Cleanliness and Safety

Giving the bed bath: Cleanliness is one of the most important needs residents have. Giving residents bed baths is a good way to keep them clean, free from infectious diseases, and feeling well. You will need a basin, soap, warm water, lotion, washcloth, towels and bath blanket.

Before starting, wash your hands, approach the patient, and introduce yourself. Explain what you are about to do. Close the curtains to maintain privacy. Cover the patient with the bath blanket and remove his or her gown under the blanket. This will help to maintain the patient’s modesty. At no time should the patient be completely exposed, even in front of healthcare personnel.

Fill the basin with warm water and add some hand lotion. Dip your washcloth into the water and rub on a little soap. Starting with the forehead, rub gently, then rinse out the cloth and rinse the skin. As the water becomes dirty or cold, empty it out the basin and refill it. Dry each area of the skin as you go.

Ask the patient to wash his or her own genitalia. If this is not possible, do not be afraid to wash them, as this is important for good hygiene. First put on a pair of gloves. In a female patient, gently open the labia and clean the area by rubbing the washcloth once down the middle and once on each side. For a male, hold the reproductive organs firmly and wash them like the rest of the skin. Dry thoroughly.

After washing the patient’s back, rub lotion in a circular motion all along the skin. This will help to prevent pressure sores.

To wash the feet, allow them to soak in your basin of water for a minute, then wash each toe separately. Dry thoroughly.

Shampooing the patient’s hair requires a doctor’s order, so it is not part of a routine bath.

Additional Reading: CNA Skill: Giving the patient a bed bath

Making the bed: Since the bed is the most important part of the patient’s environment, changing the linens daily is a good way to maintain cleanliness. Linens should also be changed if the patient has soiled the bed or if a procedure or meal has left the sheets dirty. If the patient is able to get up into a chair, this is a good time to make the bed. First, strip away the old linens and place, do not throw, them into the hamper provided by your hospital. Then place one sheet onto the mattress and unfold with as little motion as possible. Unfurling it like a flag is not a good idea, because bacteria and viruses can inhabit hospitals and waving sheets around can contaminate them and send airborne microbes through the air. Treat the upper sheet the same way. Accordion-fold the pillowcase, hold it at one end, and carefully pull over the pillow, again with as little motion as possible. Blankets and bedspreads should be handled with the same care. If any linens touch the ground, place them into the hamper and get new ones.

If the patient is unable to leave the bed, place the bottom sheet onto one side and push the rest of the sheet together as a lump in the middle of the bed. Ask the patient to roll over the lump or help him or her over it. Once the patient is over the lump, go around to the other side of the bed, smooth the sheet out and tuck it in on the second side of the bed.

When you or any other hospital personnel have completed a procedure, always clear away any old dressings, paper, etc. before leaving the room. Wipe off the bedside table.

Urinals and bedpans should never be placed onto the bedside table where the patient eats. You would not place a bedpan onto your kitchen or dining room table, and patients feel the same way.

Additional reading: CNA Skill: Making an occupied bed

Bedrails and wheel locks: When you are not standing at the bedside giving direct patient care, the side rails should be up and the bed should be in its lowest position. That will minimize the possibility of falls and injuries. The bed wheels should be in their locked position.

Transfers: When transferring a patient  from the bed to a gurney or wheelchair, first wash your hands and explain to the patient what you are going to do. Make sure that the wheels of both the bed and the wheelchair or gurney are locked. If the patient is too large or heavy for you to handle, ask for help rather than risking an accident.

To transfer the patient from the bed to a gurney, wash your hands and explain to the patient what you are going to do. Place the gurney against the bed. Stand at the side of the gurney and have a partner stand on the other side of the bed. Lift the sheet under the patient at the same time and lift him or her onto the gurney. As soon as the transfer is made, put up the rails on the gurney.

When you transport a patient in the gurney, always stand at the end where the patient’s head is, and push the patient down the hallway feet first. If you must leave the patient in the hallway for any reason, always lock the wheels.

When transferring a patient from a wheelchair to a chair or back again, wash your hands and explain to the patient what you are going to do.  Place the chair on which the patient is sitting in front of you, with the patient facing you. The other chair should be at your left side, also facing to ward you. Explain to the patient what you are going to do to enlist his or her help.  Plant your forward foot firmly against the patient’s foot. Bend your knees and place your hands under the patient’s armpits. Count aloud to three, and move the patient in one smooth motion to the other chair. Be sure that the patient is sitting firmly on the second chair. If he or she is too far forward, go behind the chair, put your hands under the patient’s armpits, and pull, using a lifting motion, until the patient is sitting firmly against the back of the chair.

Additional Reading: CNA Skill: Assist to ambulate using transfer belt


Q.  Should you use the same basin of water throughout a patient’s bed bath for those times when a patient is not receiving a full bath or shower?

A.  No, you will need to change the water as needed in the basin when giving one of your patient’s a bed bath.  The water should be changed when it starts to get cold.  It should also be changed anytime that it starts to become dirty.

Explanation:  By changing the water in the basin throughout the bath, you are helping to make certain the patient does not become chilled as a result of water that becomes too cold.  By changing water when it starts to get dirty, you are also reducing the risk of spreading germs by always maintaining clean water.

Q.  How does a nursing assistant help a patient to maintain a level of privacy and dignity while providing a bed bath and hygiene care for the patient?

A.  When you provide a bed bath for a patient, you must pull the privacy curtain around your patient’s bed so that no one can see him or her receiving the bath.  You must also have a bath blanket that you use to cover areas of the patient’s body that are not being cleaned at any given moment.  As you move on to bathe another area, adjusts the bath towel accordingly.

Explanation:  By pulling a privacy curtain, you prevent the patient’s roommate and anyone else working with the roommate from seeing your patient as they receive their bath.  You also help to ensure that the patient is not seen by anyone passing in the hall.  The bath towel is used to provide dignity to the patient, since they will never be totally uncovered in front of you as you provide the bath.

Q.  How does a nursing assistant reduce the risk of a patient falling from their bed, when they are done providing care?

A.  As a nursing assistant, you will help to prevent the risk, of injury by ensuring that the side rails are up.  You should also make certain that the bed is placed in the lowest position available.

Explanation:  Bed rails are used to help ensure that a patient does not fall out of bed.  Placing the bed in the lowest position, provides increased safety when an individual is getting out of bed-even if being assistant by their nursing and healthcare team.  It is easier for the patient to move to a gurney, wheelchair or a standing position when the bed is closer to the ground.

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