Giving a patient on bedrest a bed bath ( abbreviated as BB) is not always an easy task. There are many steps involved. These pages explain how I personally give one, unless the patient agrees to have a chlorhexidine bed bath which is similar but easier and more effective.
I normally change their bed linens while I bathe them. It kills two birds with one stone plus they won't get dirty right afterwards from dirty linens.
You will need quite a few supplies in order to give a proper bed bath. Other than the bed linens, you will need:
You may need another caregiver to help turn your patient depending on their condition.
Of course you should perform your handwashing duties and apply medical gloves if available. I often wear an isolation gown over my caregiver scrubs as well because giving a bed bath can get a little messy at times.
Make sure your patient has privacy. Close the door and the curtain if there is one before you begin.
Do not be afraid to talk to your patient while you bathe them. You can talk about anything and everything. It just makes them feel more comfortable and involved. They will appreciate you for it even if they just give short answers or have dementia and don't talk back at all. You have to remember that they may be tired, depressed, in pain, or all three. Show them that you are happy to help them feel better by bathing them.
Put some of the soap in the basin. Don't be stingy with the soap, use plenty of it because it is going to be mixed with water.
Fill it up about halfway with warm water. 110 degrees is supposed to be the perfect temperature. If you can check it with a thermometer, that's great. If not, just make your best judgement.
A neat little trick I learned is to have the lotion soaking in the basin as you give the bed bath so when it comes time to use it, it is nice and warm from the water.
If the bed is adjustable, lay it as flat as possible and raise it up so you don't break your back.
Place the dirty linen bin, basin, washcloths, and towels close to you and the patient. I personally place these things, except the bin, directly on the bed if there is enough room. Just make sure it isn't going to get knocked over or you will have a very big mess on your hands.
Start by removing the top sheet and/or blanket, the hospital gown or other clothing, their socks, and their sequential compression device stockings, ted hose, and/or heel protectors if they are wearing them. Keep a towel over the parts you aren't washing so they don't get cold.
With everything in place, now it is time to actually start giving the bed bath. Let them bathe themselves as much as they can while you get the rest. Some patients will be able to reach most of themselves while others won't be able to assist at all. Talk them through each and every step so they know what you are going to do next and be sure they are as comfortable as possible throughout the entire process.
Put a few washcloths in the basin and wring one out really good so it's just a little damp. Very gently touch the patient with the cloth and ask them if it is too hot or cold. If either, adjust accordingly.
When it is at the perfect temperature, tell the patient you are going to wash their face and gently wash it starting with their eyes. Start towards the middle at the top of their nose and wipe all the way across the eyes. Make sure you cover every inch of their face including behind their ears. I usually use the same cloth to wash their neck as well. After that, toss the cloth in the dirty linen bin next to the bed.
Then dry their face and neck with a towel. Always dry the parts you wash immediately so the patient doesn't get cold.
Next, wring out another cloth. Other than the face, I usually barely wring out the cloths so it feels more like a bed bath and not just a pat down. Too much water is better than not enough especially if you are changing the bed anyway. If you aren't changing the bed, just put a towel underneath each body part before you start washing it.
Use the cloth to wash their chest and stomach. If there are folds or creases under the breasts, make sure you lift and wash those areas as well. Always dry afterwards.
Get another washcloth and wash the patient's armpit. Then work your way up their arm getting every inch of it up to their hands. Make sure you get in between their fingers and fingernails as well. Use one cloth for each arm if you have enough. Dry immediately.
Next are the legs. I always use one cloth for each leg. Like their arms, wash every inch of their legs all the way down to their feet. If it doesn't hurt the patient, slightly lift their legs and wash on the underside towards their buttocks as well. If you can't reach the whole leg, you can finish it once your patient is turned onto their side.
When you get to their feet, make sure you clean very well including the toes. Dirt and sweat build up around these areas very easily especially if your patient had socks on. Don't forget to dry.
Next you should perform perineal care on your patient. Of course this step is different depending on their gender. Sometimes I'll use a couple or more washcloths on this area alone.
Congrats, you are about halfway through the bathing process. Hang in there, you'll be done before you know it.
You should now turn your patient on their side. An incontinence pad makes this part much easier but it can still be done without one. If they are able and the bed has rails, you can have them help by telling them to grab the rail on your side with their hand on the opposite side and pull as you pull them towards you with one hand on their hip and the other on their back. The further you can pull them on their side, the better.
Wash their back starting with their shoulders and work your way down. The funny thing I've noticed is nine times out of ten, the patient brags about how good this part feels. Make sure you take your time and wash back and forth multiple times. This part is by far their favorite part of the entire bed bath.
I usually grab another cloth to finish giving perineal care and wash the parts of their legs I couldn't reach. Make sure you get all the cracks and crevasses not only around the anus, but the legs as well. For heavier patients, you may have to lift up one side of their bottom to reach everything.
Multiple cloths may be necessary if you see traces of stool. Even when the patient hasn't had a bowel movement, gas can cause a slight amount of stool to form around the anus.
If the patient doesn't mind, I usually put lotion on their back and bottom. This helps moisten those areas because they can become dry and stiff from excessive exposure to the bed linens. Don't be stingy, cover every inch of the patient's back and bottom as well as other parts of the body if they desire. They will love you for it.
Now is the perfect opportunity to apply barrier cream, put on an adult diaper, change the incontinence pad, or change all of their bed linens if needed.
After everything is in place, have them roll back onto their back and to the other side if needed so you can wash part of their back and bottom you couldn't reach or finish changing their bed linens.
Even though the bathing part of the bed bath is through, theres still a few more things to do before you are done.
Next you should put your patient's clothes or a fresh hospital gown on them. These can be a little tricky. Even after working with them for years, I still get stumped every now and then trying to put one on especially if it's one with buttons on the sleeves.
If the patient desires, you can put socks on them as well as their sequential compression device, stockings, ted hose, and/or heel protectors if they need them. If they are in a hospital or similar facility, you should make sure they have their call light. Then you can cover them up with a sheet and blanket if they want. If the bed is adjustable, then you should adjust it to their liking and make sure the bed alarm is set. Then pull the curtain back, clean up after yourself, and turn the lights off if they want you to.
Giving a bed bath is a very complicated task. It may take you quite a while the first dozen or so times but once you get used to these steps, you can usually give one in less than thirty minutes.
Although some caregivers may bathe their patients differently, I know my way is effective because many patients have bragged about how much better they feel afterwards. Some patients have even told me I gave them the best bed bath they've ever had. If you follow these steps, they may tell you the same thing.