Essential Skills: When Making a Bed, the CNA Should Follow These Critical Steps

Contaminated healthcare textiles can contain high numbers of microorganisms, contributing to Healthcare-Associated Infections (HAIs). Therefore, when making a bed, the CNA should follow strict protocols to ensure patient safety, comfort, and prevent the spread of pathogens.

Quick Summary

A CNA making a bed must always prioritize infection control, patient safety, and resident comfort. Key actions include using proper body mechanics, never shaking linens, ensuring the bed is wrinkle-free, and maintaining patient dignity.

Key Points

• Infection Control: Always hold linens away from your uniform and never shake them. This prevents the spread of microbes through the air and via cross-contamination.

• Patient Safety: When making an occupied bed, always ensure the side rail on the opposite side is raised to prevent falls. Use proper body mechanics by raising the bed to a safe working height.

• Wrinkle Prevention: Ensure bottom sheets are smooth and tight. Wrinkles can cause pressure points, leading to skin irritation and breakdown.

• Proper Disposal: Immediately place all soiled linens into a designated hamper or bag. Never place them on the floor, furniture, or other clean surfaces.

• Communication and Dignity: Always explain the procedure to the resident before starting and maintain their privacy and comfort throughout the process.

The Importance of Proper Bed Making in Healthcare

Making a bed is a fundamental task for a Certified Nursing Assistant (CNA), but it's far more than a simple chore. It is a critical procedure that directly impacts a resident's health, safety, and psychological well-being. A clean, wrinkle-free bed reduces the risk of skin breakdown and pressure ulcers, while proper handling of linens is a cornerstone of infection control. Mastering this skill demonstrates professionalism and a commitment to providing high-quality, dignified care.

Core Principles for Every Bed Making Procedure

Before starting, every CNA should adhere to these universal principles:

• Hand Hygiene: Always perform hand hygiene before gathering clean linens and after the procedure is complete.
• Infection Control: Wear gloves when handling soiled linens. Hold all linens—clean and soiled—away from your uniform. Never shake linens, as this can aerosolize pathogens into the air. Place soiled linens directly into a designated hamper, never on the floor or other surfaces.
• Patient Safety & Dignity: Always explain the procedure to the resident. Provide privacy by closing the door or pulling a curtain. For an occupied bed, ensure side rails are used correctly to prevent falls.
• Body Mechanics: Raise the bed to a comfortable working height (usually waist-level) to prevent back strain. Avoid reaching across the bed; work from one side and then move to the other.

Step-by-Step Guide: Making an Unoccupied Bed

An unoccupied (or closed) bed is made when a resident is out of the bed for a period.

1. Gather Supplies: Collect linens in the order of use: mattress pad (if needed), fitted or bottom sheet, waterproof pad (if needed), top sheet, blanket, bedspread, and pillowcase(s).
2. Prepare the Area: Place clean linens on a clean surface, such as a bedside table. Raise the bed to a comfortable working height and lower side rails.
3. Remove Soiled Linens: Put on gloves. Check the bed for any personal items. Roll all soiled linens together, keeping the soiled side inward, and place them directly into a linen hamper. Remove gloves and perform hand hygiene.
4. Apply Bottom Sheet: Place the fitted sheet on the mattress, ensuring the seams are against the mattress. Make sure it is smooth and free of wrinkles, which can cause skin irritation.
5. Place Draw Sheet/Pad: If used, place the draw sheet or waterproof pad in the middle of the bed where the resident's torso will be.
6. Apply Top Linens: Place the top sheet, blanket, and bedspread on the bed. Ensure they are evenly distributed.
7. Make Mitered Corners: At the foot of the bed, tuck the top linens under the mattress. To create a mitered corner, lift the hanging edge of the sheet, form a 45-degree angle, and tuck the bottom part under the mattress. Then, drop the top flap down neatly.
8. Final Touches: Place a clean pillowcase on the pillow and place it at the head of the bed with the opening facing away from the door. Lower the bed to its lowest position and lock the wheels. Place the call light within reach.

Step-by-Step Guide: Making an Occupied Bed

This procedure requires extra attention to patient safety and comfort.

1. Prepare: After gathering supplies and explaining the procedure, raise the bed to working height and ensure the wheels are locked. Lower the head of the bed if the resident's condition permits.
2. Position the Resident: Lower the side rail on your side. Ask the resident to move toward the opposite side of the bed, or assist them in rolling onto their side, facing away from you. Adjust the pillow for comfort. Ensure the far side rail is up.
3. Remove Soiled Bottom Linens: Roll the soiled bottom sheet, draw sheet, and any pads inward, tucking them snugly against the resident's back.
4. Place Clean Bottom Linens: Place the clean fitted sheet on your side of the bed, securing the corners. Fan-fold the remaining half of the clean sheet and tuck it against the soiled linens under the resident.
5. Roll the Resident: Raise the side rail on your side. Move to the other side of the bed and lower that side rail. Gently roll the resident over the linens toward you.
6. Complete the Bottom Sheet: Go back to the first side, remove the soiled linens and place them in the hamper. Pull the clean, fan-folded bottom sheet through, ensuring it is tight and wrinkle-free.
7. Change Top Linens: Place the clean top sheet over the resident, on top of the old top sheet. Ask the resident to hold the clean sheet, then slide the old one out from underneath and place it in the hamper.
8. Finish: Tuck in the top linens at the foot of the bed, making mitered corners and a toe pleat for foot comfort. Change the pillowcase. Ensure the resident is comfortable, the bed is in the lowest position, and the call light is within reach.

Occupied vs. Unoccupied Bed Making: A Comparison

Feature	Unoccupied Bed Making	Occupied Bed Making
Primary Goal	Efficiency and preparation for a new or returning resident.	Patient safety, comfort, and hygiene while the resident remains in bed.
Patient Status	The resident is out of the bed (e.g., in a chair, showering).	The resident is unable to get out of bed due to illness or mobility issues.
Key Challenge	Proper technique (mitered corners, wrinkle-free sheets).	Maintaining patient safety (side rails), providing privacy, and minimizing resident movement.
Procedure Flow	Make one entire side of the bed, then the other.	Work side-to-side, rolling the patient over the old and new linens in the middle.

Conclusion: More Than Just a Clean Bed

Ultimately, when making a bed, the CNA should see it as an opportunity to provide compassionate and competent care. The procedure is a direct reflection of the facility's standards and the caregiver's attention to detail. By following established protocols, CNAs protect their residents from harm, prevent the spread of infection, and create a comfortable, dignified environment that promotes healing and well-being. For further details on handling textiles, please refer to the CDC's Guidelines for Environmental Infection Control.

Frequently Asked Questions

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

Linens should be changed at least once a week, or anytime they become wet, soiled, or wrinkled. A clean, dry bed is essential for comfort and preventing skin breakdown.

What is the purpose of making a mitered corner?

A mitered corner secures the top linens neatly and firmly under the mattress at the foot of the bed. This keeps the bedding in place and gives the bed a tidy, professional appearance.

What should a CNA do if they find a personal item, like dentures or a hearing aid, in the bed?

The CNA should stop, carefully remove the item, and place it in a safe, designated location (like a bedside table drawer). Always check the bed for personal belongings before removing soiled linens.

Why is it so important not to shake linens?

Shaking linens can send dust, skin cells, and microorganisms into the air, which can then be inhaled or settle on other surfaces, contributing to the spread of infection.

What is the difference between an open bed and a closed bed?

A closed bed has the top covers pulled up to the head of the bed, protecting the linens until a new patient arrives. An open bed is made by fan-folding the top covers down, making it easy for an ambulatory resident to get into.

What is a 'toe pleat' and why is it made?

A toe pleat is a small, horizontal fold made in the top linens over the resident's feet. It provides extra space to prevent the bedding from putting pressure on the feet and toes, which can be uncomfortable and restrict circulation.

How should a CNA hold clean or dirty linens?

All linens should be held away from the CNA's uniform and body. This prevents microorganisms from your uniform from contaminating clean linens and pathogens from soiled linens from getting on your uniform.