How to change sheet with patient in bed? A caregiver's guide

According to the Family Caregiver Alliance, there are over 43.5 million family caregivers in the U.S. who provide unpaid care to an adult or child. Many of these caregivers will need to learn how to change sheet with patient in bed to maintain hygiene and comfort, a procedure often perceived as difficult but manageable with the right technique and preparation.

Quick Summary

A step-by-step guide for caregivers on the safe and efficient method for changing bed linens for a person who cannot get out of bed. Covers preparation, patient positioning, and proper techniques for removing and replacing sheets while maintaining patient dignity and safety.

Key Points

• Prepare all supplies in advance: Gathering clean sheets, gloves, and a laundry bag beforehand prevents interruptions during the process.

• Communicate with the patient: Explain each step to the patient to ensure their comfort and cooperation.

• Ensure safety: Always lock bed wheels and use bed rails to prevent falls during the bed-changing process.

• Position the patient correctly: Gently roll the patient onto their side, using pillows for support, to clear one side of the bed at a time.

• Roll dirty linen snugly: Roll the soiled sheet and tuck it tightly against the patient's back to keep it from spreading germs.

• Use a draw sheet: A smaller, folded sheet placed under the patient's torso can simplify moving and repositioning them.

• Check for wrinkles: Ensure all new linens are smooth and wrinkle-free to prevent skin irritation and pressure sores.

• Adjust for comfort: Once complete, lower the bed, ensure top covers are not too tight, and return the call light to the patient.

Preparation is Key

Before you begin the process of changing an occupied bed, gathering all necessary supplies is crucial for a smooth and efficient procedure. This prevents you from having to leave the patient unattended during the task.

Essential Supplies Checklist

• Clean fitted sheet and top sheet (or a flat sheet to be used as a fitted one)
• Clean pillowcase(s)
• Draw sheet (optional, but highly recommended for easier maneuvering)
• Waterproof pad or incontinence pad (if necessary)
• Laundry hamper or bag for soiled linens
• Disposable gloves
• Warm water and mild soap or a basin and washcloths (if any skin cleaning is needed)

Before You Start

1. Communicate: Explain each step of the process to the patient. This helps alleviate any anxiety they may feel and ensures their cooperation.
2. Ensure Privacy: Close the door or pull the curtains around the bed to provide privacy and preserve the patient's dignity.
3. Ensure Safety: Lock the bed wheels to prevent it from moving. If it's a hospital bed, raise it to a comfortable working height to protect your back from strain. Raise the bed rails on the side opposite of where you will begin.
4. Practice Hand Hygiene: Wash your hands thoroughly and put on a fresh pair of disposable gloves.

The Step-by-Step Bed Change Procedure

The following method is designed to be performed with one person, though two people can make the process easier, especially with larger or less mobile patients.

Step 1: Prepare the First Side

Start by positioning the patient on their side, with their back facing you. Ensure they are secure by having them hold onto the bedrail or by using pillows to support their back. If possible, have them bend their knees and place one arm across their chest for stability.

Step 2: Roll the Dirty Linen Away

Working on the empty side of the bed, untuck the bottom sheet. Carefully roll the soiled sheet lengthwise toward the patient's back, tucking it snugly against them. This creates a barrier between the patient and the dirty linen.

Step 3: Place the Clean Linen

Take the clean fitted sheet and fold it lengthwise. Tuck the clean, folded portion under the mattress on the now-empty side of the bed. Roll the rest of the clean sheet toward the patient, tucking it against the soiled linen roll. Place a new waterproof pad or draw sheet on top of the clean sheet, if using.

Step 4: Turn the Patient Over

Gently help the patient roll onto their other side, over the mound of rolled linens. This might cause a slight bump, so it's helpful to warn the patient beforehand. Ensure the patient is comfortable and secure on the clean side of the bed before moving to the other side. Raise the side rail on this side for safety.

Step 5: Remove the Soiled Linen

Move to the other side of the bed. Lower the side rail. Untuck the remaining soiled sheet and pull it out from under the patient. Roll the dirty linen completely away from the patient, keeping it away from your clothes and their body. Place it immediately into the laundry hamper.

Step 6: Finish Making the Bed

Pull the clean sheet through completely and tuck it securely under the mattress. If using a draw sheet, pull that through as well. Smooth out any wrinkles or creases to prevent skin irritation and pressure sores.

Step 7: Change Top Linen and Pillowcase

Assist the patient to roll back onto their back. Place a clean top sheet and blanket over them, being mindful not to shake the linen. Have the patient hold onto the top edge of the clean sheet as you pull the old top sheet out from underneath. Change the pillowcase by gently lifting the patient's head with one hand while removing the pillow with the other.

Step 8: Final Adjustments

Lower the bed to its lowest position. Ensure the linens are tucked in securely but not too tightly, leaving enough room for foot movement to prevent foot drop. Remove and dispose of your gloves, and wash your hands. Return the call light and any personal items to the patient within easy reach.

Comparison of Bed-Changing Techniques

Feature	One-Person Technique	Two-Person Technique	Draw Sheet Method	Incontinence Pad Method
Best for	Lower mobility, less physically demanding patients	Patients with limited mobility or heavier weight	All immobile patients for easier repositioning	Patients with incontinence issues
Pros	Manages alone, builds confidence	Faster, safer for heavier patients, less back strain on caregiver	Reduces friction, protects skin, and simplifies linen changes	Protects the mattress and linens from soiling
Cons	Higher risk of back strain for the caregiver	Requires coordination with another person	Extra step in initial bed preparation	Adds an extra layer that can bunch up if not smoothed properly
Skill Level	Moderate to Advanced	Beginner to Moderate	Moderate	Beginner

Conclusion

Changing bed sheets with a patient in bed is a common caregiving task that requires proper technique, patience, and a focus on safety and dignity. By preparing all necessary supplies, communicating with the patient, and following a methodical, step-by-step process, caregivers can perform this task efficiently and comfortably. The use of a draw sheet can be a significant help, making the procedure easier and safer for both parties. Consistent practice will build confidence and ensure a hygienic and comfortable environment for the patient, contributing to their overall well-being. For a detailed video on the technique, refer to CNAonlinecourse.com's guide.

Frequently Asked Questions

What is the safest way to turn a patient for a bed change?

The safest way is to use a controlled log roll technique. Stand on the side of the bed you want to turn the patient away from. Gently roll the patient onto their side towards the opposite bed rail, using pillows to support their back and ensure they feel secure.

Can I change the sheets by myself, or do I need help?

While it is possible to change sheets by yourself, especially with smaller or more mobile patients, having a partner can make the process significantly safer and easier, particularly with heavier or less mobile individuals. A partner can help stabilize the patient and assist with pulling the linens tight.

What if the sheets are heavily soiled?

If the sheets are heavily soiled, you should first clean the patient's skin before placing the new, clean sheet. You can use a bath blanket to cover the patient for privacy and warmth while you clean. Always use gloves and dispose of soiled items properly.

How do you make 'hospital corners'?

To make hospital corners, pick up the side of the top sheet and blanket about 15 inches from the corner at the foot of the bed, making a triangle. Tuck the excess fabric hanging at the foot of the bed underneath the mattress, and then fold the triangle down over the side and tuck it in.

What is a draw sheet and why is it useful?

A draw sheet is a smaller, folded sheet placed under the patient's hips and torso. It is useful for assisting with turning and repositioning the patient, as it reduces friction and makes the movement easier for both the caregiver and the patient.

How can I prevent friction and skin irritation?

To prevent friction and skin irritation, ensure all clean sheets are pulled taut and are completely free of wrinkles or creases. Using a draw sheet can also help reduce friction when repositioning the patient.

What if the patient is uncooperative or in pain?

If a patient is uncooperative or in pain, communicate with them calmly and clearly. You may need to premedicate them for pain before starting, as directed by a healthcare provider. If they remain uncooperative, do not force them. Seek additional assistance or consult with a healthcare professional.