Bathing safety

1. Bathing safety Annual compulsory education Revised February 2013

2. Learning Objectives • Increase your understanding of the safety issues associated with bathing and showering • Increase your understanding of the bathing and showering procedures • Increase your understanding of the acceptable temperature range, the procedure and documentation associated with temperature taking • Increase your understanding of the Brenda Strafford Foundation policies for bathing and showering • Increase your understanding of the procedures for nail care Revised February 2013

3. Bathing keynotes Purpose is to clean the skin, provide comfort and promote circulation Complete tub bath or shower at least once a week or as indicated on resident’s care plan Bathing too often or soaking in water for too long can lead to skin dryness and itching Always follow facility policy and resident’s care plan Revised February 2013

4. Aging Process Changes: • Skin dries, less elastic, wrinkles, fragile, tears and bruises easily • Fingernails and toenails thicken • Perspire less and decreased oil production • Temperature regulation is less effective • Less sensitive to heat, cold, pain and pressure Revised February 2013

5. Caution Elderly are at much higher risk of scalding during bathing or showering Diabetics and residents with circulatory problems are at extreme risk Revised February 2013

6. General Safety Issues Tub or shower must be cleaned and disinfected between each use per facility policy Check that all safety aids such as handrails, shower seats and hydraulic lifts are in good repair and proper working order Wipe up all water spilled on the floor immediately to prevent falls Room temperature comfortable and area clutter free Revised February 2013

7. General Safety rules (cont.) • Wear gloves if possible if there is contact with open sores or body fluids • Observe skin for changes. Report anything unusual to the RN • Transport the resident to and from tub room • Use good body mechanics to protect yourself and resident • Never leave resident alone in tub or tub room at any time Revised February 2013

8. Bathing Special Attention Should Be Given: Between the legs Under the arms Under the breasts Under the scrotum Between the buttocks Around the anus For obese people, under the folds of skin Between toes Revised February 2013

9. The same staff is responsible for filling tub, testing the water and bathing the resident Tub temperature must be between 38-43°C No resident should be placed in water over 43˚C Record the temperature on the tracking sheet after each temperature check Filling the Tub – key notes Revised February 2013

10. Procedure – filling the tub 1. Set tap at desired temperature between 38-43 2. If temperature does not record between do NOT use the tub – Report to Maintenance 3. Turn on water – Check water temperature with portable thermometer (check 1) 4. Record temperature on Tub Cleaning and Temperature Tracking Sheet 5. Close drainage plug if temperature is safe 6. Once tub is full, swirl water around with your forearm Revised February 2013

11. Procedure – Filling the tub (Cont.) 7. Check water temperature with portable thermometer until the temperature reading stays steady (check 2) 8. Record temperature on Tub Cleaning and Temperature Tracking Sheet 9. Right before placing the Resident in the water, use your forearm to test the water temperature for at least 5 seconds (check 3) 10. Record temperature on Tub Cleaning and Temperature Tracking Sheet Revised February 2013

12. Procedure – Hand Held Shower When using the hand-held shower to wash a Resident’s hair or provide a bath: 1. Use a controlled mixture of hot & cold water 2. Check water temperature by hand before directing water stream at the Resident (check 4) 3. Record temperature on Tub Cleaning and Temperature Tracking Sheet 4. Keep your free hand in the water stream as much as possible 5. Observe Resident for any indication of discomfort Revised February 2013

13. Cleaning the tub Tubs must be cleaned between residents Staff shall wear safety goggles and gloves Staff must be come aware of specialized cleaning procedures for the different tubs in their facilities Once the tub has been cleaned, you must record that you have cleaned the tub on the Tub Cleaning and Temperature Tracking Sheet Revised February 2013

14. Procedure – Providing a Shower Staff shall wear a plastic apron and rubber boots when providing a shower 1. Turn on water using a controlled mixture of hot and cold 2. Check water temperature by hand while the water is running 3. Assist Resident to the shower chair 4. Right before the Resident enters the shower check the water flowing from the shower head with the portable thermometer (check 1) 5. Record on the Shower Temperature and Cleaning Tracking Sheet Revised February 2013

15. Providing a shower (Cont.) 6. Have the Resident check the temperature of the water with their forearm if not contraindicated (check 2). If the Resident does not check the water then the staff providing the shower will use their forearm in the water for at least 5 seconds. 7. Record on the Shower Temperature and Cleaning Tracking Sheet 8. Check the water flowing from the shower again using the portable thermometer (check 3) 9. Record on the Shower Temperature and Cleaning Tracking Sheet Revised February 2013

16. caution If there is a difference in the 2 temperatures - recheck the water temperature with the portable thermometer - report to the RN immediately - DO NOT shower the Resident until the issue is resolved Revised February 2013

17. Cleaning the shower Showers must be cleaned between residents Staff shall wear safety goggle and gloves 1. Spray disinfectant over surfaces of walls and shower chair – Leave for 10 minutes 2. Scrub surface of walls & shower chair with soft bristle brush 3. Rinse all surfaces 4. Clean safety goggles with disinfectant - hang to dry Revised February 2013

18. Cleaning the thermometer After each resident, the portable thermometer shall be cleaned using Cavi – Wipes. Revised February 2013

19. Foot and Toenail Care Only simple nail care is to be performed by the HCA Nail care shall be provided weekly Perform nail care before the bath Each Resident must have their own nail care equipment that is supplied by the family Used nail equipment must be cleaned and disinfected after use Revised February 2013

20. Foot Care Process Collect resident’s individual foot care equipment Before the resident’s bath examine nails carefully for evidence of slight discoloration or breaks in the skin and report immediately to the RN/LPN Clip toe nails straight across Smooth rough edges of the nails with an emery board While resident is bathing, gently clean under toe nails Revised February 2013

21. Foot Care Process Give special attention to drying between the toes Apply lotion sparingly as needed, ensuring that the area between and under the toes is left dry Clean nail equipment and return to labelled bag Wash hands Revised February 2013

22. Bsf requirements • All RNs, LPNs and HCAs must complete the on-line Annual Compulsory In-service each year • All LPNS and HCAs must complete the hands on Annual Competency in Bathing and in Showering procedures each year Revised February 2013