Infection Control and Universal Precautions



ADL’s – Activities of Daily Living – Oral CareLesson 1Importance of Oral HygieneGood hygiene helps people to be healthy by preventing the spreading of germs and build-up of harmful bacteria that cause dental problems. Dental problems can cause discomfort. Infection from tooth decay can lead to serious health concerns if not prevented or properly treated.Strong, healthy teeth are needed to chew food into small pieces. Digestive problems can develop when a person is unable to chew food properly. Many choking accidents and deaths can be related to people being unable to properly chew their food. This can be due to poor fitting dentures or not wearing dentures. It can also be due to mouth pain or loose teeth from poor dental care. You will learn more about health issues and how to prevent or respond to them further on in the lesson.Smiling is fun when you have a healthy mouth and clean teeth. Critical Aspects of Personal CareRespect the privacy and modesty of people. Respect and know personal preferences. Be aware of the person's comfort. Use your voice as well as your hands. Keep people safe.Respect the privacy and modesty of people.Always respect the privacy and modesty of each person as much as possible during routines. Oral care is something that some people are modest about and others will happily complete in front of others. Don't announce routines or problems with oral care in public places, including shared rooms. Be mindful of others needs in shared spaces. For example, even if a person is comfortable brushing in the living room or kitchen, others who share that space may not be comfortable with it.Respect and know personal preferences.Respect and know personal preferences for routines. This will include using preferred products, timing of routines, methods and frequency of completion, temperature of water, etc. In oral care, people often have strong preferences for types and flavor of toothpaste. Certain types of floss works better for some teeth and not others. Be familiar with these types of preferences.Be aware of the person's comfort.Be aware of the person at all times. The person is not a "chore" to be "completed." Check your hands for warmth before touching someone. Perfume or cologne is often placed on the wrist. If you use these products check to make sure they are not offensive to the person as your hands may be very close to his or her nose. Use a gentle but firm touch. Watch for tender spots or signs of infection or poor health. Pay attention to the person. Be aware of signs of discomfort at all times.Use your voice as well as your hands.Use your voice as well as your hands. Tell people before you touch them or start routines. Keep them posted along the way so they are not startled. Use a friendly, calm voice. Talk more if the person prefers. Talk less if they find it disturbing or irritating.Keep people safe.Keep people safe. You must know people's safety needs and take care to keep them safe. In oral hygiene, you may need to know proper positioning to prevent choking or gagging. It is very important that you take care to prevent transmission of disease between people by following the infection control tips in given in this lesson. Overall health is affected by poor oral hygiene. Take these tasks seriously as preventative measures to poor health. Infection Control and Universal Precautions in Oral CareTaking care to prevent the spread of disease is an important part of all personal care. It is especially important that direct support professionals take care during oral hygiene. This is because blood is more likely to be present during flossing and brushing than during other routine personal care.In addition, the mouth is a place where germs are able to enter a person's bodily systems. Much of the body has the protection of being covered by skin. However, the mouth easily absorbs many types of diseases. It's important to ensure that anything that enters a person's mouth is clean. It is also important not to share items used in oral hygiene. Infection control procedures are covered in depth in the lesson on Universal Precautions and Infection Control in the College of Direct Support course on Safety at Home and in the Community. If you are not familiar with this information, you may want to review that lesson.The mouth is one of the places on the body where germs can enter vital systemsInfection Control and Universal PrecautionsInfection control and Universal Precautions are used when assisting people with dental and oral care. On this page are several different ways in which infection control can be accomplished.Universal Precautions A standard set of procedures designed to protect individuals from coming into contact with contaminated blood or bodily fluids. Because anyone can be a carrier of these diseases and symptoms do not have to occur for a person to be contagious, universal precautions greatly reduce the chances of exposure because they require that all human blood and certain human body fluids are treated as if known to be infectious for HIV, HBV, and other bloodborne pathogens.Problems Due to Poor Oral HealthPoor oral care can lead to many health problems including those listed here:Pain and illness due to cavities, gum disease, loose teeth, abscesses, and tooth loss. Mouth pain and irritation caused by conditions such as canker sores, cold sores, or thrush (candidiasis).The build up of plaque in the mouth due to lack of flossing has been linked to heart disease.Mouth pain and tooth loss can cause people to avoid eating. It can keep them from correctly chewing food. Not only do they lose their enjoyment of food, they are more likely to choke. People may not eat enough or eat healthy foods due to these problems. For an elderly or frail person, not eating can be life-threatening Avoiding oral hygiene can lead to unnecessary pain. Cavities A breakdown of the tooth caused by bacteria, tooth decay or holes in the teeth caused by acid from the plaque bacteria.AbscessA collection of pus around an infectionCanker Sores Canker sores are small ulcers inside the mouth. They are not contagious and usually recur. The exact cause of canker sores is not known. Canker sores can heal on their own, but can also be treated with over the counter medications. Spicy and acidic foods can often irritate and further inflame canker sores.Cold Sores Cold sores are also known as fever blisters and Herpes simplex. They are groups of painful, fluid-filled blisters. Cold sores are contagious and often recur. Cold sores often heal by themselves within approximately one week. They can also be treated with prescription medicationsCandidiasis Candidiasis is a fungal infection that is also know as thrush. This most often occurs in very young children and older adults who wear dentures. Good oral hygiene is essential to treating this, but prescription medication may also be necessary.Plaque A layer of bacteria on the teeth that causes tooth decay and gum diseasePreventing Plaque Build-UpDecay and gum disease are caused by plaque. Plaque is an invisible bacterium that lives in the mouth all the time. When sugar from food is present in the mouth, plaque produces acid. This acid eats away at the teeth. This causes a cavity. If left without treatment the tooth can be lost. Worse, infection can set in and cause serious problems. Tooth or ear pain can be a sign of serious cavities and infection. However, early detection of cavities that are not yet painful is part of a regular dental visit.A build-up of plaque also irritates and destroys the gums. An early form of gum disease is gingivitis. Early stages of gum disease can be reversed through improved oral hygiene and a professional cleaning. If left untreated, gingivitis can progress to periodontitis. This form of gum disease is more serious and can cause tooth loss and pain. The signs of gingivitis include red, swollen, painful, or bleeding gums.The four elements of oral health described later in the lesson reduce the opportunity for plaque to build up on teeth. These also help when plaque that does build up is removed before teeth and gums are permanently damagedGingivitis The mildest form of Periodontal Disease. This is a disease involving the gums, that can result in a person losing their teeth. The disease is caused by a bacteria that is in plaque, a substance that forms on your teeth.Gingivitis is an early form of gum disease. It is usually not painful. Symptoms include red, swollen or soft gums that bleed easily. If left without treatment and care, more serious gum disease (periodontitis) can occur.Periodontitis A serious gum disease caused by poor oral hygiene. The symptoms include inflamed, bleeding gums, loose teeth, and mouth pain. Professional dental treatment should be sought if any of these symptoms occur. Preventive care and treatment can reverse some of the problems caused by this disease. Without treatment and daily oral hygiene the condition will get worse.Increased Risk and Obstacles to Oral HealthPeople who need support and help with daily oral hygiene are at increased risk for poor oral health. This varies from person to person. However, there are three primary reasons for this additional riskLack of Information or Understanding:Many people with and without disabilities do not understand the consequences of poor oral care. It may be that they have never been taught. It may be that they cannot understand the information.A related problem includes family care-givers or other direct support providers do not understand the risks. In these cases, the person may not get enough support. They may not be provided enough regular help to stay healthy. It's important that direct support professionals understand the risks and help effectively with this critical area of health. It's also important that direct support professionals can work within a family care-giver situation to support and help with this. Limited Physical Ability or Different Physical Needs:Some people may not be able to perform oral hygiene tasks. This may be because they cannot control their own arms or hands. They may lack the fine motor skills to reach all parts of their teeth. They may not have the physical energy to complete the routine. In these cases, the direct support professional will need to provide physical assistance to help the person to do these tasks. The amount of physical assistance will depend on the needs of the person. In addition, there are modified toothbrushes and other adaptive equipment that can make it easier for the person.People who need support often are more likely to use medications. Side effects of some of these medications may increase gum or tooth sensitivity. They may weaken teeth or encourage gum growth over the tooth. They may make the person more susceptible to gum disease. DSPs should know if the person they support has these concerns.Fear or Dislike of Oral Care:Sometimes a person can complete oral care but does not want to do it. They may be resistive to the attempts to help them. When a person understands the risks and chooses not to complete oral care, this is his or her choice. When the person does not understand the risks of avoiding oral care, the direct support professional will need to spend time assessing the situation. The direct support professional will need to support the person in understanding and managing the risks as possible. In the case where it is unlikely that the person will ever comprehend the risks, the direct support professional will work to make oral hygiene as pleasant as possible so that the person is more apt to participate.Overcoming Obstacles to Good Oral HealthTo understand why there is resistance, it is important to involve the person directly. Let the person know you are concerned about comfort and health. Remind the person of the basics of good oral hygiene (which you will learn later in the lesson.) Ask if there is something you can do to improve the situation.In some case, you may need to present accurate information in an alternative format to help the person fully understand the risks of poor oral health. This may include pictures. It may include demonstrations, or other methods. You may have to repeat this information many times before the person understands it. If the person has limited communication skills, you will need to consider the person's behavior. Look at possible environmental and other causes, such as pain, or dislike of the flavor of the toothpaste. This can be done through observation. Reading a person's medical history or background and discussing with other direct support professionals who help this person can be helpful to figuring out why the person is resistive. In some cases, a formal functional assessment may be necessary. Functional Assessment Methods and strategies used in the person's daily environment that help us understand the antecedent(s) that predict challenging behaviors and the consequences that maintain challenging behaviors. Using a definition of the behavior that is observable and measurable, functional assessment seeks to discover the function the behavior serves (that is, what the person obtains or avoids) by looking at: 1) When, where, and with whom are the behaviors are most and least likely to occur; and 2) What consequences maintain these behaviors. The results of a functional assessment are used to develop a hypothesis statement, which in turn is used to develop a behavior support plan. The hypothesis statement can be further tested through functional analysis if needed.Handling Resistance to Oral CareFor some people, experiences with oral hygiene have been very bad. If the person also has cognitive impairments or problems with impulse control, he or she may become extremely resistive to oral care. If you are working with someone who has such issues, it's important to be sensitive and caring, but it's also important not to just give up on oral health. The person's quality of life and life span can be greatly reduced if this area is neglected. If resistance is sudden and serious, get the person to a dental professional to check for pain or infection.You may need to seek additional help if oral hygiene tasks are being left undone and you cannot get cooperation from the person. However, sometimes resistance can be overcome by observing, reflecting, and trying new things. Watch carefully. What triggers resistance? If you can identify the problem, you may be able to do something to help. Identifying why someone is resistant to oral care will help you understand the situation and better address it. Many of these things are environmental. This means that something in the way things are done can change the person's response. On this page are a few things that may be part of the problem, and some ways you could try to address it. Review the information on this page. When you are ready, go to the next page. Handling Resistance to Oral CareChange the Environment: The following things are common problems in the environment that can make people reluctant to complete oral hygiene (or other self-care). Think about whether some of these may be affecting the person(s) you support and then make necessary corrective changes.Some people are very sensitive to changes in routine. A new tooth brush, a different tooth paste, and a different order in the day, or a new care-giver can cause resistance. Try developing and sticking to a routine. Let people know when change is necessary. Work to prepare the person. For example, hanging up the new toothbrush several days or even weeks before the person needs it, can help the adjustment. Some people become bored with, or dislike, the routine. Try to make it as comfortable and as enjoyable as possible. Humor, music, and/or conversation during the task may help. If the routine seems to be the problem, try different flavors of floss or toothpaste, too. Repeated reminders and nagging or insensitivity to the person's needs may make him or her resistive to working with you. Keep things friendly and calm. Check to make sure nothing is hurting or irritating during the routine. Interruptions and distractions for you or the person during the procedure may keep the process from going smoothly. When you complete hygiene tasks you should focus only on the person. Care should be in a private place and without interruptions.Handling Resistance to Oral CareInvolve the Individual: The more involved people are in their own oral care, the more likely they are to cooperate. Let people do as much as they can for themselves. However, assist them with things they find too hard. Hygiene routines should be designed for the convenience of the person, not the direct support professional. Routine can be helpful, but make sure it is the person's preferred routine and one in which he or she can participate as possible.Adaptations for Oral CareThere are several different types of adaptations that can be made. These can help a person be more independent. They may encourage the person to complete oral care more frequently or completely. Some of the more common adaptations include the following:Placing an enlarged gripper on the toothbrush handle. This may be things like a bicycle handle grip or a rubber ball with a hole through it.Lengthening the handle by attaching a piece of wood or plastic. Purchasing one of the many dental floss adapters available at most drug stores.There may be additional adaptive equipment that is designed specifically for the person you are supporting. If you think the person you support could benefit from adaptive equipment, suggest this to the person. He or she, or his or her surrogate decision maker may want to make contact with a dentist to learn about options.Surrogate decision maker People or committees, who are not legal guardians or conservators, but who are sanctioned by law to make a decision in the place of a person who does not have the capacity to make an informed decision on his or her own. State laws vary regarding the types of decisions that the surrogate can make. Most often used for consent for medical treatment and interventions, many states do not allow surrogate decisions makers to consent to restrictive procedures such as may be found in some behavior support plans.Four Elements of Maintaining Oral HealthThe following four elements should be part of every person's plan for good oral health. You will learn more about each of these as you progress through the rest of the lesson.Good eating habits.Maintaining teeth (or dentures) by cleaning them each day.Cleaning between teeth daily with floss. (Or, cleansing gums when wearing dentures.)Visiting the dentist regularly for professional cleaning and examination (every six months).To learn even more about these four elements of oral health you can visit the American Dental Association's Website at: #1: Maintaining Good Eating HabitsGood eating habits include what is eaten and when. Here are some things to know about the link between eating habits and good oral health.A wholesome diet can have many benefits to oral health. A good diet consists of whole grains, a variety of fresh, whole fruits and vegetables, lean proteins, and low sugar snacks. Calcium rich foods are important, especially to children, teenagers, and women. This helps teeth develop correctly. It also maintains the strength of the teeth.Avoiding sugar is important. Almost all foods contain some sugar, including carrots, peas, and many fruits. However, high sugar foods that are sticky are the worst for teeth. These can include candy, breads, cakes, dried fruit, soda, fruit snacks, and fruit juices. Acidic foods like lemons, limes, and soda (even sugar-free), can also weaken teeth. By limiting snacking, brushing after eating, and making good food choices, less sugar and acid are left on the teeth. Element #1: Maintaining Good Eating Habits - A Child's and Baby's Diet and Tooth DecayFor babies who nurse or use a bottle, tooth decay can start before the child even has visible teeth. Do not give children under 6-12 months anything but breast milk or formula in their bottles. Avoid giving older children who use a bottle more than one small glass of juice a day and never put soda or sugared drinks in a bottle. Do not prop a baby's bottle or put the baby to bed with a bottle. When the baby is allowed to fall asleep as it nurses or drinks from a bottle, the fluid will pool around the teeth and gum area. This pooling around teeth allows plaque to grow. It causes decay and infection (often called "baby-bottle tooth decay"). The baby teeth may fall out, decay away, or have to be removed. These situations can cause problems in the growth and health of the permanent teeth.Small amounts of fluoride have been shown to create stronger adult teeth if it is taken during the development of permanent teeth. Most cities have the correct amount of fluoride in the tap water. If a child drinks from well-water, filtered water, or bottled water only, it may be important to check with a dental care practitioner with regard to fluoride. It may need to be added to the child's water. On the other hand, too much fluoride can cause other dental problems. Therefore, it is important to check with a heath-care professional and avoid using large amounts of fluoride toothpaste with children or adults who are likely to swallow it.If baby needs help to fall asleep, try Element #3: Flossing TeethMany people need help flossing their teeth. There are different kinds of floss including waxed, unwaxed, flavored, unflavored, and floss tape. Find out what kind of floss works best for the person you are supporting.The direct support professional should do the following steps to assist a person with flossing:Wash hands and put on disposable gloves.Break off a piece of floss about 18 inches long.Wrap that piece around the middle finger of each hand.Grip floss between the thumb and index finger of each hand.Start with lower front teeth, and then floss upper teeth. Floss teeth in the back of the mouth last.Slide the floss gently between the teeth, working up until it reaches the gumline.Curve the floss around the tooth and slide it under the gum. Slide the floss up and down.Repeat this for both sides of every tooth.Adjust the floss slightly in your hand as you move from tooth to tooth so that you are using a clean section of floss for each tooth.When you have finished, throw away floss, remove and dispose of gloves, and wash hands.Remember that there are floss holders to make it easier to floss teeth. A person can use this to floss their teeth independently or it can be used by the direct support professional.Element #3: Brushing and Flossing Children's TeethSome things to know about the care of a child's teeth and gums.Before teeth erupt or when there are only one or two small teeth, oral hygiene can be completed by wiping the gums and teeth with a clean wet cloth or piece of gauze.Once a child has several teeth, purchase a small, soft bristle tooth brush. Brush or clean teeth after each feeding.Flossing should begin as soon as the child has all of his or her "baby teeth" around 2-3 years of age.Children are usually not fully able to complete all parts of oral hygiene effectively until they are 5-8 years old. Frequent checks and monitoring are important as they learn.Special care is needed to keep teeth Identifying PlaquePlaque is invisible. You cannot see it without special dyes. It can be helpful to identify if plaque remains after completing oral hygiene tasks. This will make clear if brushing and flossing are being effective. It can be one strategy for encouraging a person to be more active in dental hygiene. The following are common steps in using dyes made for the purpose. (Check directions on the packet):Complete oral hygiene as usual (brushing and flossing).Apply the dye as directed on the package, usually by chewing two small tablets.Rinse mouth with water. Do not swallow the dye. Spit the water into the sink after rinsing.Look at teeth. The darkest spots are where plaque is plete oral hygiene again to remove dye.Focus on these spots when completing oral hygiene in the future.Denture CareBacteria and food can build on partials and dentures just as it does on teeth. Partials and dentures must be brushed daily to remove the plaque build-up. It is also important to make sure that dentures are removed daily, usually at night to allow the tissue in the mouth time to rest. If you support someone with dentures, watch for soreness and tenderness. This may be a sign that their dentures no longer fit properly. They may need new ones or adjustments.Removing DenturesThese are the basics steps for removing dentures.Wash your hands and put on disposable gloves.To remove the upper denture hold the front and inner part of the denture plate with your thumbs and index finger.Put your index fingers close to the edge of the denture.Press firmly but gently to break the seal between the gum and the denture.Gently wiggle the denture and pull it forward and out of the mouth.Place the dentures in a cup.To remove the bottom denture hold the front and inner part of the dentures plate with your thumbs and index fingers.Gently wiggle the lower denture and lift up and out of the mouth.Place the dentures in the cup.Remove gloves. Dispose of them properly and wash your hands.Cleaning DenturesDentures must be cleaned every day. Use infection control procedures for these tasks (wash your hands and use gloves). Follow these steps:Place a cloth in the bottom of the sink or bowl you are using to prevent breaking the dentures if they fall.Fill the bowl half-full with warm water.Using a toothbrush and denture cleanser, brush the inside and outside of all the surfaces.Rinse the dentures in cool, running water.Place the dentures in the denture cup with clean water to store overnight.Dentures need to be cleaned daily. Caring for GumsOnce the dentures are removed, the person needs care for his or her gums. This will help keep the person's mouth healthy and ensure problems with dentures are discovered. Use infection control procedures for these tasks (wash your hands and use gloves).The mouth should be rinsed with a water and mouthwash mixture. Use a swab if the person cannot do this for him or herself.Use a soft toothbrush to gently massage the gums and roof of the mouth and tongue.Ask the person if he or she is experiencing any irritation or soreness. If the person is unable to communicate, gently look inside of the mouth to ensure there are no problems. Inserting DenturesHelp the person make sure they have the dentures in properly.Wash hands and put on disposable gloves.Apply a small amount of denture adhesive or fixative to the dentures.Wet the dentures before putting them in to help them seal with the mouth.Insert upper dentures, gently adjusting as needed. Press gently but firmly to ensure they are adhering properly to the gums.Insert the lower dentures, gently adjusting as needed. Press gently but firmly to ensure they are adhering properly to the gums.Remove gloves. Dispose of them properly and wash your hands.Element #4: Preventative Professional Dental CareVisiting with a dentist or other dental care professionals is an important part of overall oral health. Seeing a dentist regularly for a cleaning and a check can help teeth stay healthier by removing tartar and plaque at the gum line. The dentist will find and fill small cavities before pain and infection has started. Other problems are likely to be identified and treated early.A dentist can refer people to other specialists such as oral surgeons or orthodontists who can help correct more severe problems in development or alignment of teeth.Children should visit the first time between 1 and 2 years of age. Throughout the lifespan, people should visit every six months for best heath. Occasionally a dentist will recommend visits that are more frequent for people with certain health conditions or dental problems.Tartar A hard yellowish substance that develops on the gumline and edges of teeth when plaque is allowed to build up on teeth. Tartar makes teeth look yellow, but it also creates pockets where bacteria and food can collect. This can increase dental health problems. Tartar control toothpaste will not remove tartar. Daily brushing and flossing will reduce or prevent tatar build-up.Orthodontist A dental surgeon who specializes in straightening teeth and oral surgeryElement #4: Preventative Professional Dental CareYou may be asked to assist a person who needs support to identify a dentist and facilitate the visit to the dentist. Not all dentists will take people with special needs as clients. The dentist may not feel or be equipped to serve people who have certain physical or intellectual disabilities. Many will not work with public assistance.Below are some possible resources to help locate a dentist who can meet the needs of the person you support.? Ask for referrals from other people who receive supports and their family members or friends.? Check with dental schools that are affiliated with large universities. Many will provide good dental care.? Check with local advocacy organizations in your area. They may have a listing of dentists who serve people with disabilities.? Check out the website of the National Foundation of Dentistry for the Handicapped (NFDH) . There may be links to resources and options in your area.Element #4: Preventative Professional Dental CareJust as dental care at home can be intrusive and unpleasant for some people, so can visits to the dentist. To help make a dental visit as pleasant as possible for the person receiving support consider the following steps:Schedule appointments that are convenient for the person and his or her situation. Consider their normal schedule and preferences.Plan a visit to the dentist in advance of the actual appointment. The person supported can meet the dentist, the dental staff, and see the office.Let the dentist know what the person's physical limitations are so that the dentist can be prepared with any adaptations needed. Prepare the person being supported for the dental visit by explaining what is going to occur at the dentist. Using photos can be helpful. Never lie about procedures. Element #4: Preventative Professional Dental CareThe following strategies may make a visit more successful:Be sure to allow enough time! Arrive early so that you have time to handle the paperwork and communicate necessary information to the dental office. This can take as much as 30 minutes for a new patient. Bring the person's dental and health history to the appointment. The dentist will need to review for certain conditions. He or she will need to know any medications the person takes and any health concerns. Bring the person's insurance information and any necessary paperwork that needs to be completed. Some people must take antibiotics or anti-anxiety medications before visiting the dentist. Make sure you know if the person has this kind of special need. If the last visit was difficult, make suggestions to the dental team in regards to effective accommodations. A full health and dental history is usually requestedOral CareLesson Review:Infection control and Universal Precautions are used to prevent the spread of germs and blood borne pathogens when assisting a person with dental care.Obstacles to good oral hygiene can include: limited knowledge or informationphysical limitationsbehavioral concernsThe elements of good oral health include: daily cleaning of teeth and gums; maintaining good eating habits; and regular visits to a dentist.Regularly brushing and flossing teeth reduces the build-up of plaque, and maintains healthy teeth and gums.Assisting a person with his or her dentures and gums helps a person maintain a good quality of life.Oral CareReflection on the Learner Objectives. You have completed this lesson, you will be able to:Use effective infection control procedures during oral care.Identify signs of good oral health and health issues related to poor oral health.Identify obstacles to good oral health and use strategies to address them.Support people in four key elements recommended for maintaining oral health.Assist people with brushing, flossing, care of dentures, and/or care of gums.Assist people to find and use dental services.ADL’s - The Basics of Hygiene Lesson 2Critical Aspects of Personal CareAccepting assistance with personal care can be difficult. For many people this need for care is a big change from a time when they were able to take care of themselves. Even if the personal care needs have been lifelong, the routines are ones that most people feel are private. Having someone help with personal care and hygiene can feel very embarrassing and unpleasant, even if it is necessary.As a direct support professional, your image of how to complete personal care may be based on how these tasks are completed in a hospital or rehabilitation center. In these cases, personal care is second to health care. But direct support professionals work in people's homes. When reviewing the procedures in this lesson, remember, you are not working in a hospital. Support needs to be completed in very gentle and respectful ways. You are there to enhance a person's life, not just complete these tasks. Show respect and care when helping with personal care. Critical Aspects of Personal CareWhen completing personal care routines and procedures, keep the following things in mind: Respect the privacy and modesty of people. Respect and know personal preferences. Be aware of the person's comfort. Use your voice as well as your hands. Keep people safe.Respect the privacy and modesty of people.Always respect the privacy and modesty of each person as much as possible during routines. Help them stay covered and out of sight of others. Don't announce their routines to others or in public places, including shared rooms. Let them stay as covered as possible and as desired during these routines. Respect and know personal preferences.Respect and know personal preferences for routines. This will include using preferred products, timing of routines, methods and frequency of completion, temperature of water, etc.Be aware of the person's comfort.The person is not a "chore" to be completed. Check your hands for warmth before touching someone. Use a gentle but firm touch. Carefully check water temperature and room temperature as needed. Watch for tender spots or signs of infection or poor health. Pay attention to the person. Be aware of signs of discomfort at all times. Use your voice as well as your hands.Use your voice as well as your hands. Tell people before you touch them or start routines. Keep them posted along the way so they are not startled. Use a friendly, calm voice. Talk more if the person prefers. Talk less if they find it disturbing or irritating.Keep people safe.Personal care routines, particularly bathing, can be a real safety hazard to people with physical assistance needs. Slipping, scalding, and even drowning can be real concerns. You must know people's safety needs and take care to keep them safe. Outside of these most serious safety concerns, take care to prevent transmission of disease between people by following the cleaning tips given in this lesson. Infection Control and Universal PrecautionsInfection control procedures are covered in depth in the lesson on Universal Precautions and Infection Control in the College of Direct Support course on Safety at Home and in the Community. If you are not familiar with this information, you may want to review the entire lesson in that course.Infection control is the use of strategies that make it difficult for diseases to spread. They should be used when completing personal care routines. In order to reduce the possibility of transferring diseases you need to:Implement universal precautions when there is a chance of transferring blood borne pathogens. (Learn more on the next few pages.)Never share personal equipment between people (nail clippers, flossing tools, etc.).Clean and sanitize shared surfaces in-between use (bathtubs, showers, etc.)Follow the correct order of hygiene tasks to prevent transmission of disease from one part of body to another. Universal Precautions A standard set of procedures designed to protect individuals from coming into contact with contaminated blood or bodily fluids. Because anyone can be a carrier of these diseases and symptoms do not have to occur for a person to be contagious, universal precautions greatly reduce the chances of exposure because they require that all human blood and certain human body fluids are treated as if known to be infectious for HIV, HBV, and other bloodborne pathogens.Infection Control and Universal PrecautionsHIV and hepatitis can be very serious, even deadly. People are able to carry these diseases without having any symptoms. They are able to transfer the diseases without knowing they are carrying them. People can even test negative for some of these diseases and still be carrying them. You cannot tell by looking if a person has this type of disease. But you can stop the transfer of these diseases. You do this by not ever allowing blood from one person into the system of another person.By law, professionals that are likely to come in contact with blood while completing their jobs must use what are called universal precautions. They are called "universal" because you use them whenever there is a possibility of exposure to these diseases. Not just when you think someone is a carrier. They are methods and procedures to reduce the likelihood of transferring these diseases. Universal precautions are to protect you. They are also there to protect the person receiving supports. By using these precautions any time it is likely that blood could be present (either yours or the person's) you keep everyone safe.HIV Human immunodeficiency Virus (HIV)Hepatitis Hepatitis is disease of inflammation of the liver commonly caused by a virus. There are several types of hepatitis, the three most common in American are: Hepatitis A (HAV), Hepatitis B (HBV), and Hepatitis C (HCV). The severity of the disease increases from Hepatitis A, which does not cause liver damage and almost always goes away after several weeks, to Hepatitis B which often becomes chronic (keeps coming back) to Hepatitis C which can result in permanent damage to the liver and possibly liver cancer.Infection Control and Universal PrecautionsDuring routine bathing and hygiene tasks there is usually little risk of blood being present. The following are the most likely tasks where blood may be present during personal care:When helping with dental hygiene (gums often bleed, especially when flossing).When helping with menstrual care.When you, or the person supported, have skin rashes, scratches, or wounds. Infection Control and Universal PrecautionsInfection control must be practiced regularly during your work. The methods of infection control you will use on a daily basis include washing your hands. They also include cleaning shared surfaces and personal care equipment properly.Universal precautions, which include using gloves and other physical barriers to transmission, must be used when there is a possibility of blood borne pathogens being present. However, you may also want to wear gloves or other types of protective equipment at other times. You may do this to protect your clothing. It may also increase your comfort with a task.Click on each of the following to learn a little more:Hand-WashingCleaning of shared surfaces and/or personal care equipment.Wearing GlovesOther Protective EquipmentHand washing: Hand washing is the most basic and most important infection control method you can use. There are many times when it is necessary for the direct support professional to wash their hands for health and safety reasons. This includes:When first you arrive at work.After using the toilet; before and after assisting someone to use the toilet or changing a diaper.After you handle items or assist a person soiled with body fluids or wastes (for example, blood, vomit, stool, urine, drool, eye matter).After you cough, sneeze or blow your nose (or assist with this).When helping a person with bathing activities.Whenever hands look, feel, or smell unclean.When moving from one type of personal care to another (for example, bathing to brushing teeth)When moving from assisting one person to another.Before touching anything food related. (for example, washing dishes, preparing food, etc.)Cleaning of shared surfaces and/or personal care equipment: Shared surfaces are a good way to share diseases. For example, foot fungus can be transmitted by sharing a shower. Using unclean hygiene equipment may mean a person struggles with reoccurring infections. Disposable items are one way to reduce the transmission of disease. For example, using paper towels to dry hands. (And properly disposing of them!). However, other items such as nail clippers may need to be reused. Finally some surfaces such as bathtubs, may be shared.Reduce the possibility of spreading infection by doing the following:Do not share personal care items.Sanitize personal equipment between use.*Sanitize shared surfaces between use.**Check with your employer regarding preferred sanitation procedures that they prefer. The following are suggestions: For items such as nail clippers you can soak for one or more minutes in fresh rubbing alcohol, rinse and air dry. For items such as wash cloths you can wash with a light bleach solution and detergent in a washing machine. Dry in a dryer. For items like shower chairs or shower floors, you can use a solution of 1 tablespoon bleach to one gallon of water to clean the surface. Let air dry.Wearing Gloves: Disposable gloves should be worn anytime that the direct support professional could come in contact with blood or bodily fluids. Gloves are only worn one time. Gloves are changed when beginning a new hygiene task, or when assisting another person. Wash your hands before putting gloves on and after taking the gloves off.Other Protective Equipment: There may also be times when you need to use other personal protective equipment. This includes protective eye-wear, face masks and other barriers. These are used to keep potentially infectious bodily fluids from entering another person's body. These are rarely needed during routine direct support. However, you should understand the risks of exposure to bodily fluids for procedures you complete. If you need it, you need to know how to use this equipment properly. You also need to know where to find it. Ask for specific training if your position is one in which you are at risk for transmission of blood borne pathogens.Infection Control and Universal PrecautionsTo properly wash hands, you must complete all of the following steps in this order:Remove jewelry, push up sleeves.Wet hands and apply liquid soap.Rub hands together vigorously. Make sure to scrub all surfaces of hands, including palms, back of hands, between fingers, thumbs, fingernails and wrists. Continue for at least 20 seconds.Rinse well with fingertips pointed down.Thoroughly dry hands with paper towel. Dry hands from tips to fingers working upward toward wrists.Using a clean paper towel, turn off faucet, discard towel.Apply lotion if hands are dry or chapped.Helpful Hint: To encourage handwashing for at least twenty seconds, you can suggest a person sing "Happy Birthday" silently while rubbing hands together.Using soap and thoroughly rubbing all surfaces are the most important parts of Infection Control and Universal PrecautionsUsing disposable gloves. Directions: Review the following steps to putting on and removing disposable gloves. Putting on disposable gloves:Wash and dry hands thoroughly before putting on gloves.Take a new pair of disposable gloves.Pull a glove onto each hand.Look at the gloves to make sure that there are no tears or holes. If so, take off the gloves and put on a new pair.Taking off disposable gloves:With a gloved hand, grasp the outside of the other glove. Remove the glove by pulling down from the wrist area.As the glove comes off your hand, let it turn inside out.Continue to hold the removed glove with your still covered hand.Slide the fingertips of your bare hand inside the remaining glove at the wrist area. Push the glove down off the hand making sure not to touch the outside of the glove with your bare hand.Allow the glove to turn inside out as you push it down until it can be dropped of your hand.Drop both contaminated gloves in a waste container.Wash and dry hands thoroughly.Health Risk Associated with Poor Bathing HabitsPoor bathing habits can lead to infections. They can increase a person's likelihood of getting bed sores and cause the breaking down of skin on many areas of the body, which can result in infections such as impetigo. Poor bathing habits can cause discomfort or increase the likelihood of catching other illnesses.The most frequent mistakes that are made as part of bathing routines are the following:Incomplete cleaning or not cleaning frequently enough.Over-cleaning, scrubbing too hard, or using products that irritate.Spreading bacteria or yeast from one part of the body to another.Not cleaning surfaces or equipment in-between use.Not drying the body completely after cleaning.Not using moisturizers and other products as necessary to keep skin healthy.Poor habits can lead to serious problemsSkin-Related Health ConcernsRegularly checking for skin rashes and infections during bathing can help minimize health risks. Scabies is a skin infestation of tiny mites that causes severe itching. A boil can occur when a hair follicle on your skin is infected by bacteria. Ringworm is a fungus infection that can affect the scalp, body (particularly the groin), feet, and nails. Supplies and Preparation for BathingTo prepare for a bath or shower you should do the following:Clean and sanitize the bathtub or shower stall and any equipment. Or, assist the person in doing so.Gather the necessary supplies (or ask the person to gather them) including the following: Clean clothes or a bath robe.Soap, shampoo, and any other personal cleansing or skin care products.A clean wash cloth and towel.Clean, unused disposable gloves.Any adaptive equipment or safety devices.Check or assist the person as needed to check the water temperature before beginning. Protect the person from burning, scalding, and chills. NEVER leave a person who cannot monitor or adjust temperature with water running. Not even for one minute!Check again to make sure that all supplies are within reach.Wash hands and put on disposable gloves before assisting.Procedures for Completing Bed BathsFollow the steps below to give a full bath to a person in bed. Make adjustments as needed based on the person's needs.Before you begin make sure that you have all the supplies you will need at hand. Click on the graphic of the bath kit to see a list of supplies.Wash the person's eyes and face first. Start with the eyes. Use a clean section of the wash cloth for each eye. Wipe once from the inside corner to the outside. Rinse the wash cloth and wash the rest of the face. Avoid using soap unless requested.Undress the person for the rest of his or her bath. Cover the person with a large towel, leaving uncovered only the portion of the body you are cleaning at the time. If the person is easily chilled, use additional covering as needed on parts of the body you are not washing.Place a towel under each part of the body that you are washing, replacing it with a dry towel if it becomes too wet.Using only as much soap and water as necessary, wash each of these body parts in the following order. neck and earschest and abdomenarmshandslegsfeetMake sure to rinse thoroughly after each part. Left over soap residue can irritate the skin. Change the water as needed to ensure soap residue can be rinsed off and water is warm enough.Replace the water with clean, warm water. Assist the person to roll onto their side or back if possible. Bathe the back, buttocks and hip area. Wash the genitals and then the peri-anal area. (Note: You will learn more about washing the genital area later in this lesson.)Dry each area after you have washed and rinsed it. Be especially careful to thoroughly dry any areas with skin folds, such as the genitals.Help the person dress in fresh clothing. Remove towels and make sure the bedding is dry and comfortableGenitals A person's external sexual organs and the area of the body where the sexual organs are.Peri-anal The area of the body between the genitals and the anus, including the anus.Methods of Washing HairWashing a person's hair may be a part of his or her bathing routine. Or, it may be done separately. Wash hair as often as needed to keep it clean and styled as the person likes. How often a person needs their hair washed will vary greatly. For some people this will be every day. For others, it may be only once a week.Direct Support Professional Roles in Care of GenitalsPeople's support needs in the area of caring for their genitals and perineal region will vary greatly. Direct support professional (DSP) roles may include the following:General bathing and cleansing.Care for menstrual needs.Teaching of care and cleansing related to masturbation.Click on each of the following bullets to learn more about the role of the DSP:If a person has no physical capacity to clean him or herself.If the person has some physical ability and no cognitive impairment.If the person has life-long intellectual disabilities or developmental disabilities.If the person has temporary or acquired cognitive impairments.Menstrual Relating to the care of blood that is passed as part of a woman's reproductive cycle (menstruMasturbation Touching and stimulating of the genitals for sexual pleasureCognitive Related to the ability to think.Intellectual Disability Intellectual disability or mental retardation is identified by three characteristics. The first is major difficulty in intellectual activities such as thinking, remembering and learning new things. The second characteristic is major difficulty when compared with people of one's own age in the skills of daily community living, such as communicating with other people, taking care of one's self or one's home, or performing other types of expected activities. The third characteristic is that these difficulties were first noticed while the person was still in the developmental period (under the age 18, or 21).Developmental Disability(ies)A federally defined term to help identify who is eligible for funding or services, which is: A severe, chronic disability of an individual 5 years of age or older that: is attributable to a mental or physical impairment or combination of mental and physical impairments; is manifested before the individual attains age 22; is likely to continue indefinitely; and results in substantial functional limitation in three or more of the following areas of major life activity: 1) self-care; 2) receptive and expressive language; 3) learning; 4) mobility; 5) self-direction; 6) capacity for independent living; 7) economic self-sufficiency; and 8) reflects a need for a combination and sequence of supports and service that are likely to be lifelong in duration. When this term is applied to children 5 or under, it means the high probability that the person will meet this definition after 5 years of age.Female Genitals -The BasicsThe female genital area (for the purposes of understanding how to keep it clean) consists of the following. Click on each one to learn more:The labiaThe urethraThe vaginaThe anusA note about douches and similar feminine hygiene products. These products were popular in the past. Woman used them to cover natural odors. Many products claim to "clean" the internal vaginal area. However, most doctors do NOT recommend using these products. The vagina is self-cleaning and these products can upset the healthy balance of a woman's vaginal area. These products should be used only with a gynecologist's or health care provider's recommendation.Only use deodorant sprays and douches if The labia are the outer parts of the female genitals. They are folds of skin that lay over the openings to the urethra and the vagina. In adult women, the outer folds are generally covered with hair. The inner folds are not. In girls who are not sexually developed, the outer folds do not have hair.\The urethra is the opening from which urine passes out of the body from the bladder. It is a much smaller and less flexible opening than the vagina.The vagina is the opening for sexual intercourse. Monthly menstrual blood passes out of the body through this opening. Babies are born through this opening. In adult women, discharge from the vagina in between menstrual periods is normal. It is part of the body's self-cleaning processes. (Female children should rarely have discharge from the vagina. If there is any discharge, particularly bloody discharge, this can be a sign of illness or abuse. Medical attention should be sought immediately.) This discharge varies significantly from woman to woman and during the monthly cycle. Discharge should have a mild, non-offensive odor. When discharge has a strong odor, it indicates a possible infection. If this occurs, the person should consult a gynecologist.The anus is the opening through which bowl movements are made. It is not covered by the folds of the labia. Bacteria that is naturally found in the anal area can be very dangerous if spread to the vagina or the urethra.Douches Products sold to clean the internal vaginal area. These are generally not recommended and should only be used with the recommendation of a medical professional.Gynecologist A licensed health care practitioner who works with sexual health, and hygiene of womeGenital Care for Females Genital washing is often part of a regular bathing routine. If people cannot or do not wish to bathe regularly, cleansing body parts that grow bacteria is still recommended on a regular basis. These would include the genitals and perineal area. Remember that a bath can often be better than a shower for genital care, since soaking in warm water can be healing for skin and delicate tissue irritation in the perineal area. Adapt these steps as needed depending on your role (teaching or doing, during full bathing routine or as a separate routine.)Have the person sit in a tub, in a shower chair, or gather supplies to complete this process as part of a bed bath. Have all supplies ready and water that is at a good temperature.Always start with clean hands (yours, and if the person is completing any of the process, his or hers too).Put on a pair of clean, unused disposable gloves (you).Spread the labia. Using a wet washcloth with a mild cleanser wash one stroke down the sides of the labia. Using a different part of the washcloth, wash down the middle of the labia. If the person has had problems with irritation or recurring infections, check for the best cleanser to use. In some cases medical professionals will recommend using water only on this area to avoid irritation.Rinse thoroughly from front to back.Move to the anal area. You may wish to rinse this area first with just water. Using soap and a wet wash cloth, wash the anal area moving from front to back. Use a different part of the washcloth for each wipe.Rinse from front to back.Remove the gloves. Wash your hands and place a clean pair of gloves.Dry the area by blotting gently with a clean, dry towel. Dry from front to back, taking care not to spread germs from the anus to the other areas.Managing Menstrual FlowMenstruation is part of the female reproductive cycle. During this period bleeding occurs. To catch this flow of menstrual blood, women use various products listed here. Be sure to change these items as often as directed on the product box, even when the flow is light. Infrequent changing can lead discomfort and odor. It can also lead to serious and even deadly infections and disease. Review the product inserts to learn more.Pads: Pads are an absorbent, disposable, cloth-like product that is secured to the crotch of underwear with adhesive. Pads absorb the menstrual flow. Pads need to be changed at least every 4-6 hours or more frequently as needed. There are many different brands and types to choose from.Tampons: Tampons are a cotton tube that is inserted into the woman's vagina. They are inserted with an applicator and have a string attached to remove them. Tampons should be changed every 4-6 hours and should never be worn more than 8 hours. Tampons should ONLY be used when a woman is able to insert and remove it herself.Pantiliners: Pantiliners are thinner versions of pads. Pantiliners are worn to catch overflow of tampons during heavy periods or on light flow days when pads are not necessary. Or, in-between bleeding to absorb discharge or when menstruation may start unexpectedly. Change these as frequently as pads.Keeping track, helps you be Male Genitals- The BasicsThe male genital area (for the purposes of understanding how to keep clean) consists of the following. The penisThe scrotumThe perineumThe anusThe penis is the primary sexual organ for a male. The urethra opening, from which urine passes out of the body from the bladder, is in the center of the penis tip. Some males will be circumcised and others will not. Circumcision means that the foreskin on the penis has been partially removed, usually when the person is a child. If a man is not circumcised the dead skin and sebum can collect under the foreskin. This is called smegma. Smegma is a natural substance, but if smegma is not cleaned from underneath the foreskin, it can build up and harden which leads to infections and disease.The scrotum is the area at the base of the penis that contains the testes. This may more commonly be called the "balls." This area is especially sensitive to touch and handling.The perineum is skin and area between the scrotum and the anus.The anus is the opening through which bowel movements are made. Avoid using a wash cloth that has been used to clean the anus on other areas of the genitals.Genital Care for MalesHave the person sit in a tub, in a shower chair, or gather supplies to complete this process as part of a bed bath. Have all supplies ready and water that is at a good temperature.Always start with clean hands (yours, and if the person is completing any of the process, his , too).Put on a pair of clean, unused disposable gloves (you).Wash and rinse the tip of the penis with a soapy and wet washcloth. If the person is not circumcised, the foreskin should be pulled back gently, not forced back, and the tip washed and rinsed. Do not pull too hard. Be careful not to leave any soap under the foreskin as this will irritate and potentially cause infection.Wash, rinse, and dry the shaft of the penis. Be sure to wash and rinse with water going from the top of the penis down towards the scrotum.Spread the legs and then wash and rinse the scrotum area thoroughly.Wash, rinse, and dry the anal area, moving from front to back. Be sure to use a different part of the washcloth for each wipe.Remove the gloves. Wash your hands and place a clean pair of gloves.Dry the area by blotting gently with a clean, dry towel. Dry from front to back. Make sure on an uncircumcised male the skin under the foreskin is dried. Take care not to spread germs from the anus to the other areas. Dry the whole area thoroughly. Moisture and dampness especially between the scrotum and perineum can breed bacteria or yeast. Therefore it is important to make sure this area is completely dry.Cleaning Up as Part of MasturbationMasturbation is a natural part of life. In general cleaning up from masturbation can be taken care of through normal hygiene and laundry routines. In many cases, the direct support professional will be unaware of the situation. In most cases, this is how it should be. Occasionally a person being supported, usually a teenager or young adult with developmental or intellectual disabilities, will be learning how to masturbate as part of developing an adult sexuality. Or, a person may know how to masturbate but he or she may have forgotten social norms around it. In these cases, direct support professionals may have to assist the person in learning boundaries and responsibilities in this area. For example the person may need reminders to respect others' privacy. The DSPs may also need to help the person clean up, by providing reminders and supervising cleaning routines.It is important to provide this assistance respectfully. Ensure the person's privacy as you assist with these tasks. Make sure you clearly understand the roles and boundaries of this role by speaking to your employer.Role of a Direct Support Professional in Assisting with Toileting and EliminationAssisting a person with toileting and elimination can mean a number of different things. Listed here are some of the ways that direct support professionals assist. Read the text. Before going on listen to the two voice clips on this page.Providing complete assistance with toileting. This would include helping the person undress, transfer on and off the toilet; and clean the area when done.Providing targeted help such as reminders to use the bathroom or help with buttons or zippers.Training a person about how to complete a toileting routine.Managing elimination through use of diapers or adult disposable briefs. You may provide full assistance. In other cases you may be assisting with the parts of this routine that the person cannot manage.Recording and tracking information related to the person's overall health in regards to these activities. These might include recording amount of urine or frequency of elimination. It might mean recording how much and when people eat and drink.Removing bags that are used to collect body wastes and replacing with clean, empty ones. Making sure that these systems are working properly.Procedures for Using the ToiletYour priorities in assisting people with elimination are the same as when bathing. They include maintaining the person's health, safety, comfort, and dignity.Some basic things to remember are the following:Promoting independence for people with physical capacity provides them more privacy and dignity.Know how to use any adaptive equipment properly and safety. Know the limitations and safety needs of the person so you do not put him or her at risk.NEVER leave someone who needs physical assistance on a toilet out of your range of hearing. If the person falls or needs your help there is no way of getting your attention.Good hygiene is critical to good health. Know and follow infection control procedures. In all of these procedures, clean hands and clean disposable gloves are a must prior to starting. Proper disposal of gloves and hand washing afterward is critical.Remember: health, safety, comfort, and dignity.Cleaning After Using the ToiletFor both men and women the use of moistened, flushable wipes can ensure that they are sufficiently clean after a bowel movement. Click on the following to learn more about toileting.Tips For MenTips for WomenMost men like to stand when urinating. If the man is unstable or lacks the ability to hit directly in the toilet when standing, see if he is comfortable with sitting. If not it maybe necessary to stay with him to ensure safety and help him clean-up afterward. When sitting to urinate, men should ensure the penis is pointing down into the toilet. The penis should be given a few brisk but gentle shakes to expel the last few drops of urine. The tip of the penis may also be wiped to ensure that it is dry.After a male has a bowel movement, the anal area need to be cleaned. This involves wiping the anus. The anal area should always be wiped moving toward the back. This keeps the bacteria from spreading to other parts of the body. Make sure that the area is completely clean or irritation and discomfort can occur.Women and girls sit when using the toilet. After urinating wipe from front to back through the genital area with toilet paper. When the woman has a bowel movement, the anal area needs to be cleaned. Whenever wiping it is important to move from front to back. The bacteria from the anus can cause serious infection if it travels to the vagina or urethra. Make sure that the area is completely clean or irritation and discomfort can occur. Sometimes toilet paper is not sufficient and disposable wipes can be used to carefully clean the anal area. Some peoply may have hemorrhoids, so be gentle.Assisting with Diapers and Disposable BriefsAsk your employer to demonstrate and review the correct procedure when helping someone change a disposable brief or diaper.Some things to keep in mind when you complete this procedure include:Attend to privacy and dignity of the person. Don't talk loudly in public places (even shared spaces in homes) about this. If you need to ask the person about it, do so quietly and privately. Do this even with children.Change these as soon as possible after the person eliminates. Urine and bowel movements next to the skin can irritate. If the person does not communicate this, check on a regular schedule to avoid this problem. Use infection control procedures when completing this task. You will need to bag the soiled brief and dispose of properly. Wash hands before and after the routine and wear gloves while completing the routine. Make sure to clean genitals and the peri-anal area correctly. Always wipe in a motion that prevents bacteria from the anus moving forward to the urethra or vagina. Make sure people are thoroughly clean and dry. Moisture combined with bacteria and yeast can lead to rashes and irritation of the skin. Disposable briefs have gotten more discreet in the past few yearsNail CareTrimming and filing nails as needed helps a person stay healthy and look their best. Ragged dirty nails are unattractive. They can be a great place for germs to collect. They are more likely to catch, tear, and break. They can scratch the person or others. In addition, poor nail care can lead to infections that can become quite painful.Here are a few other things to know about nails and nail care:There are many types of infections and problems that can affect the nails and the feet. When caring for others you may run across these common problems. Click on each one to learn a bit more. Athlete's Food/OnychomyosisNail ringwormIngrown toenailsWhen caring for a person with diabetes, daily review of the foot for small cuts and scrapes is critically important. People with diabetes are at risk for serious infection without noticing pain. The person might require professional assistance with routine nail care. Talk to your employer regarding your roles with this. Poorly tended nails can become infectedAthlete's Food/Onychomyosis. This is a fungal infection that can be caught by walking barefoot in shared places, especially damp places. Antifungal medication is needed to treat this infection. Good use of infection control procedures should minimize spreading or re-infection.Nail ringworm. This is a fungal infection that causes the nail to grow in thick and deformed. Keeping nails clean can help prevent spreading nail ringworm. Using one set of nail care tools per person and good infection can prevent nail ringworm from spreading.Ingrown toenails. This happens when the edge of the nail grows into surrounding skin, and can be a result of trimming nails too short. This can become red and painful, and can lead to infection if not treated properly. Trim nails straight across and at a moderate length. If keeping the nail trimmed does not help, ingrown toenails should receive medical attentionNail CareThe?steps?for?nail?care?are:?Step?1:?Gather?supplies?and?find?a?comfortable?and?private?place?to? complete?this?task.? Step?2:?Wash?your?hands?and?put?on?disposable?gloves.? Step?3:?Have?the?person?to?soak?hands?and/or?feet?in?warm,?soapy? water?for?at?least?five?minutes.?This?will?soften?the?cuticle.?It? will?also?help?loosen?dirt?and?germs.? Step?4:? Thoroughly?wash?the?person's?hands?or?feet?in?the?soapy? water.?Use?a?brush?if?needed?to?get?at?areas?that?are? especially?dirty.? Step?5:? Lift?the?person's?foot?or?hand?out?of?the?water?and?on?to?a? towel.?Assist?the?person?to?gently?push?back?the?cuticle? area?with?a?cuticle?stick.? Step?6:? Assist?the?person?to?clean?under?his?or?her?nails.?There? should?be?a?small?tool?on?the?nail?clipper?that?can?be?used? for?this.?If?not?you?can?find?one?in?a?nail?care?kit.?Be?gentle.? This?can?be?a?sensitive?area.? Step?7:? Pour?out?the?dirty?water?and?replace?with?clean?warm?water.? Step?8:? Thoroughly?rinse?and?dry?the?hands?or?feet.?Proper?drying? reduces?the?likelihood?of?fungus?growth.? Step?9:? Trim?toenails?straight?across?using?a?nail?clipper?or?nail? scissors.??Fingernails?can?be?trimmed?with?a?slight?curve.? Step?10:? Use?an?emery?board?or?file?to?smooth?sharp?edges?and? shape?the?nail?area?as?desired.? Step?11:? Properly?rinse,?clean,?and?sanitize?the?equipment.?Remove? and?dispose?of?gloves.??Wash?hands.The Basics of HygieneLesson Review:When assisting with personal care, focus on four important things: the person's health, safety, comfort, and dignity.The most common infection control procedures you will use include: hand-washing, using disposable gloves, and sanitizing equipment and surfaces.Methods of reducing the development and spread of bacteria and yeast as part of bathing routines include: bathing and washing frequently and thoroughly; cleaning body parts in the order described; and thoroughly drying after bathing.The Basics of HygieneReflection on the Learner Objectives. You have completed this lesson; you will be able to:Use infection control procedures and universal precautions when completing personal plete hygiene activities related to bathing, showering, and washing hair.Assist people with personal cleanliness related to care of genitals and menstrual care.Assist people with activities related to using the toilet or disposable plete activities related to care of fingernails and toenails.ADL’s – Grooming and DressingLesson 3Grooming and Self-Esteem and PerceptionsGrooming is a form of self-care and self-nurturance. It is also a form of personal expression. Choices in grooming affect our feelings about ourselves. They also influence how other's feel about us. People choose to dress and groom in a wide variety of ways.Defining DSP Roles With Grooming SupportDirect support professional roles vary depending on the needs of the person. If you have taken the other lessons in this course, you should have a pretty good idea about the needs of persons you are supporting. As a reminder you should know the following:The person's physical support needs. What things are you supposed to complete for the person? What things are you assisting with? Are you teaching, demonstrating, or simply doing for the person?The person's cognitive, mental health, or developmental needs. Does the person have barriers and challenges that may affect behavior, judgment, or communication?The person's cultural and personal preferences. What preferred products, styles, routines, or habits are important to the person?Barriers to Personal ChoicePeople who need help with dressing and grooming may also have barriers to expression of choice. These barriers will depend upon the individual. For example, many people with developmental disabilities may not have had opportunities to learn about options in these areas. They may not have much experience making choices. They may need guidance on how their choices affect how others may view them.People with other types of disabilities may also have barriers to choice. For instance, people may have limited verbal or communication skills. As a person ages they may change preferences but their adult children may not be comfortable with their choices. Sometimes people may be embarrassed to express their preferences. They may fear the direct support professional will judge them."Here we go again. Time to train in another person. Good-bye to privacy!" Personal PreferencesActivity LevelCommunity of Choice and Affiliation to Cultural GroupEmploymentEthnicityPersonal StyleReligionActivity Level: People who are very active will often need to wash more frequently than sedentary people. As a result, their skin may need special attention to keep from over-drying. They may need to use sunscreen, special lip balm, or bug spray more often. Activity level may also influence choice of dress. People who like to be active in certain ways may choose clothing to fit these needs. They may carry items in a strap-on pack rather than a purse or briefcase. They may choose shoes and other clothing based on durability and function, rather than munity of Choice and Affiliation to Cultural Groups: People have different levels of connection to their communities and cultures. Often when people choose to be an active member of a community they also choose to groom and dress like others in the group. In some groups, grooming and hygiene practices may be outside of the mainstream. For example, a greasy or unclean appearance or a strong personal body odor may be acceptable or even expected. Forms of dress can vary a lot from group to group.Employment: The work tasks and environment of where a person works will usually influence choices in grooming, dress, and to some extent hygiene. Customer services jobs will be different than factory or warehouse jobs. Office jobs are different than maintenance jobs. Some jobs may have strictly defined dress codes and hygiene expectations. Other jobs may not define dress, grooming, or hygiene at all.Ethnicity: Ethnic groups often have strong preferences for type of dress and grooming choices. Things such as length or style of hair or the maintenance of facial hair are often defined by ethnicity. A person's ethnic background may define how often to wash or what products to use.Personal Style: Many people have a personal style that they identify with. This is more common among teenagers who are more concerned about differences and establishing themselves. Terms such as "studious, hippie, crunchy, geek, Goth, professional, preppy, classic, gangsta, conservative, and alternative" are some of the ways in which people may describe themselves or others may describe them. These may be meaningful to some people and not to others. Some people are flexible in their personal style. Others are more rigid.Religion: People from different religions may have different beliefs about what they can wear and how they should look. Some people identify more than others with their religion. Religion can be a part of a person's community. Some religions require a person to wear certain types of clothing, including saris, veils, or certain colors of clothing. Some religions have very specific rules about what women should wear and what men should wear. The direct support professional will need to be familiar with the religion of the person being supported and their preferences in relation to their religionAssisting with DressingIn this lesson you will learn about:Providing physical assistance to dress.Making helpful changes in the person's home or routine related to clothing and dressing.Using assistive technology in dressing routines.Teaching people to choose clothing for specific occasions and weather.Assisting with caring for and storing clothing.Supporting personal choice and independence in dressing.Make sure you know your support role with each person. These will depend on the needs of the person and/or expectations of the employerPhysically Assisting With DressingHere are some general guidelines that will help you be respectful and effective when assisting with dressing.Allow enough time and give the process your full attention.Respect the person's privacy. Explain what you are doing as you do it.Be aware of your presence in the person's space.Offer as much choice and independence as possible and desired.Use a gentle but efficient touch. Allow enough time and give the process your full attention. No one wants to be touched or assisted in a rushed way. This can be very offensive and stressful to the person. Plan ahead and provide each person you support with enough time. This time is needed when the person is learning or completing parts of the routine for him or herself. It will be important to making it a successful experience. Make sure the person has your undivided attention. Don't leave in the middle of a routine. If you must, make sure the person is informed about what you are doing. Ensure that he or she is comfortable and covered before you go. Return immediately.Respect the person's privacy. Dressing should always be done with as much privacy as possible. Never assist with dressing in a public or shared area. Close doors to rooms before assisting with dressing. There is no need to uncover the person's entire body during dressing. This may leave the person chilled and feeling vulnerable. Uncover and dress in stages or use robes or sheets to keep people covered as necessary. Follow these procedures even with people who do not seem to understand privacy issues. (Such as people with certain mental illnesses, dementia, profound intellectual disabilities, or similar conditions.)Explain what you are doing as you do it. This will reduce the chance that the person is startled during routines. It will help them feel more comfortable with your touch. Use a calm, friendly and professional voice. Avoid silly or sing-song voices unless working with very young children (under 8 years old). Use your voice even with people who do not appear to hear or understand your words. Avoid lots of talking during routines, unless the person clearly prefers to talkBe aware of your presence in the person's space. Make sure your hands are warm. Take care in your grooming to avoid strong personal odors. This would include using good hygiene, avoiding strong smelling foods before assisting, and ensuring scents from colognes or personal products do not bother the person. Be aware that some people who have asthma can have wheezing and difficulty breathing when near people who wear cologne or perfumed products. Respect the person's personal items. Don't comment on the items. If you have to move them, return them to the order the person prefers at the end of the routine.Offer as much choice and independence as possible and desired. Reflect on routines and environments so that the person has as much control over the situation as possible. In some cases you are being hired to complete the full task. However, in general people prefer to care for themselves as much as they can. During the routines, look for opportunities for independence and choice.Use a gentle but efficient touch. Touching a person in personal care routines is an art. It's inappropriate to linger in touching. But it is jarring and alarming to be touched too abruptly. Pace your touch to complete the job gently and completely. Be careful to ensure that you are not pulling or tugging on a person's body. Keep the person situated comfortably. The less ability the person has to communicate and control his or her body, the more careful you must be to ensure you are not injuring the person or causing discomfort during dressing.Physically Assisting With DressingTake the following steps when physically assisting with dressing.Greet the person and check in on the day.Gather everything that is needed so that the routine is not interrupted.When the person is ready to dress, position the person comfortably.Follow the person's preferred routine for order of dressing.Check in at the end of the routine to ensure the person is comfortable.Some people will need complete assistance with dressing. Greet the person and check in on the day. See if the person has any needs before dressing (for example, using the toilet, getting a cup of coffee, etc.). Find out about the day and clothing choices. Complete this step even with people who do not appear to hear or understand youGather everything that is needed so that the routine is not interrupted as you go hunt for a missing item. Let the person complete this step if able and willing. The following is a list of items that may be needed: a bra, underwear, socks/hose/tights, shoes/slippers, pants/shirt, shirt/blouse, belt, and hat/scarf.When the person is ready to dress, position the person comfortably. Positioning can make a big difference in comfort and independence. If a person does not have good balance, sitting on the edge of the bed or in a wheelchair can help. Some people may need to lie down to be dressed. Other people may be able to put some of their own clothes on, but need help with certain articles of clothing. You may need to try different positions and be creative in how to assist them in order to allow him or her to be as involved as possible.Follow the person's preferred routine for order of dressing. Only uncover the part of the body you are dressing at the time. Keep the person warm and comfortable. Let people do as much as they can and want to do for themselvesCheck in at the end of the routine to ensure the person is comfortable. Make sure there is no binding or twisting of clothing. Make sure the person is satisfied with the look and comfort of the clothing. Make sure that traditional, religious, or other cultural aspects of dress are completed properly. Many have a certain technique that must be followed. You can learn these from the person and his or her family or friendEnvironmental Changes and Assistive DevicesRearranging items in the person's home and using assistive devices can make life easier for the person. It can allow the person to handle things for him or herself. An example of an environmental change is hanging or storing clothing in places that the person can reach. Lowering closet rods, using special shoe racks and other shelving or storage systems are just a few of the ways to make modifications to a closet.There are also assistive devices that can assist a person to get dressed. These items can often be purchased. A good place to look for these devices is in stores or catalogues that specialize in services to people who are elderly. They may include a device to grip and pull up socks. Another is a shoe horn with a long handle, for people who have trouble bending to pull on their shoes. Putting handles on items or using strategically placed rods or other items that a person can pull or hold on to can make a big difference in the person's freedom to move and dress.Environmental modifications can help a person have more control and choice. Assistive devices can help people with limited mobility. Options in Clothing SelectionChoice of clothing can make it easier to dress. Choosing the right clothes can lead to more independence. It can also lead to a quicker, less stressful dressing routine. For example, if someone has difficulty buttoning a shirt, he or she can purchase a pullover or one that zips. Clothing that has Velcro?, zippers, and elastic waistbands can be easier to put on than garments that have many buttons or hooks. Women can use bras with front closures. Slip-on shoes are becoming more stylish and common.Be careful to maintain the person's dignity when helping with clothing choices. People who dress inappropriately for their age or their circumstances stand out, and not in a good way. Do not make modifications that call attention to the person in an unflattering or disrespectful way. Teaching About ClothingA person may not have the skills to choose clothes without becoming confused or frustrated. While teaching these skills, the following strategies can help the person make choices without becoming overwhelmed or impatient:Using shelving for storage as opposed to drawers to make it easier for a person to view clothes.Storing matching outfits together so that a person can choose a whole outfit. This can be easier than having to pick out a shirt, pants or skirt, socks, etc. all separately.Making sure clothing available to wear is appropriate for the weather. For instance, put summer clothes away when it gets cold outside so the person is not tempted to pick shorts and a tank top when it is 20 degrees Fahrenheit.Storing items that are "favorites" but not appropriate for everyday in another closet or room. (such as a tuxedo, or formal gown). Do this with the person's permission and knowledge.Grooming Tasks that may be Part of the Dressing RoutinePeople will often not be ready to start their day after just getting dressed. Some people complete other routine grooming tasks as part of their routine or before leaving their home. These regular tasks include the following:Applying jewelry and/or accessories. (purse, coat, etc.)Applying perfume, cologne, and bing or styling hair.Applying cosmetics. After dressing there can be more to do to feel "put together." Things to Know about Deodorants and AntiperspirantsWhen assisting people with these products please keep the following in mind:An antiperspirant stops sweat glands from producing sweat for a period of time. It is usually combined with a deodorant.A deodorant reduces odor without preventing sweating.Most deodorants and antiperspirants are scented. They come in sprays, clear or white sticks, or liquid roll-on.People usually have a preference for a brand and type. They will find some products work better. Some smell and feel more pleasant to them.Both men and women use these products. Most people use them everyday.Deodorants and antiperspirants are usually not needed before puberty. They are not meant for children.How often and when these products are applied will depend on the person. Some people sweat more or have more trouble with odor. Most people apply once a day, but some people may choose to apply more often as needed due to activity or personal need.People may have allergies to these products. Watch for any soreness or irritation at the application site. Change the product until a suitable one is found. Try an unscented brand if needed.Deodorants with scents can trigger asthma attacks in some people. Unscented brands are preferred.Jewelry, Accessories, and ScentsPutting on the finishing touches of a dressing routine can include the following. These items will be highly important to some and not so important to others. Review the following by clicking on each bulleted item and reading more about it:Accessories Jewelry Scents Accessories (belts, purses, scarves, hats, coats, gloves, shoes, etc.) are the final parts of dressing. Some people are very particular about their accessories and match whole outfits. Others are more functionally focused, having few pairs of shoes, or only one purse. Be sure to support the person in pulling together a whole outfit if desired. For people with cognitive and intellectual disabilities, make sure to provide the support and education so that they can make good choices about what matches and what doesn't.Jewelry and watches are worn by some and not others. If a person does want to wear these items keep the following things in mind. Remove most jewelry at night and before bathing. Be careful when handling these items. They can be easy to misplace and this can be very upsetting and may even cost you your job. The best thing is to find a consistent place to put these items when removing them. Jewelry should be put on after clothing so it doesn't snag the clothes. Avoid long, dangling jewelry in places where it is likely to catch (Such as, near machinery or when interacting with children or others who may inadvertently grab and tug it.)Scents these are scented perfume, cologne or sprays. Some people wear a scent nearly everyday. Other people wear them only on special occasions. Yet others never wear them. Scents are very individual and a person will want to select for themselves. Make sure not to overdo it. Some people have allergies and intolerance to scents, including those found in many grooming products (not only cologne and perfume, but also shampoo, make-up, etc.). In some public or workplaces scents are banned.Hair Care and Hair-StylingPeople vary greatly in how they handle their hair. Direct support professionals will help with combing, brushing, and styling hair. If you need help with understanding how to assist with someone's hair, going to a salon or barber can be a great place to start. The stylist can help the person learn about options for his or her hair. He or she can demonstrate how to style it.Even if the person doesn't want tips on hair styling, assisting a person to make an appointment for a haircut may be part of the direct support professional's job. Direct Support professionals should avoid cutting the person's hair, even if qualified, unless the person clearly understands the options available and chooses this route. Going to a professional usually leads to a better cut. It is an opportunity to connect with others in the community.Hair Styling Tips for Different Hair TypesPeople have widely different types of hair. Treating all hair as if it were the same as yours will often mean that the person does not have hair cared for properly. Click on each of these to learn more. Listen to the voice clip before going to the next page.Ethnic/Racial/Personal Hair DifferencesOlder HairYounger HairEthnic/Racial/Personal Hair Differences. Hair type varies from person to person. A person's genetic make-up will define the texture, color, and the amount of curl. His or her ethnic and cultural background and well as personal preferences will define how the hair is styled and treated. Certain religions require specific hair styles or cuts. People may also have special hair care needs based on life circumstances or choices. For instance, people in chemotherapy may experiences hair loss. Their hair may grow in differently. They may need assistance with these changes. People may choose to have hair extensions or dreadlocks which have special care needs. Listen to the voice clip to hear an example of how these situations may affect direct support.Older Hair: Hair changes as it gets older. There may be less of it. It may grow in thinner or courser. It will usually go gray eventually. A person's well loved products and styles may not longer work with these changes as well as changes in skin texture and coloring as the person ages. In addition, the person may want to do more or do less with their hair than they did when they were younger.Younger Hair: Younger hair is usually healthy and strong. However, children can have trouble combing or maintaining hair. They will need assistance with these and need to be taught. A shorter cut can be very beneficial. Minimal products are needed outside of shampoo. Monitor a child's use of a hair dryer or other hot or electric tools. As a child grows, he or she will need help in learning about styling and fashion. He or she may want to make a statement with hair. Fortunately this in an area in which experimenting is mostly harmless and always temporary.Hair Care and Hair-StylingMake-up and CosmeticsThese are some things to know about make-up and cosmetics:Before applying make-up the person should wash his or her face and apply any sunscreen or moisturizers. Allow this to dry and be absorbed before applying make-up.Make-up is a personal use item. Discourage sharing these items. When testing at a store do notr apply to eyes or lips. The back of the hand is a good place to test products for color and consistency.Even if not shared, make-up can carry germs. Mascara, eye liner, and lip gloss or lip stick are the most likely to carry and breed germs. Discard these items every six months.Check the product for storage needs. In general a cool dry cupboard will help the products stay freshest.Poorly applied make-up can look silly or strange. When teaching people about make-up help the person understand when and how much make-up is appropriate.Cleansing is important. Make-up must be removed at the end of the day. If the person is active in sports, it is important to remove make-up either before the activity or immediately after. Cleansing will help to prevent clogged pores and skin break outs.Cosmetics can cause allergic reactions as well as extremely dry skin, rashes, or pimples. If this does happen, the person may need to stop wearing the make-up and try a different brand or kind. Hypo-allergenic make-up is probably the safest to use, and least irritating to a person's skin. Some people may not be able to wear make-up or cosmetics at all - even if they want to. Facial and Body HairBoth men and women may be interested in grooming, trimming, or removing body and facial hair. There are many methods of doing this. However, only a few of these methods are appropriate for direct support professionals to complete or provide assistance with. The following are methods of hair removal and grooming that a direct support professional may be asked to help with. Click on each of these to learn more:Hair trimmingShaving of hairUse of depilatoriesThere are other methods for removal of hair that are not appropriate for direct support professionals to assist with. These methods are more likely to result in pain or other complications. In these cases the direct support professional can help the person find a qualified professional to assist with hair removal. These include: WaxingSugaringElectrolysisLaser treatmentsTweezingAny hair trimming or removal around the genital area, by any method. Some people prefer to have facial hair taken care of at a salon. Trimming: This is shortening of hair rather than removing it. It can be done with special tools. Some are small trimmers that are made for the nose, or ear. Short trimming scissors can be used. Electric hair cutting kits often have a beard trimmer included.Shaving: This is the removal of hair by using a razor to cut the hair very close to the skin. This leaves the hair follicle intact and a small part of the hair just under the surface. The hair usually starts to come out above the surface within a few hours to a few days depending on the person and the area shaved. Shaving can be done with a straight razor or an electric razor.Depilatories Lotions, creams and gels that chemically dissolve the hair near the root are called depilatories. This method can irritate the skin, and the product should always be tested in an inconspicuous area before using. This can be used on small areas of facial hair or larger areas such as removing leg hair. Be sure to purchase the product that is made for the particular area you applying it to.Waxing A method of hair removal. A warm strip of wax with a strip of cloth over it is placed on the skin. Once it cools and hardens the cloth is pulled back to remove the hair at the root. This method is often used for larger areas of hair to be removed. This process should not be done by a direct support professional.Sugaring A method of hair removal. Sugaring is a process that is similar to waxing. Sugar is applied to skin and rolled off with the hands. This process removes hair for up to two months and can be less painful and irritating than waxing. This is most often done in a salon.Electrolysis A method of hair removal. Electrolysis can only be done by a trained professional. It is the process of using an electric current to destroy hair at the root. A small needle is placed into the skin where the hair exits the skin to burn the hair follicle. This method can be painful, expensive, and time-consuming. It has long lasting results though it may take a few treatments to remove all of the hair. This method is typically used on smaller areas of hair.Laser Treatments A method of hair removal. Laser treatments can only be done by a trained professional and can be expensive. Laser treatments do not last long initially, but after a few treatments the effects can last up to six months. There are side effects with laser treatments, so this method should be thoroughly examined as an option before pursuing.Tweezing A method of hair removal. Plucking hair with a tweezers is a way to remove one or only a few hairs at a time. This method is most frequently used to remove hair around a person's eyebrows or the stray hair on the chin or upper lip. It is a clean, effective and safe way to remove hair at the rootDifferences Between Males and FemalesBoth men and women will groom or remove hair. The direct support professional should not participate in hair removal that is likely to be painful to the person such as plucking or tweezing. Remember people may be allergic to certain products including shaving lotion or depilatories. There are many different products available at the store. Try to choose one for sensitive skin. If a person cannot tolerate shaving cream or lotion products, it may be best to use an electric razor. Click on each bullet to learn more about management.Place that men are most likely to want to remove or groom hair:BeardEyebrowsEarsBack, shoulders, chest, or stomachPlaces that women are most likely going to want to remove or groom hair:LegsUnderarmsEyebrowsBikini lineUpper lip, chin or jaw lineStomach or breastsWomen tend to have less facial and body hair, but they tend to be less tolerant of iBeard: There are many ways for men to wear their facial hair. Some men prefer to leave their hair grow in to make a beard, mustache, or goatee. Other men will prefer to fully shave their face. Shaving is the most common method for removing a beard. Trimming of facial hair may be done prior to shaving if a beard is thick, or to keep a beard or mustache neat. How often a man shaves his face will depend on how quickly his hair grows in and his personal preferences about how to wear his facial hair. Shaving can be done with an electric or non-electric razor. You will learn the basic steps of shaving later in the lesson.Eyebrows: As men age their eyebrows may become bushy or thick. Many men prefer to keep their eyebrows trimmed. Often this can be done periodically at the barber or stylist appointment. At home, hair trimming scissors or an attachment on an electric trimmer can be used.Ears and noses: As men age hair in the ears and nose can grow longer and thicker. This can be annoying and unpleasant looking to the man. This hair is usually trimmed using a small trimming device, specially made for these areas. This can be purchased at a drug store.Back, shoulders, chest, or stomach: Some men do not like it if there is too much hair on these areas. Other men do not mind hair on these areas at all. In general removal of this hair is done at salon with wax or through electrolysis. However, some men may shave or trim this hair.Legs: It is common for women to remove hair from their legs. Some women do this regularly, others only when legs are going to be showing. A woman may choose to remove hair from her whole leg or only the calf and knee area. There are many different methods to use when removing leg hair. Shaving or depilatories are methods in which a direct support professional may assist. Many women do this hair removal during bath or shower routines.Underarms: Many women prefer to remove hair from under their arms. A common choice for this type of hair removal is to shave the hair. Many women do this as part of their bath or shower or shower routine.Eyebrows: Many women like to pluck their eyebrows to keep them thin and well-shaped. Plucking can be painful and should not be completed by the direct support professional. If the women cannot complete this for herself, she should have her eyebrow's plucked or waxed at a salonBikini line: The bikini and genital area is an area where many women chose to groom or remove hair. This is the area where that is covered by underwear or very near this area. This is a very sensitive area, and the appropriate method for removing hair should be thoroughly considered. This is NOT an area of hair removal in which is it appropriate for a direct support professional to assist. There are professionals in a salon to complete this type of hair removal.Upper lip, chin or jaw line: As women age, upper lip hair and long hairs along the jaw line or chin can grow. This is often a gradual process. If a woman is unaware of this hair or of the social implications of growing this hair, a direct support professional may help her learn about options for removal. The woman may pluck a stray long hair on the face. However, for thicker facial hair a woman may choose to use a depilatory or wax the area.Stomach or breasts: Women may find that a few course dark hairs grow on their breasts or stomach. Usually these can be trimmed with short scissors, removed with depilatories or a woman may pluck these for herself. Waxing in a salon is also an option.Shaving with a Non-Electric RazorShaving with a non-electric razor is often called a "wet shave" because it is done with water. It can be completed in the shower, bath or at a sink. If you are teaching the person, you will usually teach in the place where he or she would be expected to complete this routine independently. Make sure the person you are supporting is comfortable before starting.When using a non-electric razor remember the following safety items:Shaving carries the risk of transferring blood borne pathogens. Follow universal precautions during this procedure.Chipped, broken, or rusty razor blades should be discarded in an appropriate place.Use only the person's razor or a clean disposable razor. Do not share razors.Shaving with an Electric RazorUsing disposable gloves is optional if you are using an electric razor. Though you may still come in contact with blood, it is much less likely than if you are using a non-electric razor. Before beginning with an electric razor be sure it is clean (no accumulation of hair in the blade area). If it is not, clean the blades before turning on.The basic steps of shaving with an electric razor are:Turn on the electric razor (be sure you are a safe distance from any water).Using gentle, even pressure move the electric razor in long strokes down the area.Gently shave around difficult areas such as the lips, nose, ankles, knees, and any moles or blemishes.Clean the electric razor as needed during this process (be sure to turn it off).Check the skin for any area that was missed, and gently shave any area you find.Apply aftershave or lotion as desired by the person.When using an electric razor it is important to remember the following safety items:Electric razors should not be used in the same room where oxygen is used.Electric razors should not be used around water. Use only the person's razor. Do not share razoNail CarePeople have different preferences about the way they want their nails to look. Some people prefer to wear long nails, while others like their nails short. Some people wear nail polish, or fake nails. Grooming a person's nails can be done at a salon or at home.Some things to know about grooming fingernails and toenails:The grooming of fingernails is called a manicure. The grooming of toenails is called a pedicure. Some employers do not allow employees to wear nail polish (for instance, many restaurants and food preparation services). If the person is unaware of these possibilities, make sure to inform them before assisting with polishing. Nail care tools are personal use items and should not be shared. Be sure that they are clean before use. Always wear gloves when providing toenail or fingernail care. Use caution when clipping hangnails. This is often best to be done by a nail care professional at a salon to avoid minor cuts that can become infected. Proper filing goes from the corners to the center - do not use a sawing motion, but always move the file in one direction. Things to know about nail care at a salon:The cost of manicures and pedicures can vary greatly by salon. Professional manicures and pedicures can often last longer than those performed at home. Bacteria can be transferred from one person to another if nail care tools are shared and not cleaned properly. Checking with others who go to salons is a good way to find a salon for the person you are supporting. Bringing a set of personal tools is one way to reduce the risk of transferring infections or fungus. Grooming nails can be a personal statement. Click here to learn about Tattoos and PiercingTattoos are permanent designs applied to a person's skin by a tattoo artist using a tiny needle and ink.Body piercing is done in order to wear jewelry in the piercing. This can include common piercing such as ears. Some people choose less common piercing such as nose, bellybutton, eyebrow, tongue, or genital areas.These are some things to know about these procedures:Piercing and tattooing are painful. The area will require care for some time after being completed. Infections are possible with these procedures. There may be limits on activities after piercing for several weeks. Redness, swelling, and pain that get worse, not better, are signs that infection has started. A person should see a medical professional in these cases. Some cultures do piercing or tattooing at home. As a paid direct support professional you are not allowed to assist or complete these procedures for a person even if you are experienced with it. They must go to a professional or seek a friend or family member to complete the procedure. A person under 18 needs permission from a legal guardian to engage in these procedures. Adults under guardianship may also have limits. Check this first. However, use caution, in many cases a guardian or legal representative would not have final say in these matters, although the legal representative may think the decision is up to him or her. Help the person find a reputable professional for these services. Diseases and bodily harm can be outcomes if not done correctly. Tattoos can be religious expressions or artBasics of Grooming and DressingLesson Review:Grooming is a form of self-care and personal expression. People choose to dress and groom in a wide variety of ways.The direct support professional needs to have a basic understanding of many kinds of grooming activities, including nail care, hair care, shaving, and dressing to provide quality support.Typical direct support roles will include physical assistance with all or part of a dressing routine. It may also include teaching people about shopping, and clothing care.Dressing is only one part of a daily routine of getting prepared to go out. Most people also do some other daily grooming such as using deodorant, applying jewelry or make-up, shaving, and/or combing and styling their hair.Basics of Grooming and DressingReflection on the Learner Objectives. You have completed this lesson, you will be able to:Assist a person with grooming and dressing in a way that projects the image that he or she chooses.Assist with dressing including physical assistance and selection of plete activities of grooming including hairstyling, managing body hair, wearing makeup and jewelry, and other grooming activities.Healthy DietThe role of the Direct Support Professional can be very challenging, especially when it comes to supporting a healthy life style. You are often in the role of offering choices that impact living a healthy life. You help buy groceries, coordinate physical activity, and help the individual you support select community health care providers. Many of these duties are accomplished without the knowledge and support on what it takes to live a healthy life. As a Direct Support Professional, you have a role in offering and supporting healthy choices, in educating individuals so they can make informed choices in role modeling what it takes to live a healthy life style. Therefore, it is important for a Direct Support Professional to know something about healthy living.It is important to support healthy living because taking care of yourself helps you to feel better about yourself. When you take care of your health you feel better, have more energy, have higher self esteem, and live longer with increased health benefits. Today more than ever it is important for direct support professionals to take the initiative and support individuals with disabilities to make good decisions about living a healthy life.The role of the Direct Support Professional in supporting healthy choices becomes complicated because the individuals you support are encouraged to make choices about how they want to live their lives, even when the choices may not support healthy living. This lesson will help you identify what a healthy diet means so you can help support healthy choices. Your responsibilities include:Advocating for healthy food choices Explaining the importance of healthy food choices Encouraging individuals to make healthy food choices Assessing health care needs that directly correlate with food choicesSupporting the choices individuals make Describing what you believe are healthy food choicesPHYSICAL WELL – BEINGThe first part of living a healthy life is taking care of your body. This is your physical well-being. One of the best ways to take care of your physical well-being is NUTRITION.lefttopNutrition = Eating right!Food is the fuel that provides energy so all of the body's parts can work properly. Food is one of the essentials of life. Without proper food and nutrition, the body cannot work properly. This could lead to illnesses and early death. Without proper nutrition, you don't feel good and are less likely to take care of yourself. This can lead to not eating right. This circle of behavior keeps going round and round. So remember, living healthy starts by understanding and eating a healthy diet.Eating right includes all of the following:Picking the right foods Shopping for the right foods Cooking for health Having the right food around the house Handling food properly Eating healthfully at restaurants FOOD GROUPSPicking the right foods means eating the right amounts from each food group. The food groups consist of the following:Dairy : milk, cheese, cottage cheese, yogurtMeat/Protein: steak, hamburger, chicken, fish, nuts, beansFruit: apples, cherries, berries, bananasVegetables: green beans, carrots, broccoli, lettuce, radishesGrains: bread, potatoes, riceThe picture above details the “Food Groups”. The size on the plate indicates the suggested servings needed each day.Grains - Make at least half of your grains whole grains.Fruit and Vegetables - Make half your plate fruits and vegetables.Dairy - Switch to fat-free or low-fat (1%) milk. Depending on your age 2 - 3 cups per day.Protein - The amount needed from the Protein Foods Group (meat, poultry, seafood, beans and peas, eggs, processed soy products, nuts, and seeds) depends on age, sex, and level of physical activity. Eat lean meat baked, broiled or grilled is best.PLANNING AND SHOPPINGPlanning and shopping for the right foods is important to ensure proper nutrition. This will make it easy to have the right foods around when you are ready to eat. Here are some tips to help you plan and shop for the right foods: Choose foods low in fat, sugar and salt. Buy breads and cereals that are high in dietary fiber. Avoid convenience foods. Make meals ahead of time instead of using pre-processed food. Read food labels before you buy. Go out for a treat rather than having it in the house. COOKING AND HANDLING FOODS TO PREVENT FOOD-BORNE ILLNESSESWhat Is Food-borne Illness?Food-borne illness is a preventable public health challenge that causes an estimated 48 million illnesses and 3,000 deaths each year in the United States. It is an illness that comes from eating contaminated food. The onset of symptoms may occur within minutes to weeks and often presents itself as flu-like symptoms, as the ill person may experience symptoms such as nausea, vomiting, diarrhea, or fever. Because the symptoms are often flu-like, many people may not recognize that the illness is caused by harmful bacteria or other pathogens in food.Everyone is at risk for getting a food-borne illness. However, some people are at greater risk for experiencing a more serious illness or even death should they get a food-borne illness. Those at greater risk are infants, young children, pregnant women and their unborn babies, older adults, and people with weakened immune systems (such as those with HIV/AIDS, cancer, diabetes, kidney disease, and transplant patients.) Some people may become ill after ingesting only a few harmful bacteria; others may remain symptom free after ingesting thousands.How Do Bacteria Get in Food?Microorganisms may be present on food products when you purchase them. For example, plastic-wrapped boneless chicken breasts and ground meat were once part of live chickens or cattle. Raw meat, poultry, seafood, and eggs are not sterile. Neither is fresh produce such as lettuce, tomatoes, sprouts, and melons.Thousands of types of bacteria are naturally present in our environment. Microorganisms that cause disease are called pathogens. When certain pathogens enter the food supply, they can cause food-borne illness. Not all bacteria cause disease in humans. For example, some bacteria are used beneficially in making cheese and yogurt.Foods, including safely cooked and ready-to-eat foods, can become cross-contaminated with pathogens transferred from raw egg products and raw meat, poultry, and seafood products and their juices, other contaminated products, or from food handlers with poor personal hygiene. Most cases of foodborne illness can be prevented with proper cooking or processing of food to destroy pathogens.The "Danger Zone"Bacteria multiply rapidly between 40 °F and 140 °F. To keep food out of this "Danger Zone," keep cold food cold and hot food hot.Store food in the refrigerator (40 °F or below) or freezer (0 °F or below).Cook food to a safe minimum internal temperature. Cook all raw beef, pork, lamb and veal steaks, chops, and roasts to a minimum internal temperature of 145 °F as measured with a food thermometer before removing meat from the heat source. For safety and quality, allow meat to rest for at least three minutes before carving or consuming. For reasons of personal preference, consumers may choose to cook meat to higher temperatures.Cook all raw ground beef, pork, lamb, and veal to an internal temperature of 160 °F as measured with a food thermometer.Cook all poultry to a safe minimum internal temperature of 165 °F as measured with a food thermometer.Maintain hot cooked food at 140 °F or above.When reheating cooked food, reheat to 165 °F.In Case of Suspected Food-borne IllnessPreserve the evidence. If a portion of the suspect food is available, wrap it securely, mark "DANGER" and freeze it. Save all the packaging materials, such as cans or cartons. Write down the food type, the date, other identifying marks on the package, the time consumed, and when the onset of symptoms occurred. Save any identical unopened products.Seek treatment as necessary. If the victim is in an "at risk" group, seek medical care immediately. Likewise, if symptoms persist or are severe (such as bloody diarrhea, excessive nausea and vomiting, or high temperature), call your doctor.Call the local health department if the suspect food was served at a large gathering, from a restaurant or other food service facility, or if it is a commercial product.Call the USDA Meat and Poultry Hotline at 1-888-MPHotline (1-888-674-6854) if the suspect food is a USDA-inspected product and you have all the packaging.Safe TransportationThe Five "Knows"There are things you can do before, during, and after driving to reduce the risk of accidents. These actions assure your safety and the safety of all passengers. Your responsibilities can be summarized in the five "knows" of safe driving.The five "KNOWS" include:Know yourself.Know your vehicle.Know defensive driving strategies.Know your passengers.Know your plan.The Five "Knows"Know defensive driving strategies. A defensive driver's rules of the road include the following:Follow all traffic rules and speed limits. Extend courtesy to other drivers.Keep the vehicle and its safety equipment in good working order.Be aware of road and traffic conditions that may add to the risk of driving.Avoid or plan for road and traffic conditions where the risk for accidents is increased.Watch for and anticipate the actions and mistakes of other driversThe Five "Knows:" Know defensive driving strategiesPlanning ahead and anticipating challenges may be one of the most important defensive driving strategies. Know where you are going, who is going, how long you have, what you will need, and what you will be doing. This should all be part of preparation.The Five "Knows:" Know your passengersSome of the people you support may have conditions that will affect your driving habits. Find out about each person you have to transport. This will make sure everyone is safe. You may have completed a community safety assessment or plan for someone. If so, you may already know this information. You can also ask your supervisor for information about each person you supportThe Five "Knows:" Know your PlanYou may find yourself in an emergency roadside situation. Would you know what to do? Would you be prepared? Do you have an emergency vehicle kit? You should have one with you at all times. You should be familiar with the supplies and know how to use them. You may need different kinds of supplies. This will depend on the person and the environment.As a DSP these are important factors to think ahead about. Make sure your vehicle is supplied with gas, an emergency kit, a cell phone, or other items that may be needed for passenger health and safety. Check your supplies before each trip.Distracted DrivingDistracted driving is dangerous driving. Examples of distracted driving include:Texting.Using a cell phone.Listening to loud music.Talking to passengers.Eating in the car.Conclusion and SummaryThe 5 knows provide information and skills on being a safe driver.Knowing your own strengths and weaknesses with regard to driving may prevent accidents or problems from occurring.You should have a working knowledge of your vehicle. This ensures you can operate it safely.Defensive driving strategies are useful skills. These can help prevent accidents before they happen.You need to understand each passenger's needs to be safe when driving.Plan ahead in case of an accident or injury. This may help in an emergency.Distracted driving is a cause of motor vehicle accidents and should be avoided. ................
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