Personal Hygiene for Physical Impairment

Definition

Personal hygiene refers to maintaining cleanliness of one's body and clothing to preserve overall health and well-being. It includes a number of different activities related to the following general areas of self-care: washing or bathing, oral hygiene, grooming and dressing, keeping one's clothes clean, and toileting. These are sometimes described (along with such other daily tasks as preparing meals or managing finances) as activities of daily living or ADLs. Physical impairments may affect a person's ability to maintain personal hygiene in all these areas or in only one or two.

Purpose

Personal hygiene is a preventive health measure that serves emotional and social as well as physical well-being. Personal hygiene:

• protects against the spread of disease from external parasites (such as body or head lice) or from contact with contaminated feces or other body fluids
• protects the skin against rashes and sores from contact with urine
• protects against malnutrition or swallowing difficulties caused by lack of oral care
• minimizes the chances of social embarrassment, job loss or educational failure, and eventual isolation from others
• keeps up morale and helps avoid depression

Precautions

Maintaining personal hygiene in someone with physical impairments requires a thorough assessment of the patient's living circumstances, as well as the nature and severity of the impairment itself. Factors that should be evaluated include the following:

• duration of the impairment; that is, whether it is temporary or permanent. A person recovering from joint replacement surgery has only temporary limitations on their mobility compared to someone permanently paralyzed below the waist.
• organs or organ systems affected. Limited mobility leads to a different pattern of problems for maintaining personal cleanliness than impaired hands or wrists (the most common single impairment in patients with osteoarthritis), an ostomy, or impaired vision or hearing.
• severity of the impairment. Some patients may be able to take care of personal cleanliness and grooming with the help of personal assistive devices (canes, walkers, etc.), special tools or devices designed for arthritic hands, or environmental changes (furniture rearrangement, installation of grab bars, a seat and hose attachment in the shower, a raised toilet, etc.), while those who are completely bedridden may need help with nearly all aspects of personal hygiene.
• coexisting cognitive or emotional impairments. These can complicate maintaining personal hygiene in persons with physical impairments.

In the specific case of incontinence (inability to control the passage of urine or bowel movements), a doctor should examine the patient to determine the cause. There are several different physical causes that may contribute to incontinence: structural abnormalities or weak muscles in the area of the bladder or anus; diseases that affect the nerves leading to and from the colon or bladder; medications that interfere with normal patterns of elimination; or difficulty reaching the bathroom quickly because of mobility impairments. Urinary incontinence is a particularly important hygienic problem because it is the single most common reason for institutionalizing physically impaired elderly patients.

Relatives or health care professionals who may provide short- or long-term assistance with personal care should be sensitive to the psychological impact of needing help with such activities as bathing, toileting, or dressing. These are basic markers of independence in children as well as adults, and are also usually carried out in private. To have someone else look at or touch one's body in order to maintain basic cleanliness is uncomfortable for most people. In general, it is best to let the patient do as much of the washing or toileting as he or she is able to perform.

Description

It is difficult to describe a typical routine for maintaining personal for a patient with physical impairments because of the variety of types of impairment, as well as the wide range of severity associated with physical impairments. In the case of a patient who needs assistance with all aspects of personal cleanliness, the following is a summary description:

• bathing or washing. The caregiver must be careful to support the person (if a stool or bath seat is not used) at all times. They should never leave the patient alone in the tub or shower, as falls or other accidents can easily occur. It is also important to check the temperature of the water to make sure it is not too hot. The patient may be able to wash him- or herself once seated; if not, the caregiver must be careful to wash the genital areas and all body folds (including the area under the breasts in women). Bubble bath and bath oils should be avoided, as they can make the tub or shower slippery. Soap should be thoroughly rinsed off to avoid irritating the skin. The patient should be dried off completely with a towel. During the bath or shower, the caregiver should check for skin rashes, pressure sores, or similar problems and report them to the doctor. If the patient is completely bedridden, a sponge bath can be given, using a bowl of warm water with a small amount of soap and a soft washcloth.
• dressing and grooming. Looking one's best is important to self-esteem. It is helpful, however, to simplify dressing and grooming for a physically impaired person by choosing clothes and shoes with pull-on styling or Velcro fasteners and to arrange the hair in a simple style that is easy to wash and does not need setting. The caregiver may also need to do the patient's laundry or periodically trim fingernails and toenails if the patient cannot do these things.
• oral hygiene. The caregiver may need to brush the patient's teeth or clean their dentures, which must be done on a daily basis. Some dentists recommend foam applicators instead of brushes for cleaning the teeth of persons with physical impairments. If a brush is used, an electric model may be more efficient than a standard toothbrush. The caregiver should also check the person's mouth and gums for ulcers or irritated areas.
• toileting. Many persons with physical impairments find it easier to use a toilet with an elevated seat There should be supports or grab bars on each side of the toilet to minimize the risk of falls. It is important to remove soiled or wet clothing and cleanse the patient's body as quickly as possible if they cannot get to the toilet in time or are chronically incontinent. The area around the urethra or anus should be washed and carefully dried to prevent skin irritation. Baby powder or corn starch may be used to help keep the skin dry.

Preparation

Preparation for maintaining personal hygiene in a physically impaired person should include the following considerations:

• a safety evaluation of the person's apartment or room for such features as adequate lighting, non-slip flooring, hand rails or grab bars, properly secured electrical cords and household chemicals, and similar considerations. The temperature setting of the hot water supply should be checked to prevent accidental scalding.
• assessment of the type and frequency of assistance needed, if any, and the qualifications of the caregiver, if one is required.
• storing clothing, personal care supplies, assistive devices, etc. close to where they are used.

KEY TERMS

Activities of daily living (ADLs)— A shorthand term for the everyday tasks that must be carried out to maintain basic cleanliness, nutrition, contact with others, etc.

Incontinence— Inability to control one's bowel or bladder functions.

Ostomy— A general term for a surgical procedure in which an artificial opening is made for the drainage of body wastes.

Health care team roles

A person with physical impairments may require the assistance of one or more of the following health care professionals, depending on the extent and complexity of their impairment:

• occupational therapist. Some patients may be able to manage bathing, dressing, and oral care with instruction or rehabilitation techniques.
• physical therapist. Patients whose impairments are temporary may benefit from exercises designed by the therapist to help them with ADLs as well as regain general mobility and functioning.
• homemaker. Some patients may require assistance with laundry, changing bed linens, or shopping for food, personal care items and clothing. Homemakers do not usually provide direct assistance with personal care, however.
• home health aide. Home health aides are trained to assist patients who require help with bathing, toileting, oral care, and other ADLs. They may also give advice or instruction about personal cleanliness and self-care.

• social worker or registered nurse. These professionals typically supervise aides employed by home healthcare agencies; they may or may not have direct contact with the patient.

Resources

BOOKS

Beers, Mark H. and Thomas V. Jones. Section 1, "Basics of Geriatric Care," in The Merck Manual of Geriatrics, 3rd ed. Whitehouse Station, NJ: Merck, 2005.

Mace, Nancy L. and Peter V. Rabins. The 36-Hour Day, revised and updated edition. New York: Warner Books, Inc., 2001; by arrangement with The Johns Hopkins University Press

Morris, Virginia. How to Care for Aging Parents, revised edition. New York: Workman Publishing, 2004.

Silber, Irwin. A Patient's Guide to Knee and Hip Replacement. New York: Simon & Schuster, 1999.

PERIODICALS

Dunn, Joshua C., Brenda Thiru-Chelvam, and Charles H. M. Beck. "Bathing: Pleasure or Pain?" Journal of Gerontological Nursing 28 (November 2002): 6-13.

"How to Give a Bed Bath." CareNotes (March 1, 2005) np.

Quinn, M. E., M. A. Johnson, E. L. Andress, et al. "Health Characteristics of Elderly Personal Care Home Residents." Journal of Advanced Care Nursing 30 (August 1999): 410-417.

Westhoff, G., J. Listing, and A. Zink. "Loss of Physical Independence in Rheumatoid Arthritis: Interview Data from a Representative Sample of Patients in Rheumatologic Care." Arthritis Care and Research 13 (February 2000): 11-22.

ORGANIZATIONS

American Physical Therapy Association (APTA). 1111 North Fairfax Street, Alexandria, VA 22314-1488. (703) 684-APTA. Fax: (703) 684-7343. http://www.apta.org.

National Association of Certified Caregivers/Personal Support Workers (NACPSW). P.O. Box 175, Owen Sound, ON, Canada N4K 5P2. (519) 376-7396. Fax: (519) 376-6772. http://www.nacpsw.org.

National Association for Home Care and Hospice (NAHC). 228 Seventh Street, SE, Washington, DC 20003. (202) 547-7424. Fax: (202) 547-3540. http://www.nahc.org.

OTHER

United States Department of Labor, Bureau of Labor Statistics. Occupational Outlook Handbook: Personal and Home Care Aides. Washington, DC: Bureau of Labor Statistics, 2005.