CNA Skill: Providing Perineal Care for a Patient

Perineal care is performed after a patient uses the bedpan, becomes incontinent, and as a part of daily bathing.  As the nurse’s aide performs perineal care, she is able to observe the skin on the perineal area for signs of infection such as lesions or swelling, which can be early signs of more serious conditions.  Care performed regularly and properly will reduce the risk of urinary tract infection which can lead to bladder and kidney infection.  Before you begin, wash your hands thoroughly and put on a pair of gloves.  Then, follow these steps:

1. Ask the patient to open his or her legs if they are able.  If not, you will need to gently separate the legs.
2. Using a washcloth and warm water, gently clean the skin of the perineal area moving from front to back.  Do not move from back to front due to the risk of introducing germs from the anal area into the urethra, a primary source of urinary tract infeaction.
3. When you are finished washing, dry the area thoroughly to prevent skin from becoming chapped.
4. Never reuse linens used to clean the perineal area to clean any other part of the body.  Use a clean washcloth for this area only to minimize the spread of germs.
5. If bed linens are soiled or become wet during the cleaning process, you will need to replace them as quickly as possible.
6. Place used linens in the appropriate receptacle.  Help the patient move to a comfortable position.  Dispose of gloves and wash hands.

As you work, remember it is important to look for signs that may indicate infection.  This can include pain or tenderness in an area, rashes, sores, or boils.  If you notice any of these signs, report them to the nurse immediately.  Proper care can help your patient remain comfortable as they recover.

Examiners Checklist For This Skill:

1) Performed beginning tasks.
2) Filled basin with water at correct temperature to resident
preference, if applicable.
3) Covered the resident appropriately to avoid exposure and maintain
dignity.
4) Placed a waterproof pad under buttocks.
5) Positioned resident appropriately.
6) Wet washcloths and applied cleansing solution.
7) Washed perineal area:

A. Females: Separated the labia, cleaned front to back using
downward strokes. Used a clean area of the cloth for each
downward motion. Repeated using additional cloths, as
needed.
B. Males: Retracted foreskin in uncircumcised male. Grasped
penis, cleaned tip of penis using a circular motion, washed
down shaft of the penis and washed testicles. Replaced
foreskin of uncircumcised male.

8 ) Rinsed the perineal area, if applicable.
9) Turned the patient on their side facing away. Cleaned anal area by
washing from front to back.
10) Patted area dry, if applicable.
11) Removed waterproof pad and discarded.
12) Performed completion tasks.

Expert Tip by Tanya Glover, CNA

Providing perineal care for a patient can be an uncomfortable task for a newbie aide. But keep in mind that it is even more uncomfortable for the patient! No one wants to have someone else cleaning their most private areas so it is your job to take great care in making THEM feel comfortable with what is happening. This is the job you took so bit the bullet and get on with it, hiding your discomfort for the sake of your patient.

As far as the testing for this skill goes, please understand that you will not actually be touching the private parts of your skills partner to show your understanding of the task. I actually think that would be illegal, or at the very least crossing a line. (My attempt at comedy relief!) What you will be asked to do is walk the instructor through how you will be providing this care. If you think about it, you would be lucky to have to do this skill for the test because you can simply recite the steps from memory without having to make direct contact. That is easier for some people, including myself. I was unfortunate enough to have to do teeth brushing. Do you know how awkward it is to brush the teeth of a cute guy your own age and act as if it is totally normal? Not cool at all! The most important tip I can give you about this skill is that when doing your recitation, NEVER forget to add in hand washing when warranted. This step being missed in unforgivable in most instances, but when it comes to putting your hands in the nether regions it is especially unforgivable. Don’t worry though. Once you get a job and have done perineal care a few times it will become second nature; you will barely realize you are doing it!