Critical Aspects of Personal Care

ADL’s - The Basics of Hygiene

Lesson 2

Critical Aspects of Personal Care

Accepting assistance with personal care can be difficult. For many people this need for care is a big change from a time when they were able to take care of themselves. Even if the personal care needs have been lifelong, the routines are ones that most people feel are private. Having someone help with personal care and hygiene can feel very embarrassing and unpleasant, even if it is necessary.
As a direct support professional, your image of how to complete personal care may be based on how these tasks are completed in a hospital or rehabilitation center. In these cases, personal care is second to health care. But direct support professionals work in people's homes. When reviewing the procedures in this lesson, remember, you are not working in a hospital. Support needs to be completed in very gentle and respectful ways. You are there to enhance a person's life, not just complete these tasks. /
Show respect and care when helping with personal care.

Critical Aspects of Personal Care

When completing personal care routines and procedures, keep the following things in mind:

·  Respect the privacy and modesty of people.

·  Respect and know personal preferences.

·  Be aware of the person's comfort.

·  Use your voice as well as your hands.

·  Keep people safe.

Respect the privacy and modesty of people.

Always respect the privacy and modesty of each person as much as possible during routines. Help them stay covered and out of sight of others. Don't announce their routines to others or in public places, including shared rooms. Let them stay as covered as possible and as desired during these routines.

Respect and know personal preferences.

Respect and know personal preferences for routines. This will include using preferred products, timing of routines, methods and frequency of completion, temperature of water, etc.

Be aware of the person's comfort.

The person is not a "chore" to be completed. Check your hands for warmth before touching someone. Use a gentle but firm touch. Carefully check water temperature and room temperature as needed. Watch for tender spots or signs of infection or poor health. Pay attention to the person. Be aware of signs of discomfort at all times.

Use your voice as well as your hands.

Use your voice as well as your hands. Tell people before you touch them or start routines. Keep them posted along the way so they are not startled. Use a friendly, calm voice. Talk more if the person prefers. Talk less if they find it disturbing or irritating.

Keep people safe.

Personal care routines, particularly bathing, can be a real safety hazard to people with physical assistance needs. Slipping, scalding, and even drowning can be real concerns. You must know people's safety needs and take care to keep them safe. Outside of these most serious safety concerns, take care to prevent transmission of disease between people by following the cleaning tips given in this lesson.

Infection Control and Universal Precautions

Infection control procedures are covered in depth in the lesson on Universal Precautions and Infection Control in the College of Direct Support course on Safety at Home and in the Community. If you are not familiar with this information, you may want to review the entire lesson in that course.
Infection control is the use of strategies that make it difficult for diseases to spread. They should be used when completing personal care routines. In order to reduce the possibility of transferring diseases you need to:
·  Implement universal precautions when there is a chance of transferring blood borne pathogens. (Learn more on the next few pages.)
·  Never share personal equipment between people (nail clippers, flossing tools, etc.).
·  Clean and sanitize shared surfaces in-between use (bathtubs, showers, etc.)
·  Follow the correct order of hygiene tasks to prevent transmission of disease from one part of body to another. /

Universal Precautions

A standard set of procedures designed to protect individuals from coming into contact with contaminated blood or bodily fluids. Because anyone can be a carrier of these diseases and symptoms do not have to occur for a person to be contagious, universal precautions greatly reduce the chances of exposure because they require that all human blood and certain human body fluids are treated as if known to be infectious for HIV, HBV, and other bloodborne pathogens.

Infection Control and Universal Precautions

HIV and hepatitis can be very serious, even deadly. People are able to carry these diseases without having any symptoms. They are able to transfer the diseases without knowing they are carrying them. People can even test negative for some of these diseases and still be carrying them. You cannot tell by looking if a person has this type of disease. But you can stop the transfer of these diseases. You do this by not ever allowing blood from one person into the system of another person.

By law, professionals that are likely to come in contact with blood while completing their jobs must use what are called universal precautions. They are called "universal" because you use them whenever there is a possibility of exposure to these diseases. Not just when you think someone is a carrier. They are methods and procedures to reduce the likelihood of transferring these diseases. Universal precautions are to protect you. They are also there to protect the person receiving supports. By using these precautions any time it is likely that blood could be present (either yours or the person's) you keep everyone safe.

HIV

Human immunodeficiency Virus (HIV)

Hepatitis

Hepatitis is disease of inflammation of the liver commonly caused by a virus. There are several types of hepatitis, the three most common in American are: Hepatitis A (HAV), Hepatitis B (HBV), and Hepatitis C (HCV). The severity of the disease increases from Hepatitis A, which does not cause liver damage and almost always goes away after several weeks, to Hepatitis B which often becomes chronic (keeps coming back) to Hepatitis C which can result in permanent damage to the liver and possibly liver cancer.

Infection Control and Universal Precautions

During routine bathing and hygiene tasks there is usually little risk of blood being present. The following are the most likely tasks where blood may be present during personal care:
·  When helping with dental hygiene (gums often bleed, especially when flossing).
·  When helping with menstrual care.
·  When you, or the person supported, have skin rashes, scratches, or wounds.

Infection Control and Universal Precautions

Infection control must be practiced regularly during your work. The methods of infection control you will use on a daily basis include washing your hands. They also include cleaning shared surfaces and personal care equipment properly.

Universal precautions, which include using gloves and other physical barriers to transmission, must be used when there is a possibility of blood borne pathogens being present. However, you may also want to wear gloves or other types of protective equipment at other times. You may do this to protect your clothing. It may also increase your comfort with a task.

Click on each of the following to learn a little more:

·  Hand-Washing

·  Cleaning of shared surfaces and/or personal care equipment.

·  Wearing Gloves

·  Other Protective Equipment

Hand washing: Hand washing is the most basic and most important infection control method you can use. There are many times when it is necessary for the direct support professional to wash their hands for health and safety reasons. This includes:

·  When first you arrive at work.

·  After using the toilet; before and after assisting someone to use the toilet or changing a diaper.

·  After you handle items or assist a person soiled with body fluids or wastes (for example, blood, vomit, stool, urine, drool, eye matter).

·  After you cough, sneeze or blow your nose (or assist with this).

·  When helping a person with bathing activities.

·  Whenever hands look, feel, or smell unclean.

·  When moving from one type of personal care to another (for example, bathing to brushing teeth)

·  When moving from assisting one person to another.

·  Before touching anything food related. (for example, washing dishes, preparing food, etc.)

Cleaning of shared surfaces and/or personal care equipment: Shared surfaces are a good way to share diseases. For example, foot fungus can be transmitted by sharing a shower. Using unclean hygiene equipment may mean a person struggles with reoccurring infections. Disposable items are one way to reduce the transmission of disease. For example, using paper towels to dry hands. (And properly disposing of them!). However, other items such as nail clippers may need to be reused. Finally some surfaces such as bathtubs, may be shared.

Reduce the possibility of spreading infection by doing the following:

·  Do not share personal care items.

·  Sanitize personal equipment between use.*

·  Sanitize shared surfaces between use.*

*Check with your employer regarding preferred sanitation procedures that they prefer. The following are suggestions: For items such as nail clippers you can soak for one or more minutes in fresh rubbing alcohol, rinse and air dry. For items such as wash cloths you can wash with a light bleach solution and detergent in a washing machine. Dry in a dryer. For items like shower chairs or shower floors, you can use a solution of 1 tablespoon bleach to one gallon of water to clean the surface. Let air dry.

Wearing Gloves: Disposable gloves should be worn anytime that the direct support professional could come in contact with blood or bodily fluids. Gloves are only worn one time. Gloves are changed when beginning a new hygiene task, or when assisting another person. Wash your hands before putting gloves on and after taking the gloves off.

Other Protective Equipment: There may also be times when you need to use other personal protective equipment. This includes protective eye-wear, face masks and other barriers. These are used to keep potentially infectious bodily fluids from entering another person's body. These are rarely needed during routine direct support. However, you should understand the risks of exposure to bodily fluids for procedures you complete. If you need it, you need to know how to use this equipment properly. You also need to know where to find it. Ask for specific training if your position is one in which you are at risk for transmission of blood borne pathogens.

Infection Control and Universal Precautions

To properly wash hands, you must complete all of the following steps in this order:
1.  Remove jewelry, push up sleeves.
2.  Wet hands and apply liquid soap.
3.  Rub hands together vigorously. Make sure to scrub all surfaces of hands, including palms, back of hands, between fingers, thumbs, fingernails and wrists. Continue for at least 20 seconds.
4.  Rinse well with fingertips pointed down.
5.  Thoroughly dry hands with paper towel. Dry hands from tips to fingers working upward toward wrists.
6.  Using a clean paper towel, turn off faucet, discard towel.
7.  Apply lotion if hands are dry or chapped.
Helpful Hint: To encourage handwashing for at least twenty seconds, you can suggest a person sing "Happy Birthday" silently while rubbing hands together. /
Using soap and thoroughly rubbing all surfaces are the most important parts of

Infection Control and Universal Precautions

Using disposable gloves. Directions: Review the following steps to putting on and removing disposable gloves.
Putting on disposable gloves:
1.  Wash and dry hands thoroughly before putting on gloves.
2.  Take a new pair of disposable gloves.
3.  Pull a glove onto each hand.
4.  Look at the gloves to make sure that there are no tears or holes. If so, take off the gloves and put on a new pair.
Taking off disposable gloves:
1.  With a gloved hand, grasp the outside of the other glove. Remove the glove by pulling down from the wrist area.
2.  As the glove comes off your hand, let it turn inside out.
3.  Continue to hold the removed glove with your still covered hand.
4.  Slide the fingertips of your bare hand inside the remaining glove at the wrist area. Push the glove down off the hand making sure not to touch the outside of the glove with your bare hand.
5.  Allow the glove to turn inside out as you push it down until it can be dropped of your hand.
6.  Drop both contaminated gloves in a waste container.
7.  Wash and dry hands thoroughly.

Health Risk Associated with Poor Bathing Habits

Poor bathing habits can lead to infections. They can increase a person's likelihood of getting bed sores and cause the breaking down of skin on many areas of the body, which can result in infections such as impetigo. Poor bathing habits can cause discomfort or increase the likelihood of catching other illnesses.
The most frequent mistakes that are made as part of bathing routines are the following:
·  Incomplete cleaning or not cleaning frequently enough.
·  Over-cleaning, scrubbing too hard, or using products that irritate.
·  Spreading bacteria or yeast from one part of the body to another.
·  Not cleaning surfaces or equipment in-between use.
·  Not drying the body completely after cleaning.
·  Not using moisturizers and other products as necessary to keep skin healthy. /
Poor habits can lead to serious problems

Skin-Related Health Concerns

Regularly checking for skin rashes and infections during bathing can help minimize health risks.

Scabies is a skin infestation of tiny mites that causes severe itching. /
A boil can occur when a hair follicle on your skin is infected by bacteria. /
Ringworm is a fungus infection that can affect the scalp, body (particularly the groin), feet, and nails.

Supplies and Preparation for Bathing