The Big Picture
Bed linen needs regular changing, but the timing is not the same in every care setting. The care plan and workplace policy guide what you do.
Clean and used linen also need careful handling. Where you place linen, how you carry it, and what you do with extra or soiled items all affect safe care.
Turning pads and incontinence pads have different purposes. Some pads may serve more than one purpose when workplace policy allows it, while others must never be used for moving a client.
Look for Nova Scotia CCA Notes throughout this page for current provincial guidance.
Quick tip: Tap, click, or press Enter on any term with a dotted underline and an ⓘ icon to see its plain-English definition.
Start Here If You’re Overwhelmed
Focus on these core ideas:
- Change linen whenever it becomes wet, damp, or soiled.
- Follow the client’s care plan and your employer’s policy for routine linen changes.
- Keep clean linen away from your uniform, off the floor, and on a clean surface.
- Never shake linen in the air.
- A turning pad helps move or turn a client while reducing friction and shearing.
- A disposable incontinence pad must never be used as a turning pad.
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Course Notes: Key Ideas You Need to Know
When Linen Should Be Changed
How often linen is changed depends on the work setting.
Always follow:
- the client’s care plan
- your employer’s policy
In all settings, change linen when it is:
- wet
- damp
- soiled
In many long-term care facilities, routine linen changes happen on days when the client has a shower or bath.
Linen Changes in Different Care Settings
| Setting | Usual Timing | Important Points |
|---|---|---|
| Home care | Usually weekly, and whenever wet, damp, or soiled | Follow the client’s preferences and keep the care plan updated. |
| Long-term care | Usually weekly. Pillowcases, top sheets, and bottom sheets may be changed twice a week. Also change linen when wet, damp, or soiled. | Respect the client’s belongings and choices. |
| Hospital | Timing depends on hospital policy. Change linen at discharge and whenever wet, damp, or soiled. | Some bedding may stay with the same client if it remains suitable for reuse. |
Home Care Linen Choices
In home care, respect the client’s preferences about their bedding.
For example, one client may want extra blankets while another may want no blankets.
Follow and update the client’s care plan so it reflects these preferences.
Long-Term Care Linen Choices
Some clients bring personal bedding from home, such as:
- bedspreads
- pillows
- blankets
- quilts
These items belong to the client. Handle them carefully and make sure they have the client’s name on them.
When coloured linens are available, let the client choose the colour.
The client should also have choices about:
- how many pillows to use
- how many blankets to use
- when the bed is made, when possible
Hospital Linen
Hospital linen schedules depend on hospital policy.
Linen is changed:
- when required by hospital policy
- when the client is discharged
- when it becomes wet, damp, or soiled
A mattress pad, blanket, or bedspread is reused for the same client unless it becomes wet or very wrinkled.
Handling Clean Linen Safely
Follow Standard Practices when handling linen and making beds.
Perform hand hygiene before collecting clean linen.
Your uniform is considered dirty. Hold clean linen away from your body and uniform.
Avoid: Never shake linen in the air. Shaking can spread microbes.
Place clean linen only on a clean surface.
Never place clean linen on the floor. If clean linen accidentally touches the floor, put it in the laundry.
In rooms with more than one client, place one client’s linen only on that client’s furniture. Do not put it on another client’s furniture.
Plan Before You Enter the Room
Planning reduces unnecessary steps and helps prevent germs from moving from one client’s room to another.
Take only the linen you expect to need into the room.
If you bring extra linen into the room, do not return it to:
- the linen room
- the linen cart
Leave the extra linen in the client’s room so it can be used during the next linen change.
Collect Linen in Reverse Order
Collect clean linen in the reverse order that you will use it.
The collection order is:
- Pillowcase or pillowcases
- Bedspread, if used
- Blanket or comforter, if used
- Top sheet, flat or fitted
- Incontinence pad, if used
- Bottom sheet, flat or fitted
- Mattress pad, if used
Use one arm to hold the stack while your other hand picks up each item.
The item you need first should end up at the top of the stack when you are ready to make the bed.
For example, if you collect the mattress pad first, it starts at the bottom. After the stack is complete, turn the stack over so the mattress pad becomes the first item available.
A fitted sheet is shaped to fit a particular mattress size and usually has elastic edges.
Handling Used Linen
Used linen is considered dirty because it may contain microbes.
Wear gloves when linen is soiled with:
- blood
- body fluids
- secretions
- excretions
Some facilities require gloves for all bed-making activities to reduce cross-contamination . Follow workplace policy.
Check Used Linen Before Removing It
Look for personal belongings or other items that may have been left in the bed.
Check for:
- dentures
- hearing aids
- eyeglasses
- watches
- jewellery
Also watch for stray needles, especially when clients give themselves medications.
How to Remove Used Linen
Remove each piece of linen separately.
Roll the linen away from your body.
The side that touched the client should finish inside the roll. The side that did not touch the client stays on the outside.
Immediately place used linen into:
- a laundry container
- a special linen bag
Remove the bag from the client’s room.
Never place soiled linen on the floor because this contributes to the spread of pathogens.
Follow your employer’s policy for soiled linen.
Clients receiving cytotoxic medications, such as chemotherapy, require special handling of soiled linen.
What Is a Turning Pad?
A turning pad, also called a turning sheet, is a small pad placed across the middle of the bottom sheet.
It helps workers turn and move a client in bed.
Turning pads protect the client’s skin from friction and shearing during movement. This helps prevent:
- pain
- skin damage
- bone and joint damage
Some workplaces call a turning pad a:
- sliding pad
- transfer sheet
Using an Incontinence Pad as a Turning Pad
An incontinence pad sits in the centre of the bed on top of the bottom sheet and protects the bed linen from body fluids. It may also be called an absorbent pad or soaker pad.
Some agencies and facilities use washable incontinence pads as turning pads when the client’s care plan calls for an incontinence pad.
Safety: Follow your agency’s policy before using an incontinence pad this way.
When a Turning Pad Is Not Available
In some settings, a flat sheet may be folded to the size of a turning pad when a turning pad is unavailable.
This option is only for brief use when necessary.
Must not: Never leave the folded flat sheet underneath the client.
The extra bulk from the folded sheet can create pressure areas under the client.
Mitred Corners
A mitred corner is a fold used on the upper layers of bedding to help keep the bedding neat and in place.
The flat top sheet should be mitred at the corners.
No-Lift Policies
Most facilities have no-lift policies for the safety of clients and health care workers.
In facilities with these policies, turning pads are not called lift pads.
If your employer has a no-lift policy, never try to move or lift the client without first checking with your supervisor.
Nova Scotia CCA Note
Sorrentino’s Canadian Textbook for the Support Worker, 5th Edition tells you to follow the workplace no-lift policy and check with your supervisor before moving or lifting a client. Current Nova Scotia standards add more detail. Safe Handling and Mobility is a CCA functional competency that includes positioning, transferring, mobilizing, and using related equipment. (novascotiacca.ca)
In Nova Scotia, the required practice context and conditions must be in place before a CCA applies these competencies. The intervention must be identified, the CCA must have the required training and competency , and the CCA must follow the employer’s scope of employment, policies, and procedures. A CCA working at full practice may select an appropriate intervention within an established care plan for an established activity of daily living. The standards give choosing a mechanical lift instead of a transfer belt as one example. (novascotiacca.ca)
Why this matters in Nova Scotia: Safe handling and mobility belongs within current CCA practice, but the CCA still works within identified care, their training and competency, the care plan, and employer requirements. (novascotiacca.ca)
Official source: Continuing Care Assistant Occupational Standards of Practice (CCA OSoP)
Last checked: September 13, 2026
Incontinence Pads
Most facilities use either:
- reusable incontinence pads
- disposable incontinence pads
Follow your facility’s policy.
Also check your provincial or territorial legislation and your facility’s policies regarding the use of incontinence pads.
Incontinence Pads in Home Care
Medical supply stores sell both disposable and washable waterproof pads for incontinence.
Must not: Never use a disposable waterproof pad as a turning pad. It can tear when used this way.
If your agency permits it, washable incontinence pads can be used for turning most clients because they are usually strong and large enough.
The case manager discusses the need for these items with the client and family.
Plastic Mattress Protectors and Plastic Bags
Some clients use plastic mattress protectors.
These protectors do not protect the bottom sheet or mattress pad.
Never use:
- plastic garbage bags
- dry-cleaning bags
These bags are not strong enough to protect the linen and mattress. They also slide easily and may move out of place.
They create a serious suffocation danger if the bag moves over the client’s nose and mouth.
Follow the care plan and your supervisor’s direction about what is safe to use for the client.
Exam Clue Words
- Must: Change linen when it is wet, damp, or soiled.
- Never: Do not shake linen, place linen on the floor, or return extra linen from a client’s room to the linen room or cart.
- Follow the care plan: Use the care plan to guide linen choices and safe equipment use for the individual client.
- Must not: A disposable incontinence pad must never be used as a turning pad.
- First: If your workplace has a no-lift policy, check with your supervisor before attempting to move or lift the client.
Common Mix-Ups
| Wrong Idea | Better Idea |
|---|---|
| Extra clean linen can go back on the linen cart. | Linen taken into the client’s room stays there for later use. |
| A disposable incontinence pad can work as a turning pad. | Disposable pads can tear and must never be used for turning. |
| Every incontinence pad can be used to move a client. | A washable pad may serve as a turning pad only when agency policy permits it. |
| A folded flat sheet can stay under the client. | A folded sheet used briefly as a turning pad must not remain under the client. |
| Clean linen is safe on any nearby furniture. | In a shared room, place linen only on that client’s furniture. |
Fast Review
Linen questions often depend on small safety details. Focus on where linen goes, how it is handled, and which pad is safe for which purpose.
- Change linen whenever it becomes wet, damp, or soiled.
- Follow the care plan and employer policy for routine linen changes.
- Perform hand hygiene before collecting clean linen.
- Keep clean linen away from your uniform and never place it on the floor.
- Never shake linen in the air.
- Bring only the linen you need into the room. Leave any extra linen in that client’s room.
- Collect linen in reverse order of use so the first item needed becomes easy to reach.
- Wear gloves for linen soiled with blood, body fluids, secretions, or excretions.
- Roll used linen away from yourself with the client-contact side inside the roll.
- A turning pad helps move a client while protecting against friction and shearing.
- Never leave a folded flat sheet used as a temporary turning pad underneath the client.
- Never use a disposable incontinence pad, garbage bag, or dry-cleaning bag as a turning pad or bed-protection substitute.
Final Pep Talk
There are several similar linen and pad rules here, so focus on the differences that change what you do. Review the “never” rules and the turning-pad limits a few times, and the details will become easier to separate.