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Andrew Pollack-Gray

Nursing Notes

Perineal Care

4 min read

When & Why?

Perineal care (peri-care) involves cleaning the genital and anal areas to:

  • Maintain hygiene and comfort.
  • Prevent infection and skin breakdown.
  • Remove urine, feces, and other contaminants.
  • Preserve resident dignity.
    When: During routine bathing, after episodes of incontinence, and as needed.

Before You Start

Supplies:

  • At least 6 washcloths — 2 sets of 3:
    • Front: 1 soapy, 1 rinsing, 1 drying.
    • Back: 1 soapy, 1 rinsing, 1 drying.
  • Basin with comfortably warm water.
  • Soap or approved cleanser.
  • Gloves and other appropriate PPE.
  • Towels and waterproof underpad.
  • Clean incontinence product and barrier cream if indicated.
  • Linen bag or designated soiled-linen container.
    Preparation:
  1. Explain the procedure and obtain permission.
  2. Perform hand hygiene and gather supplies.
  3. Provide privacy and adjust the bed to a safe working height.
  4. Check water temperature and resident comfort.
  5. Position the resident on their back and expose only the area being cleaned.
  6. Place a waterproof pad beneath the resident as needed.
  7. Apply gloves before providing care.

Steps

General Principles

  • Always clean from clean to dirty.
  • Use a fresh section of washcloth for each stroke.
  • Use separate cloths for front and back.
  • Wash, rinse, then pat dry.
  • Avoid exposing more of the resident than necessary.

Front — Resident with Female Genitalia

  1. Gently separate the labia with your nondominant hand.
  2. With the front soapy cloth, clean from front to back:
    • Far labial fold.
    • Near labial fold.
    • Center, over the urethral opening.
  3. Use a clean section of cloth for each stroke.
  4. Repeat with the front rinsing cloth.
  5. Gently pat dry with the front drying cloth.

Front — Resident with Male Genitalia

  1. If uncircumcised, gently retract the foreskin only if it moves easily.
  2. With the front soapy cloth, clean the tip of the penis, moving outward from the urinary opening.
  3. Continue cleaning down the shaft and around the scrotum.
  4. Use a clean section of cloth for each stroke.
  5. Repeat with the front rinsing cloth.
  6. Pat dry with the front drying cloth.
  7. Return the foreskin to its normal position immediately after cleaning.

Back — Buttocks & Anal Area

  1. Assist the resident onto their side using appropriate positioning techniques.
  2. Expose only the buttocks and anal area.
  3. With the back soapy cloth, clean the buttocks and anal area, working from cleaner areas toward the anus and avoiding transfer of fecal contamination.
  4. Use a clean section of cloth for each stroke.
  5. Repeat with the back rinsing cloth.
  6. Pat dry with the back drying cloth, especially within skin folds.

After Care

  1. Inspect the skin for redness, irritation, moisture damage, or breakdown.
  2. Apply prescribed barrier cream if indicated.
  3. Replace soiled underpads or incontinence products.
  4. Reposition the resident comfortably.
  5. Remove gloves and perform hand hygiene.
  6. Dispose of or place used supplies in designated containers.
  7. Lower the bed, ensure safety, and place the call light within reach.
  8. Document care and relevant elimination observations according to facility policy.

Safety & Observations

  • Clean to dirty: Never wipe from the anus toward the urethra.
  • Separate cloths: Do not reuse front washcloths for the back.
  • Fresh surfaces: Use a clean section of cloth for every stroke.
  • Foreskin: Never force retraction; always replace it after cleaning.
  • Skin protection: Avoid vigorous scrubbing or rubbing fragile skin.
  • Infection control: Change gloves and perform hand hygiene whenever required to avoid cross-contamination.
  • Privacy: Keep the resident covered as much as possible.
  • Resident preference: Explain each step and adapt to comfort, anatomy, mobility, and care-plan needs.
    Report:
  • Redness, excoriation, rash, or open skin.
  • Unusual discharge, odor, or bleeding.
  • Pain or discomfort.
  • Inability to retract a foreskin when cleaning is indicated; never force it.
  • Swelling or a foreskin that cannot be returned to its normal position (urgent).

What Should I Remember?

  • 6 cloths minimum: 3 front + 3 back.
  • Each set: Soap → Rinse → Dry.
  • Female: Front to back, outer folds before center.
  • Male: Tip outward → Shaft → Scrotum → Replace foreskin.
  • Back: Buttocks → Anal area.
  • Use a clean section for every stroke.
  • Protect privacy and inspect skin throughout.

Practice

  • Studied
  • Observed
  • Practiced
  • Passed checkoff

Sources

Flashcards

In which direction should cleansing generally proceed for female perineal care?03-application / clinical-skills
Answer

Front to back to reduce contamination.

What should be done if new irritation or bleeding is noticed?03-application / clinical-skills
Answer

Report to the nurse.

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