Body, face and skin hygiene

Section 4.1 set out the anatomy of the two gland families; the question this section must answer is what can actually be done about the smell they produce. Odour is a chemical event, and each step of it offers a different target. Apocrine secretion is odourless when it reaches the skin; the smell appears only when skin bacteria digest it. The resident flora involved are mainly Corynebacterium species, which release enzymes that cleave sulphur-containing compounds into volatile thioalcohols such as 3-methyl-3-sulfanylhexan-1-ol, and coagulase-negative staphylococci, which break down the fatty-acid fraction. The nose detects those small molecules, not the sweat. This chemistry explains why three products act in three different places. A deodorant attacks the bacteria or the acids they make, so it reduces the smell without reducing wetness. An antiperspirant contains aluminium salts that form a plug at the gland opening and cut the volume of secretion, so it reduces both. A plain perfume only covers the smell and leaves the substrate in place. A nurse who knows the sequence can choose the right advice for the patient in front of her. For someone whose problem is wetness and soaked clothing, an antiperspirant applied at night, when the glands are least active, is the useful measure. For someone whose problem is odour in a hot ward, the useful measures are washing with soap to emulsify the oily residue, drying the folds, changing the underwear and treating any fungal infection in the groin with the prescribed preparation. The sequence also explains why an abrupt change of odour is a clinical finding: a sudden, one-sided or increasingly foul smell, or odour with itching, discharge or pain, may signal a bacterial or fungal infection, a wound or a retained foreign body, and it calls for examination rather than more deodorant.

The eye is not a passive organ waiting to be infected; it defends itself continuously with tears and mucus that wash away dust and microbes. During sleep the eyelids stay closed and the tear film stagnates, so its solid content — mucus, epithelial cells and proteins — dries at the inner and outer corners as the discharge a person sees on waking. That discharge is nutritious organic material, and it is exactly what certain flies are looking for. The important species is Musca sorbens, the bazaar fly, which feeds preferentially on human ocular and nasal secretions rather than on general refuse. It breeds in exposed human faeces, so poor sanitation increases its numbers, and it moves from face to face within a household or a crowded school. The fly is a mechanical vector: it does not host the organism, it simply carries it on its body and mouthparts for a short time and deposits it on the next eye it visits. The organism concerned is Chlamydia trachomatis, an obligate intracellular bacterium. Trachoma begins as a mild conjunctivitis, often in young children, and may resolve; the damage comes from repetition. Each new infection provokes inflammation of the conjunctiva and the tarsal plate, and after many episodes the inner eyelid is scarred and contracts. The lid turns inward, a condition called trichiasis, and the lashes rub against the cornea with every blink. That constant abrasion produces corneal opacity and eventually irreversible blindness. The chain therefore has several breakable links: the reservoir of infection in children’s eyes, the flies, the faeces in which the flies breed, and the fingers and shared cloths that move infection directly. WHO packages the response as the SAFE strategy: Surgery for people who already have trichiasis, Antibiotics to clear infection in the community, Facial cleanliness to remove the discharge that attracts flies, and Environmental improvement — water and latrines — to reduce fly breeding. Face washing every morning sits in the third arm, and it is the arm that a nurse or a family can act on immediately and at no cost.

Once hygiene is understood as the removal of a substrate rather than the pursuit of a nice smell, nursing practice becomes a set of ordered, explainable actions. Shared towels, face cloths and soap bars are fomites: a damp towel keeps skin scales, moisture and micro-organisms viable for hours, and a soap bar sitting in water carries a surface film. Through them, Staphylococcus aureus, Pseudomonas aeruginosa, dermatophytes that cause tinea, and the scabies mite pass between family members and, in hospital, between patients. This is why the notes state the rule absolutely: do not share soaps and towels, and why nail cutters should not be shared either. When a nurse bathes a dependent patient, she works from the least contaminated area to the most contaminated one — face first, then the trunk and limbs, then the back, and the groin and anal region last, with a fresh portion of the cloth or a fresh cloth. When cleaning the perineum she always wipes from front to back, away from the urethra, because faecal organisms introduced into the urinary tract cause catheter-associated and other urinary infections. After cleaning she dries every skin fold — axillae, groin, under the breasts, between the toes — because trapped moisture macerates the stratum corneum, softens it against friction and creates the warm, wet medium in which Candida and bacteria flourish, producing moisture-associated skin damage. Quantitative rules make the teaching concrete: bathe with body soap at least once a week, and daily or after sweating, heavy work or sport; wash the face every morning; clean the outer ear during the bath but no deeper than a little finger can reach, and never with hairpins or sharp objects; change underwear after every bath and change sweat-soaked clothing; wash and dry towels and underclothes regularly so that the microbial load is reduced. Where the patient cannot manage, the nurse documents the skin condition, including any odour, rash or maceration, and refers rather than simply repeating the instruction.