12.3.3: Procedure- Bed Bath

Assisting a patient with regular bathing is important for patient health and for promoting self-esteem and healing. Patients who are recovering from an injury or illness, have a chronic condition, are permanently disabled, dying, or who are frail may require assistance with performing this essential task. This is an important part of the job of a Home Health Aide/Personal Care Aide.

Providing for personal care gives Home Health Aides/Personal Care Aides an opportunity to assess a patient’s skin and to communicate with patients about their thoughts and feelings. Home Health Aides/Personal Care Aides should always encourage the patient to perform any personal hygiene task they are able and provide assistance as needed. Some patients will require complete (or total) care. Providing a bed bath allows a patient to receive personal hygiene care with minimal movement on their part.Explain the procedure to the patient.

1. Wash and dry your hands. Put on gloves.
2. Gather equipment needed (e.g. soap, washcloths, 2 bath towels, 2 hand towels, bath blanket or clean sheet, shampoo/conditioner, basin for water, bath thermometer, lotion, patient clothing).
3. Raise the bed to a safe working height. Lock the bed brakes. Lower the railing only on the side you are working. Take care to remember to raise the railing before moving to the opposite side of the bed.
4. Provide for privacy. If in an area where others may come in, close doors and/or curtain off area as appropriate.
5. Protect bedding with towels and/or disposable pads. Place a towel under each area where you are working.
6. Remove glasses and jewelry from the patient.
7. Offer a bedpan or urinal to the patient before bathing.
8. Place a clean blanket, bath towel, or sheet over the patient to provide for privacy as you fold down bedding and remove the patient’s clothing underneath the clean blanket. Only remove blankets and clothing on areas where you are working that need to be exposed. This provides for some privacy and warmth.
9. Fill a basin with water. Test the temperature of the water. Take care to not exceed 105 degrees Fahrenheit. Have the patient test the water to see if it is comfortable for them. You may need to change the water during the bed bath to ensure it stays warm as well as when it is dirty. Always re-check the water temperature each time you change it or add water to it.
10. Always encourage the patient to assist as much as possible. This promotes independence and self-esteem.
11. To form a mitt with the washcloth: To form a mitt with a washcloth open the washcloth on a flat surface. Place your palm facing up with four fingers on the washcloth, leaving your thumb out on the lower end of the washcloth. Fold washcloth into thirds lengthwise, around your palm. Your four fingers will be enclosed in the washcloth, with your thumb out. Straighten wrinkles. Fold the washcloth down.Tuck in the ends of the washcloth.
12. Wash and dry the patient from head to toe. Work on one part of the body at a time. Always move from cleanest area to least clean. Complete the front of the patient first before rolling them to their side to wash their backside.
13. Eyes, face, ears, neck: Wash the patient’s face with a wet washcloth without soap (unless patient requests). If the patient requests soap, take care that it does not get into the patient’s eyes. Start with the eyes and wash from the inner area of the eye (the corner closest to the nose) to the outer area (near the temple) with a corner of the washcloth. Using a different corner, clean the other eye. Ask if the patient would like soap to wash their face. Wash their face from the middle outward using gentle strokes. Wash behind the patient’s ears and their neck, from the chin downward. Rinse with a clean washcloth. Pat dry.
14. Arms and Axillae: Start with the arm furthest from you. Remove one arm from the blanket or towel. Support the patient’s wrist while washing the lower arm and hands. Support the person’s arm by holding their elbow when washing upper arms. They can rest their lower arm on your forearm. Using gentle but firm strokes wash from the lower arm to the elbow area. Then wash from the elbow area to the upper arm and shoulder. Wash the axilla. Washing from the lower arm upwards helps to promote circulation of blood back to the patient’s heart. Rinse well and pat dry. Repeat for the other arm.
15. Hands: Soak hands in a basin, cleaning one hand at a time. Clean nails with a nail brush or as directed in the Care Plan. Dry thoroughly. Ensure between the patient’s fingers are well dried. Provide nail care as assigned.
16. Chest and Abdomen: Place a bath towel over the patient’s chest and lower the bed blankets down to the waist, taking care to keep the pubic area covered. This provides for warmth and privacy. Lift the bath towel slightly to wash the patient’s chest, keeping the patient partially covered. Wash the chest using long, firm strokes from the center out. For female patients, cleanse under each breast and dry well. Wash the abdomen using long, firm strokes from the center out. Take care to wash and dry well under abdominal folds. These moist areas can harbor bacteria and fungi. Apply powder to these areas as directed by the supervisor the Care Plan. Pull the blanket back up to the patient’s chin and remove the towel. Change the water.
17. Legs: Expose only one leg at a time. Place a towel under the leg lengthwise so the linens under the leg remain dry. Wash from ankle to knee with long, firm strokes upward. Then wash from the knee to the upper thigh. Rinse and pat dry. Remove towel and place underneath patient’s foot.
18. Feet: Place one foot at a time into the basin. Ensure the water in the basin is warm. Wash the foot and between toes with a washcloth. Rinse well and dry thoroughly paying special attention that the area between the toes is well dried. Moistness between the toes promotes bacterial and fungal growth. Provide nail care as assigned in the Care Plan. Change the water.
19. Perineal area: Place a towel underneath the patient’s buttocks and upper thighs. Ask the patient if they are able to wash their own perineal area. If so, provide them with clean, warm, soapy water and a washcloth. Leave the room if the patient requests. If cleaning the patient’s perineum area, use a clean washcloth and warm, soapy water. Only expose the perineal area, leaving the rest of the patient’s body covered. Replace soiled washcloths with clean ones as needed.
    1. For female patients: Wash the perineum area from front to back with single strokes. Use a clean area of the washcloth for each stroke. Wipe one side, then the other of the labia majora. Spread the labia apart and, using a clean part of the washcloth, wipe from front to back on each side, using a clean part of the washcloth for each stroke. Wipe from top to bottom down the middle to the opening of the vagina. Clean the area between the vagina and anus last, washing from front to back. Never move from back to front. This puts the patient at risk for a urinary tract infection due to exposure to bacteria from the anal area into the cleaner vaginal area. Rinse thoroughly. Dry well with a blotting motion.
    2. For male patients: In uncircumcised males, gently pull back the foreskin toward the base of the penis. Hold the penis by the shaft and using a circular motion, wash from tip to base. Use a clean area of the washcloth for each stroke. Rinse the penis and pat dry. Be sure to replace the foreskin in uncircumcised males by gently pushing it back into its normal position. If you forget to replace the foreskin, you risk causing injury to the patient as the skin will cut off circulation to the penis, causing pain and swelling. Wash the scrotum, taking care to be gentle. Lift the scrotum up with one hand while gently washing the area underneath as well as the entire surface of the scrotum. Rinse and dry very well, using patting motions. Do not use the same water that has been used to clean the anal and genital areas on other parts of the body.
20. Back: Assist or position patient onto their side or stomach so that their back is facing you and they are in the center of the bed. Ensure side rails are up on the side they are facing toward. Place a towel so that it is slightly tucked under the patient’s back to prevent bed linens from getting wet. Fold the blanket back only enough to expose the back. Wash the back of the patient’s neck and back with long, firm strokes. Rinse and pat dry.
21. Buttocks: While the patient is on their side, wash their buttocks. Buttocks should be washed last, after you have washed the patient’s back. Never move from buttocks to back. Always work from clean to dirty areas. Replace soiled washcloths with clean ones as needed. Discard washcloths used to clean buttocks before moving on to new areas. Change the water.
22. Remember to change the water in the basin, as needed, when it becomes too cool or dirty.
23. Ensure that all body parts are thoroughly dried.
24. Apply lotion as needed, as requested, and as ordered.
25. Applying Incontinence Products: Some patients who are incontinent may wear disposable briefs to help keep them dry. If the patient is able, they may bend their knees and lift their hips. Place the brief under the patient’s buttocks. If unable, roll the patient to their side. Fanfold one side of the brief and tuck it under the patient. Check for correct placement of the brief. It should cover their buttocks and groin area. The top part of the brief will be about 1-3 inches above their buttocks. Roll the patient to the other side. Let them know they will feel a “bump” from the brief as they roll over it.Ensure the bed rails are up. Move to the other side of the bed. Pull the other half of the brief from under the patient. Assist the patient back to the supine position (patient is lying on their back with their face up). Pull the brief up between their legs. Peel tape from tabs and fold each side inward toward the front. Secure tape to the front of the brief.
26. Give a back rub if time permits and the patient requests.
27. Assist the patient with dressing.
28. Lower the bed to its lowest height. Ensure side rails are up for patient safety.
29. Clean area and put away equipment and supplies.
30. Remove your gloves. Wash and dry your hands.
31. Document completion of task and record any changes in condition or behavior. Document and report any skin issues, such as red or white areas, skin breakdown, open areas, rashes, or new bruises.