Hi
Some of you know that I have worked in the medical field in some form or another for 30 years.
I've picked up a lot--and currently, when my physical condition allows, I teach CNAs.
Here are a few tips I'd like to recommend those of you that have mostly bed-bound PALS or PALS that have home aids come in.
With my health, I've been in the hospital probably 15 times--no exaggeration. The last several times, I've gotten quite sick there. The last stay--only two days--and I got c-diff. A nasty thing, trust me.
Gentleman Jim posted about his friend with MRSR.
Here are some tips for those of you with your PALS at home with aids helping:
Tip 1. INSIST they wash their hands for 15 seconds. Here's how I teach every student:
1. Turn on water (with a paper towel) and adjust to about 105
2.Wet Hands
3/ Approx 1teaspoon of soap (3 squirts of hand pump soap)
4. 10 FULL seconds of nothing but back and forth friction of the palms
5. 5 seconds on the back of each hand--again, friction
6. Wash wrists--at least ONE hand-length (prefer two)
7. Clean webbing between EACH FINGER
8. Clean each finger (wrap around soapy hand once or twice (this gets the germs in the knuckles)
9. Clean cuticles
10. Clean under nails (or tips if no nails)
11. Rinse (keeping hands down
12. Turn off water with a TOWEL (a MUST)
Dry hands STARTING at the tips and working down to the wrist. The towel should NOT touch the hand once it's touched your wrist. Dry second hand with a NEW TOWEL.
This prevents cross contamination--and works better than the hand sanitizer.
CALS--INSIST your caregiver use this process (or similar) BEFORE THEY TOUCH YOUR PAL, whether it be a nurse, doctor or CNA (or you, sorry) Anyone that is immune compromised is at risk for picking up things like MRSR and C-Diff.
Tip 2:
Anything that will touch your PAL should NOT touch your CNAs clothes. (No holding those nice clean sheets against their likely contaminated uniform)
I will gladly give a CNA course for ANY CAL that can get to Orlando area free of charge to teach the basic techniques needed to care for the disabled--including CPR.
Tip 3
Each time the PAL is turned (which should be every 2 hours when possible) the common areas of skin breakdown should be checked for redness. Gentle massage is ok, as long as the skin is not torn.
There is a very inexpensive alternating pressure mattress pad that will help prevent pressure sores
Don't let ANYONE dress any pressure sores without sterile gloves--there is too high a risk of sepsis (an infection that reaches the bloodstream)
Tip 4
Cath care should be provided at least once per day minimum. PM for details. Just remember, ONE washing stroke with EACH spot of the cloth--never wipe more than once with the same spot---use a separate cloth to rinse) Always clean from "clean to dirty" or "top to bottom" The cath itself must be held GENTLY during this process, and should also be washed 4-6 inches.
When the bag is emptied--WEAR GLOVES--urine should be clear and light yellow. The bag must ALWAYS be below the level of the bladder--and use an alcohol wipe to clean the port before putting it back in the holder (bags are changed as often as the doc/nurse/medicare will pay for them. Again--breeding grounds for infection.
Tip 5
Turning by yourself.
1. Position for safe turning (fold one arm across the waist) and bend the knee on the same side up slightly (by holding the thigh and calf, not under the knee)
2. Position the other arm (from other side of the bed) either above or below the pillow (per PAL preference)
3. With one hand beneath the shoulder and the other mid-thigh(the one you raised) Roll them gently toward you in one smooth motion.
4. Make sure their hand is not trapped under their waist. Place a pillow beneath this arm--protecting the elbow and hand)
5. The neck should be straight, and the pillow adjusted to their comfort.
6. Place one or two pillows between the knees and ankles. It's easier to lift a heavy leg by supporting both the bent knee and calf area)
7. When positioned properly--their shoulder, hip and ankle should be pretty much in a straight line
(hint: This method can be used for perineal care when they have an accident in the bed to clean) Always clean from front to back--being sure, again, to only wipe ONE time with each area of the cloth--I teach my students to use each corner for each wipe, then the middle for the thigh creases) Use a 2nd cloth to clean the backside) A third cloth is used for rinsing. (reality here---it will take more than 3 wash clothes--but we want the rinse water to stay clean, so more clothes are used (or wipes, whatever you use in your home)
Use a bath blanket--only expose what needs cleaned for the modesty of the PAL.
For you CALS that have been doing this a long time--you know this stuff--but this was posted as we seem to have more and more new people with strangers coming into their homes.
Hope it helps someone.
Are you in Hospital, NH or have Home Health? Please read 
