What is the first thing you should do when making a patient's bed?

According to the World Health Organization, proper hand hygiene is the single most effective action in preventing the spread of infections during patient care.

This principle directly addresses the most important initial step when considering what is the first thing you should do when making a patient's bed to ensure a safe and sanitary environment for both caregiver and patient.

Quick Summary

Before you begin, the initial steps involve performing thorough hand hygiene, gathering all necessary supplies, and clearly communicating the process with the patient. These actions prioritize patient safety, maintain hygiene, and create an efficient workflow for the caregiver.

Key Points

• Hand Hygiene First: The very first action is to wash your hands and put on gloves to prevent infection transmission.

• Gather Supplies: Assemble all needed materials beforehand to ensure an efficient process and minimize patient disturbance.

• Communicate with Patient: Explain the procedure to the patient to gain their cooperation and reduce any anxiety.

• Prioritize Safety: Raise the bed to a comfortable height, lock the wheels, and use side rails to prevent falls and protect the caregiver's back.

• Ensure a Wrinkle-Free Bed: Make sure the bottom sheet is taut and smooth to prevent skin irritation and potential pressure sores for the patient.

• Maintain Privacy: Always ensure the patient's privacy throughout the bed-making process to maintain their dignity.

Prioritizing Safety and Hygiene: The Critical First Steps

Making a patient's bed, particularly an occupied bed, is a fundamental task in caregiving that requires precision and adherence to safety protocols. While many focus on the mechanics of tucking sheets, the most important work happens before a single linen is changed. The very first action, and the one that underpins all subsequent steps, is the commitment to hygiene and preparation.

Step-by-Step: The Process Before the Linen Exchange

1. Perform Hand Hygiene and Don Gloves

Before you ever touch clean or soiled linens, your hands must be clean. This prevents the spread of pathogens that could be on your hands from other tasks or surfaces. If you anticipate contact with body fluids or soiled linens, gloves are also mandatory. The process includes:

• Use an alcohol-based hand rub or wash with soap and water for at least 20 seconds.
• Dry your hands completely with a disposable towel.
• Don new, clean gloves.

2. Gather All Necessary Supplies

Efficiency is key, especially when working with a patient who cannot get out of bed. The process should be as quick and comfortable as possible for them. Gathering everything you need beforehand prevents you from having to leave and return, potentially disturbing the patient multiple times. Essential supplies include:

• Clean fitted and flat sheets
• New pillowcases
• Draw sheet or incontinence pads (if required)
• Bedspread or blankets
• Laundry hamper or bag for soiled linens
• Disinfectant wipes for surfaces

3. Communicate with the Patient

Informing the patient of what you are doing is not just a courtesy; it's a vital part of respectful care. Explain the process clearly and simply. This builds trust, reduces anxiety, and allows the patient to participate as much as they are able. For example, you can say, "I'm just going to change your sheets to make you more comfortable. I'll need your help for a moment to roll onto your side."

4. Ensure Privacy and Create a Safe Working Environment

Just as you would draw a curtain for a bath, ensure the patient's privacy during this personal procedure. After confirming their understanding and cooperation, take these important safety measures:

• Raise the Bed: Adjust the bed to a comfortable working height to prevent back strain for the caregiver. Use proper body mechanics to avoid injury.
• Lock the Wheels: Lock the bed's wheels to prevent it from moving unexpectedly during the process.
• Raise Side Rails: Secure the side rail on the opposite side of the bed from where you are working to prevent the patient from falling while they are turned.

Occupied vs. Unoccupied Bed Making Procedures

The initial steps are crucial for both, but the procedure diverges based on whether the bed is occupied.

Feature	Occupied Bed Making	Unoccupied Bed Making
Patient Involvement	Patient is in bed and must be assisted to move.	No patient in bed; focus is on efficiency.
Linens Handling	Soiled and clean linens are handled simultaneously on each side, with soiled rolled away from the patient.	All old linens are removed at once before placing new ones.
Primary Goal	Patient comfort, safety, and dignity during the process.	Preparing a clean, fresh bed for a new admission or patient return.
Risks	Risk of injury to patient from improper movement; risk of skin shear from friction.	Fewer risks, primarily related to proper lifting techniques for caregivers.

Making an Occupied Bed: A Detailed Guide

Once the initial steps of hand hygiene, gathering supplies, communication, and safety are complete, follow these steps for an occupied bed:

1. Loosen linens: Gently loosen the top linens at the foot of the bed.
2. Roll patient: Cover the patient with a bath blanket. Then, with the patient's help if possible, roll them gently to the opposite side, towards the raised side rail.
3. Roll soiled linens: Roll the soiled bottom sheet and any pads inward, tucking them tightly against the patient's back. This keeps the soiled side contained.
4. Place clean linens: Place the clean bottom sheet on the unoccupied side, fan-folding the remainder towards the patient. Tuck the new sheet securely under the mattress.
5. Roll patient back: Raise the opposite side rail, go to the other side, lower the rail, and roll the patient back over the clean sheet and the soiled linens. Let them know they will feel a "bump."
6. Remove soiled linens: Gently remove the soiled linens from the bed and place them directly into the laundry hamper. Do not shake them.
7. Smooth and tuck: Pull the new bottom sheet taut and secure it. Place the new top sheet, blanket, and bedspread over the patient, removing the bath blanket from underneath. Ensure there are no wrinkles.
8. Complete the process: Put on a fresh pillowcase and position the pillow comfortably under the patient's head. Make a "toe pleat" by grasping the linens at the patient's feet and lifting gently to create a fold, relieving pressure on the toes.

Advanced Tips for a Superior Outcome

For patients with limited mobility or special conditions, extra care is needed. Techniques like the use of lift sheets or specialized positioning devices can help. Always monitor the patient's breathing and comfort level throughout the procedure. For more information on patient safety, consult reputable resources such as the CDC on Patient Safety.

Conclusion: The First Step Defines the Outcome

Ultimately, the answer to what is the first thing you should do when making a patient's bed is not a single, mechanical action, but a critical sequence of preparation and safety measures. By prioritizing hand hygiene, gathering supplies, communicating effectively, and securing the environment, caregivers set the stage for a smooth, safe, and respectful process. These initial steps are the foundation of high-quality, patient-centered care, ensuring the patient's comfort and well-being from start to finish.

Frequently Asked Questions

Why is performing hand hygiene the first step in making a patient's bed?

Performing hand hygiene is the first step to prevent the spread of microorganisms and control nosocomial infections. Your hands must be clean before touching clean linens or the patient to ensure a sanitary environment.

What supplies should you gather before making a patient's bed?

Before starting, you should gather all necessary linens, including a clean fitted sheet, flat sheet, pillowcases, and any required draw sheets or incontinence pads. A laundry hamper or bag for soiled linens is also essential.

Is it necessary to wear gloves when making a patient's bed?

Yes, it is necessary to wear gloves, especially when handling soiled linens or if there is a risk of contact with bodily fluids. Gloves protect both the caregiver and the patient from potential infection.

How do you ensure a patient's safety when making an occupied bed?

To ensure safety, lock the bed's wheels, raise the side rails on the side opposite to where you are working, and raise the bed to a comfortable height. Communicate with the patient throughout the process to ensure their cooperation.

How do you make a patient comfortable during bed making?

You can make a patient comfortable by explaining each step, moving them gently, providing a bath blanket for warmth and privacy, and ensuring the final linens are smooth and wrinkle-free. Making a toe pleat provides extra foot room.

What is a toe pleat and why is it important?

A toe pleat is a loose fold made in the top linens at the foot of the bed. It provides extra space for the patient's feet, preventing uncomfortable pressure that can lead to skin breakdown and foot drop over time.

How do you avoid wrinkles under a patient when making the bed?

To avoid wrinkles, pull the clean bottom sheet taut and smooth it out firmly from the center outwards. When making an occupied bed, this is done in two stages, with the patient rolling from one side to the other.

How do you maintain a patient's privacy during bed making?

You can maintain privacy by closing the door to the room and using a bedside curtain or screen. Additionally, use a bath blanket to keep the patient covered during the procedure, only exposing the necessary areas.