When providing perineal care for a female client, the correct procedure is to wipe:

As a CNA, one of the most important things you can do for your patients is ensuring their comfort. This includes providing good perineal care to men and women who are unable to take care of this task themselves.

What is perineal care?

For the uninitiated, here’s the perineal care definition: Perineal care, sometimes referred to as peri-care, is when a medical professional cleans a patient’s private areas around their genitals and anus.

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Why is perineal care important?

You want to keep your patients clean and healthy. One way you can do this is by helping them clean up after they become incontinent, use a bedpan, or as part of their daily cleaning routine. As these areas are prone to infection, it’s extremely important to keep this area clean. Beyond avoiding infection, there are many other benefits of proper peri care:

• increasing the patients’ comfort
• preventing skin breakdown or injury that can arise from unnecessary pressure or friction on delicate skin
• preventing odors and skin irritation caused by urine and feces  

Procedures for peri care differ a bit based on the patient’s sex. We’ll give you a rundown of the basic procedures for proper perineal care for both. These steps are items you could be evaluated on during the skills portion of your CNA exam, so it pays to know the proper procedures.

Perineal care for females

As a CNA or nursing assistant, you should always knock before entering the room and greet the female patient by their name. Then, be sure to introduce yourself and let them know that you’re about to provide perineal care. Close the patient’s privacy curtain (if applicable), and wash your hands. Then, follow these steps:

• Apply protective gloves.
• Run water until it’s to a comfortable temperature for the patient and fill a basin with it. 
• Ensure that the patient is covered to allow them privacy and avoid unnecessary exposure.
• To avoid any unnecessary mess, put a waterproof pad beneath the patient, covering all of the area beneath their buttocks.
• Help the patient into a comfortable position that still allows you to provide proper care and access all necessary areas of the perineal region.
• Using a wet wash cloth, apply cleaner to the area. To clean properly, separate the labia and clean the patient from the front to the back using downward strokes. Each downward stroke requires a new, clean wash cloth. 
• Repeat this process until the patient is sufficiently clean. 
• Rinse the perineal region and gently pat it dry.
• Next, you’ll need to clean the patient’s anal region. To do so, turn them on their side so they are facing away from you.
• Ensure you have access and then begin to clean the area, using a similar process of washing from front to back – also using a fresh cloth for each stroke and continuing until the area is sufficiently clean. 
• At this point, you can begin cleanup by removing the pad placed beneath the patient and you can dispose of your materials. 
• Once everything has been disposed of you can wash your hands, ensure everything around the patient is clean and in order. Ask them if they are comfortable and then give them their call light and close their privacy curtain.

Perineal care for males

When performing perineal care on male patients, particularly older adults, it’s critical that you establish rapport immediately. Follow these standard steps as a CNA or nursing assistant to perform this task correctly, as you would on your CNA skills exam. First, knock before entering and then greet the patient by name before introducing yourself and letting them know that you’re about to provide peri care. Close the patient’s privacy curtain and wash your hands – then you can begin. 

• Apply protective gloves. 
• Collect the equipment and materials you’ll need including water and soap. Make sure the water temperature is at a comfortable temperature before filling a basin. 
• Place a waterproof pad beneath the patient’s buttocks to avoid their bedding getting wet or soiled.
• Cover the resident to maintain their privacy and position them so you have access to the perineal area. 
• Begin your cleaning with the upper pubis area. Use soap and then rinse the area and pat it dry. 
• The simple rule is to rinse everything you wash and dry everything you rinse. 
• For uncircumcised men, you’ll need to pull the foreskin of the penis all the way back to the head. Clean the area around the urinary opening in a circular fashion, down to the shaft of the penis. 
• You’ll need to rinse once, and then rinse again with the foreskin pulled away from the head.
• If any urine has crystallized be sure to clean it up.
• To clean the anal area, turn the patient on their side so they are facing away from you.
• Ensure you have access and then begin to clean the area, using a similar process of washing from front to back – also using a fresh cloth for each stroke and continuing until the area is sufficiently clean. 
• At this point, you can begin cleanup by removing the pad placed beneath the patient and you can dispose of your materials. 
• Once everything has been disposed of you can wash your hands, check to make sure the patient has a safe and clean environment, ask if they’re comfortable, give them their call light and pull their privacy curtain closed.