Barriers and facilitators to delivering everyday personal hygiene care in residential settings: A systematic review

Introduction Globally, the population is ageing, and more people live in residential care. Best practice in personal hygiene care may reduce distressing and debilitating skin and oral problems and improve resident outcomes. Although there is guidance on personal hygiene care, implementation may be a challenge. Aim To identify barriers and facilitators to delivering personal hygiene care for older persons in residential care settings. Methods Systematic review reported according to PRISMA 2020 guidance. Databases MEDLINE, CIHAHL, and PsychINFO were systematically searched using terms and synonyms “barriers”, “facilitators”, “hygiene”, “older adults” and “residential care”. Only empirical studies, reporting everyday skin and oral care, in English, peer reviewed and published from 2000-2021 were included. Due to methodological heterogeneity a narrative synthesis was conducted. Results Sixteen papers yielded nine categories of barrier or facilitator. Five related to skin and oral care: i) knowledge, ii) skills relating to hygiene care, iii) skills relating to supporting “uncooperative” behaviours, iv) lack of resources and v) time, workload and staffing levels. The remainder related only to oral care: vi) resident, family or carer motivation, vii) dislike of hygiene care, viii) carer attitudes and beliefs and ix) social influences and communication. Six papers reported interventions to optimise care. Conclusion This review highlights the persistent dearth of research into everyday personal hygiene practices, in particular skin hygiene in residential care. Existing literature identifies a range of barriers, however, there is a mismatch between these and reported interventions to improve practice