Caring for a bed-bound individual requires frequent and safe changing and repositioning to maintain comfort and health. This process demands attention to detail, organization, and correct physical technique to ensure the patient’s well-being while protecting the caregiver from injury. These methods focus on maximizing patient dignity and safety during routine care tasks like changing linens and providing hygiene.
Essential Safety Measures and Supplies
Before beginning any task, the caregiver must prioritize proper body mechanics to prevent strain or injury. Caregivers should bend at the knees and hips, keeping the back straight, and use the leg muscles for lifting and shifting weight. Adjusting the bed height to be level with the caregiver’s waist helps maintain a straight back and ensures proximity to the patient.
A safe working environment requires locking the bed wheels to prevent movement and lowering the side rail on the working side. All necessary supplies should be gathered and placed within easy reach before starting the procedure, minimizing the need to twist or reach. Standard supplies must be ready to use:
- Disposable medical gloves
- A plastic bag for soiled items
- Skin cleanser or moist wipes
- A barrier cream
- Clean linens
- Fresh clothing
- Incontinence products
Technique for Changing Bed Linens
Changing bed linens while the patient remains in bed requires logrolling, a technique that keeps the patient’s spine aligned and is done one side at a time. After locking the bed wheels and adjusting the bed to a comfortable working height, the caregiver should loosen and remove the top linens, covering the patient with a light blanket for warmth and privacy. The patient is then moved toward the caregiver’s side, creating working space on the far side of the mattress.
To prepare for the roll, the patient’s arm closest to the caregiver is placed across their chest. The leg farthest from the caregiver is bent with the ankle crossed over the near one. The caregiver places one hand on the patient’s shoulder and the other on the hip, gently rolling them onto their side as a single unit, avoiding any twisting of the trunk.
Once the patient is safely on their side, the soiled linens are rolled inward toward the patient’s back and tucked tightly against them. A clean fitted sheet is placed on the exposed half of the mattress, with the center fold aligned down the middle of the bed. The clean sheet is then fan-folded up against the roll of soiled linens, and the corners are secured on the exposed side.
The caregiver then moves to the opposite side of the bed, lowers the rail, and gently rolls the patient over the soiled and clean linen roll toward the clean side. This maneuver requires careful support to ensure the patient rolls smoothly. The dirty roll of linens is then removed, folding the soiled side in on itself before placing it in the laundry bag. Finally, the clean sheet is pulled taut, secured under the mattress, and the patient is repositioned comfortably in the center of the bed.
Assisting with Personal Hygiene and Clothing
Providing personal hygiene (pericare) is distinct from linen changing and requires careful attention to prevent skin irritation and infection, especially with incontinence. Before starting, the caregiver should put on disposable gloves and ensure the patient is positioned for comfort and dignity. Soiled areas should be cleaned using pre-moistened wipes or a soft cloth with a no-rinse cleanser, which is gentler on fragile skin than traditional soap and water.
When cleaning the perineal area, all wiping must be performed from front to back, using a clean section of the wipe or cloth for each stroke. This technique is important for female patients to prevent the transfer of fecal bacteria into the urethra, which can cause a urinary tract infection. For male patients, lifting the penis and cleaning the scrotum and skin folds thoroughly is necessary.
The patient must be gently turned onto their side, using the logroll technique, to access and clean the posterior area. Once clean, the area must be dried thoroughly to remove moisture, which harbors bacteria and contributes to skin breakdown. A barrier cream or ointment should then be applied to shield the skin from future moisture exposure. When changing clothing, adaptive garments with Velcro closures or larger openings can simplify the process, often by sliding clothing under the patient to minimize lifting and movement.
Monitoring and Protecting Patient Skin Health
Preventing pressure ulcers requires turning and repositioning bed-bound patients at least every two hours to redistribute pressure. Pressure ulcers result from sustained pressure on the skin that restricts blood flow and leads to tissue damage. This schedule must be maintained around the clock to provide continuous relief.
Pressure injuries most often develop over bony prominences where soft tissue padding is minimal, such as the heels, hips (trochanters), tailbone (sacrum), and shoulder blades. During repositioning, the caregiver should inspect these areas for early signs of skin breakdown. The most significant early warning sign is an area of redness that does not blanch, or turn white, when light pressure is applied.
Specialized support surfaces, like pressure-relieving mattresses or cushions, can help distribute weight more evenly, but they do not replace the need for regular repositioning. When placing a patient on their side, a 30-degree laterally inclined position is recommended, using pillows or wedges to ensure the patient is not lying directly on the hip bone. Elevating the head of the bed should not exceed 30 degrees to minimize the risk of shearing forces, which occur when the skin sticks to the sheet while the underlying tissue slides down.