69. CCA Study Notes: Bed Making, Linen Safety, and Crib Safety

The Big Picture

Bed making involves more than putting clean sheets on a mattress. You need to protect the client, handle linen safely, use good body mechanics, and follow the correct bed-making sequence.

Different situations require different bed setups. You also need to know special safety rules for cribs, mattresses, bedding, and linen.

Look for Nova Scotia CCA Notes throughout this page for current provincial guidance.

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Course Notes: Key Ideas You Need to Know

The Three Main Bed Types

Bed Type	When You Use It
Closed bed	Used when the bed is expected to stay unoccupied for several hours or days. The top linen is pulled up, and the bedspread is pulled over the pillow. In some facilities, the pillow is placed on top of the bedspread. A closed bed is usually made when the client is up for most or all of the day. After discharge, facilities clean and disinfect the bed frame and mattress before preparing a closed bed for a new client.
Open bed	The client will use the bed soon. Fold the top linens back so the client gets into bed easily.
Occupied bed	The client stays in bed while workers change the linens because illness or injury prevents the client from getting out.

For an occupied bed, know the client’s movement and positioning restrictions before starting. Explain each step before doing it, even when the client does not respond. Workers sometimes use a mechanical lift to move the client out of bed during bed making. Keep the linens free of wrinkles to help prevent pressure ulcers.

Key Bed-Making Terms

A fitted sheet fits a particular mattress size and usually has elastic edges.

An incontinence pad sits in the centre of the bed on top of the bottom sheet. It protects the sheets from body fluids. Other names include absorbent pad and soaker pad.

A mitred corner is a bedding fold that keeps the top bedding layers neat and in place.

Client-Centred Bed Making

Bed-making care should support:

• dignity
• independence
• individualized care
• preferences
• privacy
• safety

Make the bed according to the client’s wishes and care plan ⓘ. Tell your supervisor when a client’s wishes create an unsafe situation.

Linen Safety Rules

Follow these rules during bed making:

• Use good body mechanics.
• Follow medical asepsis and Standard Practices.
• Perform hand hygiene before handling clean linen and after handling dirty linen.
• Keep a bag or bin ready for soiled linen and follow employer policy ⓘ.
• Bring enough linen into the room, but avoid bringing more than needed.
• Do not use torn linen.
• Never shake linen in the air. Shaking spreads microbes, lint, and dust.
• Keep clean and dirty linen away from your uniform.
• Never place clean or used linen on the floor.
• Straighten linen whenever it becomes loose or wrinkled and at bedtime.
• Change wet, damp, or soiled linen right away to help prevent skin breakdown.
• Make as much of one side of the bed as possible before moving to the other side. This saves time and energy.

Special handling applies to soiled linen when a client receives cytotoxic medications, also called chemotherapy. Follow the specific safety information for that linen.

Bed Equipment Safety

Push manually operated bed handles back in and turn them down after use. A handle left sticking out creates a bumping hazard for anyone walking past.

Lock hospital bed wheels during bed care and during transfers to or from the bed.

Clients need information about the risks of high bed positions. They also need information about position limitations or restrictions.

Crib Safety

Cribs, mattresses, linen, and other crib items create strangulation and suffocation hazards when unsafe conditions exist. Report any crib safety hazard to your supervisor.

Remember these rules:

• Use a firm crib mattress. A soft mattress might cover the baby’s nose and mouth and cause suffocation.
• Make sure the mattress fits snugly inside the crib frame. A loose fit creates a space where the baby’s head might become trapped.
• Keep the space between the mattress and crib sides at 3 cm or less.
• Only two adult fingers should fit between the mattress and crib side. More than two fingers means the mattress is too small.
• Keep the mattress at least 65 cm (34 in.) lower than the top of the crib rails.
• Lower the mattress farther when the baby stands in the crib.
• Never use plastic garbage bags or dry-cleaning bags to protect the mattress.
• Bumper pads are no longer recommended because they pose a strangulation risk.
• Do not tuck blankets or top sheets under the mattress. The baby might become caught in them.
• Do not place pillows, fluffy comforters, stuffed toys, or heavy blankets in the crib while the baby is in it. These items pose a suffocation risk.
• Check linen for loose threads or stitching. Trim any you find because loose stitching poses a strangulation risk.
• Keep spaces between side bars at 6 cm or less.
• Do not use cribs manufactured before 1986. They do not meet safety regulations.

Making a Closed Bed

Before You Start

1. Perform hand hygiene.
2. Collect the needed supplies: clean linen, mattress pad if used, bottom sheet, incontinence or turning pad if used, top sheet, blanket or comforter if used, bedspread if used, pillowcase or pillowcases according to facility policy, gloves, and a laundry bag.
3. Place clean linen on a clean surface.
4. Put the laundry bag near the bed when your facility provides this option. Follow employer policy for dirty linen.
5. Remove all linen. After a client’s discharge, clean the bed and bed frame to prevent cross-contamination between clients.
6. Raise the bed to a comfortable working height when this step applies to the setting. This reduces back strain.
7. Put on gloves when handling linen soiled with blood, body fluids, secretions, or excretions.
8. Roll each dirty linen piece away from you. Put it into the appropriate laundry bag or follow employer policy. Follow special handling requirements for soiled linen when the client receives cytotoxic medications.
9. Remove and discard your gloves. Perform hand hygiene.

Build the Bottom of the Bed

10. Move the mattress to the head of the bed.
11. Place the mattress pad on the mattress when used. Keep it even with the top of the mattress.
12. Place the bottom sheet:
    • Unfold it lengthwise.
    • Centre the crease on the bed.
    • For a flat sheet, place the large hem at the top, the small hem at the bottom, and the hem stitching downward.
    • For a fitted sheet, place the top over the mattress on your side.
    • Keep the lower edge even with the bottom of the mattress. Pull a fitted sheet over the bottom corner.
13. Open the sheet and fan-fold it toward the other side.
14. Tuck the top under the mattress. Keep the sheet tight and smooth.
15. With a flat sheet, make a mitred corner at the top. With a fitted sheet, pull the remaining corners under the mattress.
16. Pull the bottom sheet tight so no wrinkles remain.
17. Place the incontinence pad or turning pad in the centre when used. The incontinence pad helps keep the bottom sheet clean. A turning pad helps with turning the client.

Add the Top Linens

18. Place the top sheet:
    • Unfold it lengthwise.
    • Centre the crease.
    • Keep the wide hem even with the mattress top.
    • Face the hem stitching outward.
    • Fan-fold the sheet toward the other side.
19. Place the blanket when used:
    • Centre its crease.
    • Position its upper hem about 15 to 20 cm (6 to 8 in.) from the mattress top.
    • Face the hem stitching downward.
    • Fan-fold it toward the other side.
20. Place the bedspread when used:
    • Centre its crease.
    • Keep its upper hem even with the mattress top.
    • Fan-fold it toward the other side.
    • Make sure the side facing the door looks even and covers the top linen.
21. Tuck the top linens together at the foot. Keep them smooth and tight. Make a mitred corner.
22. Move to the other side of the bed.
23. Straighten the top linens from the head toward the foot.
24. Tuck them together at the foot and make another mitred corner.
25. Turn the bedspread’s top hem under the blanket’s top hem to make a cuff.
26. Turn the top sheet down over the bedspread. Face its hem stitching downward. When the bedspread covers the pillow, tuck the spread under the bottom of the pillow.

Finish the Pillow and Bed

27. Place the pillow on the bed.
28. Open the pillowcase flat on the bed.
29. Put the pillow into the pillowcase. Fold the pillowcase edges under together and tuck them beside the pillow so the pillow stays inside.
30. Place the pillow on the bed. Face the open tucked end away from the door and the pillowcase seam toward the head of the bed.
31. Attach the call bell to the bed when this step applies.
32. Lower the bed to its lowest position and lock the wheels when these steps apply.
33. Follow employer policy for clean leftover linen in the client’s room.
34. Remove the laundry bag when the facility keeps one in the room. Follow employer policy for dirty linen.
35. Perform hand hygiene.

Some steps involving the bed, wheels, or call bell do not apply in every community setting.

Making an Open Bed

Follow this order:

1. Perform hand hygiene.
2. Collect the linens needed for a closed bed according to employer policy.
3. Make a closed bed.
4. Fan-fold the top linens toward the foot.
5. Attach the call bell to the bed when this step applies.
6. Lower the bed to its lowest position when this step applies. This reduces the risk of client injury or falls.
7. Follow employer policy for clean linen storage in the client’s room.
8. Follow employer policy for dirty linen.
9. Perform hand hygiene.

Steps involving the call bell and bed height do not apply in every community setting.

Making an Occupied Bed

An occupied bed requires careful attention to safety, privacy, communication, positioning, and the care plan.

Pre-Procedure

1. Identify the client according to employer policy.
2. Gather the number of staff required by the client’s care plan. Explain the procedure to the client.
3. Perform hand hygiene.
4. Collect the laundry bag, when available, and clean linen.
5. Place the clean linen on a clean surface.
6. Provide privacy.
7. Remove the call bell when this step applies.
8. Place the laundry bag near the bed when available, or follow employer policy.
9. Raise the bed to a comfortable working height when appropriate. Follow the care plan for bed rail use.
10. Lower the head of the bed until it lies as flat as possible. Lower the rail nearest you if it is up.

Remove the Old Bottom Linen and Protect the Client

11. Put on gloves when handling linen soiled with blood, body fluids, secretions, or excretions.
12. Loosen the top linen at the foot.
13. Remove the bedspread and blanket separately. If you will reuse them, fold them separately in this order: bring the top edge down to the bottom edge, fold the far side toward the near side, bring the top edge down to the bottom edge again, then place the folded linen over the back of a straight chair.
14. Leave the top sheet over the client for warmth and privacy.
15. Slide the mattress toward the head of the bed.
16. Move the client to the side opposite where you will start. Adjust the pillow. Keep the bed rail up on the client’s side when available. A client who holds the rail might feel more secure, and the raised rail reduces fall risk.
17. Loosen the old bottom linen from the head to the foot.
18. Fan-fold each old bottom linen piece toward the client. Start with the old incontinence pad when used. Remove a heavily soiled pad or roll it tightly to contain the soiling.
19. Cleanse the client’s buttock and genital area when necessary.
20. Put a clean incontinence pad over the old pad. Fan-fold it toward the client and tuck it next to the client. This prevents more contact between wet or soiled material and the client’s skin.

Place the Clean Bottom Linen and Turn the Client

21. Place the mattress pad lengthwise when the facility uses one. Keep its centre crease in the middle.
22. Place the clean bottom sheet. For a flat sheet, face the hem stitching away from the client, centre the crease, and keep the small hem even with the mattress bottom. For a fitted sheet, position it the same way and fit one corner at a time.
23. Make a mitred corner at the head when using a flat sheet. Tuck it under the mattress from head to foot.
24. Pull the clean incontinence pad over the bottom sheet toward you. Fan-fold both toward the client.
25. Raise the bed rail if used. Move to the other side and lower that rail.
26. Tell the client that they will roll over a bump. Reassure the client that there is no fall risk.
27. Help the client turn to the other side. Adjust the pillow.
28. Remove the soiled incontinence pad and loosen the remaining bottom linen. Remove one piece at a time and place each in the proper laundry bag or follow employer policy. Follow special handling requirements for soiled linen when the client receives cytotoxic medications.
29. Remove and discard gloves when worn. Wash your hands.
30. Straighten and smooth the mattress pad when used.
31. Pull the fan-folded clean bottom sheet and incontinence pad toward you. Keep the surface smooth and free from lumps. Make a mitred corner at the top when using a flat sheet and tuck the sheet from head to foot. Pull a fitted sheet over each corner.
32. Pull the incontinence pad tightly toward you.
33. Place the client in the supine position in the centre of the bed. Adjust the pillow.

Replace the Top Linen

34. Place a clean top sheet over the bed. Centre the lengthwise crease, keep the large hem even with the mattress top, and face the hem stitching outward.
35. Ask the client to hold the clean top sheet while you remove the old top sheet underneath. When the client does not help, tuck the clean sheet under the client’s shoulders before removing the old one.
36. Place the blanket over the client when used. Centre the crease and keep the upper hem 15 to 20 cm (6 to 8 in.) from the mattress top.
37. Place the bedspread over the client when used. Centre the crease and keep the top hem even with the mattress top.
38. Turn the bedspread’s top hem under the blanket to make a cuff.
39. Bring the top sheet down over the bedspread to form a cuff.
40. Move to the foot of the bed.
41. Make a 5-cm (2-in.) toe pleat across the foot of the bed. Position it about 15 to 20 cm (6 to 8 in.) from the foot. The toe pleat allows circulation in the client’s feet.
42. Lift the mattress corner with one arm. Tuck all top linens underneath together and make a mitred corner.
43. Raise the bed rail when used. Move to the other side and lower that rail.
44. Straighten and smooth the top linens.
45. Tuck the top linens under the mattress and make a mitred corner.
46. Change the pillowcase or pillowcases.
47. Raise the head of the bed to the level appropriate for the client, or use pillows to position the client.

Finish the Procedure

48. Provide for the client’s safety and comfort.
49. Place the call bell within reach when this step applies.
50. Lower the bed to its lowest position and follow the care plan for bed rail use when these steps apply.
51. Follow employer policy for soiled linen.
52. Remove privacy measures as needed.
53. Perform hand hygiene.

Some steps involving the bed, rails, or call bell do not apply in every community setting.