HYGIENE

► Measures for personal cleanliness and grooming that promote physical and psychological
well-being are called personal hygiene.
► Personal hygiene practices vary widely among people. The time of day one bathes and how
often a person shampoos his or her hair or changes the bed linens and sleeping garments are
very individualized choices.
► It is important that personal care be carried out conveniently and sufficiently frequently to
promote personal hygiene and wellness.

HYGIENIC CARE
Nurses commonly use the following terms to describe types of hygienic care.
► Early morning care (AM care) is provided to clients as they awaken in the morning. This care
consists of providing a urinal or bedpan to the client confined to bed, washing the face and
hands, and giving oral care.
► Early morning care- Nursing personnel on the night shift provide basic hygiene to patients geting
ready for breakfast, scheduled tests or early morning surgery.
► Routine Morning care is often provided after clients have breakfast, although it may be provided
before breakfast. It usually includes providing for elimination needs, a bath or shower, perineal
care, back massages, and oral, nail, and hair care. Making the client’s bed is part of morning
care. This is often referred to as “complete AM care”

► Afternoon Care is provided to hospitalized patients often undergo many exhausting diagnostic
tests or procedures in the morning. In rehabilitation centers patients participate in physical
therapy in the morning. Afternoon hygiene care includes washing the hands and face, helping
with oral care, offering a bedpan or urinal, and straightening bed linen.
► Evening or Hour of sleep or Hour-before-Sleep care (PM care) is provided to clients before they
retire for the night that helps patients relax and promotes sleep. It usually involves providing for
elimination needs, washing face and hands, giving oral care, giving a back massage, changing
soiled linens, and gowns or pajamas. Some patients enjoy a beverage such as juice, check diet
to determine which beverage are allowed.

(A) A closed bed is an unoccupied bed.

(B) When a closed bed is “opened,” the top sheet, blanket, and bedspread are fan-folded to the foot
of the bed, for easy entry by the client. Note that a draw sheet is in place, to help protect the bed and
to facilitate turning the client. The bed is kept in low position for safety.
(C) A surgical or postoperative bed is a closed bed that has been “opened” to receive a person on a
stretcher The top linens are fan-folded to the side of the bed and out of the way. This bed is usually in
high position, to conveniently receive the client from the stretcher.

BED MAKING
► Keep a patient’s bed clean and comfortable.
► This requires frequent inspection to be sure that linen is clean, dry, and free or wrinkles.
► When patients are diaphoretic, have draining wounds, or are incontinent, check more frequently
for wet or soiled linen.

PURPOSES OF BED MAKING

► To promote comfort of the client.

► To provide clean, neat environment.
► To provide a smooth, wrinkle-free bed foundation and remove sources of skin irritation.

SPECIAL CONSIDERATIONS IN BED MAKING

1. Practice good body mechanics. To prevent muscle strain and back injury.
2. Strip one bed linen/sheet at a time. To check if client’s valuables are present.
3. Finish one side of the bed at a time.
4. Avoid overreaching. It causes muscle strain.
5. Avoid fanning of soiled linens. May cause contamination of the environment.
6. Confine surface of bed linen that has been in direct contact with the patient. To prevent spread of
microorganisms.
7. Place the soiled linens in a pillow case, to be discarded into a linen hamper. To prevent
contamination of the environment.
8. Keep soiled linens away from the uniforms. To prevent contamination of uniform.

9. Apply bed sheets in the following order.

a. Bottom sheet
b. Rubber sheet
c. Draw sheet
d. Top sheet and blanket (blanket is optional)
e. Pillow case
10. Make mitered corner to ensure neat bed.
11. The smooth surface of the bed sheets should come in contact with client’s skin.
12. For postop bed:
a. Place pillow against the head board. Most often, the patient is placed in flat position. This will
also protect the client’s head during transfer.
b. Place towel on the head part. To prevent soiling of linens from mouth drainage or vomitus.
c. Placement of rubber sheet and draw sheet depends on the type of surgery.
d. Prepare the following at the bedside: IV pole, emesis basin, BP apparatus, suction apparatus,
O2 device.

13. For occupied bed, maintain safety of the client. Another nurse must stay on the other side of the
bed or put up the side rail on that side to prevent falls.
14. Maintain privacy of the client during the entire procedure.
15. Was hands thoroughly after the procedure. To prevent contamination with microorganisms and
maintain a safe environment.

**Asepsis is an important consideration in bed making. Drainage onto used linens may contain
microorganisms that can be transmitted through the air when linens are shaken or through contact
with the nurse’s hands or clothing. Handle linens carefully without shaking them. Wear gloves during
bed making if linen soiling is likely. Avoid touching your clothing and wash your hands after handling
soiled linens.

When do you make a bed?

► Usually in the morning after a patient’s bath or while he or she is bathing, in a shower, sitting in a
chair eating, or out of the room for procedures or tests.

► Also check the bed linen for food particles after meals and for wetness or soiling. Change any
linen that becomes soiled or wet.
MAKING AN UNOCCUPIED BED
► Usually bed linens are changed after the bath, but some agencies change linens only when
soiled.
► If the patient can get out of bed, the bed should be made while it is unoccupied to decrease
stress on the patient and the nurse.

UNOCCUPIED BED: Opened or Closed Bed

► Opened Bed
-top covers (top sheet, blanket and bedspread) are folded back so it is easy for a patient to get into
bed.
► Closed Bed
- Draw up the top covers to the head of the mattress and place a pillow at the top.
- New patient is admitted.
A. Closed bed. top sheet, blanket and bedspread are draw up.
B. Open Bed. top sheet, blanket and bedspread folded back for easy access to patient.

Equipment:
1. Bottom sheet (flat or fitted sheets)
2. Top sheet
3. Drawsheet (optional)
4. Blankets
5. Bedspread
6. Pillowcases
7. Linen hamper or bag
8. Bedside chair or table
9. Waterproof protective pad (optional)

10. Disposable gloves (for use if linens are soiled)

11. Antiseptic cleanser
12. Washcloth or paper towel

Assessment
► Assess the patient’s preferences regarding linen changes.
► Assess for any physical activity limitations.
► Check for any patient belongings that may have accidentally been placed in the bed linens, such
as eyeglasses or prayer cloths.

Nursing Diagnosis
 ► Possible nursing diagnoses may include:
• Risk for Impaired Skin Integrity
• Impaired Physical Mobility
• Risk for Activity Intolerance

Outcome Identification and Planning

► The expected outcome to achieve when making an unoccupied bed is that the bed linens will be
changed without injury to the nurse or patient.

Evaluation
► The expected outcome is met when the bed linens are changed without any injury to the patient
or nurse.

Documentation
► Changing of bed linens does not require documentation. The use of a specialty bed, or bed
equipment, such as Balkan frame or foot cradle, should be documented.

Unexpected Situations and Associated Interventions

► Drawsheet is not available: A flat sheet can be folded in half to substitute for a drawsheet, but
extra care must be taken to avoid wrinkles in the bed.
► Patient is frequently incontinent of stool or urine: More than one protective pad can be placed
under the patient to protect the bed, but take care to ensure that the patient is not lying on
wrinkles from linens.

Making an Occupied Bed

► If the patient cannot get out of bed, the linens may need to be changed with the patient still in
the bed. This is termed an “occupied” bed.

Equipment:
1. One large flat sheet
2. One fitted sheet
3. Drawsheet (optional)
4. Blankets
5. Bedspread
6. Pillowcases
7. Linen hamper or bag
8. Bedside chair
9. Protective pad (optional)
10. Disposable gloves
11. Additional PPE, as indicated
Assessment
► Assess the patient’s preferences regarding linen changes.
► Assess for any precautions or activity restrictions for the patient.
► Check the bed for any patient belongings that may have accidentally been placed or fallen there,
such as eyeglasses or prayer cloths.
► Note the presence and position of any tubes or drains that the patient may have.

Nursing Diagnosis
► Possible nursing diagnoses may include:
• Risk for Impaired Skin Integrity
• Impaired Bed Mobility
• Risk for Activity Intolerance
• Impaired Transfer Ability
• Impaired Physical Mobility

Outcome Identification and Planning

► The expected outcome to achieve when making an occupied bed is that the bed linens are
applied without injury to the patient or nurse. Other possible outcomes may include patient
participates in moving from side to side, and patient verbalizes feelings of increased comfort.

Evaluation
► The expected outcome is met when the bed linens are changed, and the patient and nurse
remain free of injury.
► In addition, the patient assists in moving from side to side and states feelings of increased
comfort after the bed is changed.

Documentation
► Changing of bed linens does not require documentation.
► The use of a specialty bed, or bed equipment, such as Balkan frame or foot cradle, should be
documented.
► Document any significant observations and communication.

Unexpected Situations and Associated Interventions

► Dirty linens are grossly contaminated with urinary or fecal drainage:
► Obtain an extra towel or protective pad.
► Place the pad under and over the soiled linens so that new linens will not be in contact with
soiled linens.
► Clean and dry the mattress according to facility policy before applying new sheets.

Special Considerations: Older Adult

► Using a soft bath blanket or a flannelette blanket as a bottom sheet may solve the problem of
“coldness” for elderly patients with vascular problems or arthritis.

SURGICAL, RECOVERY OR POSTOPERATIVE BED

- Is a modified version of the open bed.

- This is a bed that is prepared to receive a patient from the operating room.
- The top bed linen is arranged for easy transfer of the patient from a stretcher to the bed.

Equipment:
► Large sheets (2)
► Drawsheet (1) or an additional large sheet.
► Blanket.
► Pillow(s).
► Pillowcase(s).
► Towel.
► Chux, if drainage is anticipated.

Assessment
► Be aware of wrinkles and seams that the client may be lying on. They can cause pressure areas
in the client’s skin.
► Check for personal belongings in the client’s bed when changing the linens. Clients may keep
important items near them in bed.
► Be sure to keep the side rails up on the opposite side of the bed.

Nursing Diagnosis
► Risk for Impaired Skin Integrity
Outcome Identification and Planning
1. The client will have clean linens on the bed.
2. The clean linens will be appropriate to the client’s needs and condition.
3. The linens will be changed with a minimum of trauma to the client.

Evaluation
► The client has clean, unwrinkled linen.
► The linen placed on the bed is suitable for the client’s special needs.
► The linen was changed with a minimum of pain and trauma to the client.

Documentation
► Document the bed change, how the client tolerated it, and any unusual findings.

Nursing Tips
► Roll or fold the linens under the client. Don’t just stuff them underneath the client.
► Be aware of wrinkles and seams that the client may be lying on. They can cause pressure areas
in the client’s skin. Check for personal belongings in the client’s bed when changing the linens.
Clients may keep important items near them in bed.
► Be sure to keep the side rails up on the opposite side of the bed.
► Get help from another caregiver if the client is combative or difficult to move.

BED BATH
► Some patients must remain in bed as a part of their therapeutic regimen but can still bathe
themselves.
► Other patients are not on bed rest, but require total or partial assistance with bathing in bed due
to physical limitations, such as fatigue or limited range of motion.
► A bed bath may be considered a partial bed bath if the patient is well enough to perform most of
the bath, and the nurse needs to assist with washing areas that the patient cannot reach easily.
► A partial bath may also refer to bathing only those body parts that absolutely have to be cleaned,
such as the perineal area, and any soiled body parts.
► Many of the bedside skin-cleaning products available today do not require rinsing. After cleaning
the body part, dry it thoroughly.
TYPES OF BATH

► COMPLETE BED BATH

Bath administered to totally dependent patient in bed.
► PARTIAL BED BATH
Bed bath that consists of bathing only body parts that would cause discomfort if left unbathed such as
the hands, face, axillae, and perineal area.
Partial bath may also include washing back and providing back rub. Provide a partial bath to
dependent patients in need of partial hygiene or self-sufficient bedridden patients who are unable to
reach all body parts.

► SPONGE BATH AT THE SINK:

-Involves bathing from a bath basin or sink with patient sitting in a chair.
-Patient is able to perform part of the bath independently.
-Assistance is needed for hard-to-reach areas.
► TUB BATH:
-Involves immersion in a tub of water that allows more thorough washing and rinsing than a bed bath.
-Commonly used in long-term care.
-Some institutions have tubs equipped with lifting devices that facilitate positioning dependent
patients in the tub.
► SHOWER:
-Patient sits or stands under a continuous stream of water.
-The shower provides more thorough cleaning than a bed bath but can cause fatigue.

► BAG BATH/TRAVEL BATH:

-Contains several soft, nonwoven cotton cloths that are premoistened in a solution of no-rinse
surfactant cleanser and emollient.
-The bag bath offers an alternative because of the ease of use reduced time bathing and patient
comfort.
► CHLORHEXIDINE GLUCONATE (CHG) BATH:
-This antimicrobial bath wipe is used to decrease the frequency of hospital-acquired infections on
skin, invasive lines and catheters.

Bed Bath Guidelines:

► Provide Privacy
-close the door
► Maintain safety
-keep side rails up when away from a patient’s bedside
- Place the call light in the patient’s reach if leaving the bedside even temporarily.

Provide privacy- close the door and/or pull room curtains around the bathing area. While bathing a
patient, expose only the areas being bathed by using proper draping.
Maintain safety-Keep siderails up when away from a patient’s bedside when patients are dependent
or unconscious. Place the call light in the patient’s reach if leaving the bedside even temporarily.

Equipment:
1. Washbasin and warm water
2. Personal hygiene supplies (deodorant, lotion, and others)
 3. Skin-cleaning agent
4. Emollient and skin barrier, as indicated
5. Towels (2)
6. Washcloths (2)
7. Bath blanket
8. Gown or pajamas
9. Bedpan or urinal
10. Laundry bag
11. Nonsterile gloves; other PPE as indicate

Assessment
► Assess the patient’s knowledge of hygiene practices and bathing preferences: frequency, time of
day, and type of hygiene products.
► Assess for any physical-activity limitations.
► Assess the patient’s ability to bathe him- or herself. Allow the patient to do any part of the bath
that he or she can do. For example, the patient may be able to wash the face, while the nurse
does the rest.
► Assess the patient’s skin for dryness, redness, or areas of breakdown, and gather any other
appropriate supplies that may be needed as a result.

Nursing Diagnosis
► Determine the related factors for the nursing diagnosis based on the patient’s current status.
► Appropriate nursing diagnoses may include:
• Bathing Self-Care Deficit
• Risk for Infection
• Disturbed Body Image
• Risk for Impaired Skin Integrity
• Impaired Skin Integrity
• Deficient Knowledge
• Ineffective Coping

Outcome Identification and Planning

► The expected outcome to achieve when giving a bed bath is that the patient will be clean and
fresh.
► Other outcomes that may be appropriate include the following: patient regains feelings of control
by assisting with the bath; patient verbalizes positive body image; and patient demonstrates
under- standing about the need for cleanliness.

Folding a washcloth
Evaluation
► The expected outcomes are met when the patient is clean; demonstrates some feeling of control
in his or her care; verbalizes an improved body image; and verbalizes the importance of
cleanliness.

Documentation
► Record any significant observations and communication on chart.
► Document the condition of the patient’s skin.
► Record the procedure, amount of assistance given, and patient participation.
► Document the application of skin care products, such as a skin barrier.

Sample Documentation
7/14/12 2130 Bath provided with complete assistance; reddened area (3 cm x 3 cm) noted on
patient’s sacral area; skin-care team consultation made. —C. Stone, RN

Unexpected Situations and Associated Interventions

► Patient becomes chilled during bath: If the room temperature is adjustable, increase it. Another
bath blanket may be needed.
► The patient becomes unstable during the bath: Critically ill patients often need to be bathed in
stages. For instance, the right arm is bathed, and then the patient is allowed to rest for a short
period before the left arm is bathed. The amount of rest time needed depends on how unstable
the patient is and which parameter is being monitored. If the blood pressure drops when the
patient is stimulated, the nurse may watch the blood pressure while bathing the patient and stop
when it begins to decrease. Once the blood pressure returns to the previous level, the nurse can
 begin to bathe the patient again.

Special Considerations
► To remove the gown from a patient with an IV line, take the gown off the uninvolved arm first and
then thread the IV tubing and bottle or bag through the arm of the gown. To replace the gown,
place the clean gown on the unaffected arm first and thread the IV tubing and bottle or bag from
inside the arm of the gown on the involved side. Never disconnect IV tubing to change a gown,
because this causes a break in a sterile system and could introduce infection.
► Lying flat in bed during the bed bath may be contraindicated for certain patients. The position
may have to be modified to accommodate their needs.
► Incontinent patients require special attention to perineal care. Patients with urinary or fecal
incontinence are at risk for perineal skin damage. This damage is related to moisture, changes
in the pH of the skin, overgrowth of bacteria and infection of the skin, and erosion of perineal
skin from friction on moist skin. Skin care for these patients should include measures to over
hydration (excess exposure to moisture), reduce contact with ammonia and bacteria, and reduce
friction. Remove soil and irritants from the skin during routine hygiene, as well as cleansing
when the skin becomes exposed to irritants.
Avoid using soap and excessive force for cleaning. The use of perineal skin cleansers, moisturizers,
and moisture barriers is recommended for skin care for the incontinent patient. These products help
promote healing and prevent further skin damage.
• If the patient has an indwelling catheter and the agency recommends daily care for the catheter,
this is usually done after perineal care. Agency policy may recommend use of an antiseptic
cleaning agent or plain soap and water on a clean washcloth. Put on clean gloves before
cleaning the catheter. Clean 6 to 8 inches of the catheter, moving from the meatus downward.
Be careful not to pull or tug on the catheter during the cleaning motion. Also inspect the meatus
for drainage and note the characteristics of the urine.

Infant and Child Considerations

► When bathing an infant or young child, have supplies within easy reach, and support or hold the
child securely at all times to ensure safety.
► Never leave the child alone.

Older Adult Considerations

► Check the temperature of the water carefully before bathing an older patient, because sensitivity
to temperature may be impaired in older persons.
► An older, continent patient may not require a full bed bath with soap and water every day. If dry
skin is a problem, water and skin lotion or bath oil may be used on alternate days. If applying
lotion, place the lotion dispenser in warm bath water while bathing the patient. This will warm the
lotion before it is applied to the patient.

Home Care Considerations

► Evaluate the safety of the bathing area in the home. Tub mats, adhesive strips, grab bars, and
shower stools can help prevent falls. • Use plastic trash bags or a plastic shower-curtain liner to
protect the mattress when bathing or shampooing a patient in bed. Disposable washcloths may
also be an option to consider. Alarge plastic container or baby bathtub can effectively serve as a
shampoo basin.
► If linens are soiled with blood or body fluids, instruct family members to wear gloves when han-
dling them. They should be rinsed first in cold water and then washed separately from other
household wash, using hot water, laundry detergent, and bleach.
► Teach a family member or caregiver how to perform comfort measures, such as a backrub.
► Instruct patients at home with an indwelling catheter, or their caregivers, to wash the urinary
meatus and perineal area twice daily with soap and water. The anal area should also be cleaned
after each bowel movement. Careful hand washing is imperative.

BED SHAMPOO
► The easiest way to wash a patient’s hair is to assist him or her in the shower, but not all patients
can take showers.
► If the patient’s hair needs to be washed but the patient is unable or not allowed to get out of bed,
a bed shampoo can be performed.
► Shampoo caps are available, and are being used with increasing frequency. These commercially
prepared, disposable caps contain a rinseless shampoo product.

EQUIPMENT:
1. Brush
2. Comb
3. Shampoo board
4. Shampoo
5. Conditioner (optional)
6. Hydrogen peroxide (optional)
7. Towels (three or more)
8. Waterproof pad
9. Hair dryer
10. Basin of very warm water
11. Clean gloves (if needed) or shampoo cap

SHAMPOOING
► What is the frequency of shampooing?
-It depends on a person’s routines and the condition of the hair.
• Remind patients in hospitals or extended care facilities that staying in bed, excess perspirations,
or treatments that leave blood or solutions in the hair require more frequent shampooing.

Assessment
► Assess the patient’s hygiene preferences: frequency, time of day, and type of hygiene products.
► Assess for any physical activity limitations.
► Assess the patient’s ability to get out of bed to have his or her hair washed. If the physician’s
orders allow it and patient is physically able to wash his or her hair in the shower, the patient
may prefer to do so. If the patient cannot tolerate being out of bed or is not allowed to do so,
perform a bed shampoo.
► Assess for any activity or positioning limitations. Inspect the patient’s scalp for any cuts, lesions,
or bumps. Note any flaking, drying, or excessive oiliness.

Nursing Diagnosis
► Determine the related factors for the nursing diagnosis based on the patient’s current status.
► Appropriate nursing diagnosis is Bathing/Hygiene Self-Care Deficit.
► Other nursing diagnoses may include:
• Activity Intolerance
• Impaired Transfer Ability
• Impaired Physical Mobility
• Disturbed Body Image

Outcome Identification and Planning

► The expected outcome is that the patient’s hair will be clean.

► Other outcomes that may be appropriate include the following: the patient will tolerate the
shampoo with little to no difficulty, the patient will demonstrate an improved body image, and the
patient will state an increase in comfort.
Evaluation
► The expected outcomes are met when the patient’s hair is clean, the patient verbalizes a
positive body image, and the patient reports an increase in comfort level.

Documentation
► Record your assessment, significant observations, and unusual findings, such as bleeding or
inflammation.
► Document any teaching done.
► Document procedure and patient response.
► Example:
7/4/12 1130 Hair washed. Moderate amount of dried blood in hair noted. A 3-cm laceration noted over
left parietal area. Edges well approximated, slight redness of wound, sur- rounding skin consistent
with rest of skin tone, sutures intact, and no drainage noted. —C. Stone, RN

Unexpected Situations and Associated Intervention

► Glass is found in hair: Carefully comb through hair before washing to remove as much glass as
possible. Discard glass in appropriate container. When massaging the scalp, be alert to signs of
pain from the patient; glass could be cutting the patient’s head.

Special Considerations
► If the patient has a spinal cord or neck injury, use of the shampoo board may be
contraindicated. In this case, a makeshift protection area can be created to wash the patient’s
hair without using the board. Place a protective pad underneath the patient’s head and
shoulders. Roll a towel into the bottom of the protective pad and direct the roll into one area so
that water will drain into the container.

Linens and Other Supplies for Bedmaking

• Many types of linens are used to make a bed

• Linens that you may commonly see in use in a health care facility include the following:
• Mattress pads
• Bottom and top sheets
• Draw sheets
• Bed protector
• Blankets
• Bedspreads
• Pillows and pillowcases
• Bath blankets
• Occasionally, other equipment or supplies are used on a person’s bed, depending on the
specific needs of the patient or resident. Some of the items used include the following:
• A pressure-relieving mattress
• A bed board
• A bed cradle
• A footboard

Linens: Mattress Pads

• A mattress pad is a thick layer of padding that is placed on the mattress to help make the bed
more comfortable for the patient or resident, and to protect the mattress from moisture and
soiling
• Fitted mattress pad:
• Has elasticized sides that wrap around and underneath the mattress, holding the pad
securely to the mattress
• Flat (non-fitted) mattress pad:
• Pad is not secured to the mattress
• Rubberized mattress:
• A mattress with a rubber coating
• When a rubberized mattress is in use, a mattress pad may be used to help pull moisture
away from the person’s skin
Linens: Bottom and Top Sheets
• A bed is made with two sheets, a bottom sheet and a top sheet
• Bottom sheet may be:
• Flat, or non-fitted
• Fitted
• The top sheet is a flat sheet
• The sheets may be white or colored, plain or print

Linens: Draw Sheets

• A draw sheet is a small, flat sheet that is placed over the middle of the bottom sheet, covering
the area of the bed from above the person’s shoulders to below his or her buttocks
• A lift sheet is simply a draw sheet that is used to help lift or reposition a person who needs
assistance with moving in bed

Linens: Bed Protector/Rubber Sheet

• A bed protector is a square of quilted absorbent fabric backed with waterproof material
• It measures approximately 3 feet by 3 feet
• It may be disposable, or it may be laundered and reused
• It is used for people who are incontinent or have draining wounds
• Sometimes, only the bed protector needs to be changed, resulting in more efficient and
economical care
• Rubber sheet used to protect the bottom sheet from soothing due to patient secretions and
prevent the patients from getting bedsore.

Linens: Blankets

• Blankets are usually woven cotton and should be available as requested by a person for his or
her comfort
• Blankets may be of wool, cotton, or synthetic, depending on the person’s preference and the
climate
• Electric blankets should be checked for faulty wiring or plugs and may not be safe to use if the
person is incontinent or unable to adjust the controls independently; should only be used
according to facility policy

Linens: Bedspreads
• A bedspread adds the finishing touch to a well-made bed and can add a decorative touch to a
person’s room
• Hospitals and extended-care facilities may supply bedspreads for their patients to use
• Other types of health care facilities or agencies may encourage their residents to use their own
bed coverings
• Allowing a person to use his or her bedspread from home is one way to foster a sense of
independence and individuality in residents

Linens: Pillows and Pillowcases

• Pillows are used for comfort and to aid in positioning
• They may be available in many sizes, are made from a variety of materials and may be covered
with waterproof material or treated with a waterproofing substance
• Pillows are always covered with clean pillowcases

Linens: Bath Blankets

• A bath blanket is a lightweight cotton blanket or flannel sheet that is used to provide modesty
and warmth during a bed bath or a linen change
• A flat sheet may also be used for this purpose if the facility does not provide a special bath
blanket

Linens: Pressure-Relieving Mattress

• May be placed on top of the regular mattress to help prevent skin breakdown in patients and
residents who must stay in bed for long periods of time
• Newer versions of pressure-relieving mattresses may be filled with air or water, and are made
 out of a material that is easily cleaned

Linens: Bed Board

• A bed board is a piece of wood (usually plywood) that is placed under the mattress to provide
extra support
• It keeps the mattress from sagging, helping to keep the person’s body properly aligned

Linens: Bed Cradle

• A bed cradle is a metal frame that is placed between the bottom and top sheets to keep the top
sheet, the blanket, and the bedspread away from the person’s feet
• Bed cradles are often used for people who are recovering from burns to prevent the top sheet
from touching the burned skin, which would be very painful
• They are also often used for people who are at risk for developing pressure ulcers on their feet

Linens: Footboard
• A footboard is a padded board that is placed upright at the foot of the bed
• The person’s feet rest flat against the footboard, helping to keep the feet in proper alignment

Handling of Linens
Guidelines for Handling Linens
1.
WHAT YOU DO
• Always wash your hands before collecting clean linens

WHY YOU DO IT
• Always wash your hands before collecting clean linens
• Washing your hands prevents microbes on your hands from being transferred to the clean
linens

WHAT YOU DO
• Do not hold linens, clean or dirty, against your uniform
WHY YOU DO IT
• If you hold clean linens against your uniform, microbes on your uniform could be transferred to
the linens
• If you hold dirty linens against your uniform, microbes from dirty linens could be transferred to
your uniform

WHAT YOU DO
• When collecting linens, collect only those that you will need for that person’s bed

WHY YOU DO IT
• Extra linens brought into a person’s room are considered soiled, and therefore must not be
returned to the clean linen cart or used for another person
• These linens must now be laundered, which costs the facility extra money and manpower and
creates additional wear on the linens, shortening their lifetime of use

WHAT YOU DO
• Collect linens in the order that they will be used and flip the stack over so that the item you will
need first is on the top of the stack
WHY YOU DO IT
• Collecting linens in the order that they will be put on the bed helps you to remember which
linens you need to collect
• You will be able to make the bed more efficiently, without searching through the stack for the
proper item

WHAT YOU DO
• Place clean linens on a clean surface in the room, such as the over-bed table or a chair
• Do not place clean linens on the floor
WHY YOU DO IT
• Clean linens can become contaminated with microbes if you place them on a “dirty” surface,
such as the floor

WHAT YOU DO
• Wear gloves when removing used linens from a bed
• Roll the linens toward the center of the bed to confine the soiled area inside

WHY YOU DO IT
• Any item contaminated with blood or other body substances is a potential source of exposure
to pathogens for the health care worker
• Following the standard precautions and wearing proper personal protective equipment (PPE)
will help to minimize your exposure
• Confining the soiled area to the inside of the linens helps to ensure that other people, such as
the people in the laundry, do not come in contact with the potentially infectious material

WHAT YOU DO
• If body fluids or substances leak through the linens to the mattress or bed frame, the mattress
or bed frame should be wiped with an appropriate cleaning solution before placing clean linens on the
bed
• Remove your gloves and wash your hands before handling the clean linens
WHY YOU DO IT
• These infection control methods help to prevent the clean sheets from becoming contaminated

WHAT YOU DO
• After removing the dirty linens from the bed, place them in the linen hamper immediately
• Your facility may require you to place dirty linens in a plastic bag or pillowcase before placing
them in the linen hamper
• Do not place dirty linens on the floor or on any other surface.
WHY YOU DO IT
• Placing the dirty linens in the linen hamper immediately helps to control the spread of infection

Standard Bedmaking Techniques

• Routine bedmaking is usually done in the morning, before visiting hours, while your patients or
residents are bathing or dressing
• How often the linens on a person’s bed are changed will vary according to the type of health
care facility and the person’s needs
• However, a person’s bed must be remade each time any of the linens become soiled or
excessively wrinkled, regardless of the time of day
• Change as many of the bed linens as necessary to ensure a clean, dry, wrinkle-free bed for your
patient or resident

How to Make a Mitered Corner

• Mitering is a way of folding and tucking the sheet so that it lies flat and neat against the mattress

Closed Bed
• A closed bed is an empty bed
• A bed that is unoccupied because the previous patient or resident has been discharged from the
facility and a new patient or resident has yet to arrive is considered a closed bed
• A bed that is unoccupied because the patient or resident is simply not in it at the moment
(and is not expected back
 any time soon) is also
considered a closed bed

Open Bed
• When the top sheet, blanket, and bedspread of a closed bed are turned back, or fanfolded, the
closed bed becomes an open bed, or a bed ready to receive a patient or resident
• The wheels of an open bed should always be locked and the bed should be in the lowest
position

Surgical Bed
• A surgical bed is a closed bed that has been opened to receive a patient or resident who will be
arriving by stretcher

Surgical Bed/Post-op Bed

a. Place pillow against the head board. Most often, the patient is placed in flat position. This will
also protect the client’s head during transfer.
b. Place towel on the head part. To prevent soiling of linens from mouth drainage or vomitus.
c. Placement of rubber sheet and draw sheet depends on the type of surgery.
d. Prepare the following at the bedside: IV pole, emesis basin, BP apparatus, suction apparatus,
O2 device.

Occupied Bed
• Some conditions make it difficult or impossible for a person to get out of bed for a linen change.
When this is the case, it is necessary to change the linens while the person is still in the bed.
This is called making an occupied bed.

Guidelines for Bedmaking

WHAT YOU DO
• Always place linens on the bed so that the seams of the sheets face away from the person’s
skin
WHY YOU DO IT
• The seams of the sheets can rub the person’s skin, causing irritation and leading to skin
breakdown

WHAT YOU DO
• Linens must be pulled tightly to avoid wrinkling. Layering should be kept to a minimum

WHY YOU DO IT
• The wrinkles and extra layers of linens can cause skin breakdown and contribute to the
formation of pressure ulcers

WHAT YOU DO
• Linens should be changed whenever they become soiled or wet, regardless of the time of day
WHY YOU DO IT
• Besides causing discomfort, soiled or wet sheets can cause skin breakdown and contribute to
the formation of pressure ulcers

WHAT YOU DO
• Do not shake linens when placing them on the bed
WHY YOU DO IT
• Recall that dust is a transport mechanism for microbes. Shaking linens stirs up dust from the
floor. The dust then settles on surfaces in the room and can be easily transferred onto eating utensils
or into a wound, causing an infection.

WHAT YOU DO
• When you need to change the linens on a person’s bed with the person still in the bed, always
be sure to explain what you are doing throughout the procedure
• Close the door, pull the privacy curtain, and keep the person covered
WHY YOU DO IT
• This can be a very frightening experience for a bedridden person, particularly if the person is
unconscious
• Even if the person is conscious, movement may cause pain, and incontinence can be very
embarrassing if it occurs
• If the person is mentally impaired, he or she may become combative
• Talk reassuringly to the person, even if the person is unconscious
• Always provide for privacy and modesty by keeping the person covered at all times

WHAT YOU DO
• Check the bed linens for personal items before removing the linens from the bed
WHY YOU DO IT
• Personal items may become lost in the bed linens
• Personal items may be expensive and inconvenient to replace
• If they hold sentimental value, they may be irreplaceable

Body Mechanics in Bedmaking

• When you must bend, bend your knees not your back, in order to keep the center of gravity
directly above and close to the base of support and help prevent fatigue.
• Face your entire body in the direction that you are moving and avoid twisting in order to prevent
back strain or injury
• Organize your work. Conserve steps by making few trips around the bed as possible.

Nursing Tips
• Roll or fold the linens under the client. Don’t just stuff them underneath the client.
• Be aware of wrinkles and seams that the client may be lying on. They can cause pressure
areas in the client’s skin. Check for personal belongings in the client’s bed when changing the
linens. Clients may keep important items near them in bed.
• Be sure to keep the side rails up on the opposite side of the bed.
• Get help from another caregiver if the client is combative or difficult to move.