Hygiene refers as a practise that associated to ensuring good health and cleanliness. In medical terms, its definition means the science of preventive medicine and the preservation of health (Nicolle L, 2007). According to Sinclair J. it means the practice of keeping yourself and your surrounding clean, especially in order to prevent illness or the spread of disease (2003). All of this proposal can give rise to a conclusion that the hygiene is the fundamental matter that applied to the people. The term hygiene comes with different condition such as personal hygiene, domestic hygiene, dental hygiene, and occupational hygiene (Nicolle L, 2007). The hygiene care is very crucial especially in the hospital because dirty wards can contribute to increasing rates of meticillin-resistant Staphylococcus aureus (MRSA) attainment (Dancer S.J, 2008). Furthermore, the hospital environment is the area with many pathogens and microbes in its surrounding such as Salmonella or Shigella spp. and Escherichia coli (Hospital hygiene and infection control, para. 13). That is the reason why the hygiene among the patient needed to put in the towering priority to complete the client’ recovery process. It has many purposes to concern about the hygiene care such as to removes transient microorganism, increase self esteem, maintaining a good health and correlation of good health.
The most imperative care that must give the higher precedence in the hospital is the client’s personal hygiene. Over the decade, there are many changes occur to the personal hygiene with one goals that to achieve the highest level of hygiene among the client (Parker L, 2004). These changes either in term of procedure or facilities provide more comfortable environment to the client for daily activity in the hospital. Personal hygiene is the self care by which people attend to such functions as bathing, toileting, general body hygiene and grooming (Kozier, Erb, Berman & Snyder, 2004).
Bathing is common activity applies by all people to keep the cleanliness and refresh the human body. It has applied with miscellaneous method as long as convenience with the person’s condition. In hospital, for the client with immobility or weakness, the bed bath is the answer to this problem. Bed bath is referring to bathing patient at the bed side using small towel, shampoo, soap, and warmth water (Heckenberg G, 2008). Bed bath is considered a necessary and therapeutic nursing intervention since it provides hygienic care to clients.
In fact, bathing and nursing have gone simultaneously since the time of Florence Nightingale (Dunn J.C., Chelvam B.T. & Beck C.H.M., 2004). She was elucidating the methods of bathe in term that integrated the therapeutic effect of the bath, as well as its function to purify the body. For unconscious patient that unable to perform personal hygiene cause of acute illness and chronic debilitation, bed bath has long time take part in order to increase the patient cleanliness (Dancer S. J., 2008). The importance of bed bath are to remove transients microorganism, promote relaxation and comfort, promote blood circulation, regain the good body image, prevent the lower body odour, promote joint and muscle movement. Besides that, it will help nurse to do assessment on the skin and patient physically (Kozier, Erb, Berman & Snyder, 2004).
Before performing the bed bath, staff nurse should have understanding about six principles of bed bath procedure. That principles are, staff nurse should wash from the clean area to dirty area, from the upper level to lower level, from anterior to superior, clean the area at the far from staff nurse followed by closer to the staff nurse, exposed the body part involved only and change the water when water is dirty(Potter P. A et. al, 2005). All this principles was established to ensure bed bath will be performed completely and impressive to achieve the highest level of hygiene and also contribute to the healing process of the client.
One research was performed to study about the effectiveness of traditional basin bath and unexpectedly microbiological effect the bathing in general (Larson E.L et.al; 2004). Basically, bacteria from the client’s body remains in the basin because staff nurse using the same basin of water after wash the first part of client body. When the staff nurse wash another part of the body, bacteria from the basin can transfer again to the client’s body and this will reduce the effectiveness of the bed bath. This method of bathing should be improved to another technique such as disposable bed bath in order to manage the conscious or not critically ill client. Four basic elements can take as a consideration to change the technique of bathing to the disposable bed bath which is time and quality, skin microbiology, nurse satisfaction and cost (Larson E.L. et. al, 2004). From that study, its show the time needed is less and the quality is higher rather than using basin bath. Furthermore, the nurse also satisfies with this technique because less infection of skin microbiology. Although some people claimed that the usage of disposable bed bath increase in expenditure both of the client and hospital, it is still in doubt because there are nothing more important than health as a proverb said “health is wealth”.
Furthermore, another research was show that the using of soap on the client can cause dry the skin (Heckenberg G, 2008). As another option, the use substitute soap must take consideration like bath gel, shampoo body or soap without perfumed and rich in moisture. Besides that, if the soap used can’t be avoided and consequently cause the dry skin, the author think staff nurse can use the cream body to moisture the skin.
Oral hygiene is referring to the care of the oral cavity that includes the whole area of the mouth. The importance of oral hygiene is to help maintain the healthy state of the mouth, teeth, gums and lips. Besides that it will brush outs the teeth of food particles, plaque and bacteria as well as massages the gums and relieves discomfort resulting from unpleasant odour and testes (Potter P. A et. al, 2005). Complete oral hygiene enhances well-being comfort and stimulates the appetite. A client’s oral health affects his or her general level health and rate of recovery.
In caring the client’s oral hygiene, there are many type of tool capable to monitoring patient’s need, evaluating care and identifying potential problem. In hospital, the usage of the manual toothbrush for unconscious client should be change due to ineffectiveness removal of plaque and prevention of periodontal disease. As the author compared to the gentle brush, its efficiency is more rather than the manual toothbrush. Besides that, using the toothbrush in conjunction with fluoride toothpaste is important for properly removing the toothpaste as it has drying effect on mucosa (Munn Z, 2007).
For the conscious client, the assisting from the nurse is highly required in maintaining good oral hygiene. Nurse can help the client by teaching the importance of correct techniques and a routine daily schedule (Potter P. A et. al, 2005). The observation from the nurses is also needed to determine the level of assistance that client need. The author think, staff nurse can involve in helping client with provide short and simple instructions, using ‘watch me’ technique and monitor daily oral care. In addition, training of nurses in the assessment and implementation of oral care protocols may improve the oral health of client.
Elimination of waste consists of two elements which is bowel elimination and urinary elimination. Regular bowel and urinary elimination of waste product is a basic process that most people take for granted. These process essential for normal body functioning and any alterations in both types of elimination affect from the imbalance of several factors, elimination patterns and individual habits. Besides that, there are many factors that influence the bowel elimination like age, diet, fluid intake, physical activity, psychological factors, personal habits, position during defecation, pain, pregnancy, surgery and anaesthesia, medications and diagnostic test (Kozier, Erb, Berman & Snyder, 2004). Commonly, in ward the immobilized patient can perform the elimination process at the bed using the toileting facilities such as bed pan for both bowel and urinary elimination.
In order to perform the elimination process to the client, staff nurse must consider many aspects such as client’s culture and background because it is the private activity.
“The elimination of waste is a personal and private activity that individual do not share with others” (Potter P. A et. al, 2005).
Sometimes the client feels shy and uncomfortable to perform this elimination process especially with present of many people in the ward during visiting time. In this situation, staff nurse needs to give more attention to client’s privacy with pull the curtain around client’s bed and also avoid the other people to look beyond the curtain. Keeping the client’s privacy in elimination process is important in order to improve the hygienic to the client.
Moreover, some clients have their own mode during pass the bowel. For instance some client likes to read the newspaper, hear the music and some client like the silence environment. That why, staff nurse also take it under consideration about the client need to make client’s elimination process run smoothly and easier to keep the client hygienic. Last but not least, the important aspect to consider on issue of improving client’s hygiene in elimination waste process is the staff nurse itself. Staff nurse needs to understand the elimination process, find acceptable solutions for any problem and provide understanding and sensitivity to all client needs as the author have discussed above.
For hair care of the client, it’s not complicated rather than the other self care elements. This is because the hair is exposed to the surrounding so the extra care for this part of body diminishes. Although the care of hair is simple compared to the others, but it’s also have a role for person’s health. According to the Potter P.A. et. al 2005:
Hair growth, distribution and pattern indicate a person’s general health status.
Hormonal changes, emotional and physical stress, aging, infection, and certain illnesses affect hair characteristics. The hair shaft itself is lifeless, and physiological factors do not directly affect it. However, hormonal and nutrient deficiencies of the hair follicle cause changes in its colour or condition (p. 852).
Among the deviations from normal hair is patches of hair loss (alopecia), very thin hair (hypothyroidism), excessively oily or dry hair, flaking, sores, lice, nits (louse eggs) and ringworm and irsutism (abnormal hairiness) in women. The purposes of providing hair care for clients in the hospital is to stimulate the blood circulation to the scalp, distribute hair oils as well as provide a healthy sheen, increase the client’s sense of well-being and to assess or monitor hair or scalp problems of the client (Kozier, Erb, Berman & Snyder, 2004).
In hair care for client, the comb that uses to comb the hair of client is equal for the other client. This action may causes lice or nits transfer to the other client that uses the same tomb. The author thinks that, hospital should provide the self comb to each client or advice client to use their own comb. If the expenditure issue blocked this suggestion, maybe the nurse should wash the tomb first before use it for another patient. This step is important to ensure the client can get the full care of hygiene and avoid from any infections.
In conclusion, the author would like to reiterate that hygiene is very important to the people. Personal hygiene which is bathing, oral care, hair care as well as bowel and urinary elimination influences client’s comfort, safety and well being in the hospital. Improving the client hygiene contribute to the enhancement recovery process and defend the infections of microbe as well as provide the more comfortable condition to the client. The hospital’s management should take part seriously in the developing new hospital’s facilities for client needed. Time ahead is still broad open for new technology to keep clients cleanliness to improve beyond today’s expectations.