Personal Hygiene Support When Immobile

Sally Madeley-Carr, OT
21 Oct 2022

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There are many situations in life which bring about the need for an individual to spend a long period of time in bed. These can include illness and accident (plus appropriate rehabilitation), as well as a weakening frame and instability brought on by old age.

Having to be supported with personal hygiene needs whilst in bed can be embarrassing and have a detrimental effect on one's personal esteem and character, even though time in bed might be for only a short period of time (e.g. two weeks or so), as opposed to permanently.

Giving such personal and constant care to someone close to you can alter the dynamics of that relationship e.g. husband and wife may eventually feel more like patient and carer, as closeness becomes more of a task than a relationship. 

A Starting Point in Caring for Another

Environment is so important, as light, airiness and fresh air, as well as good communication and interaction, send positive vibes to the individual needing your support. A clean and organised room, as well as sunlight and a good view are all therapeutic.

Changing the individual's clothes and also the bed linen are important feel good factors too.

The individual spending time in bed will have many thoughts running through their mind, including thoughts relating to the situation they find themselves in and their expected future.

Showing that one really does care about giving the right support sends the right signals for positive improvement.

Why Movement is Important

Lack of exercise or movement for even the fittest person can make everyday tasks a little more cumbersome, as muscles and joints need movement.

For the person who needs to spend many days lying down, consideration needs to be given to some form of exercise, always appropriate to the person's health and reason for being in bed.

There is also the need to help the individual with occasional movement of the body, as lying without movement for even just a few hours can cause bedsores to develop. Also known as pressure sores, these sores come as a result of the pressure of the body on a sensitive skin part, which interrupts the flow of blood through that area.

Don't allow the upper body to be raised more than thirty degrees, as more than this can cause the body to slide down the bed and, in so doing, cause bed sores to appear on the bony areas of the body.

Should bed sores start to appear, try to keep the pressure off that particular point, to allow healing to commence.

Mild ointments, such as antibiotic cream and petroleum jelly (e.g. Vaseline) will help keep the skin from becoming too dry and so aid recovery.

Personal Hygiene

Personal hygiene includes bathing or showering, cleaning our teeth, eye and ear care, washing our hair and nail care.

The individual who finds him-/ herself confined to bed for some time, will need support with some, or maybe all, of these tasks during their time of immobility. Whilst immobile, these tasks will most often be performed in the bedroom:-

• A Body Wash

A body wash involves placing a towel under the individual who is in bed, in order to keep the bed dry during the washing process. Take step-by-step action, to make the process quick and comfortable:-

1. With the sheet and blanket (or duvet) still in place (for both warmth and dignity), begin by cleaning and freshening up the person's face, using non-perfumed soap and a flannel. Dry off with a warm towel.
2. Uncover the top part of the body and proceed to wash the upper body, with particular attention to the armpits and hands. Dry off the face, upper body, arms and hands.
3. Cover the upper body with a dry towel and proceed to clean the lower body, legs and feet. Dry off these parts of the body.
4. If it is safe to do so according to the person's health situation, roll the person over onto their side and gently wash the person's lower body and private region. Dry off with a clean and warm towel and roll the person back onto their back.
5. Finish the body wash, by applying the same gentle care to the person's legs and feet.

• Cleaning Teeth

Make it regular practice to have toothpaste and a toothbrush at hand for the individual in your care, either for them to clean their own teeth in their own time, or for you to help with the process, maybe after every meal, or at least morning and night.

If the individual has false teeth (dentures), remember that these also need regular care.

• Eyes and Ears

Eyes and ears can be cared for during the body wash process, though be aware of any eye infection or build up of wax, which may need attention.

• Hair

Whilst a dry shampoo can be used to remove oil from one's hair maybe a couple of times a week, it will not replace the pleasure of having one's hair touched by warm water and shampoo. 

The way to do this is to:-

• place a towel under the person's head and shoulders
• brush the hair to remove any tangles and to make it ready to shampoo
• spray the hair with warm water
• rub shampoo (don't apply too much) into the scalp and work the washing process down the length of the prepared hair (or try adding this shampoo to the first spraying of the hair)
• spray again with warm water, to remove the shampoo residue (you might have to repeat this rinsing process, to remove all shampoo residue still present)
• towel dry and then finish the drying process with a hairdryer.

• Nail Care

Nail care is about keeping the nails clean and also about keeping them short, or to the individual's desire. Any everyday dirt which gathers under the nails can lead to a buildup of bacteria which, if transferred to the skin via scratching, can lead to infection.

Once personal care is completed, the individual will be in a better frame of mind and ready for the day.

Toileting  

Using a toilet is a personal experience and so having to be helped with this function will not come easily to the individual needing support, or to the person giving support. Finding the right equipment to make this function as hassle-free is paramount.

• Passing Urine

If an individual can't leave his / her bed to pass urine, a urine bottle with lid (portable urine bottle) allows the person to relieve their bladder in situ. Urine bottles come in different designs, especially to match the individual's male or female anatomy.

• Males

Shaped rather like a bottle, the individual may need only cognition and the use of his arms to use the portable urine bottle unaided.

To support an individual to use a urine bottle, it proves easier if the person can reach a sitting position, before use.

Place the bottle between the user's spread legs and then cover the bottle and the user's lower body with a towel or sheet, so that the process remains private to them.

Empty the bottle and remember to wash it out with soapy water at least twice a day, bleaching the bottle out at least once a week.

• Females

Shaped like a jug, there is a right and a wrong way to use it. With legs spread, the opening of the urine bottle is placed into position, with the handle uppermost when in use. To use it successfully, pressure needs to be applied between the body and urine bottle to create an airtight joint, so as to prevent leakage.

Empty the bottle and remember to wash it out with soapy water at least twice a day, bleaching the bottle out at least once a week.

• Bed Pans

Bed pans can be used for urination but are more purposeful for bowel movements.

A bed pan can be either regular or fracture (also known as slipper):-

• the regular is the larger of the two and is most often used for people who are incontinent
• the slipper bed pan has one flat end, for use with individuals who can't sit up, or shouldn't be moved e.g. hip replacements and hip or leg fractures. The wedge shape slides easily under the body and a fitted lid allows for safe transport, without spilling or leakage.

NB - Shaving and ladies' personal needs can also be handled from the bed position.

Summary

To prevent bedsores, reposition the person every two or three hours, to once again allow blood to flow freely through that area.

A urine bottle carrier is a handy piece of equipment, particularly if the individual can use the bottle when on their own and wish to stand the bottle safely, for later emptying.

When purchasing a slipper bed pan, always look for the lidded design which seems most practicable for straightforward use.

It is the whole environment which promotes good care and positive vibes, so pay attention to room cleanliness, good communication and conversation, personal hygiene and your relationship with the person you are supporting during their period of immobility.