9.3 Perineal Care, Dressing, and Grooming

Perineal Care, Dressing, and Grooming on the INACE

Perineal care ("peri care"), dressing and undressing, hair care, and fingernail care all appear among the 21 mandated INACE skills. Each is scored against a checklist that rewards privacy, dignity, correct sequence, and reporting of abnormal findings. Gloves are mandatory for peri care because of contact with body fluids, and hand hygiene must be repeated immediately after the gloves come off.

Female Perineal Care

Peri care cleans the genital and anal area to prevent urinary tract infections, skin breakdown, and odor. The cardinal rule is always clean and dry from front to back, moving from the cleanest area (urethra) toward the dirtiest (anus). Wiping back to front drags rectal bacteria toward the urethra and causes UTIs — the most-tested trap in this skill.

1. Wash hands, glove, explain, provide privacy.
2. Position the resident supine with knees bent and apart; place a waterproof pad under the buttocks.
3. Use warm water (about 105°F-109°F) with mild soap or a no-rinse cleanser.
4. Separate and wash the labia front to back, using a clean section of washcloth for every stroke.
5. Clean the folds, then the perineum, then the anal area last, always front to back.
6. Rinse and pat dry front to back; apply barrier cream only if ordered.
7. Remove gloves, wash hands, lower the bed, place the call light, document.

Dressing and Undressing

Memory aid: dress the weak side first, undress the strong side first. Doing the affected limb first while dressing means you never have to force a stiff or weak joint through a sleeve that is already taut.

• Shirt: weak arm in first, pull over the head, then the strong arm.
• Pants: weak leg in first, then the strong leg, then pull up.
• Let the resident choose the outfit to support self-determination; assist only with fasteners they cannot manage.

Hair Care

1. Offer a choice of style and provide privacy.
2. Use a wide-tooth comb or soft brush.
3. Start at the ends and work up toward the scalp to free tangles without painful pulling; for matted hair, hold the strand above the tangle so you do not tug the scalp.
4. Style as the resident prefers; report excessive hair loss, scalp sores, dandruff, or lice (nits on the hair shaft) to the nurse.

Fingernail Care

1. Soak the fingernails in warm water about 5-10 minutes to soften.
2. Clean under the nails with an orangewood stick.
3. Trim straight across with clippers (only if facility policy permits), then smooth with an emery board.
4. Apply lotion to the hands, but keep lotion out of the area between the toes to avoid trapping moisture.

Scope limits you must honor:

• Do not trim toenails, and never trim the nails of a diabetic resident — poor circulation and reduced sensation turn a small nick into a non-healing wound; refer to the nurse or podiatrist.
• Never use scissors; use clippers and an emery board only.
• Always follow your specific facility policy, which may restrict CNA nail trimming further.

Male Perineal Care and the Catheter Resident

For an uncircumcised male, gently retract the foreskin, clean the tip of the penis in a circular motion from the urethral opening outward, then return the foreskin to its natural position — leaving it retracted can cut off circulation. Wash the shaft, then the scrotum, and the anal area last. For any resident with an indwelling (Foley) catheter, clean the catheter tubing by wiping away from the body — from the insertion site outward about four inches — using a fresh cloth section per stroke, and never tug the tubing.

Anchor the drainage bag below the level of the bladder so urine does not flow backward, a known cause of infection.

Worked Example: Dressing a Hemiplegic Resident

The scenario card reads: "Mrs. Park has right-sided weakness. Help her put on a cardigan and slacks." You offer her a choice between two outfits to honor her preferences, then provide privacy. For the cardigan you gather the right (weak) sleeve, guide her right arm in first, bring the sweater across her back, then slip in the left (strong) arm. For the slacks you thread the right leg first, then the left, and have her lift her hips or roll side to side as you draw them up. You fasten only the buttons she cannot reach and confirm nothing is bunched under her back where it could cause a pressure point.

When you later undress her, you reverse the rule and free the strong left side first. The memory phrase "weak goes in, strong comes out" keeps the order straight under exam pressure.

Observations to Report