What Precautions Should Be Taken While Preparing a Bed for a Patient?

According to the Agency for Healthcare Research and Quality (AHRQ), fall-related injuries are a significant concern in both hospital and home care settings. Understanding what precautions should be taken while preparing a bed for a patient is crucial to prevent these injuries and ensure a hygienic and comfortable environment, promoting better health outcomes.

Quick Summary

Ensuring patient bed safety involves meticulous hygiene to prevent infection, maintaining a wrinkle-free surface to prevent pressure sores, and implementing fall prevention measures like proper bed height and locked wheels. Caregivers must also use proper body mechanics and consider patient comfort with strategic linen and pillow placement.

Key Points

• Hand Hygiene: Wash hands thoroughly before and after handling linens to prevent infection.

• Prevent Falls: Lock bed wheels, use side rails judiciously, and keep the bed at the lowest safe height when unattended.

• Smooth Surface: Make sure all sheets are taut and wrinkle-free to prevent the formation of pressure sores.

• Proper Positioning: Adjust the bed and use supportive pillows to ensure the patient is comfortable and safe according to their specific needs.

• Ergonomic Practices: Raise the bed to a comfortable working height for the caregiver to prevent back strain and injury.

• No Contamination: Never shake linens and avoid letting them touch your uniform to contain microbes.

• Emergency Access: Ensure the call bell and any necessary items are within easy reach of the patient at all times.

Essential Infection Control Measures

Proper hygiene is the foundation of patient bed preparation, preventing the spread of infection. Microorganisms can easily transfer from soiled linens and surfaces, posing a serious risk to vulnerable patients. By following a strict protocol, caregivers can maintain a clean and safe environment.

Hand Hygiene and Personal Protective Equipment (PPE)

• Wash Hands Thoroughly: Before and after handling any linens, perform rigorous hand hygiene. Use soap and water or an alcohol-based hand sanitizer to minimize the risk of contamination.
• Wear Gloves: Always don clean, disposable gloves when dealing with soiled linens or if there is a risk of contact with bodily fluids. Remove gloves correctly and wash hands immediately afterward.

Handling and Disposing of Linens

• Never Shake Linens: Shaking sheets can spread airborne pathogens, including dust mites and bacteria. Instead, roll soiled linens inward to contain any contaminants.
• Avoid Contact with Uniform: Hold linens away from your body to prevent cross-contamination from your clothing. This is a critical step in a healthcare setting but is equally important for at-home care.
• Use Designated Containers: Place soiled linens directly into a designated laundry bag or hamper. Never put them on the floor, on another patient's bed, or on clean surfaces.

Ensuring Patient Safety and Comfort

Beyond hygiene, the physical preparation of the bed is key to a patient's safety, preventing falls and other injuries while ensuring their comfort.

Proper Bed Adjustment and Positioning

• Adjust to Working Height: For caregivers, raising the bed to a comfortable waist level before starting prevents back strain and allows for better ergonomics. Remember to lower it and lock the wheels once finished.
• Lock the Wheels: A patient attempting to get in or out of a bed with unlocked wheels can cause it to shift unexpectedly, leading to a fall. Always ensure the wheels are locked firmly in place.
• Use Side Rails Appropriately: Side rails can prevent falls for some patients, but for others, they can present an entrapment hazard. Use them according to a healthcare provider's recommendations and facility protocols. Always raise the side rail on the opposite side before turning the patient to prevent them from rolling off.

Linens and Pressure Sore Prevention

• Wrinkle-Free Sheets: A smooth, taut surface is essential for preventing skin irritation and pressure sores, also known as decubitus ulcers. Any wrinkle can create a pressure point that damages fragile skin over time.
• Implement a Toe Pleat: When making the top covers, create a small tuck or pleat at the foot of the bed. This provides room for the patient's feet to move freely and prevents the weight of the sheets from causing foot drop.
• Use Pressure-Relief Devices: For bedridden patients, consider using specialized mattresses, overlays, or cushions to distribute pressure evenly. Examples include air-filled pads, gel pads, and medical sheepskin. For more detailed information on pressure sore prevention, consult authoritative sources like the Centers for Disease Control and Prevention.

Special Considerations for Patient Conditions

Different patient needs require tailored bed preparation strategies. A patient recovering from surgery has different requirements than a patient with respiratory issues or reduced mobility.

Post-Operative Bed

• Easy Access: Make the bed with the top covers fan-folded to one side, or prepare it as an 'open bed,' allowing for easy patient transfer from a stretcher.
• Monitoring Equipment: Ensure all necessary monitoring equipment, drainage bags, and IV lines have a clear path and are not tangled in the bed covers.

Patient with Respiratory Issues

• Elevate the Head: Positioning the head of the bed slightly can help patients with breathing difficulties. Use pillows to provide additional support in a comfortable, upright position.

Comparison of Standard vs. Occupied Bed Making

Feature	Unoccupied Bed (Patient is Out)	Occupied Bed (Patient is In)
Hygiene	Full linen change, mattress inspection, and sanitization if needed.	One-sided process, rolling the patient safely to access all linen.
Safety	Lock wheels, raise to working height, then lower.	Requires careful patient movement, side rail use, and communication.
Technique	Work one side at a time for efficiency. Miter corners for tautness.	Minimize patient exposure; use a bath blanket for privacy.
Ergonomics	Focus on proper lifting and posture while arranging linens.	Involves careful patient repositioning, requiring excellent body mechanics.
Risk Factor	Lower risk of direct patient harm; focus is on infection control.	Higher risk of patient falls or injury; requires meticulous attention.

Conclusion: A Proactive Approach to Care

Taking comprehensive precautions while preparing a bed for a patient is an act of proactive, compassionate care. It goes beyond simply changing sheets to create a secure, hygienic, and comfortable environment that supports a patient's healing and well-being. By focusing on infection control, preventing pressure sores, and implementing fall prevention strategies, caregivers and healthcare providers can significantly improve the quality of care and safety for those in need.

Frequently Asked Questions

How often should a patient's bed linens be changed?

Linens should be changed at least once a week or more frequently if they become soiled or damp. For patients with incontinence or excessive sweating, daily changes may be necessary to maintain hygiene and prevent skin breakdown.

What is the importance of a 'toe pleat' when making a bed for a patient?

A 'toe pleat' is a small, vertical tuck in the top linens that provides extra space for the patient's feet. This prevents pressure from the sheets, which can cause discomfort, skin irritation, and a condition called foot drop.

What is the safest way to move a bedridden patient while changing their sheets?

The safest method involves rolling the patient to one side of the bed, tucking the clean sheets and rolling the soiled linens to the center, and then rolling the patient back over the new linens to the clean side. This process minimizes patient movement and risk of injury. A hospital bed's adjustable height feature also helps.

When should I use a waterproof mattress protector or soaker pad?

A waterproof protector or soaker pad should be used for any patient at risk of incontinence or excessive wound drainage. This protects the mattress from spills and contaminants, making cleaning and hygiene management much easier.

What are the key precautions to take with bed rails?

Bed rails must be used with caution, following a healthcare provider's instructions. Ensure they are securely locked and there are no gaps where a patient could become entrapped. For some patients, bed rails may increase fall risk if they attempt to climb over them.

Is there any special equipment recommended for bed preparation?

For bedridden patients, equipment such as a transfer or draw sheet with handles can significantly help with repositioning. Other items include protective waterproof pads, pressure-relieving mattresses, and a bed cradle to keep top sheets off the patient's feet.

How can caregivers use proper body mechanics when preparing a patient's bed?

To prevent back strain, caregivers should always raise the bed to waist level, stand close to the bed, and use their leg muscles to lift and move patients rather than their back. Rolling a patient instead of lifting is also safer.