Chapter 19: Bedmaking
Purposes of Bedmaking
Promote Comfort and Well-being: Making a bed properly is essential for the physical and psychological comfort and well-being of the patient or resident.
Infection Control: Bedmaking is an important component of maintaining a hygienic environment and controlling the spread of infections.
Skin Integrity: A properly made bed helps prevent skin breakdown and the formation of pressure ulcers.
Professionalism: A neat, well-made bed is considered a sign of capable and competent care provided by the healthcare facility.
Common Types of Admission Linens
Many types of linens are utilized to make a bed in a healthcare facility, including:
Mattress pads: Placed directly on the mattress.
Sheets: These include both fitted and flat sheets.
Draw sheets: Small sheets placed over bottom sheets.
Bed protectors: Used for moisture control.
Blankets: For warmth and comfort.
Bedspreads: For aesthetics and finishing.
Pillows and pillowcases: For head support and positioning.
Bath blankets: Used during procedures like bed baths.
Detailed Linen Specifications and Use Cases
Mattress Pads:
A thick layer of padding placed on the mattress to increase comfort and protect the mattress from moisture and soiling.
Fitted mattress pad: Features elasticized sides that wrap around and underneath the mattress to hold the pad securely.
Flat (nonfitted) mattress pad: A pad that is simply laid on the mattress and is not secured.
Material Considerations: Some facilities use rubberized or plastic mattresses. Placing only a sheet between the mattress and the person can cause skin breakdown. In these cases, a mattress pad acts as a necessary barrier.
Modern Mattresses: Newer versions may not require mattress pads as they are made of liquid-resistant material that is easily cleaned and allows air to circulate, preventing heat buildup under the patient.
Draw Sheets and Lift Sheets:
Draw sheet: A small, flat sheet placed over the middle of the bottom sheet. It covers the area from above the person’s shoulders to below their buttocks.
Lift sheet: A draw sheet that is specifically used to help lift or reposition a person who requires assistance moving in bed.
Bed Protectors:
A square of quilted absorbent fabric backed with waterproof material.
Standard dimensions are approximately .
Can be disposable or reusable/laundered.
Targeted for individuals who are incontinent or have draining wounds.
Using these allows for more efficient and economical care because sometimes only the protector needs to be changed rather than the whole bed.
Blankets:
Typically woven cotton, though wool or synthetic materials may be used depending on climate and patient preference.
Electric blankets: Must be checked for faulty wiring or plugs. They may be unsafe if the person is incontinent or cannot adjust controls independently. They can be used to warm the bed before entry but should be turned off once the person is in bed, following facility policy.
Bedspreads:
Provides a decorative finishing touch to the room.
In long-term care facilities, residents are often encouraged to use their own bedspreads from home to foster a sense of independence and individuality.
Pillows and Pillowcases:
Used for comfort and to assist in proper positioning.
May be covered with or treated with waterproof material.
Must always be covered with clean pillowcases.
Bath Blankets:
A lightweight cotton blanket or flannel sheet.
Used to provide warmth and maintain modesty during a bed bath or linen change.
A flat sheet is a suitable substitute if a specific bath blanket is unavailable.
Specialized Bedmaking Equipment
Pressure-Relieving Mattress:
Placed on top of a regular mattress to prevent skin breakdown for patients who remain in bed for long periods.
Newer versions may be filled with air or water and are constructed from easily cleaned materials.
Bed Cradle:
A metal frame placed between the bottom and top sheets.
Keeps top linens (sheets, blankets, bedspreads) away from the person's feet.
Used for burn recovery patients to prevent painful contact with skin.
Used for those at risk for pressure ulcers on their feet.
Footboard:
A padded board placed upright at the foot of the bed.
The person's feet rest flat against it to maintain proper alignment.
Guidelines for Handling Linens
Perform hand hygiene first: This prevents the transfer of microbes to clean linen.
Do not hold linens against your uniform:
Microbes can transfer from the uniform to clean linens.
Microbes can transfer from dirty linens to your uniform.
Collect only needed linens: Any extra linens taken into a patient's room are considered dirty. This prevents additional cost and unnecessary wear and tear on the linen supply.
Sequence of collection: Collect linens in the order of use. Flip the stack over so the first item needed is on top. This increases efficiency and serves as a memory aid.
Clean surfaces only: Never place clean linens on the floor or any dirty surface to avoid contamination.
Gloves and Soiled Linens:
Always wear gloves when removing used sheets.
Roll linens toward the center of the bed to confine the soiled area inside. This prevents exposure to other healthcare workers, as soiled linens are potential sources of pathogens.
Immediate Disposal: Place dirty linens in the laundry hamper immediately. Do not place them on any other surface to prevent the spread of infection.
Linen as Fomite: Linens can act as a fomite (an inanimate object that can carry infection), so infection control practices are mandatory.
Standard Bedmaking Techniques and Bed Types
Routine Timing: Usually performed in the morning while patients are bathing or dressing, prior to visiting hours.
Frequency: Varies by facility and patient needs, but beds must be remade immediately if linens become soiled or excessively wrinkled.
Mitered Corner: A specific way of folding and tucking sheets so they lie flat and neat against the mattress, helping to secure them.
Closed Bed:
An empty or unoccupied bed.
The previous patient has been discharged and the new one has not arrived.
The patient is out of the bed and not expected back soon.
Open Bed:
A closed bed where the top linens are fanfolded down.
Ready to receive a patient.
Wheels must be locked, bed in the lowest position, and the call light control clipped to the bottom sheet.
Surgical Bed:
Prepared for a patient arriving via stretcher.
Raise the bed to the highest level to match the stretcher height.
Lock the wheels and ensure the path to the bed is clear.
Occupied Bed:
Linens are changed while the person remains in the bed because they are unable to get out.
Best Practices for Bedmaking
Seams: Always place the seams of sheets away from the person's skin to prevent irritation and skin breakdown.
Micro-environment: Pull linens tight to avoid wrinkles and keep layering to a minimum to prevent pressure ulcers.
No Shaking: Do not shake linens, as this stirs up dust and transfers microbes to clean surfaces.
Communication: Always explain the procedure to the individual in an occupied bed before starting. Talk reassuringly even if the patient is unconscious to prevent stress, fear, or combativeness.
Privacy: Always provide privacy and protect the patient's modesty.
Safety Disconnection: Disconnect the call light, tubes, or drains from the linens before moving them to prevent pulling or accidental removal.
Personal Property: Always check linens for personal items like dentures, eyeglasses, jewelry, or sentimental items before removing them to prevent loss or damage.
Occupied Bed Safety: When making an occupied bed, keep the side rail up on the opposite side from where you are working to give the patient something to hold and to prevent them from rolling out of bed.
Questions & Discussion
Question 1: What benefit does the use of clean linens provide the patient or resident? Clean linens are a sign the facility is providing competent care. What do clean linens contribute to? (Select all that apply)
A. Patient and resident comfort
B. Infection control
C. Prevent skin breakdown
D. Competent care
Answer 1: A, B, C, D. Clean linens contribute to patient and resident comfort, infection control, and help prevent skin breakdown. It is also a sign that the facility is providing competent care.
Question 2: No matter what type of bed or type of linens used, it is important to always handle the linens in the proper manner to help prevent spreading of any potential infections.
A. True
B. False
Answer 2: A. True. Linens can act as a fomite. For this reason, always use infection control practices when handling linens to ensure you do not spread infection or potential pathogens.
Question 3: When making an occupied bed, it is a good idea to keep the side rail up on the opposite side from which you are working.
A. True
B. False
Answer 3: A. True. Keeping the side rail up gives the patient or resident something to hang onto and prevents you from rolling the individual out of bed.