HYGIENE

BED BATH

Definition: Bathing a client in a bed is an essential component of nursing care and a critical time to assess the client.

Two types of Bed Bath:

a. Therapeutic
b. Cleansing

A. THERAPEUTIC BATH:
 Given for a physical effect such as soothe the skin.

Types of Therapeutic Bath:

1. Colloid Bath – prepared by adding soothing agent such as starch, milk for purposes of relieving skin irritation or
pruritus.

2. Contrast Bath – alternate immersion of a part in hot or cold water

3. Tepid sponge Bath

 The sponge bath using tepid water, alcohol or a mixture of the two causes superficial blood vessels to dilate and
release heat, thereby lowering body temperature.

Purpose:
a. To reduce fever
b. To refresh and cool the client

MATERIALS:
2 Basin of tepid water 2 Bath towel
Gown 2 hand towel
Tray

Nursing Considerations:
 Avoid unnecessary exposure of any body parts.
 Maintain the right water temperature of 18 to 32 degrees Centigrade.
 Take the client’s temperature before and after 15 to 30 minutes after the sponge.
 Strokes should be long, rhythmical, firm, directed towards the heart.
 Carefully bathe the breasts of the postpartum patient to prevent drying the nipples and causing
 painful fissures.
 TSB should be finished in 30 minutes.
a. Face and neck – 3 to 5 minutes.
b. Arm – 5 minutes each arm
c. Chest and abdomen -3 to 5 minutes
d. Back – 3 to 5 minutes
e. Leg – 5 minutes each leg

4. Sitz bath – immersion of only the hips and the buttocks which is used to relieve pain, discomfort following a rectal
surgery.
 B. CLEANSING BATH:

TYPES:
a. Self- help Bath – a patient confined in a bed but is able to bathe himself with a nurse washing the feet only or the back
and other areas that the patient cant.

b. Shower Bath – done by patients who are ambulatory; with minimal assistance of the nurse.
c. Complete bed Bath - A bath given to a client in bed.

Purpose:
1. To cleanse, refresh, and give comfort to the client who must remain in bed.
2. To stimulate circulation and aid in elimination.
3. To provide for an opportunity to inspect the patient’s body for any sign of abnormality.
4. To help the client have some form of movement and exercise.
5. To provide for an opportunity for nurse client interaction.

Special Considerations:
1. Avoid unnecessary exposure and chilling.
2. Expose, wash, rinse and dry only a part of the body at a time.
3. Use correct water temperature 43 to 46 degrees Celsius.
4. Observe clients body closely for physical signs such as rashes, swelling, discoloration, pressure
sores, burns, abnormal discharges and body lice.
5. Give special attention to the following body areas, behind the ears axillae, under the breast,
umbilicus, pubic region, groin, and the spaces between the fingers and toes .Do the bath quickly
but unhurriedly and use even, smooth but firm stroke.
6. Use adequate amount of water and change it as frequently as necessary.
7. If possible, do such procedure as vaginal douche, hair shampoo oral care, before bath

DEMONSTRATION ON HYGIENE (BED BATH)

Procedure Rationale

1. Review chart for any limitations in physical activity. Identifying limitations prevents patient discomfort
and injury.

2. Explain to the client what you are going to do, why Promotes reassurance and provides knowledge
it is necessary, and how the client can cooperate. about the procedure. Encourages client
participation and allows individualized nursing
care.

3. Bring necessary equipment to the bedside table. Conserves time and energy.

4. Provide for client privacy by drawing the curtains Ensures client privacy.
around the bed or closing the door to the room.

5. Offer the patient a bedpan or urinal. Voiding or defecating before the bath lessens the
likelihood that the bath will be interrupted because
warm bath water may stimulate the urge to void.

6. Perform hand hygiene, and observe other Prevents the spread of microorganisms.
appropriate infection control procedures.

8. Position the bed at a comfortable working height. Having the bed at a comfortable working height
Loosen top sheet prevents strain on the nurse’s back.

9. Lower the side rails on the side close to you. Keep Having the patient positioned near the nurse and
other side rail up. Assist the client to move near you. lowering the side rail avoid unnecessary stretching
Have the patient lie on his or her back. and twisting of muscles on the part of the nurse.

10. . Place a bath blanket over the top sheet. Remove The bath blanket provides comfort, warmth,.
the top sheet from under the bath blanket by starting
at client’s shoulders and moving the linen down
towards the client’s feet. Ask the client to grasp and
hold the top of the bath blanket while pulling the
linen to the foot of the bed. Place the used linen in
the hamper.

11. Ask patient to turn to sides and untie the strap at This provides uncluttered access during the bath
the back. Put back the patient on his/her previous and maintains warmth of the patient. IV fluids
positions then remove the gown while keeping the must be maintained at the prescribed rate.
client covered with the bath blanket.

NOTE: If the patient has an IV line and is

not wearing a gown with snap sleeves,
remove gown from other arm first. Lower
the IV container and pass gown over the
tubing and the container. Rehang the
container check and regulate the drip rate.

12. Dip a washcloth separately on each basin. One

for soaping, another one for rinsing.

13. Make a bath mitt with the washcloth. A bath mitt retains water and heat better than a
(Follow the steps in making a bath mitt. You can use cloth loosely held and prevents ends of washcloth
either triangular or rectangular method). from dragging across the skin.

14. Begin the bath at the cleanest area and work To prevent the spread of microorganisms.
downward toward the feet.

15. Lay a bath towel across the patient’s chest and on This prevents chilling and keeps bath blanket dry.
top of bath blanket.

16. Place another bath towel under the client’s head. It protects the bed from becoming wet.

17. Without soap on the washcloth, wash the client’s
eyes with water only (squeeze off excess water from
the washcloth and wipe from inner to the outer
canthus). Rinse or use a separate corner of the
washcloth before washing the other eye.
Soap is irritating to the eyes. Moving from the
inner to the outer aspect of the eye prevents
carrying secretions from entering the nasolacrimal
ducts. Using separate corners prevents
transmitting microorganisms from one eye to the
other.

18. Wash the face. Ask whether the client wants soap Soap has a drying effect and may be avoided as a
used on the face. Start from the forehead, down to
the cheeks, bridge of the nose, chin, back
of the ears, and neck. Wash, rinse (soap once and
rinse twice) and pat dry. Remove the towel from
under the client’s head.
19. Wash the arms. Expose the patient’s far arm and
place towel lengthwise under it. Using firm strokes,
wash, rinse and dry the wrist to shoulder including
the axillary area by elevating the client’s arm and
supporting the client’s wrist and elbow.
20. Wash the hands. Place a folded towel on the bed
next to the patient’s hand and put a basin on it. Soak
the patient’s hand in basin. Wash (paying particular
attention to the spaces between fingers), rinse and
pat dry.
21. Repeat the steps for hand and arm nearest you.
An option for the shorter nurse or one prone to back
strain might be to bathe one side of the patient and
move to the other side of the bed to complete the
bath.
22. Wash the chest and abdomen. Spread a towel
across/lengthwise the patient’s chest. Lower bath
blanket to the patient’s umbilical area. Wash using
long firm strokes, rinse and dry chest. Keep chest
covered with towel between the wash and dry. Pay
special attention to the skin folds under the breasts.
23. Lower the bath blanket to the perineal area. Place
a towel over the patient’s chest.
24. Wash, rinse and dry abdomen. Carefully inspect
and cleanse umbilical area and any abdominal folds
or creases.
25. Return bath blanket to original position and
expose far leg being careful to keep the perineum
covered. Lift leg and place bath towel lengthwise
under the leg. Using firm strokes, wash, rinse and dry
leg from ankle to knee, and knee to thigh.
26. Fold a towel near the patient’s foot area and place
basin on it. Place foot in basin while supporting the
ankle and heel in your hand and the leg on your arm.
Wash, rinse and dry paying particular attention to
area between toes.
27. Make sure the patient is covered with the bath
blanket. Change water and washcloth at this point or
earlier if necessary. Put the side rails up when
matter of personal preference.
The towel helps to keep the bed dry. Washing the
far side first eliminates contaminating a clean area
once it is washed. Firm strokes from distal to
proximal areas promote circulation by increasing
venous blood return.
Placing the hand in the basin of water is an
additional comfort measure for the patient. It
facilitates thorough washing of the hands and
between the fingers and aids removing debris from
under the nails.
Exposing, washing, rinsing and drying one part of
the body at a time avoids unnecessary exposure
and chilling. Skin-fold areas may be sources of odor
and skin breakdown if not cleansed and dried
properly.
Keeping the bath blanket in place avoids exposure
and chilling.
Skin-fold areas may be sources of odor and skin
breakdown if not cleansed and dried properly.
The towel protects linens and prevents the patient
from feeling uncomfortable from a damp or wet
bed. Washing from distal to proximal areas
promotes circulation by stimulating venous blood
flow.
Supporting the patient’s foot and leg helps reduce
strain and discomfort for the patient. Placing the
foot in a basin of water is comfortable and relaxing
and allows for thorough cleaning of the feet and
the areas between the toes and under the nails.
Water may become dirty and/or cold. Putting side
rails up ensures the safety of the client.
refilling the basin with water.

28. Assist the client into a prone or side-lying position This provides warmth and prevents undue
facing away from you. Place a bath towel lengthwise exposure.
alongside the back and buttocks while keeping the
client covered with the bath blanket as much as
possible.

29. Wash, dry and rinse the client’s back, moving
from shoulders to the buttocks, and upper thighs,
paying attention to the gluteal folds, and observe for
any redness or skin-breakdown in the sacral area.
Fecal material near the anus may be a source of
microorgansims. Prolonged pressure on the sacral
area or other bony prominences may compromise
circulation and lead to development of decubitus
ulcer.

30. If not contraindicated, give the patient a backrub. A backrub improves circulation to the tissues and is
an aid to relaxation. A backrub may be
contraindicated in patients with cardiovascular
disease or musculoskeletal injuries.

31. Proceed with the perineal care. (Use the separate

tool for the procedure).

32. Help the client put on a clean gown and/or To provide comfort and privacy.
pajamas. Slowly pull the bath towel on the side of the
patient inside the top sheet. Replace top sheet to
cover the patient.

33. Arrange linens of bed. Put back pillow of patient.

34. Validate feelings of patient.

35. After care of used materials.

36. Remove gloves and do hand washing. To prevent spread of microorganisms.

37. Document:
 Type of bath given.
 Skin assessment such as excoriation,
erythema, exudates, rashes, drainage, or skin
breakdown.
 Nursing interventions related to skin integrity.
 Ability of the client to assist or cooperate
with bathing.
 Client response to bathing.
 Educational needs regarding hygiene.
 Information or teaching shared with the
client or their family.

B. BED SHAMPOO
Definition: It is the washing of hair in bed

Purpose:
1. To cleanse the hair and the scalp.
2. To refresh the patient.

Equipments:
Tray Shampoo Dipper
Dry cotton balls Comb Under pad
2 bath towels 2 pails (1 with water) Kelly pad
Clean gloves News paper Patient Gown
Rubber sheet Bed Screen

PROCEDURES RATIONALE

1. Inform patient you will be assisting with Shows respect for client; maximizes
hair care. cooperation and comfort.

2. Prepare room environment: provide Maximizes patient comfort and prevents

privacy, adjust temperature chilling.

3. Review client history for allergies and Need prescription for medicated supplies
confirm/obtain provider’s orders for
medicated shampoo or scalp treatment as
needed.

4. Organize equipment at bed side Promotes efficiency.

5. Adjust bed to comfortable height Prevents back strain and proper body
mechanics.

6. Wash hands and wear clean gloves Reduce the transmission of microorganisms.

7. Remove pillow from under patient’s Position for comfort and efficiency, and
Head, place the rubber sheet and bath towel protects patient pillow.
in the pillow of the patient.

8. Bring –patient’s head close to the edge

Of the bed by placing him diagonally
over the bed.

9. Place pillow under patient’s shoulder Protect patient from getting wet by preventing backflow of
water.

10. Place Kelly pad under patient’s head so

that the through empties into the pail.

11. Fold top sheet to the middle and place a
Bath towel over the shoulders toward
midline of chest.
12. Gently comb/brush patient’s hair.
Observing scalp and hair for color, texture
To protects patient’s clothing.
Removes tangles, loosens dead cells and
debris, distributes oils, stimulate scalp
distribution, scaling, infestation or infection
13. Ask the patient to check the warm water
14. Plug ears with cotton balls
15. Place a hand towel above the eyes
of the patient.
16. Carefully pour the warm water over the
hair, moistening thoroughly.
17. Place a small amount of shampoo
into the dipper with small amount of water
and massage it into the hair, working the
shampoo into a lather. Using your
fingertips, gently massage the shampoo into
the scalp
18. Rinse the hair by using the small pitcher
to pour warm water over the hair and scalp.
19. Repeat application of shampoo and
Massage scalp and hair gently but vigorously
For a longer period of time
20. Rinse again using several pitchers
of water until hair and scalp are free
from shampoo.
21. Support client’s head while you remove
The Kelly pad. Set to one side.
22. Wrap patient’s hair by gently pulling the
bath towel from shoulders up and over scalp.
Gently and briskly massage the scalp and hair
with the towel. Leave hair covered with the
towel.
23. Remove the rubber sheet and under pad.
24. Elevate the head of bed to desired angle
within prescribed and/or client-tolerated
limits.
25. Dry hair; concentrate on one section at
a time, while moving your fingers, comb, or
brush gently through the hair as it dries.
26. Gently comb/brush the hair.
circulation and identifies abnormalities.
Warm water promotes scalp circulation using his/her dorsal part
of the hand and prevents chilling and second injury.
To prevent entrance of water into the auditory canal.
To prevents shampoo or water from
irritating eyes.
Moisten hair facilitates the cleansing
action of the shampoo.
Shampoo lather facilitates removal
of dirt, debris, and excess oils from
scalp and hair. Massage promotes lather,
stimulates scalp circulation, and relaxes
client.
Removes shampoo and dirt.
Promotes thorough cleansing of hair
and scalp, provides opportunity to observe
hair and scalp abnormalities as fingers move
through hair and across scalp, and massages
relaxes scalp and shoulder muscles.
Removes remaining residue of shampoo.
Clears area for completion of procedure
to prevents inadvertent injury.
Absorbs water from hair and scalp while
stimulating scalp circulation. Prevents
chilling while waiting to dry the hair.
Prevents debris from falling onto bed.
Promotes access to hair and client
comforts
Facilitates drying and removes tangles.
Removes all tangles and stimulates the scalp.
27. Style hair per client preference. Maintaining personal appearance and increases sense of well-
being.

28. Reposition the client comfortably; Maintains client comfort, rest and safety.
adjust bed as requested, safety measures,

and communication needs

29. Empty the water. Remove, clean, and Provides clean environment.
return equipment.

30. Removes gloves and wash your hands. Reduces the transmission of microorganisms.

31. Document:
 Hair assessment
 Ability of the client to assist or
cooperate with bathing.
 Client response to bed shampoo.
 Educational needs regarding hair
Shampoo

C. ORAL CARE
Purpose:
1. To remove food particles from around and between the teeth.
2. To prevent odors and formation of sordes.
3. To remove dental plaque
4. To prevent sores and infection of the oral tissues

General Considerations:
1.Clients with oral lesions may be sensitive to fluoride. Use mild or nonfluoride mouth-cleaning products to decrease
irritation during oral care.
2. Toothpaste with a higher concentration of fluoride may be prescribed to prevent dental caries.
3. Clients on anticoagulants mat bleed and need soft toothbrushes or toothettes.

Equipments:
Toothbrush Clean gloves Towel Cup of water
Tooth paste with fluoride Tray
Kidney basin Mouthwash ( Bactidol/Betadine)

PROCEDURE RATIONALE

1. Introduce yourself and explain the procedure To establish rapport. Patient cooperates well
to the patient. when informed about care to be done.

2. Perform hand hygiene, and observe other Proper hand washing reduces the
appropriate infection control procedures. number of bacteria and prevents cross infection.

3. Assemble all articles for brushing Promotes efficiency.

4. Provide for client privacy by drawing the Embarrassment can cause patient to
curtains or closing the door. become tense and thus reduce her/his
cooperativeness.

5. Place patient in a high fowler’s position To decrease the risk of aspiration.

6. Wash hands and apply clean gloves Reduces the transmission of microorganisms

7. Place towel on patient’s chest To catches secretions.

8. Moisten toothbrush, apply small amount Moisten the mouth and facilitates plaque
of toothpaste, and brush teeth and gums. removal.

9. Grasp the dental floss in both hands or Removes plaque and prevents gum
use a floss holder and floss between all disease.
teeth; hold floss against tooth while moving
floss up and down sides of teeth.

10. Reapply toothpaste and brush the teeth Permits cleaning of back and sides
and gums using friction in a vertical or of teeth and decreases microorganisms
circular motion. On inner and outer growth in mouth.
surfaces of the teeth, hold brush at 45˚
angle against teeth and brush from sulcus
to crowns of teeth. On bitting surfaces,
move brush back and forth in short
strokes. All surfaces of teeth should be
brushed from every angle.

11. Assist the client in rinsing and drying Removes toothpaste and oral secretions.
mouth.

12. Apply lip moisturizer, if appropriate Maintains skin integrity of the lips.

13. Reposition client, raise side rails, and Provides an orderly environment.
place call button within reach.

14. Rinse, dry and return articles to proper Provides an orderly environment.
place.

15. Removes gloves, wash hands.

Reduce the transmission of microorganism
16. Document the procedure.

D. PROVIDING SPECIAL ORAL CARE FOR THE UNCONSCIOUS CLIENT.

Purpose:
 To maintain the intactness and health of the lips, tongue and mucous membranes of the mouth.
 To prevent oral infections.
 To clean and moisten the membranes of the mouth and lips.

Equipments:
Towel Emesis basin Disposable clean gloves
Toothbrush Tissue Suction catheter with suction apparatus
Tepid water Foam swabs

PROCEDURE RATIONALE

1. Prior to performing the procedure, introduce self and Promotes reassurance and provides knowledge about
verify the client’s identity. Explain to the client and the the procedure. Encourages client participation and
family you are going to do why it is necessary. allows individualized nursing care.

2. Perform hand hygiene and wear the clean gloves To prevent the microorganism.

3. Provide for client’s privacy by drawing the curtains around Hygiene is a personal matter
the bed or closing the door to the room.

4. Prepare the client:

a. Position the unconscious client in a side-lying position,
with the head of the bed lowered.

b. If the client’s head cannot be lowered, turn it one side. In this position the saliva automatically runs out by
gravity rather than being aspirate into the lungs.
The fluid will really run out of the mouth or pool in the
side of the mouth, where it can be suctioned.

c. Place the towel under the client’s chin. To collect the fluid from the mouth.
d. Place the curved basin against the client’s chin and lower
cheek.

5. Clean the teeth and rinse the mouth.

a. If the client has natural teeth, brush the teeth.

b. Rinse the client’s mouth by drawing about 10 ml of water If the solution is injected with force, some of it may flow
or alcohol-free mouthwash into the syringe and injecting it down the client’s throat and be aspirated in the lungs.
gently into each side of the mouth.

c. Watch carefully to make sure that all the rinsing solution Fluid remaining in the mouth may be aspirated into the
has run out of the mouth into the basin. If not, suction the lungs.
fluid from the mouth.

6. Inspect and clean the oral tissues.

a. If the tissues appear dry or unclean, clean them with the
foam swabs or gauze and cleaning solution.

b. Picking up a moistened foam swab, wipe the mucous

membrane of one cheek. Discard the
swab into a waste container; use a fresh one to
clean the next area.

c. Clean all mouth tissues in an orderly progression, using Using separate applicators for each area of the mouth
separate applicators: the cheeks, roof of the mouth, base of prevents the transfer of microorganisms
the mouth and tongue. from one area to another.

d. Observe the tissues closely for inflammation and dryness.

e. Rinse the client’s mouth.

f. Remove and discard gloves.

7. Ensure client comfort.

a. Remove the basin, and dry around the client’s mouth with
the towel.

b. Lubricate the client’s lips with water soluble moisturizer. Lubrication prevents cracking and subsequent infection.

8. Document assessment of the teeth, tongue, gums, and

oral mucosa. Include any problems such as sores or
inflammation and swelling of the gums.

E. PERINEAL CARE
 Definition: The cleansing of the perineum to remove the secretions, odor and bacteria.

Purpose:
1. For cleanliness and comfort of the patient.
2. For prevention of infection.
3. To promote healing of perineal wound.
4. As preparation for a treatment of examination.

Materials and Equipments:

1. Bedpan
2. Bed screen
3. Perineal tray with the following:
a. Forceps in a jar of disinfectant solution
b. Flushing pitcher or cup with warm water
c. Jar of cotton balls
d. Jar of cotton balls soaked in soap and solution
e. Waste receptacle

General Considerations:
1. Practice medical aseptic technique.
2. Direction of cleansing should start from the pubic region down the rectal area.

PROCEDURE RATIONALE

1. Introduce yourself to the client. Establish rapport.

2. Explain to the client what you are going to do, Patient cooperates well when
why it is necessary, & how the client can informed about the care to be done.
cooperate, being sensitive to any embarrassment
felt by the client.

3. Perform hand hygiene, and observe other Proper hand washing reduces the
procedures. number of bacteria and prevents cross
infection.

4. Provide for client privacy by drawing the curtains Embarrassment can cause patient to or
nd thus reduce her anxiety.

5. Prepare the client.

a. Fold the top bed linen to the foot of the bed and
fold the gown up to expose the genital area.

b. Position the client and drape the client and clean the
upper inner thighs.

FOR FEMALES

a. Position the female in a back-lying position

with her knees flexed and spread well apart.

b. Cover her body and legs with the top sheet.

c. Drape the legs by tucking the bottom corners

 of the bath blanket under the insides of the legs.

d. Bring the middle portion of the base of the

blanket up over the public area.

e. Raise the buttocks with one hand and place

bedpan with the other hand. Inspect if in
proper position then cover the patient first.

f. Put on gloves and wash and dry the upper

inner thighs.

FOR MALES

a. Position the male client in a supine in a supine

position with his knees slightly flexed and his
hips slightly externally rotated.

b. Put on gloves and wash and dry the upper

inner thighs.

c. Inspect the perineal area.

 Note particular areas of inflammation,
excoriation or swelling, especially between
the labia in females or scrotal folds in males.
 Also note excessive discharge or secretions
from the orifices and the presence of odors.

d. Wash and dry the perineal-genital area.

FOR FEMALES

a. Pick cotton ball soaked in soap solution and
cleanse the vulva using the figure of seven
from mons veneris passing through the labia
majora, going down to the anus. Discard
cotton ball.
b. Spread the labia to wash the folds between
the labia majora and the labia minora.
Because of the layer of oil on the
skin water alone cannot remove the
debris cleanse the skin. Soap must be
used to lower the surface tension of
the water and dissolve the oil on the
skin.
Placed on the cleansing from the
pubic region to the back rectal area
preventing contamination

c. Use separate cotton ball for each Ascending infection. Temperature above
stroke and wipe from the pubis to the rectum. 105F may injure the tissue.
For menstruating women and clients with
indwelling catheters, use clean wipes,
cotton balls, or gauze. Take a clean wipe for
each stroke.

d. Rinse the area well.

e. Dry the perineum thoroughly. To prevent infection and bad odor from moist.

FOR MALES
a. Wash and dry the penis, using firm strokes.
b. If the client is uncircumcised, retract the
prepuce/foreskin to expose the glans penis for
cleaning. Replace the foreskin after cleaning the
glans penis.

c. Wash and dry the scrotum. The posterior folds of the

scrotum might need to be cleaned in step 9, with the buttocks.

d. Remove bedpan.

e. Inspect perineal orifices for intactness.

f. Inspect particularly around the urethra in clients with

indwelling catheters.

g. Clean between the buttocks.

 Assist the client to turn onto side, facing away from you.
 Pay particular attention to the anal area and
posterior folds of the scrotum in males.
 Clean the anus with toilet tissue before washing it, if necessary.
 Dry the area well.

d. For post-delivery or menstruating females,

apply a perineal pad as needed, from front to back.

e. Clean and replace equipments. To prevent the spread of infection through body
secretions.

Modification:
1. Clean the laceration or episiotomy. Undue pressure on the wounds is always avoided
to prevent pain, discomfort and gapping of the wound.

2. Apply gentle friction while cleaning Friction exerted in washing with cotton
the perineum balls facilitates removal of lochia and bacteria
lodged in the perineum.

3. Place a sterile perineal pad after drying

with sterile cotton balls.

4. Observe proper disposal of used pads. This aids in the prevention of the transmission of diseases.

5. If indicated, apply perineal heat before

application of ointment or antiseptic solution.

Charting: (Use tickler/notepad)

1. Record procedure or treatment and time administered.
2. Observe and chart odor, color and amount of vaginal discharge.
3. Observe the condition of the wound.