Giving a Bed Bath

Goal: The patient will vocalize feeling clean and fresh.

1. Review chart for any limitations in physical activity.

2. Bring necessary equipment to the bedside stand or overbed table.

3. Perform hand hygiene and put on gloves and/or other PPE, if indicated.

4. Identify the patient. Discuss procedure with the patient and assess the patient’s ability to assist in the bathing process, as well as personal hygiene preferences.

5. Close curtains around bed and close the door to the room, if possible. Adjust the room temperature, if necessary.

6. Remove sequential compression devices and antiembolism stockings from lower extremities according to agency protocol.

7. Offer patient bedpan or urinal.

8. Remove gloves and perform hand hygiene.

9. Adjust the bed to a comfortable working height; usually elbow height of the caregiver (VISN 8 Patient Safety Center, 2009).

10. Put on gloves. Lower side rail nearer to you and assist patient to side of bed where you will work. Have patient lie on his or her back.

11. Loosen top covers and remove all except the top sheet. Place bath blanket over patient and then remove top sheet while patient holds bath blanket in place. If linen is to be reused, fold it over a chair. Place soiled linen in laundry bag. Take care to prevent linen from coming in contact with your clothing.

12. Remove patient’s gown and keep bath blanket in place. If patient has an IV line and is not wearing a gown with snap sleeves, remove gown from other arm first. Lower the IV container and pass gown over the tubing and the container. Rehang the container and check the drip rate.

13. Raise side rails. Fill basin with a sufficient amount of comfortably warm water (110 F to 115 F). Add the skin cleanser, if appropriate, according to manufacturer’s directions. Change as necessary throughout the bath. Lower side rail closer to you when you return to the bedside to begin the bath.

14. Put on gloves, if necessary. Fold the washcloth like a mitt on your hand so that there are no loose ends.

15. Lay a towel across patient’s chest and on top of bath blanket.

16. With no cleanser on the washcloth, wipe one eye from the inner part of the eye, near the nose, to the outer part. Rinse or turn the cloth before washing the other eye.

17. Bathe patient’s face, neck, and ears. Apply appropriate emollient.

18. Expose patient’s far arm and place towel lengthwise under it. Using firm strokes, wash hand, arm, and axilla, lifting the arm as necessary to access axillary region. Rinse, if necessary, and dry. Apply appropriate emollient.

19. Place a folded towel on the bed next to the patient’s hand and put basin on it. Soak the patient’s hand in basin. Wash, rinse if necessary, and dry hand. Apply appropriate emollient.

20. Repeat Actions 18 and 19 for the arm nearer you. An option for the shorter nurse or one susceptible to back strain might be to bathe one side of the patient and move to the other side of the bed to complete the bath.

21. Spread a towel across patient’s chest. Lower bath blanket to patient’s umbilical area. Wash, rinse, if necessary, and dry chest. Keep chest covered with towel between the wash and rinse. Pay special attention to the folds of skin under the breasts.

22. Lower bath blanket to the perineal area. Place a towel over patient’s chest.

23. Wash, rinse, if necessary, and dry abdomen. Carefully inspect and clean umbilical area and any abdominal folds or creases.

24. Return bath blanket to original position and expose far leg. Place towel under far leg. Using firm strokes, wash, rinse, if necessary, and dry leg from ankle to knee and knee to groin. Apply appropriate emollient.

25. Wash, rinse if necessary, and dry the foot. Pay particular attention to the areas between toes. Apply appropriate emollient.

26. Repeat Actions 21 and 22 for the other leg and foot.

27. Make sure patient is covered with bath blanket. Change water and washcloth at this point or earlier, if necessary.

28. Assist patient to prone or side-lying position. Put on gloves, if not applied earlier. Position bath blanket and towel to expose only the back and buttocks.

29. Wash, rinse, if necessary, and dry back and buttocks area. Pay particular attention to cleansing between glutealfolds, and observe for any redness or skin breakdown in the sacral area.

30. If not contraindicated, give patient a backrub, as described in Chapter 10. Back massage may be given also after perineal care. Apply appropriate emollient and/or skin barrier product.

31. Raise the side rail. Refill basin with clean water. Discard washcloth and towel. Remove gloves and put on clean gloves.

32. Clean perineal area or set patient up so that he or she can complete perineal self-care. If the patient is unable, lower the side rail and complete perineal care, following guidelines in the accompanying Skill Variation. Apply skin barrier, as indicated. Raise side rail, remove gloves, and perform hand hygiene.

33. Help patient put on a clean gown and assist with the use of other personal toiletries, such as deodorant or cosmetics.

34. Protect pillow with towel and groom patient’s hair.

35. When finished, make sure the patient is comfortable, with the side rails up and the bed in the lowest position.

36. Change bed linens, as described in Skills 7-8 and 7-9. Dispose of soiled linens according to agency policy. Remove gloves and any other PPE, if used. Perform hand hygiene.