9.3 Perineal Care, Dressing, and Grooming

Perineal Care, Dressing, and Grooming

Perineal care (often called "peri care"), dressing/undressing, hair care, and nail care are all among the 21 mandated INACE performance skills. These personal care tasks require attention to dignity, privacy, and proper technique to prevent infection and promote comfort.

Perineal Care — Female (INACE Skill)

Perineal care is the cleaning of the genital and anal area. Proper technique prevents urinary tract infections, skin breakdown, and odor.

Key Principle: Always wipe from FRONT to BACK — this prevents bacteria from the rectal area from reaching the urinary tract (reducing UTI risk).

Procedure:

1. Wash hands and apply gloves
2. Explain the procedure and provide privacy
3. Position the resident on their back with knees bent and legs apart (or on their side if unable to maintain back position)
4. Place a waterproof pad under the buttocks
5. Prepare warm water and mild soap (or no-rinse perineal cleanser)
6. Wash the labia from front to back using a clean area of the washcloth for each stroke
7. Clean the folds between the labia
8. Wash the perineum (area between vagina and anus) front to back
9. Wash the anal area last — front to back
10. Rinse thoroughly (front to back)
11. Pat dry thoroughly (front to back)
12. Apply barrier cream if ordered
13. Remove gloves and wash hands
14. Document care and observations

Dressing and Undressing (INACE Skill)

General Rules:

• Undressing: Remove from the strong/unaffected side first
• Dressing: Put clothing on the weak/affected side first
• Memory aid: "Dress the weak side first, undress the strong side first"

Dressing Procedure:

1. Allow the resident to choose their clothing (promotes self-determination)
2. Provide privacy
3. For a top/shirt: Put the weak arm in first → pull over the head → then the strong arm
4. For pants: Put the weak leg in first → then the strong leg → pull up
5. Assist with fasteners (buttons, zippers) as needed
6. Ensure clothing fits comfortably and shoes are on properly

Hair Care (INACE Skill)

Procedure:

1. Offer the resident a choice of style
2. Use a wide-tooth comb or soft brush
3. Start at the ends and work toward the scalp to prevent pulling and pain
4. Be gentle — avoid pulling or tugging
5. Style as the resident prefers
6. Report excessive hair loss, scalp lesions, or signs of lice to the nurse

Nail Care — Fingernails (INACE Skill)

Procedure:

1. Soak fingernails in warm water for 5-10 minutes to soften
2. Clean under nails with an orangewood stick
3. Trim nails straight across with nail clippers (if permitted by facility policy)
4. File rough edges smooth with an emery board
5. Apply lotion to hands

IMPORTANT Restrictions:

• Do NOT trim toenails — this is typically outside CNA scope due to injury risk, especially for diabetic residents
• Do NOT trim nails of diabetic residents — refer to the nurse (risk of cuts that do not heal)
• Do NOT use scissors to trim nails
• Follow your facility's specific policy on nail care scope

Observations During Personal Care