Personal hygiene care is done both in supportive care facilities and in a client’s home. Personal hygiene care includes the basic personal hygiene that is done either by the client or by the HCA every morning and evening.

The skills outlined below describe personal hygiene in a supportive care facility. It can, of course, be adapted to provide care in the home. When doing personal hygiene care (often referred to as “Morning or A.M. Care, and “bedtime or H.S Care”) you usually do not give the client a full bath. The areas that are washed, rinsed, and dried are:

• the face – including eyes, neck, and behind the ears,
• the axilla (underarm area) and under breasts,
• the hands,
• the back – from neck to lower back; and
• the perineal (genital) area.

Bathing

Assisting a client with regular bathing is important for their health and for promoting self-esteem and healing. Clients who are recovering from an injury or illness, who have a chronic condition, who are permanently disabled, who are dying, or who are frail, may require assistance for performing this essential task (Sorrentino, et al., 2019; Taylor, et al., 2001). This is an important part of the job of an HCA. The care plan will direct the HCA as to the frequency and type of bath that should be performed. At minimum, a client should have their face, underarms, under breasts or folds, hands, and genital areas cleansed daily in the morning and evening.

Providing personal care gives HCAs an opportunity to assess and communicate with clients (Sorrentino, et al., 2019). Covering the areas to be washed with the bath blanket or towel maintains warmth and dignity. Providing personal hygiene care gives the HCA the opportunity to observe the client’s skin condition by uncovering and observing each area as you wash. The HCA should observe the client’s skin for changes in color, temperature, swelling, new bruises, open areas, red areas, or sores. These should be documented and the supervisor informed.

Health Care Assistants should always encourage the client to perform any personal hygiene task they are able to, and help as needed. Some clients are able to bathe or shower independently, or with minimal assistance. Some clients will require total care, meaning the HCA will have to provide their personal hygiene care completely (McLain, et al., 2018). If a client is immobile, weak, or frail, bed baths should be provided instead of risking a fall in a bathtub. Never allow a weak or frail client to stand in a shower alone. In these types of situations, a tub or bed bath may be more appropriate. The HCA can also shampoo the client’s hair in bed by using a shampoo tray or a no-rinse shampoo cap.

Clients have a right to refuse any treatment, including bathing. The HCA should educate the client about the importance of bathing. Try to find out why the client does not want a bath. Sometimes, they may not want a bath at that moment, but would be willing to have one at a later time. Document the reason for refusal and inform the supervisor (Sorrentino, et al., 2019; Taylor, et al., 2001).

When providing or assisting with a bath, the water temperature should be checked. The temperature should be no greater than 40 degrees Celsius (105 degrees Fahrenheit). Allow clients to test the water temperature to determine if it is comfortable for them. It is important, when providing or assisting with a bath, that the client is provided privacy (Sorrentino, et al., 2019; McLain, et al., 2018). This includes closing doors, drawing curtains, and limiting access to the area for others while the client is bathing. Towels, gowns, or bath blankets can be used to cover the client’s body, exposing only the body part being washed during bed baths. Sometimes allowing the client to get into the bath with their gown or shirt on can not only make the client feel comfortable, but can also make the bathing experience go more smoothly.

Providing a back rub after a bath, before bed, or anytime a client needs to relax is an important skill for the Health Care Assistant, but is often overlooked. This is an excellent way to teach a client how to relax, observe their skin, and promote good circulation. Giving a proper back rub will be discussed later in the chapter. Instructions for providing a tub or shower bath, assisting with a transfer into and out of a tub, providing a bed bath, providing a shampoo in bed, and providing a back rub are also discussed in this section.

Tub or Shower Bath

Table 4.3.1 Procedure: Tub or Shower Bath?

STEP	ACTION	REASON
1.	Read the  client’s “CARE PLAN”
2.	Wash and dry hands according to proper hand washing guidelines.
3.	Assemble equipment needed: soap shampoo/conditioner wash cloths towels personal items clean clothing	Good organization is time efficient.
4.	Ensure the bathroom is warm and comfortable. Take care that it is not too cold or too hot.	Client comfort.
5.	Remove any fall risk hazards, such as loose rugs, from the floor.	Safety.
6.	Place any safety devices in the tub/shower as needed (e.g., shower chair, rubber mats).
7.	Ensure safety items such as handrails and grab bars are in good working order. Immediately inform a supervisor if they are not.
8.	Turn on the water and test water temperature using a bath                       thermometer. Water temperature should be no higher than 40 degrees Celsius (105 degrees Fahrenheit). If providing a tub bath, fill the bath and test the temperature before putting the client in the tub.	Prevent scalding injury
9.	Allow the client to test the water temperature for their comfort.              Adjust as needed.
10.	Assist the client to the bathroom. If the client is ambulatory,                      assist as needed to undress just before transferring them into the tub or shower. This prevents them from chilling.
11.	If the client is independent, give them privacy to bathe, if they prefer. If leaving a client unattended, check on them every 5 minutes or more frequently as needed. Ensure the client knows how to use safety items, such as shower chairs and grab bars.	Tub baths, or very warm showers, can lead to a person feeling faint, nauseous, or tired. Baths should not last longer than 20 minutes and should be discontinued at the first sign of client discomfort, weakness, or complaints of feeling faint.
12.	If the client is standing to shower, stay in the bathroom and monitor the client’s need for assistance. If they are weak, always stay with them in the bathroom, providing privacy as possible.
13.	Never let a weak person stand to bathe or leave them alone in the bath. You can stay in the bathroom and draw the shower curtain to provide privacy. Communicate with the client frequently to let them know you are there to help.
14.	Water should be turned off, and the tub drained, before assisting the client to transfer out of the tub.

Partial Bed Bath

Health Care Assistants should always encourage the client to perform any personal hygiene task they are able to, and help as needed. Some clients will require personal hygiene care in bed because they are unable to move to the bath or shower. Providing a bed bath allows a client to receive personal hygiene care with minimal movement on their part. There are two types of bed baths: full and partial. A full or complete bed bath requires the care provider to clean the client’s entire body — head-to-toe. Whereas a partial bed bath is washing the important areas, such as the face, neck, axilla, hands, and peri-area. The peri-care, also known as perineal care, involves cleaning the urethra, vagina, or penis, perineum (the area between the vagina or penis and the anus), and anal areas. Peri-care is critical as this area is prone to infection and must be cleaned daily, especially if the client is incontinent.

Table 4.3.2 Procedure: Personal Hygiene Care (Partial Bed Bath)

STEP	ACTION	REASON
1.	Read the client’s “CARE PLAN”
2.	Call the client by their name. Introduce yourself and explain what you are going to do.	Minimizes embarrassment to the client by using clear and respectful communication.
3.	Wash your hands. Set up the environment and provide privacy. Make sure windows are closed and the room is warm enough. Assemble all supplies. For washing, you should have the following supplies ready: washbasin with warm water soap or Peri-wash 2 large towels 2 washcloths clean gown 2 pairs of gloves, lotion	Good organization saves time.
4.	Raise the bed to working height.	Allows the use of correct body mechanics and protects you from back injury.
5.	Lower the bedrails nearest to you. Place the towel across the client’s chest.	Safety and client’s comfort.
6.	Make a bath mitt with the washcloth by folding it over your hand. Wet the bath mitt and squeeze out excess water. Keep access to the water basin close to prevent dripping water over the client.	Provides a thick, soft surface to wash with. Bath Mitt
7.	Eyes: Do not use soap. Wash from the inner eye by the nose outwards. Do this as often as necessary to cleanse the eye. Use a different part of the face cloth with each wipe. Rinse the cloth before proceeding to wash the second eye. Note: Many clients will have mucous crusting caked along the eyelashes. To remove this crusting, fold a warm wet washcloth and place it over the eyes for a few minutes. Remove the cloth and gently wash away the crusting using the procedure for washing the eyes.
8.	Start with face, forehead, neck, ears: (outer ear and behind ear). Wash, rinse and dry. ASK the client if they want to use soap on their face. Remove gown.	Remember the principles of asepsis — do not transfer microorganisms from clean to dirty. Many clients have dry skin and do not need soap on their faces. Soap will dry the skin more.
9.	Axilla and Breasts Cover chest with a towel. If there is no other cover, use gown to cover the client’s chest. Expose only areas to be washed. Observe skin for redness, rash, scratches, broken skin, Lift breasts to observe and wash. Wash, rinse and dry axilla and under breasts. Then wash under each arm.	Privacy, self esteem. Always encourage independence and range of motion for joints.
10.	Hands Wash the client’s hands with wash cloth and dry thoroughly. If possible, it is desirable to soak the hands in a basin of water for comfort and thoroughness of cleansing. This can be done in bed with the basin placed on a towel, or with the client sitting up and the basin on the over-bed table.	Putting the hand in a basin of water is a more thorough way of washing the hand than just wiping it with a washcloth. It is also comforting and relaxing.
11.	Assist client to put on clean gown. Apply deodorant as desired by the client.	Self-esteem and comfort, as well as client comfort and privacy.
12.	GO TO PERINEAL CARE (Peri-care) INSTRUCTIONS FOR MALE AND FEMALE
13.	After completing peri-care, raise side rail. Empty and rinse wash basin and fill with clean water. Return to bedside and lower side rail. Turn the client on their side away from you.	For safety and medical asepsis.
14.	Back Place the towel along back on the bed. Wash, rinse and dry from nape of neck to lower back.	Prevent water dripping on bed linens to maintain medical asepsis.
15.	Back Massage Gently massage and check the entire back. Gently massage all bony prominences and pressure areas with non-prescription moisturizing lotion. Do not rub any reddened areas.	Promote self-esteem and comfort. Do not massage or rub hot reddened areas, as these may be the start of a pressure sore.
16.	Assist the client onto their back. Lower bed to lowest setting, return call bell. Open curtains.
17.	Clean area by placing dirty linen in hamper. Rinse the wash basin and return it and other items to the nightstand.	To maintain a tidy environment.
18.	Wash hands.	To maintain medical asepsis, to prevent cross-contamination.
19.	Report and record observations to supervisor.