Hygiene systems are designed to improve wellbeing for residents as well as helping to reduce the challenges that can often be associated with assisted hygiene. Carol Hucknall, who is responsible for patient handling consultancy and education at Arjo, considers the options available
Hygiene care tasks can be a significant challenge for time pressured care givers as the number of frail, elderly, heavy or dependent residents with complex health issues continues to rise.1
Decisions regarding how people access hygiene facilities are made by care givers many times each day and these decisions and the resulting choices made can impact on resident dignity, comfort and safety as well as increasing the physical load and workload of their carers.
In-bed hygiene may not always be the most effective way of washing a resident, although it may be the most appropriate solution. For those who are unable to get out of the bed, it may be the only way to meet their hygiene needs.
Showering may be preferred for frequent or daily personal hygiene procedures. A shower can help the resident feel clean and fresh. It is also an opportunity to check for any changes in tissue integrity. The skin protects the body and showering may help to protect the skin.
Bathing may also have health benefits and can have an important role in nurturing wellness and improving quality of life. It has been recognised as a pleasurable and relaxing experience for centuries.
Maintaining mobility
Maintaining and promoting resident mobility is considered crucial for good quality care. By matching those needs, hygiene equipment can provide a level of support designed to maintain and where possible encourage and promote mobility.
Effective hygiene through showering and bathing is becoming increasingly important for individuals with impaired mobility and reduced cognitive function. During the hygiene process, residents are encouraged to wash themselves as this provides an opportunity to help them maintain their personal hygiene and can contribute to their independence, comfort, safety, wellbeing and dignity.4
Out of bed hygiene can offer a natural and pleasurable way to encourage residents to maintain a mobility maintenance programme. Bathing in warm water may offer important benefits for people with limited joint mobility as they try to regain movement during rehabilitation.2Immersion in warm water may ease muscle tension and increase blood circulation.3Importantly, being immersed in water makes the body feel lighter and may reduce the load on joints and make movement easier.
The benefits of bathing
Bathing promotes health benefits and can have an important role in nurturing wellness and improving quality of life. It has been recognised as a pleasurable and relaxing experience for centuries and is the basis for providing effective personal hygiene as well as promoting a sense of wellbeing. A warm bath can relax both muscles and mind.5
Goto et al suggest that routine immersion experienced during bathing can have positive effects on both psychological and physiological health, which includes lowering stress and anxiety levels as well as increasing hyperthermic action, which increases blood flow.6
The relaxing nature of bathing in warm water has shown positive clinical results, potentially diminishing the need for painkillers and sedatives.7It may also reduce stress and anxiety and improve sleep,2while the use of music can lessen responsive behaviours in those with dementia.8,9
Associated challenges
Carrying out hygiene tasks may be difficult for care givers and residents. However, there are a number of risks that can be minimised by using suitable assistive equipment and adopting best practice.
For the resident, risks include:
- falls- wet bathroom floors can be particularly hazardous, especially for those with restricted mobility.10Therefore the right equipment should be used
- infection– there may be a risk of cross infection through sharing bath tubs unless a robust decontamination process or backflow prevention solution are used
- scalding- there is a risk of scalding if the bath does not have TMV3 type mixer taps
- adverse skin damage- for preventive skin care there is a need to keep the skin clean.11Pressure ulcers and/or moisture associated skin damage may develop if proper hygiene is not performed
- wellbeing, dignity and experience Hygiene events can be rushed with a focus on getting residents clean quickly and have a significant impact on a person’s wellbeing and quality of life
For the care giver, risks include:
- injury- hygiene tasks expose care givers to a high risk of back and shoulder pain and injury12
- efficiency - efficiency of providing hygiene care is dependent upon the mobility levels of the resident, the type of equipment available and appropriate training received13
- responsive behaviours- the pressures on a care environment and individual carers to mitigate episodes of responsive behaviour that may be exacerbated by daily activities such as hygiene needs, as well as the moments of friction they entail, can be significant.
Facility related risks include:
- limited space- limited space for transfer and a lack of appropriate lifting and showering equipment may increase the risk of injury in residents and care givers, which can also result in an increase in staff sick leave or turnover
- environment- the environment can vary between en-suite facilities for use by one person and shared bath or shower rooms. The more flexible the design, the better the environment can be adapted for individual needs including either assisted or independent showering or bathing.
Minimising risk
Postural overload is one of the most common challenges for care givers when assisting with resident hygiene tasks. Height adjustable bathing equipment can result in significantly less stress on the musculoskeletal system, especially when compared to a fixed bath, fixed shower trolley, fixed shower chair or hi-low bed.14
Bathing a resident using a high-low bath can reduce static overload on the care giver’s back by over 15 per cent when compared to using a fixed height bath.14
In their study, Knibbe et al(2016) showed that the care giver often determines the time taken for washing, depending upon the perception or subjective feelings of the resident. They also suggest that when bathing and showering, care givers often make the most of the ’wellness opportunity’, rather than just performing the assisted hygiene routine.15
Functions on a bathtub that save time at the pre-bathing stage, such as a pre-fill function, can provide more time for positive wellbeing opportunities with residents while they are in the bath.
The good fit between hygiene equipment and resident transfer hoists is also of the utmost importance and may ease the transfer process and contribute to overall efficiency.
The right skills
It is crucial that a carer working with people living with functional mobility or cognitive impairment can personalise the care of each individual in a sensitive manner.
In 2010, the Department of Health set out a range of best practice benchmarks, which include the requirement to assess an individual’s hygiene needs combined with the routine planning, evaluation and revision of how these are delivered. In addition, advice and assistance should be delivered in a safe and appropriate environment by knowledgeable and skilled carers to ensure these needs and preferences are met.16
A hygiene assessment should consider pain, mobility, sensation, vision, hearing, dizziness and balance as well as the carer considering the resident’s preferences, mood and function every time they approach them.
A person´s need for support with personal hygiene can increase gradually as functional mobility is lost or a cognitive impairment progresses and the loss of independence, dignity and privacy can be intimidating, unpleasant or even threatening, especially for a person with dementia.
Conclusion
There are a number of choices when it comes to performing personal hygiene, with the most appropriate depending on an individual’s functional mobility and other health aspects.
Conclusion There are a number of choices when it comes to performing personal hygiene, with the most appropriate depending on an individual’s functional mobility and other health aspects.
Investing in the right environmental architecture and assistive equipment and adopting the best care practices can provide optimal conditions to promote and enhance mobility.
Promoting mobility can reduce the need for support, reduce the risk of injury and improve overall operating efficiencies, which ultimately will result in improved quality of care and optimised financial outcomes.
References available on request
arjo
Head Office, Houghton Hall Business Park, Houghton Regis LU5 5XF
Phone: +44 (0) 8457 342000
Private customer: +44 (0) 3457 342000
Fax: +44 (0) 1582 745745
Email: sales.admin@arjo.com www.arjo.com
