How to do a brief change on a patient? The complete caregiver's guide

According to the Centers for Disease Control and Prevention, over half of older adults in nursing homes have urinary incontinence, making brief changes a routine task for many caregivers. This authoritative guide explains exactly how to do a brief change on a patient with dignity, comfort, and minimal stress for all involved.

Quick Summary

Mastering the process of changing a patient's brief involves proper preparation, gentle positioning, thorough cleaning, and careful application of a new brief to ensure hygiene and patient comfort. Caregivers can streamline this routine by gathering supplies beforehand, protecting their backs, and maintaining clear communication with the patient throughout the process.

Key Points

• Prepare all supplies: Gather your new brief, underpads, gloves, cleanser, and barrier cream before you begin to avoid interruptions and stress.

• Protect your back: Raise the bed to a comfortable working height to prevent injury from bending over during the brief change.

• Ensure patient dignity: Maintain privacy and explain each step to the patient to reduce anxiety and promote cooperation.

• Clean from front to back: This vital technique prevents the spread of bacteria, especially when caring for female patients.

• Prioritize skin health: Always dry the skin thoroughly and apply a protective barrier cream to prevent rashes and skin breakdown.

Preparing for a Smooth Brief Change

Proper preparation is the cornerstone of a safe and dignified brief change. Having everything you need within reach prevents interruptions and protects your back from strain. A disorganized setup can lead to unnecessary discomfort for the patient and potential injury for you.

Supplies You Will Need

Before beginning, gather all necessary items and arrange them on a nearby surface, such as a bedside table. Your supply kit should include:

• A new, clean brief of the correct size.
• Disposable gloves (at least one pair, but have extras).
• Disposable underpads, also known as 'chucks,' to protect the bed.
• Warm water and a mild soap or a no-rinse perineal cleanser.
• Soft washcloths or pre-moistened wipes.
• A protective barrier cream or ointment.
• A plastic-lined trash can or a sealable disposal bag.
• A clean towel for drying the skin.

Setting the Scene for Comfort and Safety

Create a safe and private environment for the patient. This not only shows respect but also minimizes patient anxiety and makes the process easier. Close the door or draw the privacy curtain. Raise the bed to a comfortable working height to prevent back strain. Lower the head of the bed to a flat position if the patient can tolerate it. Position the patient on their back and cover them with a blanket to maintain dignity, only exposing what is necessary during the process.

The Step-by-Step Brief Changing Process

Once you have your supplies ready and the environment set, you can proceed with the brief change. Always remember to communicate with the patient, explaining each step to them as you go.

Step 1: Initial Assessment and Removal

First, put on your disposable gloves. Unfasten the tabs on both sides of the old brief. If the brief is soiled, fold the front panel inward between the patient’s legs to contain the waste. For a bedridden patient, gently roll them onto their side, turning them away from you by placing one hand on their hip and the other on their shoulder. As you roll them, tuck the soiled brief and any disposable pads towards their back, trapping the soiled material within. Place a new, clean underpad on the exposed bed, ready for the next step.

Step 2: Thorough and Gentle Cleaning

Once the patient is on their side, you can perform a thorough cleaning. Always wipe from front to back to prevent the spread of bacteria, especially for female patients. Use a mild soap and warm water or the perineal cleanser with soft washcloths, or use pre-moistened wipes. Clean thoroughly in all skin folds and creases. As you clean, roll the soiled brief and wipes inward, away from the patient's clean skin. Check the patient's skin for any signs of redness, rash, or skin breakdown during this process. If your gloves become soiled, remove them, wash your hands, and put on a fresh pair before continuing.

Step 3: Skin Protection and New Brief Application

After cleaning, gently pat the skin completely dry with a clean towel. Air drying for a few moments is also beneficial. Apply a thin layer of protective barrier cream to the skin, paying close attention to areas prone to moisture buildup. Prepare the new brief by unfolding it and folding it in half lengthwise. Tuck the folded half of the new brief under the patient, ensuring the tab side is at the back. Roll the patient back towards you, over the new brief and clean underpad, and then onto their other side to remove the old, soiled brief completely.

Step 4: Securing the Brief and Final Touches

After removing the old brief, roll the patient onto their back. Pull the front of the new brief up between their legs and bring the front panel up over the abdomen. Pull the back panel to the front and fasten the side tabs securely. The fit should be snug but not too tight, ensuring a finger can fit comfortably under the waistband. Smooth out any wrinkles in the brief to prevent skin irritation. Remove and discard all waste, including gloves, in the appropriate receptacle. Finally, wash your hands thoroughly. Ensure the patient is comfortable, their bed is made, and they are positioned safely.

Brief Options for Different Needs

Choosing the correct type of incontinence product is crucial for effective care. The table below compares common types of briefs and their suitability for different patient needs.

Feature	Tab-Style Briefs	Pull-Up Style Underwear
Best For	Bedridden or less mobile patients; heavy incontinence	Active or more mobile patients; moderate to heavy incontinence
Ease of Change	Can be changed with the patient lying down, making it ideal for bedridden individuals	Requires the patient to stand or pull on like underwear; can be a challenge for bedridden patients
Fit	Adjustable tabs allow for a customized, snug fit for various body shapes and sizes	Designed to fit like regular underwear, with a more discreet, streamlined profile
Leak Protection	Excellent leakage containment, especially with refastenable tabs	Good leakage protection, but relies on a good fit around the waist and legs
Discreetness	Can be bulkier and more noticeable under clothing	More discreet and comfortable for active wearers
Overall Comfort	Can offer a very secure, dry feeling when fitted correctly	Can be more comfortable and feel less like a diaper for mobile patients

Final Recommendations for Confident Caregiving

Mastering the skill of changing a brief for a patient is an essential part of quality caregiving. It is a process that can be made simpler and more respectful through consistent practice and attention to detail. Always prioritize the patient's dignity and comfort by ensuring privacy, maintaining communication, and handling them with gentleness. By following a structured process, using the right supplies, and understanding the patient's needs, caregivers can confidently provide excellent care while protecting their own health and safety. Remember to be vigilant about skin health, as proper hygiene and protection are vital for preventing complications. For more information on skin care for seniors, consult authoritative health resources like the National Institute on Aging [https://www.nia.nih.gov/health/skin-care/taking-care-your-skin-during-aging].

Frequently Asked Questions

How often should you change a patient's brief?

The frequency depends on the patient's needs, but a brief should be changed as soon as it is soiled or wet. A regular schedule, such as every 2-4 hours or as needed, helps maintain skin health and hygiene.

What is the proper way to roll a bedridden patient during a brief change?

Gently roll the patient onto their side, away from you. To do this, place one hand on their hip and the other on their shoulder, and use a smooth, controlled motion. You can also use a draw sheet for assistance.

How do I choose the correct brief size for a patient?

Measure the patient's waist and hips to find the correct size. An ill-fitting brief, either too tight or too loose, can cause chafing, leaks, and discomfort. Always refer to the manufacturer's sizing guide.

What kind of cream should I use for skin protection?

Use a specialized protective barrier cream or ointment. These products create a barrier against moisture and help prevent skin irritation, rashes, and breakdown. Avoid standard lotions.

What if the patient is uncooperative during the brief change?

Try to maintain a calm and reassuring tone. Explain what you are doing in simple terms. If the patient is agitated, you may need to pause, provide distraction, or seek assistance from another caregiver to ensure safety for both of you.

How can I reduce odor during a brief change?

Use a sealable plastic bag for disposing of the soiled brief and wipes immediately. Some briefs also have built-in odor protection. Ensure the room is well-ventilated if possible.

Is it better to use wipes or a washcloth and soap?

For basic cleaning, pre-moistened wipes are convenient. However, a gentle wash with warm water and a mild, no-rinse cleanser can be more effective for a deeper clean, especially for bowel incontinence. Always follow with thorough drying.