Personal Hygiene Disclaimer

Personal Hygiene

Presented by: KEPRO SW PA Health Care Quality Unit (KEPRO HCQU)

August 2017 ret

Disclaimer

Information or education provided by the HCQU is not intended to replace medical advice from the individual’s personal care physician, existing facility policy, or federal, state, and local regulations/codes within the agency jurisdiction. The information provided is not all inclusive of the topic presented.

Certificates for training hours will only be awarded to those attending the training in its entirety. Attendees are responsible for submitting paperwork to their respective agencies.

1 Objectives

• Identify the aspects of a person’s life impacted by personal hygiene

• Describe things that can influence a person’s beliefs regarding personal hygiene

• List ways to effectively promote good personal hygiene habits

Hygiene

“1. A science of the establishment and maintenance of health

2. Conditions or practices (as of cleanliness) conducive to health”

(Merriam‐Webster, n.d.)

2 Personal Hygiene Impact

• Health

• Relationships

• Self‐esteem

• Opportunity

Personal Hygiene: Beliefs and Customs

• A person's perspective of personal hygiene practices is strongly influenced by

– Cultural factors / customs

– Learned behaviors

– Personal preference

3 Personal Care

• Skin care

• Hair care

• Nail care

• Foot Care

• Oral care

• Care of clothing /devices

Skin

• Largest organ of the body

• Serves 5 main functions: – Protective covering – Regulates body temperature – Secretes sebum – Provides information about pain, temperature, touch, pressure – Produces and absorbs vitamin D

4 Skin Care: Bathing

• Removes dead cells, accumulated oils, and bacteria from the skin

• Stimulates circulation

• Provides opportunity for visual inspection of skin

• Avoid long baths/showers in hot water

• Avoid strong soaps

Skin Care: Ways to Bath

• Shower

• Tub bath

• Sponge / partial bath

• No rinse packaged bathing system

5 Bathing Considerations: Privacy

• Right to privacy

• Minimize exposure of person’s body

• May prefer assistance from caregiver of same gender

• Ask first if okay to assist person / explain what to expect

• Support independent completion of tasks

Bathing Considerations: Safety

• Level of safety

– Ability to operate faucets / regulate temperature

– Ability to lather / wash all body parts thoroughly

– Ability to bathe thoroughly / rinse shampoo completely

6 Bathing Considerations: Assess Skin

• Examine the person’s skin for any problems or abnormalities

• Document and report any unusual findings

– Body‐check flow sheet

Skin Care ‐ Drying

• Gently pat the skin dry with a towel

• Dry the skin thoroughly to prevent increased irritation and bacterial growth, especially

– Between the toes

– The underarms

– Under breasts

– Genital area

7 Skin Care Products

• Deodorants and antiperspirants help to reduce underarm odor

• Perfumes and colognes, if used, should be applied sparingly

• Moisturizers or lotions may be applied to help dry skin

REMEMBER: Using these products is not a substitute for bathing – they do not clean the skin.

Skin Care: Shaving Safety

• Safety is top priority

– Safety razor / blade

– Electric razor

REMEMBER: A safety razor should NOT be used to shave a person who is prescribed blood thinning medication!

8 Skin Care: Shaving Process

• Avoid shaving if skin is irritated

• Shave in the same direction as hair growth or what works best

• Never share razors

Hair Care

• Brush or comb hair daily

• Wash hair as needed

• Different types of hair may require different methods of care

• Oily hair may need washed more frequently

• Dry hair can be washed less frequently

9 Hair Care: Beards and Moustaches

• Periodically wash and comb

• Trim as needed

Nail Care

• Keep nails clean and trimmed

• Care for cuticles

• Special concerns for people with diabetes

10 Oral Care

• Maintain healthy teeth and gums

• Prevent the need for extensive dental and periodontal treatment

• Contributes to a person’s overall health

Oral Care: Brushing the Teeth

• Brush at least twice a day, 2 minutes

• Use fluoride toothpaste

• Use soft toothbrush

• Use the proper technique

• Rinse the mouth thoroughly after brushing (ADA, 2017)

11 Oral Care: Tooth Brush

• Replace toothbrush – When bristles flare to sides – Every 3 ‐ 4 months (ADA, 2011) – After person recovers from illness

• Rinse thoroughly with cold water

• Store in upright position

• Store separately from others’

• Do not cover – allow to air dry

• Rinse / soak in antibacterial rinse

Oral Care: Flossing

• Floss at least once daily (ADA, 2016)

• Use flossing devices for people who have difficulty grasping the floss

• Use proper technique

• Rinse after flossing

12 Oral Care: Dental Rinses

• Therapeutic mouthwashes – Antimicrobial mouth rinses – Fluoride mouth rinses

• Cosmetic mouthwashes – Temporarily control bad breath – Don’t decrease the risk of cavities / gum disease

• Consider mouth rinse without alcohol

Oral Care: Dentist Visits

• Teeth and gums should be checked at least once a year for disease – People with diabetes should receive checkups every six months (ADA, 2014)

• Teeth should be professionally cleaned every six months

• Regular checkups can prevent costly and excessive dental work

13 Oral Care: Dentures and Dental Plates

• Rinse after each meal

• Remove at night and soak in tap water with denture cleaner

• Brush using denture cleaning paste

• Use adhesives to keep in place as needed

• Inspect for any damage or loose fit

Care of Other Personal Devices

• Eyeglasses – Clean daily or more often as needed – Use cleaning cloth or warm water and mild soap

• Hearing Aids – Turn off and remove when not in use – Clean with dry soft cloth or tissue – Use proper cleaning tool to remove wax build‐up

– Do not use alcohol to clean a hearing aid.

14 Clothing Care

• Encourage individuals to change clothes daily

• Wash clothing and bed linens weekly

• Use scented laundry soaps and dryer sheets sparely

Supporting Individuals with I/DD

• Assess the person’s level of ability

• Design a plan that advocates for the individual to – Independently perform personal hygiene activities – Independently care for equipment to best of his or her ability

• Explain and demonstrate tasks

• Support the person in completing a task, rather than doing it for him or her

15 Safety Considerations

• Standing surfaces are not slippery and floor is dry • Provide proper equipment to assist with getting in and out of tub • A shower chair is available, if needed • The water and room are at a safe, comfortable temperature • There is a way for the person to communicate a need for help • Proper body mechanic techniques are followed • Ensure adequate assistance is available (e.g. caregiver/s) • Ensure doors/locks may be opened in event of emergency

Seizure Considerations

Individuals with seizure disorder, dizziness, or difficulty in maintaining upright position may require direct supervision or a caregiver in close proximity at all times while bathing.

Follow medical recommendations and agency policies at all times.

16 Personal Considerations for Individuals

• Personal preferences and anxieties – Respect preferences and adjust plans to reduce anxiety

• Explain each action beforehand so person knows what to expect

• Respect person’s feelings – Talk with the person / focus on abilities

• Organize – Gather all supplies needed before starting

• Never leave a person unattended whose safety may be compromised if left alone

Safety Considerations for Caregivers

• Standard Precautions

– Always follow best practices for health and safety of both individual and caregiver.

– Always wear gloves and follow applicable standard precautions when providing personal hygiene care.

• Refer to agency policy / consult supervisor for further guidance.

17 Additional Resources

• The Hygiene Expert “The Importance of Good Personal Hygiene” http://www.hygieneexpert.co.uk/ImportanceGoodPersonalHygiene.html

• National Institute of Health “Practical Oral Care for People With Intellectual Disability” https://www.nidcr.nih.gov/OralHealth/Topics/DevelopmentalDisabilities/ PracticalOralCarePeopleIntellectualDisability.htm

Related Training Topics

• Dental Diseases and Prevention

• Skin Care

• Standard Precautions

18 References

• American Academy of Dermatology. (AAD). (2017). About skin: Your body's largest organ. Retrieved July 24, 2017, from https://www.aad.org/public/kids/skin • American Dental Association (ADA). (2017). 5 Steps to a Flawless Floss. Retrieved July 24, 2017, from http://www.mouthhealthy.org/en/az‐ topics/f/Flossing%20Steps • American Dental Association (ADA). (2012). Brushing Your Teeth. Retrieved July 24, 2017, from http://www.mouthhealthy.org/en/az‐ topics/b/brushing‐your‐teeth • American Dental Association (ADA). (2017). Dentures. Retrieved July 24, 2017, from http://www.mouthhealthy.org/en/az‐topics/d/Dentures • American Dental Association (ADA). (2014, October 10). Diabetes and Oral Health Problems. Retrieved July 24, 2017, from http://www.diabetes.org/living‐with‐diabetes/treatment‐and‐care/oral‐ health‐and‐hygiene/diabetes‐and‐oral‐health.html

References

• American Dental Association (ADA). (2017). Flossing. Retrieved July 24, 2017, from http://www.mouthhealthy.org/en/az‐topics/f/flossing • American Dental Association (ADA). (2012). How to Brush. Retrieved July 24, 2017, from http://www.mouthhealthy.org/~/media/Mouth Healthy/Files/ Kids_Section/ADAHowToBrush_Eng.pdf?la=en • American Dental Association (ADA). (2017). Mouthwash. Retrieved July 24, 2017, from http://www.mouthhealthy.org/en/az‐topics/m/mouthwash • American Dental Association (ADA). (2016, August 4). News Releases – Federal Government, ADA Emphasize Importance of Flossing and Interdental Cleaners. Retrieved July 24, 2017, from http://www.ada.org/en/press‐room/news‐ releases/2016‐archive/august/statement‐from‐the‐american‐dental‐ association‐about‐interdental‐cleaners

19 References

• Council on Scientific Affairs. (2011). Toothbrush Care: Cleaning, Storing and Replacement ‐ American Dental Association (ADA). Retrieved July 24, 2017, from http://www.ada.org/en/about‐the‐ada/ada‐positions‐policies‐ and‐statements/statement‐on‐toothbrush‐care‐cleaning‐storage‐and‐ • Centers for Disease Control and Prevention (CDC). (2015, January 20). Water, Sanitation & Environmentally‐related Hygiene –Hygiene‐related Diseases. Retrieved July 24, 2017, from https://www.cdc.gov/healthywater/hygiene/disease/index.html • Hoffman, MD., M. (2014, November 16). Picture of the Skin: Human Anatomy –WebMD. Retrieved July 24, 2017, from http://www.webmd.com/skin‐problems‐and‐treatments/picture‐of‐the‐ skin#1 • Krames Patient Education. (2017). Personal Hygiene Basics. Retrieved July 24, 2017, from https://dhch.kramesonline.com/3,S,82141

References

• Mayo Clinic. (2016, November 29). Maintaining good health. Retrieved July 24, 2017, from http://www.mayoclinic.org/healthy‐lifestyle/adult‐ health/in‐depth/skin‐care/art‐20048237?pg=2 • Mayo Clinic. (2014, December 16). Skin care: 5 tips for healthy skin. Retrieved July 24, 2017, from http://www.mayoclinic.org/healthy‐ lifestyle/adult‐health/in‐depth/skin‐care/art‐20048237?pg=1 • Mayo Clinic. (2017, February 14). Sweating and body odor. Retrieved July 24, 2017, from http://www.mayoclinic.org/diseases‐conditions/sweating‐ and‐body‐odor/home/ovc‐20307975 • Merriam‐Webster. (n.d.) Hygiene: Definition of Hygiene. Retrieved July 24, 2017, from https://www.merriam‐webster.com/dictionary/hygiene • Pennsylvania Department of Human Services. (2017). Personal Hygiene. Retrieved July 24, 2017, from http://services.dpw.state.pa.us/pch_ comptest/Modules/module4.html

20 To register for future trainings or for more information on this or any other physical or behavioral health topic, please visit hcqu.kepro.com

Test and Evaluation

Please take a few moments to complete the test and evaluation forms for this training.

Thank you!

PERSONAL HYGIENE ASSESSMENT For Preferences, Independence and Safety

Name: ______Date:______

1. What time of day do you prefer to bathe?

2. Do you prefer a shower or a bath? □ Shower □ Bath

3. Name preferences for the following products: a. Soap b. Shampoo c. Toothpaste d. Deodorant e. Perfume or Cologne ______

4. Are you able to operate the faucet? □ Yes □ No

5. Can you regulate the water temperature? □ Yes □ No

Caregiver: If the individual answers yes to question 4 and/or 5, ask for a demonstration to assure ability to do these things.

6. Do you require assistance to get in and out of the tub or shower? □ Yes □ No Caregiver: If no, ask for a demonstration to assure safety.

7. Role play the following gestures and note if the person is able to complete them: a. Lathering a wash cloth □ Yes □ No b. Washing face □ Yes □ No c. Washing upper body □ Yes □ No d. Washing lower body □ Yes □ No e. Washing hair □ Yes □ No f. Putting toothpaste on a toothbrush □ Yes □ No g. Using a toothbrush □ Yes □ No h. Using dental floss □ Yes □ No i. Brushing/styling hair □ Yes □ No j. Cleaning eyeglasses □ Yes □ No □ N/A k. Cleaning hearing aid □ Yes □ No □ N/A l. Cleaning dentures □ Yes □ No □ N/A Caregiver: The individual will require assistance for any items in # 7 on page 1 that are marked “no”.

PERSONAL HYGIENE ASSESSMENT For Preferences, Independence and Safety

8. Does the individual use a. A cane □ Yes □ No b. A walker □ Yes □ No c. A wheelchair □ Yes □ No

9. Does the individual have a. A seizure disorder □ Yes □ No b. Diabetes □ Yes □ No c. Dizziness □ Yes □ No d. Difficulty maintaining an upright position □ Yes □ No

10. Is the individual non‐verbal or using a communication device? □ Yes □ No Caregiver: If the answer is yes to any part of questions 8, 9, and/or 10, consider having staff with the person in the bathroom or in the vicinity at minimum when the individual is performing personal hygiene. It is advisable to be in the room if the person cannot maintain an upright position.

11. Is this person on anticoagulant medication or medication that acts as an anticoagulant? □ Yes □ No Caregiver: If yes, this individual should use an electric razor only.

12. Did the individual do an adequate job a. Washing the skin □ Yes □ No b. Rinsing the skin □ Yes □ No c. Washing the hair □ Yes □ No d. Rinsing the hair □ Yes □ No e. Brushing the teeth □ Yes □ No f. Flossing the teeth □ Yes □ No g. Rinsing the mouth after oral care □ Yes □ No h. Brushing/styling hair □ Yes □ No Caregiver: Any “no” answers would require support at the level that the person needs. This may be verbal prompts or hand over hand.

Source: Pennsylvania Department of Human Services. (2017). Personal Hygiene. Retrieved http://services.dpw.state.pa.us/pch_comptest/Modules/module4.html

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PERSONAL HYGIENE Shaving Facial Hair with a Safety Razor

This information is provided to help individuals and caregivers to safely shave a man’s facial hair with a razor blade.

1. Wear gloves.

2. Wash skin with warm water and mild cleanser prior to shaving.

3. Apply lubricating shaving cream or gel to the area to be shaved (if possible leave on a minute or two before shaving to soften the hair).

4. DON’T shave close to skin.

5. DON’T pull the skin taut while shaving!

6. In general, hold the razor blade at a 45 degree angle to the skin and use short, firm strokes, in the direction of the hair growth. Though a study found that men who shaved against the direction of hair grown did see rashes improve. Try both to see what works best for the individual and what is approved by PCP.

7. When finished, wipe the face clean with a wet washcloth and then pat dry.

8. Use a styptic pencil or apply Vaseline to razor nicks.

9. Use aftershave or lotion as the individual prefers.

Source: Mayo Clinic. (2015, March). Ingrown hair. Retrieved from http://www.mayoclinic.org/diseases‐conditions/ingrown‐hair/basics/prevention/con‐ 20034717

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PERSONAL HYGIENE SEIZURES: FIRST AID IN THE WATER

If a seizure occurs while a person is in the water, follow these recommendations:

While in the water

 Make sure the individual is face up.

 Support the head out of the water.

 Tilt the head back, slightly, to keep the airway clear.

 Get the individual out of the water as soon as possible. (This will be easier, if you place a sturdy blanket under the person, to use as a lift. You will need assistance from others to do this.)

Once out of the water

 Place the individual on his or her side.

 Check for breathing.

 If not breathing, begin CPR guidelines immediately, and call 911.

After the incident

 Assure the individual has a medical check‐up (e.g. 911 to Emergency room) as per your facility policy. Inhaling or swallowing water may cause medical problems that require additional follow‐up.

A seizure that happens in water needs immediate medical attention.

– (Krames, n.d.)

Source: Krames Patient Education. (n.d.). Epilepsy: Safety During a Seizure. Retrieved from https://dhch.kramesonline.com/3,S,40163

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PERSONAL HYGIENE Body Check Flow Sheet

Name: ______Date and Time: ______

Place the appropriate symbol on the picture where the mark is located on the individual:

Bruise  Open Wound  Burn  Unusual Mark 

Place your initials in the box that describes the skin condition:

BRUISING OPEN WOUNDS BURNS Yellow Seeping Open Green Scabbed over Blistered / Bubbled Purple Dry Seeping Fading Bleeding Dry

Skin is intact and free of bruises, burns and unusual marks.

Write a short description of the skin condition: ______

Name: Initials: Source: HCQU Staff 2005 QR 08.17/ret

PERSONAL HYGIENE

̴ Special Considerations for Women ̴ Menstrual Periods Hygiene is especially important during menstruation. Woman should be encouraged to wash their hands before and after changing pads or tampons. To prevent odors and possible infection, the genital area should be cleaned daily or more frequently if needed. Hygiene products used during this time of the month are a personal preference. Many women prefer sanitary pads because they are easier to use than tampons. For light to normal flow, sanitary pads should be changed every four to six hours and more often for heavier periods. The genital area can be wiped with toilet paper or a sanitary wipe during pad changes. Some women may prefer to wear tampons. These should also be changed at least every four to six hours. Tampons should never be worn to bed or for more than eight hours. Bacteria can grow in the vagina when tampons are not changed frequently, possibly leading to Toxic Shock Syndrome (TSS). This is a rare but sometimes fatal condition. Symptoms of TSS are:

 Fever greater than 102 degrees  Vomiting  Severe muscle aches  Extreme weakness, dizziness  Rash  Diarrhea

Perimenopause Perimenopause is the stage before a woman reaches menopause, when the ovaries gradually begin to secrete less estrogen. This stage usually begins in a woman’s 40’s, earlier for women with Down syndrome. During the premenopausal stage, menstrual periods are often irregular, making it difficult to know when to expect the next menstrual period. Therefore, encourage women to pack hygiene products on outings to prevent leakage onto underclothing, causing odor and embarrassment.

Menopause Hot flashes and sweating are common symptoms during menopause. Sleepless nights may be attributed to damp linens and night clothes from heavy perspiration. Assist and encourage women to change night clothes and bed linens during the night if necessary. A shower may be needed in the morning even if the woman showered before bed, due to heavy perspiration throughout the night.

Source: Johnson, J. (2013, September). Menstrual Hygiene. Retrieved from http://www.hygieneexpert.co.uk/menstrualhygiene.html

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