BED BATH PROCEDURE

• Bathing can be one of the most enjoyable and refreshing activities of the day for many elderly individuals. For individuals who are confined to bed, a bed bath can provide the same refreshing experience. The bath can also improve blood flow around the individual's body, help ease any discomfort the individual may be experiencing, help the individual relax, and give you, the caregiver, an opportunity to observe the person's needs.

• Bed bathing is an exceptionally good time to inspect the person's skin for pressure areas. These areas can develop in individuals who remain in one position for long periods of time. Circulation may be cut off to certain areas of the body resulting in skin breakdown. This lack of circulation can be a serious problem if not cared for immediately.

• If, while giving a bed bath, you should notice any early warning signs, such as reddened areas on the person's skin, try to place the individual in a position which relieves pressure on that area until the redness goes away. From then on, try to make sure that the person changes position approximately every half hour to minimize the chance of additional pressure areas.

• Elderly individuals should be encouraged whenever possible to assist in the bed bath. You should listen, consider, and follow the older adult's wants and needs, such as the use of body powder, perfumes, and skin lotions. Non-perfumed lotions and powders may be necessary if the person has sensitive skin.

• Privacy should be an important part of the bed bath. The use of a light cover at all times and the closing of doors and curtains to the bedroom helps maintain the individual's sense of privacy.

• A bed bath can be an opportune time to change bed linen. Remember to support the individual during turning. Always keep alert to ensure the person's safety.

• You, as a caregiver, can make the bed bath relaxing and refreshing by following some of the basic procedures listed in this section and by maintaining light conversation with the individual. By being aware of the individual's abilities and limitations and by applying patience and understanding, the bed bath can be enjoyable for both of you.

• In preparation for giving the bed bath, discuss what you will do with the person. Encourage the person to select a change of clothing. Wash your hands before beginning. Be sure your hands are body temperature so as not to shock the person being bathed.

• The basic steps to use when giving a bed bath are outlined as follows:

• Prepare area for bath.

a. Make the room comfortable. Especially notice and adjust the room temperature, if necessary.

b. Close the windows to prevent drafts.

c. Close doors and curtains for privacy.

• Gather supplies and equipment as listed below.

a. Two chairs with hard seats,

b. Wash bowl or large pan,

c. Soap and container (A dish is fine.),

d. Bath towel(s) and wash cloth,

e. Change of clothing,

f. Newspaper (To protect the chair from water), and

g. Body powder, deodorant, and perfume.

• Place chairs close to the bed.

• Cover one chair with newspaper.

• Place the wash bowl, soap, and dish on the newspaper covered chair.

• Use the second chair for the extra bedcovers.

• Remove any extra bedcovers, but leave on a light cover for warmth and privacy.

• Place extra bedcovers on the chair until you are finished with the bath.

• Remove the person's clothing. Invite the person to help.

a. Begin at the top leaving bottom clothing on until the top part of the person has been cleaned, dried, and covered.

b. Remove paralyzed or weakened limbs from clothing last when undressing a person.

c. Remove bottoms by slipping pants down over the legs and off the feet. Ask the person to help by lifting his or her bottom. If the person can't lift, remove clothing one side at a time by turning the individual.

• Cover all the body except the small area being washed.

• Fill the bowl with warm water.

a. Half fill the bowl, and test the water with your elbow.

b. Adjust water temperature as needed.

• To avoid excessively sudsy water, keep the soap in the dish and use with washcloth only as needed.

• Wash the person's face.

a. Place a towel below the person's neck and over the bedcovers.

b. Dampen the washcloth, squeeze out excess water, and give it to the person to wash the face, if possible.

c. If the person cannot manage to wash the face, dampen the wash cloth and squeeze out excessive water. Catch up the washcloth's edges in your hand to avoid dripping water.

d. With the person's eyes closed, wash the eye area wiping from the inner corner toward the ear. Use your forefinger for one eye and your little finger for second eye. You may need to wash each eye several times to remove "matter."

e. Only use soap on the cloth if the person requests it for face washing.

f. Wash in order the forehead, nose, cheeks, and chin.

g. Rinse the wash cloth and the person's face in the same order.

h. Place the wash cloth in the bowl. Pat the person's face dry with a towel. (When drying, do not rub as rubbing could irritate the skin.)

• Wash person's neck and ears.

a. Wet the wash cloth, and hold edges to avoid dripping.

b. Apply soap to wash cloth. Squeeze out excess water.

c. Wash the person's neck and ears, including behind the ears. (Do not use a Q-Tip or any other device to cleanse the ears. If needed, notify a doctor to order an ear lavage by a licensed person.)

d. Rinse wash cloth, and rinse person's neck and ears.

e. Dry person's neck and ears with the towel.

• Wash person's arms.

a. Place a towel under the arm farthest from you.

b. Wet and soap the wash cloth. Squeeze out excess water.

c. Lift the arm to be washed, and support it at the elbow.

d. Wash the arm with long, firm strokes.

e. Wash the underarm while still supporting the elbow.

f. Rinse the wash cloth, and rinse the arm and underarm area following the same procedure.

g. Dry the arm and underarm well.

h. Wash, rinse, and dry the other arm in the same manner.

• Check to see if the person can wash hands with assistance.

a. Place the towel at the person's side, about waist level.

b. Place the bowl of water on the towel.

c. Hold the bowl by one hand to balance it and to prevent spilling water.

d. Place the soap in the person's hand.

e. Place the person's hands into the bowl.

f. Help the person to soap and clean hands.

g. Place soap back into dish, and allow the person to rinse and soak the hands.

h. Remove the person's hands from the bowl. Place hands on towel.

i. Return the bowl to the chair.

j. Dry the person's hands well, especially between the fingers.

k. Trim fingernails, if necessary.

(If the water is exceptionally soapy after this procedure, empty and refill being sure to retest temperature.)

• Wash the person's chest and abdomen.

a. Cover arms with towels.

b. Fold a towel over the blanket at lowest portion of abdomen.

c. Wet and soap the wash cloth. Wring out excess water.

d. Wash the person's chest and abdomen using circular motions.

e. Wash the folds of skin under the person's chest or breasts.

f. Rinse the wash cloth. Rinse and pat dry the person's chest and abdomen. g. Cover the washed areas with a towel.

• Wash the lower front part of the body.

a. Wet and soap wash cloth. Squeeze out excess water.

b. Wash the lower abdomen, using circular motions.

c. Be sure to clean the naval area and any skin folds.

d. Rinse using firm, circular motions.

e. Dry well.

• Wash the person's legs.

a. Uncover the leg farthest from you. Tuck a draping blanket under the closest leg and cover all the person's body except the leg farthest from you.

b. Raise the leg while supporting it behind the knee.

c. Place a towel under the leg.

d. Wet and soap the wash cloth. Squeeze out excess water.

e. Wash the leg with long firm strokes moving from hip to knee.

f. Rinse and dry the upper leg in the same manner. Cover with a towel.

g. Repeat from knee to ankle.

h. Repeat this procedure with the unwashed leg.

i. Drape blanket to cover the person except for the feet.

• Wash the person's feet.

(If someone is able to sit in a chair, do this while the person sits up. Place a tub of water on newspaper. If the tub is large enough, place both feet in the tub to soak. Trim nails after soaking feet.)

a. Help the person to bend a knee to place one foot on the bed.

b. Place a towel on the bed close to the foot.

c. Put the bowl of water on the towel.

d. Balance the bowl of water with one hand to avoid spilling water.

e. Guide the person's foot slowly into the bowl of water.

f. Wash the foot, especially between the toes, with a soapy wash cloth.

g. Rinse and help the person remove the foot from the bowl.

h. Dry foot completely.

i. Follow the same procedure for the unwashed foot.

j. Have the person keep knees bent. Remove wash bowl to the chair. (Check to see if the person can keep knees bent without support.)

k. Straighten the person's legs while providing support behind the knees.

l. Trim nails if needed.

(Nail trimming should not be done for someone with diabetes or who has a circulation problem. Professionals only should provide this service.)

m. Change water.

• Assist person in washing between the legs (perineal area).

a. Cover chest and abdomen with towel.

b. Fold draping blanket to upper thigh level.

c. Place a towel on the bed beneath the person's bottom. Roll the person towards you. Place half the towel on the bed with the second half rolled next to person's bottom. Roll the person away from you, and unroll the towel. Roll the person back.

d. Fold the wash cloth, wet it, and squeeze out any excess moisture.

e. Sparingly soap the cloth.

f. Hand the cloth to the person.

g. Turn your back briefly to give the person privacy.

h. Rinse the cloth when the person finishes washing the perineal area. Allow the person to rinse the just washed areas.

• Wash between the legs if the person is unable to perform the task. (If the person is unable to hold legs apart with knees bent, gently spread the person's legs on the bed.)

a. Repeat Steps a, b, and c, from above.

b. Wet and lightly soap wash cloth.

c. Wash the area with strokes from the front of the person's body to the back.

d. Rinse and resoap cloth after every stroke.

e. Rinse thoroughly, especially the skin folds.

f. Dry completely.

g. Cover for warmth and privacy. Change water.

(If knees are bent, help the person straighten them. Check about the use of powder. Use powder sparingly.)

• Wash the person's back. (The side with the most strength and movement should be washed last for comfort.)

a. Help the person turn over onto the side.

b. Keep person covered for warmth.

c. Fold back the cover to expose the person's back.

d. Fold a towel lengthwise and lay it behind the person on the bed. (The towel can be used as a support to help hold the person.)

e. Wet the wash cloth, and put soap on it.

f. Wash the person's back and the back of the neck using long, firm strokes.

g. Rinse and dry. Apply lotion gently. Remove towel.

h. Turn the person onto the just washed side. Put the towel in place.

i. Wash the side that was not washed earlier.

j. Dry completely. Apply lotion while the person is still on his or her side.

(At this time, check with the person and see if powder or deodorant is desired.)

• Wash the back part of the person's body between the legs.

a. Place the towel beneath or next to the person's bottom.

b. Bend the person's upper leg at the knee.

c. Place a pillow between the person's knees for support.

d. Wet and soap the cloth.

e. Wash hip and then buttocks using a single stroke from the front to the back.

f. Rinse and resoap cloth after each stroke.

g. Rinse thoroughly.

h. Dry completely. Apply lotion.

(Begin bed linen change while the person is lying on his or her side.)

• Put pajama top on the person, or cover with a blanket to ensure warmth and privacy if the person doesn't wear pajamas.

a. Place pajama top on the person starting with any physically involved limb.

b. Keep pajama top loose on top of the person's head while inserting other arm.

c. Pull pajama top down in back by grasping at sides and slowly moving it under the person.

(Check the person's comfort at this time. Be sure wrinkles in pajama top are minimal.)

• Dress the person if the person desires clothing other than pajamas.

a. Check with the person on desired clothing.

b. See the "Dressing" section for guidelines, especially when the person has a
physically involved limb.