Caring for an elderly person who is bedridden and requires a brief change must be approached with respect, practicality, and compassion. This act of care is an opportunity to maintain the individual’s comfort, hygiene, and personal dignity. Successfully managing incontinence requires a systematic approach that prioritizes their emotional well-being and physical safety throughout the procedure.
Essential Supplies and Preparation
Gather all necessary items and place them within immediate reach before initiating the change to minimize movement and time away from the person. Supplies include disposable medical gloves, a clean adult brief of the correct size, a plastic trash bag, and protective underpads, often called “chucks.” These underpads shield the bedding from potential spills during the process.
Cleansing materials should include pre-moistened wipes, preferably alcohol-free and fragrance-free for sensitive skin, or a no-rinse perineal cleanser with soft washcloths. A barrier cream or ointment, such as one containing zinc oxide, must also be ready to apply to the skin afterward to prevent irritation. The caregiver should wash their hands thoroughly and then put on a fresh pair of disposable gloves before touching the person or the supplies.
Safe Positioning and Soiled Brief Removal
The process begins with the person lying comfortably on their back, if possible, allowing the caregiver to unfasten the tabs of the soiled brief. Fold down the front panel and remove any visible solid waste using toilet paper or a wipe, placing it into the soiled brief to contain the mess. This initial cleaning helps manage contamination before repositioning.
To access the back and complete the cleaning, the person must be gently turned onto their side using a modified log-roll technique. This method keeps the spine and hips in alignment, preventing uncomfortable twisting or straining. The caregiver should roll the person away by placing one hand on the hip and the other on the shoulder, guiding the movement gently.
Once the person is safely on their side, roll the soiled brief inward toward the back to trap remaining waste and tuck it underneath the hip. This keeps the soiled material away from the clean bedding protected by the underpad. While the person is positioned on their side, thoroughly clean the perineal and gluteal areas, wiping from front to back to prevent bacteria transfer.
Applying the New Brief and Securing
After cleaning the back area, prepare a new brief by folding it lengthwise and tucking the back half underneath the person, ensuring the tabs face the back. Gently roll the person back toward the center of the bed, over the tucked-in clean brief. The soiled brief and used protective pad can now be easily removed, rolled up, and discarded into the trash bag.
Once the person is on their back, pull the clean brief through the legs and smooth the front panel over the abdomen. Ensure the brief is free of wrinkles, which cause skin irritation, and that the leg gathers are positioned correctly to prevent leaks. Fasten the securing tabs; a snug fit prevents leakage but must not restrict circulation or cause pressure points.
Maintaining Skin Integrity During Diaper Changes
Frequent exposure to moisture from urine and feces can compromise the skin’s natural barrier, leading to incontinence-associated dermatitis (IAD). To prevent this, use gentle, pH-neutral cleansers designed for incontinence care, avoiding harsh soaps or alcohol-based wipes that strip protective oils. The skin must be completely dried after cleaning, as trapped moisture increases the risk of breakdown and fungal infections.
After cleansing and drying, apply a thin layer of barrier cream or ointment, such as one containing zinc oxide, to the perineum and buttocks. This cream shields the skin from moisture and irritants until the next change. During the process, visually inspect the skin for any signs of early irritation, such as persistent redness, blisters, or broken areas, which may indicate a pressure injury or rash.