Topic: 9

How to Give a Bed Bath and Attend to Personal Hygiene

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What You Need to Know

People who are sick and weak and who are struggling to help themselves, have the same priorities as you do. They want for themselves what you want for yourself:

  • To maintain a sense of dignity and privacy, as much as possible;
  • To maintain a sense of control, as much as possible;
  • To be treated with respect, sensitivity and an awareness of their feelings; and
  • To avoid being a burden to their family and friends, as much as possible.

By focusing on the priorities, the experience of providing a bed bath will be more pleasant for both you and the person you are caring for.

Helping with a Bath or Shower
Bathing is an important part of personal care and offers both physical and emotional comfort. When the person is receiving care, observe to find out if they are in pain. They may need more medication or choose to pass up their bath for the day until the increased dose of medication takes effect. There are medications that can be given just before turning or changing dressings. In the last few hours of life, the person may not want to be disturbed. When the person can go into the bath or shower you may find the following tips useful:

  • Before the person goes into the bathroom, have all the things they will need ready. Run the bath and check the water for the person's preferred temperature. Have the soap, washcloth, shampoo and other items (razor blade, cream, etc) nearby. Have the towels within easy reach. If possible, put the towels in the dryer for two minutes to warm them up so the person can feel warm when they dry
  • Helping people to stand up or sit/lie down can be very difficult on your own body. It is important to remember all the rules of lifting and leaning over that you were taught in school. Remember to bend at the knees when you are picking up an object and keep your back as straight as possible. Remember as well, that the closer you are to the person or object you are lifting, the less strain you put on your lower back, arms and legs. Some regular squatting exercises will help strengthen your legs and lower
  • If you get quite sore by helping someone get up or down, ask your family doctor, visiting home nurse, occupational therapist or chiropractor to give you clearer instructions of how to lift someone properly so that you do not continue to hurt
  • Help the person into the bath or shower making sure you bend your knees slightly and keep your back as straight as you can. You may want to put a long towel under their arms to help lower them into the
  • If the person is able to help themselves more, you can help them sit on the side of the tub (on a warm, non-slip towel or mat), swing their legs over and help them to ease into the tub. Reverse the procedure when they want to get out.
  • Make sure the bath or shower has a non-slip bath

If the person needs help for weeks or months, it may be wise to adapt your bath or shower with handles and other safety aids. Check with an occupational therapist or physiotherapist through your home care program.

  • If the person prefers a shower, rent or borrow a bath chair or use a water- resistant chair so they can sit down comfortably. Your home care program may be able to arrange this.
  • The person may feel more comfortable if their genital area is covered. You can use a short apron or modified towel with Velcro tabs so the person has the privacy they want.

(“Caring for the Terminally Ill: Honouring the Choices of the People, Person/Family/Community, 3rd Edition, August 2014)

How to Give a Bed Bath

Remember to wash another person as if you were having the bath given to you. The bath is a form of exercise for the person being cared for, even if you are doing it for him or her. Even with you doing the moving and lifting of limbs, the person still must use their own energy to assist you.

Wash your Hands and Gather Equipment Wash your hands with warm, soapy water if available or with a hand sanitizer. How long should you wash your hands? How long it takes to sing “Happy Birthday” is just about right.

Gather the supplies that you will need

  • Flannel sheet to cover the person
  • Two washcloths and two towels-one set for face and body, other set for genital care
  • Soap and soap dish
  • Moisturizer
  • Clean pajamas, nightgown, or clothes, underwear, socks
  • Incontinent brief if required
  • Clean sheets
  • Basin of warm water

Note: Vaseline is not to be used if a person wears oxygen. Powder should be avoided as it is a lung irritant and, if spilled, can cause slippery floors.

Prepare the person to be washed

  • If possible, raise the level of the bed to lessen the strain on your back.
  • Cover the person with a light sheet or blanket for warmth. Only uncover and wash one part of the body at a time.
  • Put dry towels under the body part being washed to keep the person and bed linens dry.

Wash the Person’s Face, Neck, and Behind Ears

  • Wash the face first, making sure to carefully wash eyelids, wiping from the inside corner outward.
  • Wash behind the ears and the back of the neck
  • Rinse the cloth out
  • Dry well

Wash the Arms and Hands

  • Remove the pajamas
  • Uncover one side of the body first
  • Soap up the same wash cloth that used for the face
  • Lay a towel under one arm of the person. Wash the arm and hand and between fingers. Rinse off all the soap, and dry well
  • Wash the armpit
  • It is a good idea to place the person’s hand right in the basin of warm water.

Wash the chest, abdomen, back, each leg, and then feet

  • Wash the chest first, then the abdomen, leg and foot
  • Rinse as many times as needed to get all the soap off
  • When drying, make sure the skin under women’s breasts is dry
  • Wash carefully under the skin folds since these are the most likely spots for rashes or other skin problems. This is especially true under the arm, in the groin area, buttocks, stomach skin folds, and under a woman’s breasts. The person may prefer washing sensitive areas themselves.
  • Cleaning the back is the perfect opportunity to give someone a back rub if they are able to lay on their side. This will promote blood supply, be relaxing, and will help prevent sores from developing.
  • Massage the back and pressure areas with lotion. Use soft pressure and move your hands in a circular motion. Check for reddened areas and be sure to bring them to the attention of the Community Care Team. Apply lotion if desired after drying an area.
  • People often enjoy having their face, temples, neck, hands, elbows, feet and heels massaged as well. This can be done using cream or oil. Again follow their wishes. This can also be done throughout the day, not just during bathing.
  • Apply lotion to all pressure areas (i.e. shoulders, elbows, wrists, tailbone, hips, calves, heels). Massage the back and pressure areas with lotion after each turn. Use soft pressure and move your hands in a circular motion. Ask the Community Care Team for more instructions if needed.
  • If a complete bed bath is too tiring, wash the person’s face, hands, back, underarms, and genitals daily.
  • Remember to ask the person’s preferences on: deodorant, shaving, make-up and brushing and styling
  • hair and help them accomplish those tasks. Often a rest before and after these activities will help
  • prevent the person from becoming over- tired.
  • Take special care of a person’s feet, especially if they are diabetic. Be sure they are clean and dry, and encourage the person to wear socks and appropriate footwear to prevent sores and nail problems.
  • You may want to use some moisturizer on the back, arm, leg, foot or other dry skin areas to soothe and comfort the person. Remember to be gentle

Now repeat Steps 4 and 5 on the opposite side of the body first covering up the washed side.

Wash the genital area

  • Using the second wash cloth, clean the genital area by folding the washcloth like a mitt and wipe the area with a small amount of soapy water.
  • Rinse and dry thoroughly.
  • Never use the water for washing after you have cleaned the genital areas.

Put the patient in clean pajamas or clothes.

  • Ensure that items like reading glasses and hearing aids are returned within reach of the person at the end of the bed bath.
  • The bed linens should be changed at the same time as the bed bath. If changing the bed linens at the same time as the bed bath, finish washing the person, then change the pajamas prior to pulling all layers of the clean linens through. Pull tightly to make the bottom straight and wrinkle free, then tuck in the clean sheets.

Dispose of the water and washcloths and towels.

  • Put the wash cloths and towels in the laundry.

Watch this video to see a demonstration of a caregiver giving a person a bed bath at home.

General Hair Care

People need their hair clean, combed/brushed (at least twice a day), cut and set. The condition of one's hair often tells visitors and the person themselves how well they are doing. Clean and groomed hair is important for good health and feeling good about yourself.

Dry Shampoo
You can wash someone's hair using 'dry' shampoo like a commercial dry shampoo, cornstarch or natural (unscented) talcum powder. For someone who needs their hair washed in bed, dry shampoo can sometimes be a quick alternative to a normal wash. Do the following:

  1. Place a towel under the person's head.
  2. Sprinkle powder on the scalp and massage the hair and scalp gently.
  3. Brush the powder out of the hair with slow, even strokes. If hair is tangled, hold it firmly near the scalp before brushing through to the end.
  4. Wash the hairbrush after each dry shampooing

Wet Shampoo
If the person needs a normal hair wash but cannot use the bath or shower, you can wash their hair in bed. You will need:

  • A plastic sheet to protect the bed
  • A waterproof cape (like in a hair salon) or a plastic garbage bag with a hole for the head and cut along the sides to make a cape
  • A jug or pitcher of warm-to-hot water (several if the person has long hair)
  • A bucket or large basin to collect water, (there are also special shampoo trays available through some drug stores)
  • A wash cloth or small towel, plus two larger towels for drying
  • Pillow(s)
  • Shampoo
  • Comb or brush
  • A hair dryer (if needed)

To help the person wash their hair if they are not able to do it themselves:

  • You may want to put a towel or plastic sheet on the floor under the bucket to catch any spilled water.
  • Have the person lie on their back with their head over the side of the bed (adjust pillows, covers, etc. so they are comfortable). Put the bucket or basin on a small table under the person's hair.
  • Cover the area with the plastic sheet and have the person wear their cape with the back side covering their pillow rather than tucked under them.
  • Pour warm water from the jug over their hair so that the water falls in the bucket or basin below.
  • Put the shampoo into the hair and gently massage it in to lather the hair and scalp.
  • Rinse the hair with the remaining water.
  • Dry the hair with a towel and then with the dryer if necessary.
  • Empty the bucket and tidy up the bed. Remove the cape and plastic sheet. Place the other dry towel on the pillow to soak up any moisture still in the hair.

Other tasks like setting or coloring the hair can be done in bed using the same common sense approach to comfort and cleaning as described here.
(“Caring for the Terminally Ill: Honouring the Choices of the People Person/Family/Community 3rd Edition August 2014)

Personal Hygiene

The person that you are caring for may be susceptible to colds and viruses that visiting family and friends may carry into your home.

Infection control is important because anyone can carry germs. These topics apply to everyone who comes into contact with the person who is seriously ill. You might need equipment, like gloves and masks; some of this can be provided by your home health care team. Your Community Care Team will support you by giving advice, and teaching you how to do the physical care safely and how to use the equipment.

Handwashing – Washing your hands is the most effective way to prevent the spread of infections. Wash them with warm soapy water before and after every contact with the seriously ill person. Keep nails trimmed so your hands are easy to keep clean. Prevent dryness and chapping with hand lotion. You can also use alcohol-based waterless antiseptic if hands are not visibly soiled. It is important to wash your hands after food preparation and after contact with pets.

Garbage Disposal – Be sure to be aware of garbage disposal in your community. All garbage, especially products with blood or body fluids need to be disposed of in a safe manner.

Medical Equipment – Dispose used gloves, aprons, and masks appropriately. Needles and syringes need to be placed in a hard plastic or metal container with a lid. Place the lid on the container when it is full and tape it shut so the needles will not fall out and stick anyone. Clearly label the container with an alert as to what it contains. Ask your home care nurse how it is done in your community.

How can you protect the person and yourself from getting sick?

The way to stop germs, infections, viruses, bacterium from spreading is by breaking this chain at any link.

Break the chain!

  • DO wear gloves whenever you come in contact with anything that is “ooey, gooey, wet, not yours”.
  • DON’T touch your face when wearing contaminated gloves.
  • DON’T touch surfaces when wearing contaminated gloves.
  • DO WASH YOUR HANDS FREQUENTLY
  • DO stay up to date with your vaccines and flu shots.
  • DO cover coughs and sneezes.
  • DO clean and disinfectant the environment regularly.
  • DO follow safe injection practices.
  • DO follow prescriptions exactly.
  • DO use dishwashers with sanitize settings.

Remember these simple rules!

Will your hands be exposed to blood, excretions, secretions, contaminated towels or linens? WEAR GLOVES

Will your face be exposed to coughing, sneezing, a spray? WEAR A MASK

Wash Your Hands Often

Watch the video by Public Health Ontario to make sure that you are washing your hands correctly. https://www.publichealthontario.ca/en/BrowseByTopic/InfectiousDiseases/JustCleanYourHands/Pages/JCYH-videos.aspx  

 

 

How to Make a Simple Household Disinfectant
1 part water, 1 part rubbing alcohol or Hydrogen peroxide Spray and leave after you’ve cleaned a surface, Use only use where required i.e. points of contact in the bathroom.

  • Rubbing alcohol– at least 65% USP in order for it to qualify as a disinfectant, can be mixed with water
  • Hydrogen peroxide– naturally occurring bleach, used in Oxy powders. Uses oxygen to break bonds between dirt and bacteria and the surface they are on. A great disinfectant, stain remover and natural whitener.

How to Give a Simple Massage

People dealing with a variety of issues—some that are physical and some that are more emotional—can benefit from a simple massage. Very slow, gentle and gently applied techniques are the most appropriate. The overarching goal is to provide comfort without doing harm and, as with all massage, tailoring the massage to the individual. Remember:

  • The massage should not be painful. It should feel good. Be sure to check if the pressure is comfortable.
  • Don’t massage anything that feels bony. Bones don’t relax. They also tend to be very pain sensitive. So everything you massage should feel relatively soft.

To learn how to give a massage visit:
https://www.goodnet.org/articles/5-relaxing-massage-techniques-anyone-do-at-home
 

 

Complete the chart below. For each task explain how you could break the chain of infection. If you can’t think of an answer, review the content above.

Task You pick up dirty dishes from the person’s meal including a drinking glass, fork, knife, plate and a used napkin.

How will you break the Chain of Infection? You assist the person with toileting.

How will you break the Chain of Infection? You help the person brush their teeth.

How will you break the Chain of Infection? You change a dressing as the nurse has shown you.

How will you break the Chain of Infection? You give a bed bath.

How will you break the Chain of Infection? You provide the person with their medications.

How will you break the Chain of Infection?

 

 

ADDITIONAL RESOURCES

Use these additional resources to learn more about the topic.

Community & Home Assistance to Seniors: Infection Prevention and Control
http://www.chats.on.ca/InfectionControl

Caregiving Takes a Toll on your Back
http://www.nextavenue.org/keep-caregiving-taking-toll-your-back/

Protecting your Marriage while being a Caregiver for a Loved One
http://www.3rdactmagazine.com/aging/care-caregiving/protecting-marriage/

The Flu
https://www.ontario.ca/page/flu-facts