Beds are usually made in the morning after baths. Or they are made while the person is in the shower, up in the chair, or out of the room. To keep beds neat and clean:

• Change linens when they are wet, soiled, or damp.

• Straighten linens whenever loose or wrinkled and at bedtime.

• Check for and remove food and crumbs after meals and snacks.

• Check linens for dentures, eyeglasses, hearing aids, sharp objects, and other items.

• Follow Standard Precautions and the Bloodborne Pathogen Standard. Contact with blood, body fluids, secretions, and excretions is likely.

Types of Beds

Beds are made in these ways.

• A closed bed is not in use. Top linens are not folded back (Fig. 21-1, p. 320). The bed is ready for a new patient or resident. In nursing centers, closed beds are made for residents who are up during the day.

• An open bed is in use. Top linens are fan-folded back so the person can get into bed. A closed bed becomes an open bed by fan-folding back the top linens (Fig. 21-2, p. 320).

FIGURE 21-2 Open bed. Top linens are fan-folded to the foot of the bed.

• An occupied bed is made with the person in it (Fig. 21-3, p. 320).

• A surgical bed is made to transfer a person from a stretcher to bed (Fig. 21-4, p. 320). This includes an ambulance stretcher.

Linens

When handling linens and making beds, practice medical asepsis. Your uniform is considered dirty. Always hold linens away from your body and uniform (Fig. 21-5). Never shake linens. Shaking them spreads microbes. Place clean linens on a clean surface. Never put clean or used linens on the floor.

Collect enough linens. If the person has 2 pillows, get 2 pillowcases. The person may need extra blankets for warmth. Do not bring unneeded linens to a person’s room. Once in the person’s room, extra linens are considered contaminated. Do not use them for another person.

Collect linens in the order you will use them. That way you avoid fumbling with linens to find the piece you need. Linens stay neat and clean in your pile. You will use bed linens in the following order.

• Mattress pad (if needed)

• Bottom sheet (flat or fitted)

• Cotton or padded waterproof drawsheet (if needed)

• Waterproof under-pad (if needed)

You may also need:

Use 1 arm to hold the linens. Use your other hand to pick them up. The first item you will use is at the bottom of the stack. To get it on top, place your arm over the stack. Then turn the stack over onto the other arm (Fig. 21-6). The first item you will use is now on top. Place the clean linens on a clean surface.

FIGURE 21-6 Collecting linens. Linens are held away from the body and uniform. A, The arm is placed over the top of the stack of linens. B, The stack of linens is turned onto the arm.

Remove used linens 1 piece at a time. Roll each piece away from you. The side that touched the person is inside the roll and away from you (Fig. 21-7). Discard each piece into a laundry bag.

FIGURE 21-7 Roll used linens away from you.

In hospitals, top and bottom sheets, the drawsheet, waterproof under-pad (if used), and pillowcases are changed daily. If still clean, the mattress pad, blanket, and bedspread are re-used for the same person. They are not re-used if soiled, wet, or wrinkled. Change wet, damp, or soiled linens right away. Wear gloves and follow Standard Precautions and the Bloodborne Pathogen Standard.

See Focus on Long-Term Care and Home Care: Linens.

See Focus on Surveys: Linens.

Focus on Long-Term Care and Home Care

Linens

Long-Term Care

In nursing centers, linens are not changed every day. A complete linen change is usually done on the person’s bath or shower day. This may be 1 or 2 times a week. Pillowcases, top and bottom sheets, and drawsheets (if used) are changed twice a week. Linens are always changed if wet, damp, soiled, or very wrinkled.

Some residents bring bedspreads, pillows, sheets, blankets, quilts, or afghans from home. Use them to make the bed. These items are the person’s property. The items must be labeled with the person’s name. This prevents loss or confusion with another person’s property.

Some centers have colored or printed linens. If so, let the person choose what color to use. Also let him or her decide how many pillows or blankets to use. If possible, the person chooses the time when you make the bed. The resident has the right to personal choice.

Home Care

Linen changes in the home are usually done 1 or 2 times a week. Follow the person’s routine. Change linens more often if the person asks you to do so. Always change linens that are wet, damp, soiled, or very wrinkled. Contact the nurse if the person refuses to have linens changed.

Focus on Surveys

Linens

Linens may contain blood, body fluids, secretions, or excretions. They may contain microbes. You must help prevent and control the spread of infection. Surveyors will observe:

• How you transport linens.

• If you practice hand hygiene after handling soiled or used linens.

• If you double-bag linens when the outside of the laundry bag is visibly contaminated or wet.

• If you bag contaminated linens where they are used. The person’s room and the shower room are examples.

Drawsheets

A drawsheet is a small sheet placed over the middle of the bottom sheet. The drawsheet may have tuck tails for tucking the sheet under the mattress.

• A cotton drawsheet is made of cotton. It helps keep the mattress and bottom linens clean (Fig. 21-8, A).

FIGURE 21-8 A, Cotton drawsheet. B, Padded waterproof drawsheet. C, Waterproof under-pad. D, Disposable bed protector.

• A padded waterproof drawsheet is a drawsheet made of an absorbent top and waterproof bottom (Fig. 21-8, B). It protects the mattress and bottom linens from dampness and soiling. The waterproof side is placed down, away from the person. The absorbent top is placed up, toward the person. Other waterproof drawsheets are disposable. They are discarded when wet, soiled, or wrinkled.

Many agencies use incontinence products (Chapter 24) to keep the person and linens dry. Waterproof under-pads or disposable bed protectors also are common (Fig. 21-8, C and D).

Plastic-covered mattresses cause some persons to perspire heavily, causing discomfort. A drawsheet reduces heat retention and absorbs moisture. Drawsheets are often used as assist devices to move and transfer persons in bed (Chapters 18 and 19). If used as an assist device, do not tuck the drawsheet in at the sides.

See Focus on Long-Term Care and Home Care: Drawsheets.

Focus on Long-Term Care and Home Care

Drawsheets

Home Care

A flat sheet folded in half can serve as a cotton drawsheet. A twin-sized sheet is easier to use for this purpose. The nurse tells you what to use.

Medical supply stores sell waterproof drawsheets and waterproof under-pads. The nurse discusses the need for these items with the person and family.

Some people use plastic mattress protectors. They protect mattresses but do not protect bottom linens (cotton drawsheet, bottom sheet, and mattress pad). Some people place plastic under the drawsheet. The nurse tells you what is safe for the person.

Do not use plastic trash bags or dry-cleaning bags. They are not strong enough to protect the linens and mattress. They slide easily and move out of place. Suffocation is a risk if the bag covers the person’s nose and mouth.

Making Beds

Safety and medical asepsis are important for bedmaking. Follow the rules in Box 21-1.

Box 21-1

Rules for Bedmaking

• Use good body mechanics at all times (Chapter 17).

• Follow the rules in Chapters 18 and 19 to safely move and transfer the person.

• Follow the rules of medical asepsis.

• Follow Standard Precautions and the Bloodborne Pathogen Standard.

• Practice hand hygiene before handling clean linens.

• Bring enough linens to the person’s room. Do not bring extra linens.

• Bring only the linens that you will need. You cannot use extra linens for another person.

• Place clean linens on a clean surface. Use the bedside chair, over-bed table, or bedside stand. Place a barrier (towel, paper towel) between the clean surface and the linens if required by agency policy.

• Do not use extra linens in the person’s room for another patient or resident. Extra linens are considered contaminated. Put them with the used laundry.

• Do not use torn or frayed linens.

• Never shake linens. Shaking spreads microbes.

• Hold linens away from your body and uniform. Do not let used or clean linens touch your uniform.

• Never put used linens on the floor or on clean linens. Follow agency policy for used linens.

• Bag used linens in the room where they are used. Do not carry used linens un-bagged outside of the person’s room.

• Keep bottom linens tucked in and wrinkle-free.

• Straighten and tighten loose sheets, blankets, and bedspreads as needed.

• Make as much of 1 side of the bed as possible before going to the other side. This saves time and energy.

• Change wet, damp, or soiled linens right away.

See Focus on Long-Term Care and Home Care: Making Beds.

See Delegation Guidelines: Making Beds.

See Promoting Safety and Comfort: Making Beds, p. 324.

See Teamwork and Time Management: Making Beds, p. 324.

Focus on Long-Term Care and Home Care

Making Beds

Home Care

Some home care patients have hospital beds. Others do not. They have twin-, regular-, queen-, and king-sized beds. Water beds, sofa sleepers, cots, and recliners are common. Make the bed as the person wishes. Follow the rules in Box 21-1. If the person’s wishes are not safe, tell the nurse.

Your assignment may include doing laundry. Wash linens when soiling is fresh to help prevent staining. Urine, feces, vomit, and blood can stain linens. Follow these guidelines.

• Wear gloves. Linens may contain blood, body fluids, secretions, or excretions.

• Rinse the item in cold water to remove the substance.

• Treat the stain. The person may use a stain-removing agent. Read and follow the manufacturer’s instructions. Or follow the nurse’s directions.

• Wash and dry linens as the person prefers.

Delegation Guidelines

Making Beds

Before making a bed, you need this information from the nurse and the care plan.

• What type of bed to make—closed, open, occupied, or surgical.

• If you need to use a cotton drawsheet or a padded waterproof drawsheet, waterproof under-pad, or incontinence product.

• If the person uses bed rails.

• The person’s treatment, therapy, and activity schedule. For example, Mr. Smith needs a treatment in bed. Change linens after the treatment. Change Mrs. Chapman’s bed while she is in physical therapy.

• Position restrictions or limits in the person’s movement or activity.

• How to position the person and the positioning devices needed.

• If the bed needs to be locked into a certain position (Chapter 20).

• When to report observations.

• What patient or resident concerns to report at once.

Promoting Safety and Comfort

Making Beds

Safety

You need to raise the bed for body mechanics. The bed also must be as flat as possible. If the bed is locked, unlock it. Then adjust the bed. Return the bed to the correct position when you are done. Then lock the bed.

Wear gloves to remove linens from the person’s bed. Also follow other aspects of Standard Precautions and the Bloodborne Pathogen Standard. Linens may contain blood, body fluids, secretions, or excretions.

After making a bed, lower the bed to the correct level for the person. Follow the care plan. For an occupied bed, raise or lower bed rails according to the care plan.

Comfort

For an occupied bed, cover the person with a bath blanket before removing the top sheet. Do not leave the person uncovered. The bath blanket provides warmth and privacy.

Adjust the person’s pillow as needed during the procedure. After the procedure, position the person as directed by the nurse and the care plan. Always make sure linens are straight and wrinkle-free.

Teamwork and Time Management

Making Beds

Making beds with a co-worker is faster, easier, and safer for patients, residents, you, and your co-worker. Make 1 side of the bed while your co-worker makes the other. Always thank your co-worker for helping you. Also help your co-worker make beds when asked to do so.