- Procedure for washing patients’ hair in bed
- Hair care
- Using appropriate equipment
- Glove use
- Undertaking hair washing in bed
- The procedure
- Head Lice
- How to Get Lice
- Life Cycle of Lice
- Treatment with Lice Medicine and Removing Nits
- After Treating with Lice Medicine
- Over-The-Counter Medicines
- Prescription Medicine
- Washable Items:
- When to Call the Doctor
- School and Other Parents
- How Are Head Lice Treated?
- How Can I Prevent Head Lice?
Procedure for washing patients’ hair in bed
The condition of their hair and how it is styled is an important part of patients’ identity and wellbeing, so assisting them with hair care is a fundamental aspect of nursing care
Hair care is an essential part of personal hygiene and has an important role in maintaining self-esteem and quality of life. Supporting patients to maintain hair care when they cannot do this themselves is a fundamental aspect of nursing care. This article outlines the procedure for washing patients’ hair when they are confined to bed.
Citation: Lawton S, Shepherd E (2019) Procedure for washing patients’ hair in bed. Nursing Times [online]; 115: 6, 60-62.
Authors: Sandra Lawton is nurse consultant dermatology, Rotherham Foundation Trust; Eileen Shepherd is clinical editor, Nursing Times.
- This article has been double-blind peer reviewed
- Scroll down to read the article or download a print-friendly PDF here (if the PDF fails to fully download please try again using a different browser)
Supporting patients to maintain their hygiene needs while in hospital is a fundamental aspect of nursing care yet there is very little evidence to support practice (Coyer et al, 2011). Personal hygiene includes care of the hair, skin, nails, mouth, eyes, ears, perineal areas (Dougherty and Lister, 2015) and facial shaving (Ette and Gretton, 2019).
Helping patients to wash and dress is frequently delegated to junior staff, but time spent attending to a patient’s hygiene needs is a valuable opportunity for nurses to carry out a holistic assessment (Dougherty and Lister, 2015; Burns and Day, 2012).
The condition of a patients’ hair and how it is styled is an important part of their identity, so hair care should be carried out – as far as possible – according to their wishes. Washing and styling patients’ hair can also be a valuable social activity and help boost their self-esteem and sense of wellbeing.
Caring for patients’ hair provides an opportunity to observe the scalp for signs of pressure damage, dandruff or dry skin and underlying skin conditions. It is also important to observe for head lice (Fig 1), which must be treated immediately to avoid others being affected (Dougherty and Lister, 2015).
If patients are in hospital for a long time, it may not be possible to maintain their hairstyle so a referral to a hairdresser or barber may be required. Alternatively, some may wish to ask their regular hairdresser or barber to visit.
Using appropriate equipment
Patients who are confined to bed will be unable to wash their own hair – this can have a negative effect on their wellbeing. However, it is possible to maintain clean hair using dry and no-rinse shampoos or no-rinse shampoo caps (Dougherty and Lister, 2015) (Fig 2a). Devices such as inflatable basins (Fig 2b) and shampoo trays (Fig 2c) are also available, which:
- Allow the hair to be washed with water and shampoo while the patient remains in bed;
- Drain soapy water away from the head, helping to keep the patient dry.
Source: Peter Lamb
Preferences for hair care products is individual, so patients should be invited to provide their own if they wish. Those with underlying skin problems may have therapeutic shampoos, which may need to be prescribed, or allergies to some of the ingredients found in washing and cosmetic products. Information about allergies should be recorded in the nursing records.
Before attempting to wash a patient’s hair with water and shampoo, it is important to check there are no contraindications or precautions, such as spinal or neck injuries (Dougherty and Lister, 2015). You should also assess how quickly the patient becomes tired – for example, it may be appropriate to plan hair washing at a different time to bed bathing.
Disposable equipment should be used – including bowls and jugs – to reduce the risk of infection (Marchaim et al, 2012). Non-disposable items, such as shampoo trays, should be washed and dried according to local policy.
Hair products such as hairbrushes or curlers should be the patient’s own or supplied as single-patient use, while patients’ own electrical items, such as hairdryers/straighteners, should undergo a safety test (PAT test) before use – check local policies.
The World Health Organization (2009) has stated that non-sterile gloves are not routinely required for washing and dressing patients. Nurses need to assess individual patients for risk of exposure to blood and body fluids (Royal College of Nursing, 2018) and be aware of local policies for glove use.
When gloves are required, they must be single-use and disposed of in line with local policy (Loveday et al, 2014).
Undertaking hair washing in bed
General principles for hair washing are outlined in Box 1.
Box 1. General principles of hair washing
- Keep the patient warm at all times
- Position a linen skip near the patient and ensure you dispose of used linen immediately to minimise the dispersal of microorganisms and dead skin cells into the environment (Dougherty and Lister, 2015)
- Check the scalp and surrounding skin for pressure damage and underlying skin conditions
- Avoid contaminating dressings and drains with water
- Gently pat the hair and surrounding skin dry to reduce the risk of friction damage and discomfort for the patient
- Use the correct manual handling procedures and equipment to avoid injury to yourself and the patient
- If the patient is unconscious remember to talk them through what you are doing – and avoid talking to colleagues over the patient
The following equipment will be required:
- Laundry skip;
- Disposable wash cloths;
- Plastic sheet;
- Preferred shampoo and conditioner;
- Comb or brush;
- Clean clothes and bed linen;
- Shampoo tray;
- Disposable jug and basin.
- Review the patient’s care plan for hygiene needs and check there are no contraindications to positioning the patient flat in bed.
- Ensure someone will be available to help position the patient during the procedure if required.
- Decontaminate your hands in line with the WHO’s 5 moments for hand hygiene.
- Discuss the procedure with the patient, ask about their usual hair routine and gain their informed consent for the procedure.
- Check whether the patient has any pain. Administer analgesia if necessary and ensure it has taken effect before starting the procedure, to help relieve any pain associated with moving the patient.
- Ensure the patient’s privacy and check that the environment is warm and free of draughts.
- Check whether the patient needs to empty their bowel/bladder before the procedure.
- Assemble your equipment and ensure everything is to hand to minimise the amount of time the patient is lying flat.
- Ensure the bed is at the correct working height.
- Decontaminate your hands and put on an apron to reduce the risk of infection.
- Remove the patient’s clothes from their upper body and cover them with a sheet to maintain dignity.
- Remove the pillows from behind the patient’s head so they are lying flat.
This allows water to drain away from the eyes and ears during the procedure (Dougherty and Lister, 2015). Ask the patient to let you know if they feel uncomfortable in this position at any time.
- Remove the head of the bed so you can access the patient’s hair easily (Fig 3a).
- Place a plastic sheet under the patient’s head and shoulders, and wrap a towel around their shoulders (Fig 3b).
- Position the patient’s head on the shampoo tray, ensuring you follow manufacturer’s instructions carefully (Fig 3c). A towel can be placed under the neck for support (Dougherty and Lister, 2015).
- Following manufacturer’s instructions, ensure the receptacle that will collect the water from the shampoo tray is positioned under the drainage spout.
- Fill a disposable wash bowl with warm water and allow the patient to check the temperature.
- If required, cover the patient’s eyes with a disposable washcloth to protect them from water and shampoo.
- Using a disposable jug, take water from the disposable bowl and wet the patient’s hair. Start at the front hairline and allow the water to drain down and away from the face, avoiding the eyes and ears (Fig 3d).
- Apply the shampoo and massage it into the hair.
- Using the jug, rinse the patient’s hair with water.
- Apply conditioner, if required by the patient, and rinse the hair again.
- Check, regularly, the patient is comfortable and can maintain their position.
- Pat the hair with a towel to remove the excess water – avoid pulling on the hair as this can be uncomfortable.
- Remove the shampoo tray and wrap a towel around the patient’s head to dry the hair and ensure they do not feel cold.
- Dry the surrounding skin, paying particular attention to skin folds in the neck.
- Change any wet bed linen.
Dispose of soiled bedlinen directly into the linen skip.
- Replace the bedhead and reposition the patient so they are comfortable (Fig 4).
- Help the patient get dressed.
- Style the patient’s hair according to their preferences.
If possible, try to make this a social situation – offer them a drink and a mirror so they can advise you about the style and participate in their care.
- Finish making the bed and ensure the patient is warm and comfortable with a call bell, a drink (if allowed) and their belongings within reach.
- Dispose of equipment according to local policy. Decontaminate the shampoo tray and drainage receptacle according to local policy.
- Remove and dispose of your apron and decontaminate your hands.
- Record care that has been given, record and report any abnormal findings and update the patient’s care plan if required.
Source: Peter Lamb
Source: Peter Lamb
Burns S, Day T (2012) A return to basics: ‘interventional patient hygiene’ (a call for papers). Intensive and Critical Care Nursing; 28: 4, 193-196.
Coyer FM et al (2011) The provision of patient personal hygiene in the intensive care unit: a descriptive exploratory study of bed-bathing practice. Australian Critical Care; 24: 3, 198-209.
Dougherty L, Lister S (2015) The Royal Marsden Manual of Clinical Nursing Procedures. Chichester: John Wiley & Sons.
Ette L, Gretton M (2019) The significance of facial shaving as fundamental nursing care. Nursing Times; 115: 1, 40-42.
Loveday HP et al (2014) epic3: National evidence-based guidelines for preventing healthcare-associated infections in NHS hospitals in England. Journal of Hospital Infection; 86: S1, S1-S70.
Marchaim D et al (2012) Hospital bath basins are frequently contaminated with multidrug-resistant human pathogens. American Journal of Infection Control; 40: 6, 562-564.
Royal College of Nursing (2018) Tools of the Trade: Guidance for Health Care Staff on Glove Use and the Prevention of Contact Dermatitis.
World Health Organization (2009) WHO Guidelines on Hand Hygiene in Health Care.
Head lice are tiny, 6-legged insects about this long (-). They may be grayish white. If they are filled with blood, they will look red. They do not have wings, so they cannot fly. They do not jump but they can move very fast. This makes it hard to find them in the hair.
Nits are the eggs of the lice. They look bits of dandruff in the hair but do not flake off when touched. They are stuck to the hair. They are about this size ( ' ). Nits may be yellowish white to brown.
Head lice attach their nits to a hair shaft with waterproof «glue.» The eggs are laid close to the scalp where the temperature is warm and constant. It is a perfect place for them to grow and hatch. Look for nits at the back of the neck and behind the ears.
Usually the first sign of head lice is intense itching. Lice do not pass along disease. However, if the skin is scratched open, sores can get infected.
How to Get Lice
Lice are usually spread from child to child when sharing clothing, hats, scarves, combs, brushes, hair trims or helmets that have strands of hair with nits. Lice can also be passed when playing contact sports.
People of all ages and races can get lice, but they are less common in African American children. It doesn’t matter how clean you are or where you live. House pets do not carry human lice (and should not be treated).
Life Cycle of Lice
Lice spend their entire life on human heads. A louse can live up to a month if it can feed on blood several times a day. If lice fall off the scalp, they will die within a day or two.
The female louse can lay up to 8 nits per day. The eggs hatch in about a week (6 to 9 days). The baby “nymphs” need a blood meal within minutes of hatching. In another 7 days, they grow to be adults and can start laying eggs. Knowing the life cycle will help you to understand the treatment of lice.
There are no over-the-counter or prescription treatments that totally kill both lice and nits. Nits cannot be washed out or brushed the hair. They must be picked or pulled out with a special nit comb or by hand.
Various natural remedies exist for treating lice but there is no scientific proof that they work.
A combination of approaches is needed:
- Using over the counter or prescription lice medicine
- Removing nits with a nit comb and by hand, the single most important treatment!
- Environmental control, vacuuming and washing
- Regular head checks followed by less frequent head checks to detect re-infestation
- Checking others who have close contact with someone who has lice
Treatment with Lice Medicine and Removing Nits
Head lice shampoo is an insecticide. It should be used with caution. Many lice medicines are not recommended for children under 2. Check the instructions for suggested age limits.
If you are pregnant or have a weakened immune system, ask your health provider if it is safe to handle lice shampoo.
Follow these steps for most lice medicine:
- Read the label to be sure how long the medicine should be left on the hair and how it should be washed out. Many medicines are left on for 10 minutes. Do not use more or keep it on the head longer than what is recommended.
- Wash the hair with regular shampoo. Do not use a conditioner. It can keep the lice medicine from working.
- Rinse well with warm water and towel dry. Do not use the towel again until it has been laundered.
- Use a regular comb to get out any snarls. This comb will need to be treated later (see Environmental Control below).
- Wear gloves and apply lice medicine only to the scalp. Avoid getting the medicine on other parts of the body. If it gets in the eyes, flush the eyes with water right away.
- Stay with your child while the medicine is on the hair. Do not put a shower cap or plastic bag on your child’s head.
- Sometimes it will be easier to remove the nits if you wet the hair with white vinegar while you are combing the nits out. Vinegar helps loosen the «glue» that holds the nits to the hair.
- Separate and comb small sections of hair at a time. It might be helpful to use hairclips to pin up sections of hair as you check your child’s head.
- Use a nit comb to remove the nits. Metal ones work best. Combing can take more than an hour, depending on hair length and the number of nits. You may have to pick out the nits with gloved hands if other methods do not work.
- Place nits and lice in toilet and flush or place in a small plastic bag. Seal the bag and throw it away.
- Wash your hands carefully. Be sure to scrub under your fingernails.
After Treating with Lice Medicine
- Have your child put on clean clothing after every lice treatment.
- Check for lice again in 8 to 12 hours. Use the nit comb to remove dead lice and nits.
- If some are still present but moving slowly, do not shampoo again.
- If lice are still active and no dead lice are found, call your health care provider. These lice may be resistant to the medicine. Do not use more than one head lice medicine at a time without asking your doctor.
- Do not rewash hair for 1 to 2 days after the lice treatment. It may reduce the effectiveness of the lice medicine.
- Continue to check hair and use the nit comb to remove nits and lice every 2 to 3 days for 2 to 3 weeks. This process should be done for as long as nits and lice are still found on the head.
- Many lice medicines recommend a second treatment in 9 to 10 days. This will kill any new nymphs that have hatched since the first treatment. Do not treat a person more than 2 times with the same medicine without talking to your doctor.
- Do not use conditioner for 10 days after any treatment.
If all nits are not removed, they may hatch into live lice. The hair will be re-infested and you will have to start the treatment process all over again.
There are two types of medicine that you can buy without a prescription. At times, the medicine does not work. If the lice do not die after treatment, you can suspect resistance.
Nix Cream Rinse® (permethrin based product) This medicine is put on hair that has been shampooed and towel dried. After 10 minutes, the medicine is rinsed off. Nix Creme Rinse® kills lice, but not the nits.
It is the favored medicine because it may continue to kill newly hatched lice for a few days after treatment. A second treatment is needed on day 9 to kill newly hatched lice. It can be used on children 2 months of age or older.
Rid®, Pronto®, R&C®, Triple X®,and A-200® (pyrethrin based product) This type of medicine is applied to dry hair and then rinsed off after 10 minutes. It kills lice and not the nits.
A second treatment is needed on day 9 or 10. It cannot be used on children younger than 2 years. In addition, it should not be used by people who are allergic to chrysanthemums or ragweed.
Pyrethrin based products could cause a serious allergic reaction.
Avoid using mayonnaise, olive oil, tea oils, petroleum jelly, margarine, or butter. These alternative treatments aim to suffocate the lice. They have not been proven to be effective and may be hard to wash the hair.
The doctor may order a prescription lice medicine if the over the counter medicine does not work. A prescription medicine might be needed for treating lice in a very young child.
These medicines have chemicals that are different than the over-the-counter medicines. | The directions for using them may be different. Some may require only one treatment.
They often cost more and may not be covered by insurance.
If using the prescription medicine Ovide® (Malathion), do not use a hairdryer after treatment. Malathion has flammable ingredients that could set the hair on fire.
- Machine-wash in hot, soapy water then dry. Use the hot cycle of a dryer for at least 20 minutes. Wash all washable clothing (including hats, scarves and coats) and all bed linens, towels and washcloths that have had contact with your child in the past 3 days.
- Soak combs, brushes, hair barrettes, hair bands and sports helmets:
- In hot water (above 130?F) for 10 minutes
- In a solution made with the Nix Creme Rinse® for one hour
- In rubbing alcohol for one hour, then washed in hot, soapy water
- Vacuum all carpets and furniture, including beds. This will remove any hairs that might have nits attached that are still alive.
- Do not spray insecticides on carpet and furniture nor hire a pest control company to treat your home. It is not necessary and could expose children to harmful chemicals.
- Pillows, stuffed animals, clothing and other things that cannot be washed may be dry-cleaned. Or you can put them in a tightly-sealed plastic bag for 3 days (Picture 1). Any nits or lice on these things will die in 2 days.
- Check the hair and scalp of all family members every 2 to 3 days by combing the hair until no live lice are found for 10 days. If you find nits or lice, treat that family member’s hair and clothing the same way.
It is not necessary to treat anyone unless they have lice. Treatment that is not needed increases resistance to the lice medicine.
When to Call the Doctor
- The lice treatment has not been effective.
- Lice remain as active as before treatment.
- After 2 treatments, your child still has lice.
- Your child has open, oozing sores or crusting on the scalp.
- Your child has a fever or enlarged lymph nodes in the neck.
School and Other Parents
- Tell parents of your child's closest friends that their children may also have lice since the children play together.
- Tell the school nurse at your child's school. The nurse can check other children for nits and make sure they're treated too.
- Check the lice policy at your child’s school. In some schools a child cannot return until he or she has received one treatment and is checked for live lice by the school nurse. If live lice are found, the nurse will send the child home. Although unusual, some schools may require that a child’s hair must be free of all nits before being allowed to go back to school.
The single most important thing to prevent lice is to «Never Share What Touches the Hair.» Teach your child to not share combs, brushes, hats, scarves, hair accessories, «scrunchies,» helmets, headphones, or pillows.
Check your child's hair often during the school year, especially when the school tells parents there is a lice problem.
Lice: Treatment and Prevention (PDF)
HH-I-49 5/76, Revised 7/16 Copyright 1976, Nationwide Children’s Hospital
How Are Head Lice Treated?
The two main ways to treat lice are:
- removing by hand
Medicine. If you think you have lice, call your doctor. Your doctor can recommend a medicated shampoo, cream rinse, or lotion to kill the lice. These may be over-the-counter (OTC) or prescription treatments. It all depends on what your doctor thinks will work best for you.
Lice can be hard to get rid of. If you still have lice 2 weeks after you started treatment, let your doctor know. Your doctor may want to try a different medication or repeat treatment in case any nits were left behind and hatched after treatment.
Lice are insects, so the treatments for lice are basically insecticides or pesticides. To avoid getting overexposed, you'll need to follow the directions carefully when it comes to how much to use and how often to use it. Medicated lice treatments usually kill the lice, but it may take a few days for the itching to stop.
Removing by hand. Your doctor may recommend wet combing in addition to (or as an alternative to) chemical treatments. Medicated treatments aren't 100% effective, so removing by hand is also important.
To remove lice and nits by hand, use a fine-tooth comb on wet, conditioned hair every 3–4 days for 3 weeks after the last live louse was seen. Go through small sections of hair at a time. Wetting the hair temporarily stops the lice from moving, and the conditioner makes it easier to get a comb through the hair. When possible, it works best to have someone else do the combing and removal.
You may have heard that petroleum jelly, mayonnaise, or olive oil can suffocate head lice, but these treatments may not be effective.
If you choose to get rid of lice without using medicine, you'll need to remove lice and nits carefully each week, for at least 3 weeks in a row. Watch for any live lice and take action if you see them.
Scratching a lot can lead to a scalp infection. Call your doctor as soon as possible if:
- the skin on your scalp is red and tender
- your scalp has crusting and oozing
- you have swollen lymph glands
Your doctor may want to treat an infection with antibiotics.
A few important things to NOT do: Don't use a hairdryer after applying scalp treatments. Some treatments for lice use flammable ingredients and can catch on fire. Don't use pesticide sprays or hire a pest control company to try to get rid of the lice; these can be harmful.
Don't use essential oils (such as ylang ylang oil or tea tree oil) to treat lice on the scalp. They can cause allergic skin reactions and aren't approved by the U.S. Food and Drug Administration (FDA). Don't ever use highly flammable chemicals such as gasoline or kerosene.
How Can I Prevent Head Lice?
Lice can be tricky to get rid of because nits can remain unhatched on your head or you might pick up lice that are still on bedding or other items. Here's what to do if you've had lice — or someone in your family has:
- Wash bed linens and clothing that anyone with lice has used recently. Use very hot water (130°F [54.4°C]), then use the hot cycle of the dryer for at least 20 minutes.
- Take items that can't be washed to the dry cleaner. Or put them in airtight bags for 2 weeks.
- Vacuum carpets and any upholstered furniture, as well as car seats, then throw away the vacuum cleaner bag.
- Soak hair-care items combs, barrettes, hair ties or bands, headbands, and brushes in hot water or just throw them away.
- Because lice can move easily from person to person in the same house, family members should be checked for lice. Anyone who has them needs treatment.
Here are some ways to avoid getting lice in the first place:
- Try to avoid head-to-head contact, in gym or during sports.
- Don't share combs, brushes, hats, scarves, bandanas, ribbons, barrettes, hair ties or bands, towels, helmets, or other personal care items with anyone else.
- Don't lie on bedding, pillows, and carpets that someone with lice has used in the past couple of days.
- If someone in your family or at school has lice, ask a parent or adult to check your hair and scalp every 3–4 days to be sure you haven't picked up lice.