Procedure – Assisting with Changing a Clean (Non-sterile) Dressing

Home Health Aides are able to provide assistance with or perform changing of clean dressings. They may not change sterile dressings. Sterile dressings are used over new, open, or draining wounds in which sterile technique must be maintained. This is to prevent introducing bacteria and other pathogens into the wound and causing infection. Clean (non-sterile) dressings are those applied to dry, closed wounds that have less risk of getting an infection. Personal Care Aides may not provide assistance with changing any dressings, whether they are clean or sterile.

1. Explain the procedure to the patient.
2. Wash your hands.
3. Assemble all necessary equipment.
4. Provide for privacy and adequate lighting.
5. Raise the bed to waist height. Lower the side rail nearest you where you will be working.
6. Place a garbage can near the area where you will be working.
7. Remove any clothing necessary that is over the old dressing.
8. Wash your hands and don gloves.
9. Clean (sterilize) a table to use in which to place your dressings and supplies.
10. Remove wrappings from new dressing. Take care not to contaminate gloves by touching any surfaces. Lay new, clean dressings on a clean surface.
11. Cut tape with clean scissors. Hang tape within reach on the edge of a clean table.
12. Remove and discard old dressing. Peel off tape by pulling toward the center of the dressing.
13. Carefully lift dressing off the wound. To prevent skin tearing or injury to the patient, hold the skin underneath the tape taut while pulling the tape off.
14. Prevent the soiled dressing from touching the wound or other body parts of the patient or nearby surfaces or objects.
15. Observe the wound for odor, drainage, color, and healing/not healing characteristics. Report these to a supervisor. Document findings.
16. Remove and discard gloves. Wash your hands.
17. Put on new gloves.
18. Cleanse skin around wound, according to directions in the Care Plan and as directed by a supervisor.
19. Apply a new dressing to the wound.
20. Tape the new dressing in place. Ensure the new dressing is firmly secured.
21. Discard all waste items.
22. Remove and dispose of gloves. Wash your hands.
23. Store unused supplies and clean working area.
24. Document the procedure and any observations or changes in condition. Record and report any changes or observations of the wound.

Introduction to Mouth Hygiene

Performing or assisting with mouth hygiene is an important task of the Home Health Aide/Personal Care Aide. Mouth hygiene should be performed at least twice per day, with morning and evening care. Mouth hygiene may also be performed after eating meals and any time the patient requests. Regular, daily flossing helps to remove plaque and food debris which promotes bacteria, from the patient’s mouth. Unclean mouths harbor bacteria, which can cause additional health problems for the patient. Having a clean mouth promotes a sense of comfort and self-esteem for a patient.

Providing oral care also gives Home Health Aides/Personal Care Aides a chance to assess the health of their patient’s teeth, gums, and tongue. Home Health Aides/Personal Care Aides should encourage their patient to perform as much mouth care independently as possible. For patients who are unable to grasp the handle of a toothbrush, special toothbrushes may be available for them. A split rubber ball or tape can be used to build up the handle of the toothbrush to make it easier for the patient to hold. An electric toothbrush may also be used.

Avoid using hydrogen peroxide or alcohol based products because they promote mouth irritation and mucosal membrane breakdown. For patients in which using a toothbrush is unsafe, such as those who are unable to spit or who are unconscious, special mouth swabs are available for use. Mouth care should be provided every two hours for patients who are unconscious or unable to drink. This helps to prevent dryness and breakdown of mouth surfaces. When finished providing mouth care, apply lip moisturizer or petroleum jelly to lips to prevent skin breakdown, chapping, and drying of the lips.

Procedure – Patients Who Can Brush Their Own Teeth or Need Some Assistance

 1. Explain the procedure to patient.

1. Provide for privacy.
2. Wash and dry hands. Always wear gloves when providing mouth care.
3. Assemble equipment (emesis basin, water, cup, toothbrush, toothpaste, mouthwash, and a towel).
4. Ensure the patient is in an upright position for safety. A high sitting position prevents choking or aspiration.
5. If the patient is able to brush their own teeth, provide equipment and assist as needed.
6. Wet toothbrush, apply a small amount of toothpaste to the bristles on the brush.
7. Hold the toothbrush at a 45 degree angle to the gum line. Brush one tooth at a time in an up and down motion. Start from the top of the gum line and work down the tooth. Start at the upper teeth and then complete the lower teeth.
8. To clean biting surfaces of teeth and the tongue, use a back and forth motion.
9. Be sure to brush all surfaces of the teeth, gums, tongue, and mouth.
10. Ensure the patient adequately rinses their mouth with clean water and dries their lips/face. Offer mouthwash and lip moisturizer as needed and according to patient preferences.

Procedure – Patients Who are Unable to Perform Mouth Hygiene Independently, such as an Unconscious Patient

1. Complete hand hygiene and assemble needed equipment.
2. Put the patient in a side-lying position for safety. Turn their head to the side.
3. Place a towel or waterproof pad under their cheek and chin to prevent the patient or bed linens from getting wet.
4. Place an emesis basin against the side of their mouth and cheek.
5. Place a padded tongue blade on the side of their mouth to keep their mouth open. To make a padded tongue blade, place two wooden tongue blades together. Wrap gauze over the top half and tape it into place. Pull the patient’s mouth apart by placing gentle pressure on their chin and upper mouth.
6. Never put your fingers inside their mouth because the patient may bite down, even if they do not mean to.
7. Brush teeth gently, using a dry toothbrush or with a mouth swab. Dip the swab in solution and squeeze excess solution from the swab. Swab all surfaces of their teeth, gums, inside their cheeks, the roof of their mouth, and tongue. Use clean swabs as necessary.
8. Rinse entire mouth with a clean swab. Ensure there are no pooled secretions. Suction excess secretions as directed in the Care Plan.
9. Ensure the patient’s mouth, face, and neck are dry.
10. Apply moisturizer to lips.
11. Return the patient to a comfortable position. Lower the bed to its lowest height and raise side rails.
12. Put away equipment and supplies.
13. Remove your gloves. Wash and dry your hands.
14. Document completion of task and record any changes in condition or behavior. Report any tooth or mouth conditions observed, such as sores, open areas, or bleeding from gums, tongue, or teeth. Report any new broken or missing teeth.

 Procedure – Denture Care

1. Complete hand hygiene and assemble needed equipment.
2. Assist the patient to remove dentures if needed by placing a tissue, gauze pad, or washcloth underneath the patient’s denture line and gently pulling forward to break the suction. You may need to gently rock the dentures from side to side or forward to break the suction.
3. Carefully place dentures in a water filled cup or container.
4. Carry the dentures to the sink using a denture cup to prevent accidental breakage.
5. Place a towel in the sink to prevent accidentally breaking dentures on the hard surface of the sink while you are washing them. Hold them firmly.
6. Clean dentures as you would teeth. Use denture cleaning products. Use warm, but not hot water. Hot water can cause dentures to warp and no longer fit the patient correctly. Rinse dentures completely.
7. Provide or assist with mouth care prior to replacing dentures. Assist the patient to brush their gums and tongue with toothpaste and a toothbrush. Ensure they rinse their mouth completely. Offer mouthwash.
8. If returning dentures to the patient’s mouth, apply denture cream or adhesive, as needed.
9. Assist the patient to place dentures back in mouth. To reinsert dentures, insert at an angle, pressing firmly onto the gum line.
10. If storing dentures, store them in clean, cool water in a container with a closed top to prevent accidental breaking or misplacement. If in a facility, ensure the patient’s name is on the denture cup to prevent loss.
11. Remove your gloves. Wash and dry your hands.
12. Document completion of task and record any changes in condition or behavior. Report any tooth or mouth conditions observed. Report if dentures are broken or missing.

Procedure – Flossing

1. If assisting with flossing, break off about 18 inches of floss. Wind ends of floss around your pointer or middle finger. Wrap the other end of the floss around the same finger on the opposite hand.
2. Hold the floss tightly between your thumb and forefingers. Starting at the top and back of the mouth, guide the floss between two teeth. Use a gentle rubbing motion to guide the floss between the teeth. Do not quickly snap the floss between the teeth or you can cause pain or injury.
3. Once you reach the gum line, curve the floss into a C shape against one tooth. For upper teeth, move the floss away from the gum line with a gentle downward motion against the tooth. For lower teeth, use an upward motion against the tooth, away from the gum line.
4. Repeat for each tooth, using a clean section of floss for every 1-2 teeth.
5. Allow the patient to rinse and dry their mouth. Dispose of floss. Do not reuse floss.