How do you change an adult diaper CNA?

According to the National Institute on Aging, millions of older adults experience some form of incontinence, making skilled and respectful diaper changing a critical task for CNAs. This detailed guide addresses how you change an adult diaper CNA, ensuring safety, dignity, and proper skin care for the patient during the process.

Quick Summary

Certified Nursing Assistants approach adult diaper changes with a focus on preparation, hygiene, and patient dignity. The procedure involves gathering supplies, providing privacy, carefully removing the soiled brief, performing meticulous perineal care, and properly applying a new diaper while minimizing patient discomfort.

Key Points

• Thorough Preparation is Essential: Gather all supplies, including a clean brief, gloves, and protective pads, before starting to ensure a smooth, quick change.

• Prioritize Patient Dignity: Always maintain privacy, explain your actions calmly, and keep the patient covered as much as possible to ensure they feel respected and safe.

• Use Proper Body Mechanics: Raise the bed to a comfortable height and roll the patient gently by the hip and shoulder to prevent injury to yourself and the patient.

• Maintain Meticulous Hygiene: Always wipe from front to back, ensure the skin is clean and dry, and use a barrier cream to protect against moisture.

• Inspect and Protect the Skin: During each change, check the patient's skin for signs of redness, rash, or irritation and apply barrier cream to prevent breakdown.

• Ensure a Secure Fit: After applying the new brief, check that the leg gathers are flat and the tabs are fastened snugly—but not too tight—to prevent leaks.

Preparing for the Task

Proper preparation is key to an efficient and dignified adult diaper change, minimizing the time the patient is exposed and uncomfortable. A CNA must first ensure they have all necessary supplies within easy reach to avoid leaving the patient unattended. The environment should also be prepared to prioritize the patient's privacy and comfort.

Gather Your Supplies

Before beginning, collect all needed items and place them on a clean, flat surface, such as a bedside table, covered with a protective pad.

• Clean, appropriately-sized adult diaper or brief
• Disposable gloves (multiple pairs)
• Disposable underpad (or 'chux')
• Pre-moistened disposable wipes or washcloths with warm, soapy water
• Moisture barrier cream or ointment (e.g., zinc oxide-based)
• Plastic trash bag for disposal
• Clean linens (if needed)
• Bedpan (optional for containing mess)

Ensure Patient Comfort and Privacy

• Close the door or pull the privacy curtain around the bed.
• Explain each step of the procedure to the patient, even if they appear unresponsive. This maintains their dignity and shows respect.
• Raise the bed to a comfortable working height for you, and lower the head of the bed to a flat position or as tolerated by the patient. Adjusting the bed height protects your back from strain.
• Roll back the top bedding, leaving a sheet or blanket to cover the patient as much as possible.

The Step-by-Step Diaper Change

Following a systematic process is essential for cleanliness and preventing cross-contamination.

1. Don Gloves and Position the Underpad: Wash your hands, put on your first pair of gloves, and then place a clean underpad underneath the patient's buttocks to protect the bed linens. You can do this while rolling the patient onto their side in the next steps.
2. Remove the Soiled Diaper: Unfasten the tabs of the soiled brief from the front. Gently tuck the side of the diaper furthest from you under the patient's hip. Roll the patient away from you onto their side by placing one hand on their hip and the other on their shoulder. Roll the soiled diaper inward toward the patient's back to contain waste as you remove it. Place the used diaper and any soiled wipes into the plastic trash bag, but do not seal yet.
3. Perform Perineal Care: With the patient still on their side, use fresh wipes to clean the area thoroughly. For female patients, always wipe from front to back to prevent urinary tract infections (UTIs). For male patients, clean the genital area and shaft. If uncircumcised, retract the foreskin to clean and then return it to its natural position. Continue wiping until all areas are clean, using a fresh wipe for each pass.
4. Inspect Skin and Apply Barrier Cream: Gently pat the skin completely dry. Inspect the skin for any signs of redness, rash, or skin breakdown, especially over bony prominences. Report any concerns to the charge nurse. Apply a thin, even layer of moisture barrier cream to the perineal area and buttocks to protect the skin from further moisture and irritation.
5. Apply the New Diaper: With the patient still on their side, fold the clean diaper in half lengthwise and tuck it under the patient's hip, with the tabs on the back side. Roll the patient back toward you onto their back, and then pull the clean diaper through their legs. Ensure it is centered and smooth out any wrinkles.
6. Fasten Securely: Pull the front panel over the patient's belly. Secure the lower tabs by pulling them slightly upward for a snug fit that cups the buttocks. Fasten the upper tabs downward to secure the waist. Ensure the fit is snug but not too tight; you should be able to slide a finger easily under the waistband. Adjust leg gathers so they are not tucked inside the diaper and provide a secure seal.
7. Final Clean-up: Remove and dispose of your soiled gloves in the trash bag. Securely seal the bag and discard it in the designated receptacle. Wash your hands thoroughly. Lower the bed, cover the patient, and position the call light within reach. Perform a final scan of the room to ensure it is tidy and the patient is comfortable.

Briefs vs. Pull-Ups: A Comparison for CNAs

Feature	Tab-Style Briefs (Adult Diapers)	Pull-Up Underwear
Best For	Bedridden patients, heavy incontinence, and individuals with limited mobility.	Mobile or semi-mobile patients with light to moderate incontinence.
Application	Put on while lying down, using side tabs to secure.	Stepped into like regular underwear, requiring the wearer to stand.
Leak Protection	Often provides superior absorbency and adjustable fit for heavier needs.	Generally less secure for heavy incontinence; leaks can occur if not changed promptly.
Ease of Use	Easier for a CNA to change a bedridden patient without lifting.	Easier for independent individuals who can change themselves.
Dignity	The tab design allows for a less invasive change for immobile patients.	The underwear-like design can feel more dignified for active users.

Maintaining Professionalism and Patient Dignity

As a CNA, your approach is as important as your technique. Performing this task with respect and empathy is crucial for maintaining a therapeutic relationship and the patient's sense of self-worth. Always maintain a positive, reassuring tone and ensure the patient feels safe and respected throughout the process. Your sensitivity and communication can significantly reduce patient anxiety.

Troubleshooting Common Issues

• Skin Irritation: If you notice redness or rashes, ensure the patient's skin is completely dry before applying barrier cream. Use a perineal cleanser designed for fragile skin instead of harsh soaps or alcohol-based products. Report severe or persistent irritation.
• Leaks: The diaper may be the wrong size, either too tight or too loose. Check the fit around the legs and waist. Ensure the leg gathers are pulled out. Consider using a booster pad for extra absorbency or a brief with a higher absorbency level.
• Odor: Ensure the brief is changed promptly and the area is cleaned thoroughly. Using scented disposal bags can also help to contain odors.

Conclusion

Changing an adult diaper is a fundamental CNA skill that combines technical competence with compassionate care. By mastering the proper procedure, prioritizing hygiene, and always maintaining the patient's dignity, a CNA ensures not only physical comfort but also emotional well-being. This methodical approach contributes to superior patient care and helps prevent complications like skin breakdown, allowing for a safer and more respectful experience. For additional guidelines on preventing infections, consult authoritative resources such as the CDC's Hand Hygiene in Healthcare Settings guide [https://www.cdc.gov/handhygiene/index.html].

Frequently Asked Questions

How often should a CNA change an adult diaper?

For optimal skin health and hygiene, an adult diaper or brief should be changed as soon as it is soiled, and at regular intervals, typically every 2-4 hours, or based on the absorbency of the product and the patient's needs. Overnight diapers can offer longer protection.

What is the proper way to roll a bedridden patient for a diaper change?

To roll a bedridden patient, first ensure the side rail is up on the side they will be facing. With the patient on their back, place one hand on their shoulder and the other on their hip. Gently and smoothly roll them away from you toward the side rail, which they can hold for stability.

What should a CNA do if they find a skin rash during a diaper change?

If a CNA finds a skin rash, they should note the area, size, and appearance, and report it to the charge nurse. They should ensure the skin is clean and dry and apply a moisture barrier cream as instructed in the patient's care plan. Harsh scrubbing or certain products should be avoided.

How can a CNA handle a diaper change for a patient with heavy bowel incontinence?

In cases of heavy bowel incontinence, use a generous amount of wipes and roll the soiled brief inward to contain waste as you remove it. A perineal wash can be used for extra cleansing. Changing gloves after removing the soiled brief and before starting to clean can help prevent cross-contamination.

What is the purpose of barrier cream during an adult diaper change?

Barrier cream creates a protective layer on the skin, shielding it from prolonged exposure to moisture from urine and feces. This helps prevent skin irritation, redness, and the formation of pressure ulcers.

Should a CNA use scented products during a diaper change?

It is generally best to avoid scented wipes or powders, as they can contain chemicals that irritate sensitive skin. Stick to fragrance-free, hypoallergenic options and a gentle, no-rinse perineal cleanser.

What is the difference between an adult brief and a pull-up for a CNA?

A CNA will typically use tab-style briefs for bedridden or less mobile patients, as they can be changed without standing. Pull-ups are better suited for more mobile patients who can participate in their own care, allowing them to step into the absorbent underwear.