A bed bath is a common procedure used to maintain hygiene for patients who are unable to bathe themselves due to injury, illness, or limited mobility. Gloves are a foundational component of infection control, creating a physical barrier to prevent the transfer of microorganisms between the patient and the caregiver. Adhering to a strict glove-change protocol during this process is a non-negotiable step in maintaining a clean and safe environment for both individuals.
The Principle of Clean-to-Dirty
The primary rule governing glove changes in patient care is the principle of “clean-to-dirty.” This rule dictates that care should start with the cleanest areas of the body and finish with the areas carrying the highest concentration of microbes. By moving from clean to dirty, the caregiver minimizes the possibility of cross-contamination. Gloves worn while cleaning a less contaminated site are considered soiled before moving to a more contaminated area, requiring immediate removal. This systematic approach ensures that the gloves act as a barrier to prevent the spread of flora from one body site to another within the same patient.
Procedural Change Points During the Bath
The standard bed bath procedure is organized to follow the clean-to-dirty principle. Care typically begins with the face, eyes, ears, and neck, which are considered the cleanest areas and are often washed without soap. After washing these initial areas, the first procedural glove change should occur before moving to the upper extremities, chest, and abdomen. These areas are considered clean, but the gloves may have been exposed to the patient’s initial skin flora, warranting a new pair before proceeding to the trunk and limbs.
A second glove change is necessary after washing the torso and legs but before cleaning the back and buttocks. The most significant and non-negotiable glove change must occur immediately before washing the perineal and anal areas, which are the most microbe-dense regions of the body. The perineal area is highly likely to harbor a concentrated amount of bacteria and bodily fluids, making a fresh pair of gloves essential to prevent the transfer of these microorganisms to other areas. After the perineal care is complete, the gloves are immediately removed and discarded.
Situations Requiring Immediate Removal
Beyond the standard procedural changes, gloves must be removed and replaced immediately if their integrity is compromised. This includes any instance where a glove is visibly torn, punctured, or ripped, as this breach in the barrier exposes the caregiver’s skin to potential pathogens. Gloves must also be promptly discarded if they become visibly or heavily soiled with blood, feces, or other body fluids, regardless of the stage of the bath.
A glove must also be changed if the caregiver touches an environmental surface or object that is not part of the direct patient care area. This includes touching bed rails, door handles, a phone, or contaminated equipment, as these actions transfer microbes from the glove to the environment. The use of gloves is a single-use indication, meaning they must be donned immediately before the task and removed immediately after it is over. Following the removal of any pair of gloves, the caregiver must perform hand hygiene by washing hands thoroughly with soap and water or using an alcohol-based hand rub to remove any potential contamination that may have seeped through or occurred during the removal process.