Personal Hygiene
Objectives
• Define the key terms and key abbreviations in this chapter.
• Explain why personal hygiene is important.
• Describe the care given before and after breakfast, after lunch, and in the evening.
• Explain the purposes of oral hygiene.
• Describe the safety measures for giving mouth care to unconscious persons.
• Explain how to care for dentures.
• Describe the rules for bathing.
• Identify safety measures for tub baths and showers.
• Explain the purposes of perineal care.
• Identify the observations to report and record when assisting with hygiene.
• Perform the procedures described in this chapter.
• Explain how to promote PRIDE in the person, the family, and yourself.
Key Terms
Hygiene promotes comfort, safety, and health. The skin is the body’s first line of defense against disease. Intact skin prevents microbes from entering the body and causing an infection. Likewise, mucous membranes of the mouth, genital area, and anus must be clean and intact. Besides cleansing, good hygiene prevents body and breath odors. Good hygiene also is relaxing and increases circulation.
Culture and personal choice affect hygiene. (See Caring About Culture: Personal Hygiene, p. 336.) Some people take showers. Others take tub baths. Some bathe at bedtime. Others bathe in the morning. Some people bathe 1 or 2 times a day—before work and after work or exercise. Some people do not have water for bathing. Others cannot afford soap, deodorant, shampoo, toothpaste, or other hygiene products.
Caring About Culture
Personal Hygiene
Personal hygiene is very important to East Indian Hindus. Their religion requires at least 1 bath a day. Some believe bathing after a meal is harmful. Another belief is that a cold bath prevents a blood disease. Some believe that eye injuries can occur if bath water is too hot. Hot water can be added to cold water. However, cold water is not added to hot water. After bathing, the body is carefully dried with a towel.
From Giger JN: Transcultural nursing: assessment and intervention, ed 6, St Louis, 2013, Mosby.
Many factors affect hygiene needs—perspiration (sweating), elimination, vomiting, drainage from wounds or body openings, bedrest, and activity. Illness and aging can affect self-care abilities. Some people need help with hygiene. The nurse uses the nursing process to meet the person’s hygiene needs. Follow the nurse’s directions and the care plan.
See Body Structure and Function Review: Teeth, Gums, and Skin, p. 336.
See Focus on Communication: Personal Hygiene, p. 336.
See Focus on Children and Older Persons: Personal Hygiene, p. 337.
See Promoting Safety and Comfort: Personal Hygiene, p. 337.
Body Structure and Function Review
Teeth, Gums, and Skin
The Teeth and Gums
The teeth cut, chop, and grind food into small bits for digestion and swallowing. A tooth has 3 main parts: the crown, neck, and root (Fig. 22-1). The crown is the outer part. It is covered by enamel. The neck is surrounded by gums (gingivae). The root fits into the bone of the lower or upper jaw.
The Skin
The skin is the largest system. It is the body’s natural covering. There are 2 skin layers (Fig. 22-2).
Sweat glands (sudoriferous glands) help regulate body temperature. Sweat is secreted through pores in the skin. The body is cooled as sweat evaporates. Oil glands (sebaceous glands) secrete an oily substance into the space near the hair shaft. Oil travels to the skin surface. This helps keep the hair and skin soft and shiny.
The skin has many functions.
Focus on Children and Older Persons
Personal Hygiene
Older Persons
Some older persons resist your efforts to assist with hygiene. Illness, disability, dementia, and personal choice are common reasons. Follow the care plan to meet the person’s needs. Also see Chapter 49.
Bending and reaching are hard for older and disabled persons. Some have weak hand grips. They cannot hold soap or a washcloth. Adaptive devices for hygiene promote independence (Fig. 22-3). Always let the person do as much for himself or herself as safely possible.
Daily Care
Most people have hygiene routines and habits. For example, teeth are brushed and the face and hands washed after sleep. These and other hygiene measures are often done before and after meals and at bedtime.
Infants and young children need help with hygiene. So do some weak and disabled persons. Routine care is given during the day and evening (Box 22-1, p. 338).
• Early morning care (AM care)—routine care given before breakfast.
• Morning care—care given after breakfast. Hygiene measures are more thorough at this time.
• Evening care (PM care)—care given in the evening at bedtime.
You also assist with hygiene as needed. Always protect the person’s right to privacy and to personal choice.
Oral Hygiene
Oral hygiene (mouth care):
• Keeps the mouth and teeth clean.
• Prevents mouth odors and infections.
• Reduces the risk for cavities (dental caries) and periodontal disease.
Periodontal disease (gum disease, pyorrhea) is an inflammation of tissues around the teeth. Plaque and tartar build up from poor oral hygiene. Plaque is a thin film that sticks to the teeth. It contains saliva, microbes, and other substances. Plaque causes tooth decay (cavities). Hardened plaque is called tartar. Tartar builds up at the gum line near the neck of the tooth. Tartar buildup causes periodontal disease. The gums are red and swollen and bleed easily. Bone is destroyed and teeth loosen. Tooth loss is common.
Illness, disease, and some drugs often cause:
• A whitish coating in the mouth and on the tongue.
• Redness and swelling in the mouth and on the tongue.
• Dry mouth. Dry mouth also is common from oxygen, smoking, decreased fluid intake, and anxiety.
The nurse assesses the person’s need for mouth care. So may the speech-language pathologist and the dietitian.
See Focus on Children and Older Persons: Oral Hygiene.
See Delegation Guidelines: Oral Hygiene.
See Promoting Safety and Comfort: Oral Hygiene.
Focus on Children and Older Persons
Oral Hygiene
Children
Infants and young children need mouth care to remove food and bacteria. This helps prevent baby bottle tooth decay (early childhood caries). Common in the upper front teeth, it can occur in all teeth (Fig. 22-4). Prolonged teeth exposure to liquids containing sugar is the usual cause. Such liquids include breast-milk, milk, formula, fruit juice, and other sweetened drinks. Bacteria in the mouth use sugars in such drinks for nourishment.
To prevent baby bottle tooth decay, the American Dental Association (ADA) recommends the following.
• Wipe the gums with a clean, damp gauze pad or washcloth after each feeding.
• Brush the teeth when they begin to erupt. Use a child’s soft toothbrush and toothpaste. Brush gently.
• Ages 3 to 6 years—use a pea-sized amount of fluoride toothpaste.
• Supervise brushing until the child can spit out toothpaste. This is usually until age 6 or 7.
• Do not put the baby to bed with a bottle. Bottles should be finished before bedtime or nap-time.
• Do not dip a pacifier in sugar, honey, or anything sweet.
• Do not put a pacifier in your mouth to clean it. Bacteria in your mouth can be passed to the baby.
• Encourage drinking from a cup by the first birthday.
Flossing
Dental floss is a soft thread used to clean between the teeth. Flossing helps prevent periodontal disease and cavities by:
The ADA recommends flossing at least once a day. Usually done after brushing, it can be done at other times. Some people floss after meals. If done once a day, bedtime is the best time to floss or when the person has time to floss thoroughly. You need to floss for persons who cannot do so themselves.
See Focus on Children and Older Persons: Flossing.
Equipment
A toothbrush, toothpaste, dental floss, and mouthwash are needed. A toothbrush with soft bristles is best.
Sponge swabs are used for persons with sore, tender mouths. They also are used for unconscious persons. Use sponge swabs with care. Check the foam pad to make sure it is tight on the stick. The person could choke on the foam pad if it comes off the stick.
You also need a kidney basin, water cup, straw, tissues, towels, and gloves. Many persons bring oral hygiene equipment from home.
Brushing and Flossing Teeth
Many people perform oral hygiene themselves. Others need help gathering and setting up oral hygiene equipment. You perform oral hygiene for persons who:
See procedure: Assisting the Person to Brush and Floss the Teeth.
See procedure: Brushing and Flossing the Person’s Teeth.
Assisting the Person to Brush and Floss the Teeth
Pre-Procedure
1. Follow Delegation Guidelines: Oral Hygiene, p. 339. See Promoting Safety and Comfort: Oral Hygiene, p. 339.
• Toothbrush with soft bristles
• Mouthwash (or solution noted on the care plan)
• Straw
• Gloves
4. Place the paper towels on the over-bed table. Arrange items on top of them.
5. Identify the person. Check the ID (identification) bracelet against the assignment sheet. Use 2 identifiers (Chapter 13). Also call the person by name.
Post-Procedure
14. Provide for comfort. (See the inside of the front cover.)
15. Place the call light and other needed items within reach.
16. Raise or lower bed rails. Follow the care plan.
18. Wipe the over-bed table with the paper towels. Discard the paper towels.
20. Complete a safety check of the room. (See the inside of the front cover.)
21. Follow agency policy for used linens.
22. Remove and discard the gloves. Practice hand hygiene.
Brushing and Flossing the Person’s Teeth 
Pre-Procedure
1. Follow Delegation Guidelines: Oral Hygiene, p. 339. See Promoting Safety and Comfort: Oral Hygiene, p. 339.
• Toothbrush with soft bristles
• Mouthwash (or solution noted on the care plan)
• Straw
• Gloves
4. Place the paper towels on the over-bed table. Arrange items on top of them.
5. Identify the person. Check the ID bracelet against the assignment sheet. Use 2 identifiers (Chapter 13). Also call the person by name.
7. Raise the bed for body mechanics. Bed rails are up if used.
Procedure
8. Lower the bed rail near you if up.
10. Place the towel across the person’s chest.
11. Adjust the over-bed table so you can reach it with ease.
12. Practice hand hygiene. Put on the gloves.
13. Hold the toothbrush over the kidney basin. Pour some water over the brush.
14. Apply toothpaste to the toothbrush.
15. Brush the teeth gently (Fig. 22-5, p. 342). Brush the inner, outer, and chewing surfaces of upper and lower teeth.
16. Brush the tongue gently. Also gently brush the roof of the mouth, inside of the cheeks, and gums.
17. Let the person rinse the mouth with water. Hold the kidney basin under the person’s chin (Fig. 22-6, p. 342). Repeat this step as needed.
18. Floss the person’s teeth (optional).
a Break off an 18-inch piece of dental floss from the dispenser.
b Hold the floss between the middle fingers of each hand (Fig. 22-7, A, p. 342).
c Stretch the floss with your thumbs. Hold the floss between your thumbs and index fingers.
d Start at the upper back tooth on the right side. Work around to the left side.
e Rub gently against the side of the tooth. Use up-and-down motions (Fig. 22-7, B, p. 342). Do not jerk or snap the floss against the tooth. Work from the top of the crown to the gum line.
f Move to a new section of floss after every second tooth.
19. Let the person use mouthwash or other solution. Hold the kidney basin under the chin.
20. Wipe the person’s mouth. Remove the towel.
Post-Procedure
22. Provide for comfort. (See the inside of the front cover.)
23. Place the call light and other needed items within reach.
24. Lower the bed to a safe and comfortable level for the person. Follow the care plan.
25. Raise or lower bed rails. Follow the care plan.
27. Wipe off the over-bed table with the paper towels. Discard the paper towels.
29. Complete a safety check of the room. (See the inside of the front cover.)
30. Follow agency policy for used linens.
31. Remove and discard the gloves. Practice hand hygiene.
Mouth Care for the Unconscious Person
Unconscious persons cannot eat or drink. Some breathe with their mouths open. Many receive oxygen. These factors cause mouth dryness. They also cause crusting on the tongue and mucous membranes. Oral hygiene keeps the mouth clean and moist. It also helps prevent infection.
The care plan tells you what cleaning agent to use. Use sponge swabs to apply the cleaning agent. Apply a lubricant (check the care plan) to the lips after cleaning. It prevents cracking of the lips.
Unconscious persons usually cannot swallow. Protect them from choking and aspiration. Aspiration is breathing fluid, food, vomitus, or an object into the lungs. It can cause pneumonia and death. To prevent aspiration:
• Position the person on 1 side with the head turned well to the side (Fig. 22-8). In this position, excess fluid runs out of the mouth.
• Use only a small amount of fluid to clean the mouth.
• Do not insert dentures. Dentures are not worn when the person is unconscious.
Keep the person’s mouth open with a padded tongue blade (Fig. 22-9). Do not use your fingers. The person can bite down on them. The bite breaks the skin and creates a portal of entry for microbes. Infection is a risk.
Mouth care is given at least every 2 hours. Follow the nurse’s directions and the care plan.
See Focus on Communication: Mouth Care for the Unconscious Person.
See Promoting Safety and Comfort: Mouth Care for the Unconscious Person.
See procedure: Providing Mouth Care for the Unconscious Person.
Providing Mouth Care for the Unconscious Person
Pre-Procedure
1. Follow Delegation Guidelines: Oral Hygiene, p. 339. See Promoting Safety and Comfort:
b Mouth Care for the Unconscious Person
• Cleaning agent (check the care plan)
• Gloves
4. Place the paper towels on the over-bed table. Arrange items on top of them.
5. Identify the person. Check the ID bracelet against the assignment sheet. Use 2 identifiers (Chapter 13). Also call the person by name.
7. Raise the bed for body mechanics. Bed rails are up if used.
Procedure
8. Lower the bed rail near you.
9. Position the person in a side-lying position near you. Turn his or her head well to the side.
11. Place the towel under the person’s face.
12. Place the kidney basin under the chin.
14. Clean the mouth using sponge swabs moistened with the cleaning agent (see Fig. 22-8). Squeeze out excess cleaning agent.
a Clean the chewing and inner surfaces of the teeth.
b Clean the gums and outer surfaces of the teeth.
c Swab the roof of the mouth, inside of the cheek, and the lips.
e Moisten a clean swab. Swab the mouth to rinse.
f Place used swabs in the kidney basin.
15. Remove the kidney basin and supplies.
16. Wipe the person’s mouth. Remove the towel.
17. Apply lubricant to the lips.
Post-Procedure
19. Provide for comfort. (See the inside of the front cover.)
20. Place the call light and other needed items within reach.
21. Lower the bed to a safe and comfortable level for the person. Follow the care plan.
22. Raise or lower bed rails. Follow the care plan.
24. Wipe off the over-bed table with paper towels. Discard the paper towels.
26. Complete a safety check of the room. (See the inside of the front cover.)
27. Tell the person that you are leaving the room. Tell him or her when you will return.
28. Follow agency policy for used linens.
29. Remove and discard the gloves. Practice hand hygiene.
Denture Care
A denture is an artificial tooth or a set of artificial teeth (Fig. 22-10). Often called false teeth, dentures replace missing teeth. Tooth loss occurs from gum disease, tooth decay, or injury. Full and partial dentures are common.
• Partial dentures. The person has some natural teeth. The partial denture replaces the missing teeth.
Mouth care is given and dentures cleaned as often as natural teeth. Dentures are slippery when wet. They easily break or chip if dropped onto a hard surface (floors, sinks, counters). Hold them firmly when removing or inserting them. During cleaning, firmly hold them over a basin of water lined with a towel. This prevents them from falling onto a hard surface.
For cleaning, a denture cleaner, denture cup, and denture brush or toothbrush are needed. Use only denture cleaning products to avoid damaging dentures.
The manufacturer’s instructions tell how to use the cleaning agent and what water temperature to use. Hot water causes dentures to lose their shape (warp). If not worn after cleaning, store dentures in a container with cool or warm water or a denture soaking solution. Otherwise they can dry out and warp.
Dentures are usually removed at bedtime. Some people soak their dentures over-night in a denture cleaning solution. Rinse the dentures before they are inserted.
Some people do not wear their dentures. Others wear dentures for eating and remove them after meals. Remind patients and residents not to wrap dentures in tissues or napkins. Otherwise, they are easily discarded.
Many people clean their own dentures. Some need help collecting denture cleaning items. You clean dentures for those who cannot do so.
See Promoting Safety and Comfort: Denture Care.
See procedure: Providing Denture Care.
Providing Denture Care 
Pre-Procedure
1. Follow Delegation Guidelines: Oral Hygiene, p. 339. See Promoting Safety and Comfort:
• Denture brush or toothbrush (for cleaning dentures)
• Denture cup labeled with the person’s name and room and bed number
• Soft-bristled toothbrush or sponge swabs (for oral hygiene)
• Straw
• Mouthwash (or other noted solution)
• Gloves
4. Place the paper towels on the over-bed table. Arrange items on top of them.
5. Identify the person. Check the ID bracelet against the assignment sheet. Use 2 identifiers (Chapter 13). Also call the person by name.
Procedure
8. Raise the bed for body mechanics.
9. Lower the bed rail near you if up.
10. Practice hand hygiene. Put on the gloves.
11. Place a towel over the person’s chest.
12. Ask the person to remove the dentures. Carefully place them in the kidney basin.
13. Remove the dentures if the person cannot do so. Use gauze squares for a good grip on the slippery dentures.
a Grasp the upper denture with your thumb and index finger (Fig. 22-11, p. 346). Move it up and down slightly to break the seal. Gently remove the denture. Place it in the kidney basin.
