Changing a patient in bed is a common caregiving task requiring careful technique to protect the patient’s well-being and the caregiver’s physical health. The primary goal of this process is to maintain the patient’s dignity and comfort while preventing friction injuries or skin breakdown caused by soiled or wrinkled linens. Safe patient handling relies on precise movements and preparation to ensure the immobile individual is moved as a single, stable unit. This comprehensive approach minimizes strain on the caregiver and promotes a clean, safe environment.
Essential Preparation and Body Mechanics
Before initiating any movement, the caregiver must complete a thorough preparation of the environment and gather all necessary supplies to prevent interruptions. Having clean sheets, incontinence briefs, protective pads (chucks), gloves, and hygiene products immediately available ensures the procedure is completed efficiently and quickly. This preparatory step is important for the patient’s comfort and helps maintain the caregiver’s focus.
Optimizing the physical setup of the bed is important for caregiver safety and injury prevention. If the bed is adjustable, the wheels must be locked, and the mattress should be raised to approximately the caregiver’s waist level. Adjusting the bed height significantly reduces the need for the caregiver to bend at the waist, protecting the lumbar spine from excessive strain. Caregivers should also remove any unnecessary pillows or top linens to create a clear working area.
Proper body mechanics are fundamental to minimizing the risk of musculoskeletal injury, which is common in caregiving roles. When positioning to move the patient, the caregiver should adopt a wide, stable base of support with feet shoulder-width apart, with one foot slightly in front of the other. Movement should be initiated by bending the knees and hips while keeping the back straight, ensuring the powerful leg muscles perform the work. Caregivers should pivot their feet to turn instead of twisting their torso, maintaining neutral spinal alignment.
Safe Patient Turning: The Logrolling Technique
The movement of an immobile patient should utilize the logrolling technique, which ensures the patient’s head, spine, and legs move simultaneously. This maintains anatomical alignment and prevents shear or friction forces on the skin. The caregiver should communicate each step clearly to the patient, even if the patient is non-responsive, to promote cooperation. The initial step involves positioning the patient’s arms across their chest and bending the knee furthest from the caregiver.
The caregiver moves to the side of the bed where the patient will be rolled toward, lowering that side rail. To begin the roll, the caregiver places one hand on the patient’s shoulder and the other on their hip, ensuring a firm, broad contact point for stability. The patient is gently and uniformly rolled toward the caregiver, moving the body as a single, cohesive “log.”
Once the patient is safely on their side, a pillow or specialized positioning wedge is placed behind their back to maintain the side-lying position securely. The patient’s upper leg can be slightly forward of the lower leg to enhance stability. This positioning frees the caregiver to work on the exposed section of the bed without continuously supporting the patient’s weight. The patient should be positioned far enough toward the edge of the bed to allow ample room for the linen change.
Step-by-Step Guide to Changing Bed Linens
With the patient secured in the side-lying position, changing the soiled bottom linens begins on the exposed half of the bed.
Removing Soiled Linens
The caregiver first loosens and rolls the soiled bottom sheet and any protective pads tightly toward the patient’s back. Tucking the rolled linen snugly against the patient creates a barrier between the patient and the soiled materials, effectively clearing the mattress surface.
Placing Clean Linens
The clean bottom sheet, draw sheet, or protective pad is placed on the mattress and smoothed out to eliminate all wrinkles. The portion of the clean linen that will remain on the exposed side is tucked securely under the mattress. The remainder of the clean linen is tightly rolled lengthwise and pushed under the soiled linen roll, stopping at the patient’s back. This ensures a smooth, clean surface on one half and prepares the clean linen for the next stage.
Repositioning the Patient
The caregiver then moves to the opposite side of the bed, raising the first side rail for safety before lowering the rail on the new side. The patient is gently rolled over the mound of clean and soiled linen in the center, moving them onto the now-clean side of the mattress. The caregiver should use the logrolling technique, ensuring the patient rolls smoothly over the central seam without friction.
Finishing the Change
Once the patient is safely positioned on the clean side, the caregiver pulls the entire roll of soiled linens out and places it directly into a designated laundry receptacle. The tightly rolled clean linen is then grasped and unrolled across the exposed mattress surface. The caregiver pulls the sheet taut to remove any wrinkles or creases, which are a common cause of skin friction and breakdown. Finally, the edges of the clean sheet are securely tucked under the mattress to complete the wrinkle-free foundation.
Hygiene and Comfort After the Change
After the clean linens are in place, the caregiver gently rolls the patient back to a supine position, centered in the bed. This provides an opportunity for a quick but important skin assessment, focusing particularly on bony prominences that bear weight. Areas like the sacrum, heels, hips, and elbows should be visually inspected for any signs of redness, non-blanchable erythema, or early signs of skin breakdown.
Soiled briefs or clothing should be removed and replaced with clean items. The patient’s skin must be cleaned and dried according to standard hygiene protocols, applying any necessary barrier creams. Keeping the skin clean and dry is an important preventative measure against moisture-associated skin damage. Once the patient is clean and positioned comfortably, the caregiver must lower the bed to its lowest safe position to prevent falls.
The final steps involve ensuring the patient has access to all immediate necessities. The call light must be placed within easy reach, and any personal items, such as a water bottle or remote control, should be nearby. The caregiver must then dispose of all soiled materials and remove gloves before performing thorough hand hygiene.