How to change a bedridden adult?: A comprehensive caregiver’s guide

According to the Centers for Disease Control and Prevention, urinary incontinence is one of the most common chronic conditions in older adults. Knowing how to change a bedridden adult safely and with dignity is a vital skill for caregivers to maintain hygiene and prevent skin complications.

Quick Summary

Successfully changing a bedridden adult involves preparing necessary supplies, using the log-rolling technique to safely reposition the person, performing thorough skin cleaning and protection, and managing linens without causing strain.

Key Points

• Gather Supplies: Prepare all necessary items like gloves, wipes, and fresh briefs before starting to ensure a smooth, quick process.

• Use the Log-Roll Technique: Safely turn the person onto their side by guiding their hip and shoulder, minimizing strain on both the caregiver and the patient.

• Prioritize Skin Health: Clean the perineal area from front to back, dry thoroughly, and apply a protective barrier cream to prevent rashes and pressure sores.

• Maintain Dignity: Communicate with the individual throughout the change, protect their privacy by keeping them covered, and be gentle and respectful.

• Consider Equipment: Utilize helpful tools like underpads or draw sheets to aid in repositioning and protect bed linens during the process.

• Inspect Regularly: Use the opportunity to inspect the skin for any signs of irritation or redness, especially on bony areas, and report concerns to a healthcare provider.

Preparing for the Change

Before you begin, gather all the necessary supplies and prepare the environment to ensure the process is as smooth and quick as possible. This minimizes the time your loved one is exposed and reduces the risk of skin irritation.

Essential Supplies Checklist

• Gloves: Use disposable medical-grade gloves to maintain hygiene for both you and the patient. Keep an extra pair on hand in case the first becomes soiled.
• Protective Underpad (Chux): Disposable, waterproof pads protect the bed linens from soiling. If you don't have a disposable one, a folded towel can work in a pinch.
• Cleansing Agent: Gentle wipes or a no-rinse skin cleanser in a spray bottle are effective for cleaning. Avoid harsh soaps that can dry out the skin.
• Barrier Cream or Ointment: A moisture-barrier cream protects the skin from moisture and helps prevent rashes or pressure sores.
• Fresh Incontinence Product: Ensure you have the correct size and type of brief or pull-up ready to go.
• Clean Linens: Have a fresh bottom sheet, draw sheet, and top cover ready.
• Trash Bag: A plastic bag placed within easy reach is essential for disposing of soiled items immediately.

Setting up the Environment

Adjust the bed to a comfortable working height, typically around your waist level. This helps prevent back strain. If the bed has side rails, raise the rail on the side opposite you to create a safety barrier once the person is turned. Lock the bed wheels to prevent any movement.

The Log-Rolling Technique: A Step-by-Step Guide

This technique is fundamental to safely changing a bedridden adult, as it protects their spine and prevents injuries.

1. Start on the back: With the person lying on their back, gently undo the tabs on the soiled brief.
2. Position for the turn: Cross the person's arms over their chest. Bend the knee farthest from you and place that foot flat on the bed.
3. Turn the person: Place one hand on their shoulder and the other on their hip. In one smooth, steady motion, gently roll the person onto their side, away from you, so they are facing the raised side rail or a helper.
4. Roll and remove: While the person is on their side, roll the soiled brief inwards, containing any waste, and pull it away. Place the soiled brief and any used wipes into the trash bag.

Cleaning and Inspecting the Skin

Proper cleaning is crucial to prevent infection and maintain skin integrity.

The Cleaning Process

• Use moist wipes or a warm, damp washcloth with a no-rinse cleanser to clean the perineal area from front to back. Use a new wipe with each pass to prevent the spread of bacteria.
• Pay special attention to all skin folds, ensuring they are thoroughly cleaned.
• Dry the skin completely by patting gently. Avoid rubbing, as this can cause friction and irritate fragile skin.
• Allow the skin to air dry for a moment before proceeding.

Inspecting for Skin Breakdown

While cleaning, take time to check the person's skin for any red spots, irritation, or open areas, particularly on bony prominences like the tailbone, hips, and heels. Report any concerns to a healthcare professional, as these could be early signs of pressure ulcers.

Changing Linens with a Person in Bed

If linens are also soiled, you can change them at the same time as the brief.

1. Create the clean side: After removing the soiled brief, roll the dirty linen towards the person's back and tuck it tightly against them.
2. Place the new linen: Position a fresh, rolled-up sheet and a new underpad on the now-exposed side of the bed. Tuck the clean, rolled-up linen against the person's back.
3. Roll back over: Gently roll the person back onto their other side, over the 'hump' of rolled-up linen.
4. Finish the change: Go to the other side of the bed, remove all the soiled linen, and pull the clean linen flat. Smooth out any wrinkles and ensure the new brief is positioned correctly before fastening the tabs.

Positioning the New Brief

After cleaning and inspection, apply the new brief while the person is still on their side.

1. Tuck and roll: Tuck the new brief, folded lengthwise, under the person's hips.
2. Roll back: Gently roll the person back onto their back, over the new brief.
3. Pull through: Pull the front of the brief up through their legs and fasten the tabs snugly, but not too tightly. The top tabs should angle down, and the bottom tabs should angle up for a secure fit.

Tab-Style vs. Pull-Up Incontinence Products

When choosing the right product, consider the person's mobility and level of assistance needed. Both tab-style briefs and pull-up underwear have their distinct advantages.

Feature	Tab-Style Briefs	Pull-Up Underwear
Ease of Changing	Ideal for bedridden or immobile individuals, as they can be changed without lifting the person's legs.	Best for individuals with some mobility who can stand and assist with the process.
Containment	Often offer a more secure and customizable fit with adjustable tabs, providing superior protection against leaks.	Can be less secure than tab-style briefs, with a fixed waistband that may not fit as snugly.
Dignity & Feel	May feel more like a diaper, which can cause embarrassment for some.	Resembles regular underwear, which can improve a person's sense of dignity and normalcy.
Use Case	Perfect for overnight use, heavier incontinence, or for patients who are completely reliant on a caregiver.	Good for daytime use for individuals who can manage some of their own care or for lighter incontinence.

Important Considerations for Dignity and Comfort

Always communicate with your loved one throughout the process. Tell them what you are doing step-by-step and maintain eye contact. Ensure they are covered with a blanket as much as possible to protect their privacy and keep them warm.

For more information on safe patient handling, a crucial aspect of long-term care, visit MedlinePlus Medical Encyclopedia.

Conclusion

Learning how to change a bedridden adult is a foundational skill in caregiving that demands attention to detail, safety, and respect for the individual's dignity. By preparing properly, using gentle techniques, and prioritizing skin health, you can ensure a clean, comfortable, and respectful experience for both the caregiver and the person receiving care. Consistent, kind care is essential for maintaining physical and emotional well-being.

Frequently Asked Questions

How often should I change a bedridden adult?

This depends on the individual's needs, but generally, soiled products should be changed immediately. For urinary incontinence, a change every 2 to 4 hours is often recommended to maintain skin health. Follow a schedule and check regularly.

What if the person is too heavy to roll on my own?

For heavier or less mobile individuals, a second person is recommended to assist with the log-rolling technique. If assistance is not available, consider using a draw sheet, which provides a handle for easier repositioning, or specialized lifting equipment.

How do I prevent skin breakdown and bedsores?

In addition to frequent changes, apply a moisture-barrier cream, ensure the skin is clean and dry, and regularly reposition the person (every two hours if possible) to relieve pressure on bony areas. Make sure linens are smooth and wrinkle-free.

Is it better to use tab-style briefs or pull-ups for a bedridden person?

Tab-style briefs are generally better for individuals who are completely bedridden or have very limited mobility, as they can be changed with the person lying down. Pull-ups are easier for those who can stand or assist with the change.

How do I maintain the person's dignity during the change?

Always announce what you are about to do, ensure privacy by closing doors or using curtains, and expose only the necessary parts of the body during cleaning. Speak in a calm and respectful tone throughout the process.

What should I do if I notice a rash or skin irritation?

Clean the area gently and apply a protective barrier cream. If the condition does not improve or appears to be worsening, contact a healthcare professional for advice. Continued moisture and friction can quickly lead to more severe skin problems.

Can I use baby wipes to clean a bedridden adult?

While convenient, baby wipes may contain ingredients that can irritate adult skin, which is often more fragile. It is best to use wipes specifically designed for adult skin or a no-rinse skin cleanser with a warm washcloth.