Hygiene disaster areas

Nurses General Nursing

Published

Specializes in ER.

We have had some real winners come into the ER that have not bathed in years. Literally years. Funky smell, obviously, but with rough tanned bumpy skin, dirty long nails, and hair with foreign material matted and caked. I make a project out of them, and do a bit at a time, but I don't want to humiliate them either. I assume that if I'm respectful the benefits of scrubbing outweigh the embarrassment.

So the last guy that came in like that Was a GI bleeder and had been incontinent. There was lots to do, basically from the waist down. I was scrubbing away to get dried blood off, and found that what I thought was a combination of weathered skin, and moles... washed off to reveal a regular foot. Arghhhh. Next I scrubbed a clean spot for each EKG lead, since the stickers weren't sticking until I used elbow grease. I swear there was 1/4" of dirt almost everywhere.

He was dirty enough that I tossed each washcloth in the laundry after cleaning about a playing card size spot. I was worried about causing pain with strong scrubbing, or cold because the process was taking so long, or skin abrasions/injuries because I was taking a protective layer off. Seriously.

How do you go about this kind of indepth cleaning? How do you talk to the patient, mine have all been quiet, but seem mostly glad to have it done. Do you soak body parts first? Do you scrub hard and debride the dirt, or take it off over a period of days? Facecloth, scrubbrush, or other implement? Layer with lotion or oil to soften it first?:down:

Specializes in OB, Med/Surg, Ortho, ICU.

One word-whirlpool. I've only done that if they are admitted. It's difficult if you treat and release. Our bath oil helps remove dead skin. It's also the reason I would never use the whirlpool in a million years if I were a patient.

Specializes in ICU, ER, EP,.

Honestly, the ER that I worked was way too busy to do what you have described. I documented the skin assessment as it presented. There was never any time to wash and bathe, unless treatment dictated it to be addressed to a specific area.

Unfortunately, patients in this condition were sent to the perspective admitting floors/units.. as cleanliness could never be a priority of care, unless described as above. If we weren't focused upon a specific area.. we never cleaned it. Couldn't be done in our ER.... 130k patients a year, with an average of 30 holding.

Specializes in Med/Surg, DSU, Ortho, Onc, Psych.

You could try putting baby oil on first. That would keep their skin moist & help remove dirt etc gently.

I feel sorry for some of these people. They may be homeless with no access to clean water. Some are mentally ill, but yes, some are just plain lazy.

You can remove dirt without vigorous scrubbing by using oil but the residue can make it difficult to stick something to the skin afterwards.

Specializes in ER.

Mostly I started right away because he was incontinent, and had to be washed. It was just too much to remove one layer when he needed about five taken off. Also morbid curiosity as to what's under there. EHS said the house matched the man. I agree that a tub and scrub brush would be ideal, but the TIME needed, OMG!

One of my nursing instructors said she used Comet on someone once, but that sounds too abrasive on bare skin.

If someone is incontinent of stool, and you know it's a project, I 'm guessing you get the triage, bloods, EKG, IVs etc before you wash and press, right? But then we need to wash before sticking IVs, and the leads kept coming off. No one wants to do a good thorough exam either, so there's an argument for washing first unless he's actively bleeding. A,B,C's, but D for dirt is right up there. I hate when someone comes in and says, "do you have two large bore IV's and a 12lead yet?" and I've decided hot water is my first attack plan. What if family comes in? And once we hook him up, it'll all have to be unhooked. And safety to staff is an issue with bloody diarrhea left uncleaned.

Sorry for monopolizing, OK I promise to shut up, but honestly what would you do first?

Specializes in ED/ICU/TELEMETRY/LTC.

Do you have a queen room with a shower? If you can get it empty and he can sit up, put the joker on a bedside commode and scrub him like crazy.

Several times.

If not just wash him like a car on the stretcher, call housekeeping to come and clean the room after.

Funny nurses! Thanks for the laugh!!

Specializes in LTC, assisted living, med-surg, psych.

When I worked acute care, we got a patient from ER with only one thing written on the admission orders: "Give this man a BATH." He was an elderly gentleman who had not taken a shower or changed his clothes in two and a half years according to his wife, who was too tiny and far too frail to wrestle a demented, combative, six-foot, 200-lb. husband into the tub.

The funk was just......well......overwhelming. There must've been half an inch of crud caked onto his entire body, and when we went to remove his clothing, it more or less crumbled in our hands. His socks had to be soaked off his feet, and the smell was enough to make a seasoned nurse blow her groceries. And of course, the guy was fighting tooth and nails to avoid all of this; it took five of us to get him up to the maternity ward where the only Jacuzzi tubs in the building were located.

The LDRP nurses were appalled, and protested this unwanted "invasion" through channels to no avail; meanwhile, we got the fellow into the whirlpool and two CNAs took over the rest of the job. We heard later in the night that he ended up liking it so much that he refused to get out, and sat in that tub for two hours! I can only imagine what it looked like after they got through with him........anyway, I never found out what became of him afterwards, but always hoped that Social Services and the DHS got involved and found an appropriate placement for the couple.:coollook:

Had a 40-something (old enough to know better, young enough to get a grip) guy admitted for something...don't remember. What a gem. :uhoh3: He was with us for a couple of weeks. And refused to bathe or have the linen changed....:down:.... He also did neat little things like hurl the full urinal across the room and yell "someone get the he!! in here and clean this up"...I was in charge...the PRN Foley just became necessary.

One night, his assigned nurse came to the nurses station and said she just couldn't go in the room. She was dry heaving when she opened the door. I told her to go get the shower cap, no-rinse foam, deodorant, toothettes - and whatever else looked good- and I'd meet her in the room with the linens....she asked what we were doing . I said "ambush". (5 am- guy still asleep).

We had the shower cap on and "sudsed" before he woke up completely. He didn't refuse (good- no legal issues :D). We kept working. Finally he looked at me- so I handed him a foamy washcloth and told him to wash between his legs and family jewels while I held the sheet up to give him some "cover".... I could tell he was only waving the washcloth back and forth- so told him "OH no- you wash like you're going to church"...He moaned "Oy. I need to go home." I told him this was working out well for both of us. His nurse was working on his back...she stopped cold, and looked at me. I asked what was up- she couldn't really say much other than "come over on this side and look at this"...OK.

He had a Heinz mustard packet taped to his back. There were some cultural issues around there- so I asked him if he wanted the mustard packet for some reason....he freaked out :D "Get it off of me".... OK. :confused: Best we could figure, the EX-wife, who had been trying to get him cleaned up every day left it there to see when someone got him cleaned up :up: Got the bath finished, and dragged his sorry butt to the chair (God forbid :uhoh3:) to get the sheets changed.

He was discharged not long afterwards :up:

And another thing...if you're rotund, but insist on wearing low cut pants, then you better damn well wash your crack!

One of my nursing instructors said she used Comet on someone once, but that sounds too abrasive on bare skin.

i wouldn't use comet, but have used scrubbing bubbles on my son, when he was a young boy.

he got into some 'mischief' and was one big soot/grime ball when he came in the house.

i threw him in the shower but was only getting tops layers off.

scrubbing bubbles worked its magic - and no dermatologic reaction.

me personally?

if labs, ekg weren't urgent in nature, i'd definitely clean pt first.

that would be my priority...

as well as the obvious benefit, of reducing risk of infection/contamination.

leslie

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