a
slightly moistened swab, gently swab the
lower lid from the inner canthus outwards.
• Using a new swab each time, repeat the
procedure until all the discharge has been
removed.
• Swab from the nasal corner outwards and
use a new swab each time until all
discharge has been removed.
• Once both eyelids have been cleaned and
dried, make the patient comfortable.
 Contact lens removal: hard lenses
• Essential equipment • Sterile dressing pack • Contact lens
solution • Low-linting or lint-free swabs • Apron
• Optional equipment • Sterile/non-sterile powder-free
gloves
• Wearing non-sterile gloves and using thumb and
forefinger, separate the eyelids. Keeping the eyelid
stationary, place the index finger on the lens. Gently move
the lens to one side of the cornea and pull away
• Store lenses in the appropriate solution as recommended
by the manufacturer and ensure lenses are placed in the
correct left and right storage pots
 Contact lens removal: soft lenses
Wearing non-sterile gloves,
gently pinch the lens
between the thumb and
index finger
Store lenses in the
appropriate solution as
recommended by the
manufacturer and ensure
lenses are placed in the
correct left and right storage
pots
Make the patient
comfortable
Mouth care • Mouth care is the care given to the oral mucosa, lips, teeth and gums in
order to promote health and prevent or treat disease
Principles of care The aims of oral care are to:
• keep the oral mucosa and lips clean, soft, moist and intact
• keep natural teeth free from plaque and debris
• maintain denture hygiene and prevent disease related to dentures
• prevent oral infection
• prevent oral discomfort
• maintain the mouth in a state of normal function
 1.Prepare solutions required.

Mouth care 2.Carry out oral assessment using an oral assessment tool.
3.Using a soft, small toothbrush and toothpaste
brush the patient’s natural teeth, gums and tongue
• Essential equipment • Small torch • 4. Hold the brush against the teeth with the bristles at a 45°
Plastic cups • Mouthwash or angle
cleaning solutions • Appropriate 5. Give a beaker of water to the patient.
equipment for cleaning • Clean Encourage patient to rinse the mouth vigorously then spit the
receiver or bowl • Paper contents into a receiver.
tissues/gauze • Wooden spatula • 6. If the patient is unable to rinse and spit, use a rinsed
Small-headed, soft toothbrush • toothbrush to clean the teeth
Toothpaste • Non-sterile disposable and moistened foam sticks to wipe the gums and oral mucosa.
gloves • Dental floss 7. Floss teeth
Mouth care for the patient with dentures

If the patient cannot remove their own dentures, remove the

lower denture first.
(a) Lower denture: grasp it in the middle and lift it, rotating it
gently to remove from the mouth, and place in denture pot
(b) (b) Upper denture : remove the upper denture by grasping
firmly in the middle and tilting the denture forward while
putting pressure on the front teeth to break the seal with
the palate.
Clean the patient’s dentures on all surfaces with a denture
brush. Dentures should be removed for at least 1 hour but
ideally overnight and placed in a suitable cleaning solution
Usage of sleeper bad pan
bed pan is a receptacle used for the toileting of a
bedridden patient in a health care facility, and is usually
made of metal, glass, ceramic, or plastic.
 Usage of commode, assisting a patient
Before you start Using the commode or toilet frame
• Make sure that the commode is not 1 Help the person to stand at the front of the seat, and move
damaged in any way.
into a position where they can feel the toilet seat behind their
• Adjust the seat to the right height for
the person. Generally feet should be flat knees.
on the ground, with knees just above hip 2 Have them put both hands on the armrests, with even
height whilst seated. Extra height may be pressure on both sides to prevent tipping.
needed following hip surgery.
• Lift up the commode lid.
3 Encourage them to bend slightly forward at the waist, slowly
• If the frame is to be used over an
lowering themselves onto the seat.
existing toilet, remove any pan. 4 If required, you could put your hand on the person’s lower
• Lift up the toilet seat and put the toilet back and give gentle forward pressure
frame over it.
• You may need to remove the existing
toilet seat to allow the over toilet frame
to be positioned as close to the toilet
bowl as possible.
• Ensure toilet paper is within easy reach.
 Penile sheath application
Equipment 1. Bowl of warm water and soap. 2. Non sterile
gloves 3. Selection of appropriate penile sheathes 4. Anti
-Bactericidal alcohol hand rub 5. Disposable plastic apron 6.
Drainage bag and stand or holder 7. Hypoallergenic tape for
1.Wash hands tethering or leg strap 8. Catheter leg bag
2.Put on a disposable plastic apron
3.Prepare the clean trolley, placing all equipment required on the bottom shelf
4.Take the trolley to the patient’s bedside, disturbing screens as little as possible
5.Put on non-sterile gloves
6.Retract the foreskin, if necessary, and clean the penis with soap and water.
7.Trim any excess pubic hair from around the base of the penis using disposable scissors
8.Squeeze the sheath gently around the penile shaft
9.Connect catheter bag and ensure tubing is not kinked
10.Dispose of equipment in an orange plastic clinical waste bag and seal the bag before moving the trolley
 Stoma care

• Tracheostomy care
• Colostomy care
 Definition
A tracheostomy is the surgical creation of an opening in the anterior wall of
the trachea to facilitate ventilation , by the use of a tracheostomy Tube. The
opening is commonly made at the level of the second or third cartilaginous
ring.
 Indications and Contraindications
1.Obstructed upper airway - foreign object or edema of the soft tissues.
2.Need prolonged artificial ventilation – reduces the risk of tissue damage and work of
breathing by shortening the dead space.
3.The patient is unable to independently maintain their airway-those with reduced
consciousness levels may be unable to maintain a patent airway or protect from aspiration.
4. Poor cough effort - the patient is therefore at risk of aspiration.
5. The patient is undergoing upper airway surgery.
6. Undergone laryngectomy – the stoma will be permanent

The only absolute contraindications for tracheostomy are severe localized sepsis/skin
infection, uncontrollable or prior major neck surgery which completely obscures the
anatomy
 Types of tracheostomy

• Temporary tracheostomy
• Permanent tracheostomy
• Percutaneous tracheostomy
• Surgical tracheostomy
 Tracheostomy Tubes
Portex Blue Cuffed Tracheostomy Tube
Shiley Cuffed and Shiley Cuffed Fenestrated Tube
Structure of Tracheostomy Tube
 Tracheostomy Dressing Change

Essential equipment • Sterile dressing pack • Tracheostomy

dressing or keyhole dressing • Cleaning solution, such as 0.9%
sodium chloride • Tracheostomy securing tapes • Bactericidal
alcohol handrub.

Medicinal Products : Review a possible need for analgesia

• Indications: Prevent from bacterial colonization, done 2 or more

times in a day
• Contradictions: Must not be changed during first 24-48 hours
 Tracheostomy Suctioning
• Indications: Mechanism of closing the glottis is
compromised, ability to remove secretions is decreased ,
secretion becomes tick and dry
• Contradictions: When suction may be complicated by
hypoxaemia , bradycardia and cardiovascular
compromise ,alveolar collapse, tracheal mucosal
damage, bleeding and the introduction of infection
• Essential equipment • Suction source , collection
container and tubing• Disposable plastic apron • Eye
protection, for example goggles • Bactericidal alcohol
hand rub
• Sterile suction catheters (assorted sizes according to
tube size) • A selection of non-sterile, powder-free,
clean boxed gloves • Sterile bottled water
 Gastrostomy Tube
When enteral feeding is required for a long-term period, an
enterostomal tube may be placed through an opening created
into the stomach (gastrostomy) or into the jejunum
(jejunostomy).
 EQUIPMENT

• Nonsterile gloves
• Additional PPE, as indicated
• Washcloth, towel, and soap
• Cotton-tipped applicators
• Sterile saline solution
• Gauze (if needed)
 Procedure
1. Assemble equipment. Perform hand hygiene and put on PPE, if indicated.
2. Identify the patient. Explain the procedure
3. Assess the presence of pain at the tube insertion site. If pain is present, offer
patient analgesic medication per physician’s order and wait for medication
absorption before beginning insertion site care.
4. Pull the curtain. Raise bed to a comfortable working position
5. Put on gloves. If gastrostomy tube is new and still has sutures holding it in place,
dip cotton-tipped applicator into sterile saline solution and clean around the insertion
site. Avoid adjusting or lifting the external disk for the first few days after placement
except to clean the area. If the gastric tube insertion site has healed and the sutures
are removed, wet a washcloth and apply a small amount of soap onto washcloth.
Gently cleanse around the insertion, removing any crust or drainage
8. If the sutures have been removed, gently rotate
the guard or external bumper 90 degrees at least
once a day. Assess that the guard or external
bumper is not digging into the surrounding skin.
Avoid placing any tension on the feeding tube.
9. If drainage is present, place gauze pad under the
external bumper and change as needed to keep the
area dry. Use a skin protectant or substance such as
zinc oxide to prevent skin breakdown.
10. Remove gloves. Lower the bed and assist the
patient to a position of comfort as needed.
11. Remove additional PPE, if used. Perform hand
hygiene
 Changing and Emptying an Ostomy
Appliance
The word ostomy is a term for a surgically formed opening from the inside of
an organ to the outside.
The intestinal mucosa is brought out to the abdominal wall, and a stoma, the
part of the ostomy that is attached to the skin, is formed by suturing the
mucosa to the skin.
An ileostomy allows liquid fecal content from the ileum of the small intestine
be eliminated through the stoma
Can be: permanent or temporary
Location: Right iliac fossa mainly
Output: 200-600 ml in a day
Ostomy appliances are available in a one-piece (barrier backing already
attached to the pouch) or two-piece (separate pouch that fastens to
the barrier backing) system; they are usually changed every 3 to 7 days,
although they could be changed more often.
 EQUIPMENT
• Basin with warm water • Closure clamp, if required, for
appliance
• Skin cleanser, towel, washcloth
• Stoma measuring guide
• Silicone-based adhesive remover
• Graduated container, toilet or
• Gauze squares bedpan
• Washcloth or cotton balls • Disposable gloves other PPE, as
• Skin protectant indicated
• One- or two-piece ostomy appliance • Small plastic trash bag
• Waterproof disposable pad
 ACTION
1. Bring necessary equipment to the bedside
2. Perform hand hygiene and put on PPE. Identify the patient
4. Close curtains around bed and explain procedure
5. Assist the patient to get a comfortable sitting or lying position
 Emptying an Appliance
6. Put on disposable gloves. Remove clamp and fold
end of pouch upward like a cuff
7. Empty contents into bedpan, toilet, or measuring
device
8. Wipe the lower 2 inches of the appliance or
pouch with toilet tissue
9. Close the edge of appliance or pouch and apply
clip or clamp, or secure Velcro closure. Remove
gloves. Assist patient to a comfortable position.
10. If appliance is not to be changed, remove
additional PPE, if used. Perform hand hygiene
 Changing an Appliance
11. Place a disposable pad on the work surface. Set up the wash basin with warm water and
the rest of the supplies. Place a trash bag within reach.
12. Put on clean gloves. Place waterproof pad under the patient at the stoma site. Empty the
appliance as described previously.
13. Gently remove pouch faceplate from skin by pushing skin from appliance rather than pulling
appliance from skin. Start at the top of the appliance, while keeping the abdominal skin taut.
Apply a silicone-based adhesive remover by spraying or wiping with the remover wipe
14. Place the appliance in the trash bag, if disposable. If reusable, set aside to wash in
lukewarm soap and water and dry
15. Use toilet tissue to remove any excess stool from stoma. Cover stoma with gauze pad.
Clean skin around stoma with mild soap and water or a cleansing agent and a washcloth.
Remove all old adhesive from skin; use an adhesive remover, as necessary.
16. Gently pat area dry. Make sure skin around stoma is thoroughly dry. Assess stoma and
condition of surrounding skin
17. Apply skin protectant to a 2-inch (5 cm) radius around the stoma, and allow it to dry
completely, which takes about 30 seconds
18. Lift the gauze squares for a moment and
measure the stoma opening, using the
measurement guide. Replace the gauze. Trace the
same-size opening on the back center of the
Appliance. Cut the opening 1/8 inch larger than
the stoma size.
19. Remove the backing from the appliance and ease
the appliance over the Stoma. Apply gentle pressure
to appliance for 5 minutes.
20. Close bottom of appliance or pouch by folding the
end upward and using the clamp or clip that comes
with the product.
21. Remove gloves. Put on new gloves. Assist the
patient to a comfortable position. Cover the patient
with bed linens. Place the bed in the lowest position.
22. Remove or discard equipment and assess patient’s
response to procedure.
23. Remove gloves and additional PPE, if used.
Perform hand hygiene
20. Close bottom of appliance or pouch by folding the end upward and using the clamp or
clip that comes with the product, or secure Velcro closure. Ensure the curve of the clamp
follows the curve of the patient’s body.
21. Remove gloves. Assist the patient to a comfortable position. Cover the patient with bed
linens. Place the bed in the lowest position.
22. Put on clean gloves. Remove or discard equipment and Assess patient’s response to
procedure.
23. Remove gloves and additional PPE, if used. Perform hand hygiene.
 Thank you for your attention!
This presentation does not represent the
studying material
Reading:
1. The Royal Marsden Manual of Clinical
Nursing Procedures. Part 2. Ch. 5 p 189, Ch.
8., Ch.9 p.475, 476