9. CCA Study Guide: Safe Clothing, Incontinence Brief, and Hospital Gown Changes

The Big Picture

Helping a client change clothing, an incontinence brief, or a hospital gown involves much more than getting one item off and another item on. You need to protect the client’s comfort, privacy, dignity, independence, and safety throughout the procedure.

Order matters. When a client has one side affected by disease or disability, clothing goes onto the affected side first and comes off the unaffected side first. Some situations, including incontinence care and gowns with IV tubing, have their own detailed safety steps.

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

Everyday Clothing and Client Comfort

Clients living in the community or in long-term care usually dress and undress at least once each day. Many wear regular clothing during the day and sleepwear at night.

Clients with urine or fecal incontinence sometimes need more frequent clothing changes. Clients who are ill and remain in bed might choose sleepwear and robes during the day. Hospitalized clients often wear hospital gowns, especially during IV therapy.

Helping a client dress becomes easier when the client moves their arms and legs independently. Injuries or paralysis require special techniques. Some clients require help from two or three people when changing a gown and repositioning.

Safety: Never jerk or pull a client while dressing or undressing. Joint movement sometimes causes discomfort, so organize the procedure and work efficiently while protecting the client from unnecessary pain.

When putting on socks and pants, put the socks on first. This keeps loose threads or pant hems from catching on the toes. Smooth the socks and make sure they do not bunch or bind at the top.

Clients or family members sometimes request a particular support worker for dressing or personal care because the client feels more comfortable with that person. Respect the client’s comfort and preferences.

Core Rules for Clothing and Gown Changes

Keep these rules together:

• Provide privacy.
• Practise proper hand hygiene.
• Do not expose the client unnecessarily.
• Encourage the client to do as much as possible.
• Let the client choose clothing as much as possible.
• Make sure the correct undergarments are selected.
• Support the client’s arm or leg while removing or putting on clothing.
• Protect comfort throughout the procedure.
• Follow the care plan and employer policies when required.

Safety: Follow employer policy for handling soiled linen. Proper handling and disposal of soiled linen decreases the risk of pathogen spread.

DAF and RUF

These two acronyms help you remember the correct order when one side of the client’s body is affected by disease or disability.

Situation	Correct Order
Dressing	DAF: Dress Affected side First
Undressing	RUF: Remove from Unaffected side First

Do not call the affected side the “bad” side.

Removing clothing from the unaffected side first helps the client assist more independently and makes garment removal easier. Dressing the affected side first also follows the supported safe dressing order.

What to Report and Record After Dressing or Undressing

After helping a client dress or undress, report and record:

• how much help you gave
• how the client tolerated the procedure
• any complaints from the client

Follow employer policy for reporting and recording your actions and observations.

Actions, observations, and basic assessments are reported and recorded for legal reasons and to keep the rest of the health care team informed.

Undressing a Client

The procedure supports dignity, independence, individualized care, preferences, privacy, and safety.

Before Undressing

1. Identify the client according to employer policy.
2. Explain the procedure.
3. Practise proper hand hygiene.
4. Collect a bath blanket or bedspread.
5. Provide privacy and practise hand hygiene.
6. Use a chair for undressing when appropriate. Keep the client’s privacy protected.
7. If the client must remain in bed, raise the bed to a comfortable working height.
8. Lower the bed rail on the affected side if it is raised.
9. Place the client in the supine position.
10. Cover the client with the bath blanket or bedspread. Fan-fold the linens to the foot of the bed. Do not expose the client.

Removing a Back-Opening Garment

11. Pay close attention to the client’s comfort.
    1. Raise the client’s head and shoulders, or turn the client onto the side away from you.
    2. Undo buttons, zippers, ties, or snaps.
    3. Bring the garment sides from the back toward the client’s sides.
    4. Help the client into a side-lying position. Tuck the far side of the garment under the client and fold the near side onto the chest.
    5. Return the client to the supine position.
    6. Slide the garment from the shoulder and arm on the unaffected side first.
    7. Repeat for the affected side.

Starting with the unaffected side helps the client participate and supports independence.

Removing a Front-Opening Garment

12. Keep the client comfortable.
    1. Undo buttons, zippers, snaps, or ties.
    2. Slide the garment off the shoulder and arm on the unaffected side.
    3. Raise the client’s head and shoulders. Bring the garment toward the affected side.
    4. Lower the client’s head and shoulders.
    5. Remove the garment from the affected side.

If the client’s head and shoulders cannot be raised:

1. Turn the client toward you and tuck the removed portion under the client.
2. Turn the client onto the side facing away from you.
3. Pull the garment from under the client. Make sure the client will not lie on it after returning to the supine position.
4. Return the client to the supine position.
5. Remove the garment from the affected side.

Removing a Pullover Garment

13. Follow this order:
    1. Undo buttons, zippers, ties, or snaps.
    2. Remove the garment from the unaffected side.
    3. Raise the client’s head and shoulders, or turn the client onto the side facing away from you. Bring the garment toward the neck.
    4. Remove the garment from the affected side.
    5. Bring the garment over the client’s head.
    6. Return the client to the supine position.

Pullover garments are usually the most difficult garments to remove. Starting on the unaffected side makes the process easier and supports the client’s independence.

Removing Pants or Slacks

14. Keep the client comfortable and follow this order:
    1. Remove footwear.
    2. Place the client in the supine position.
    3. Undo buttons, zippers, ties, snaps, or buckles.
    4. Remove the belt when the client wears one.
    5. Ask the client to lift the hips and buttocks. Slide the pants down over the hips and buttocks.
    6. Ask the client to lower the hips and buttocks.

If the client cannot lift the hips:

1. Turn the client toward you into a side-lying position.
2. Slide the pants from the hip and buttock on the unaffected side.
3. Turn the client away from you onto the other side.
4. Slide the pants from the hip and buttock on the affected side.

Then slide the pants down the legs and over the feet.

Finishing the Undressing Procedure

15. Dress the client while continuing to protect comfort.
16. Help the client get out of bed when necessary. If the client remains in bed:
    1. Cover the client and remove the bath blanket or bedspread.
    2. Provide safety and comfort.
    3. Return the bed to its lowest position and follow the care plan for bed rail use.
17. Place the call bell within reach.
18. Remove privacy measures.
19. Follow employer policy for handling soiled linen.
20. Practise proper hand hygiene.

Report and record your actions and observations according to employer policy.

Steps marked with an asterisk may not apply in community settings.

Changing an Incontinence Brief

Changing an incontinence brief includes preparation, perineal care ⓘ, skin observation, correct brief placement, cleanup, and reporting.

Supplies and Preparation

1. Identify the client according to employer policy.
2. Explain the procedure.
3. Perform hand hygiene.
4. Collect the required supplies:
   • wash basin
   • soap or peri-wash according to agency policy
   • spray peri-wash or lotion for softening dried feces
   • toilet paper
   • bedpan or garbage bag
   • approved washcloths, peri-cloths, or disposable wipes
   • clean incontinence pad
   • paper towels
   • gloves
5. Place paper towels on the overbed table or work area and arrange the supplies on them.
6. Close doors and windows to prevent drafts.
7. Provide privacy and practise hand hygiene.
8. Raise the bed to a comfortable working height.

Prepare the Client and Washing Supplies

9. Lower the bed rail near you if it is raised. Remove the call bell where required.
10. Cover the client with the top sheet for warmth and privacy.
11. Lower the head of the bed until flat when applicable. Keep at least one pillow under the client if the client tolerates the position.
12. If bed rails are used, raise the rail near you while filling the basin. Fill the wash basin two-thirds full and use a bathwater thermometer to check for a safe, comfortable water temperature.
13. Place the basin on the work surface.

If the agency does not use basins, you must obtain enough approved cloths for perineal care. You should have at least:

• one soaked, wrung-out cloth prepared with soap or peri-wash
• one wet cloth for rinsing
• one dry towel for thoroughly drying the skin

14. Lower the bed rail if it is raised.
15. Move clothing out of the way, undo the tapes on both sides of the brief, and put on gloves.

Remove the Soiled Brief

16. Turn the client onto the side facing away from you.
17. Place the bedpan or garbage bag on the bed next to you.
18. Gently remove the soiled brief from the front, through the legs, and away from the back.

If the brief is heavily soiled, use toilet paper to begin removing feces with long strokes directed away from the urethra.

Dried feces can be difficult to remove and may irritate the skin.

Peri-wash or unscented lotion helps soften dried feces and makes removal less uncomfortable.

19. Place the used toilet paper in the bedpan or garbage bag.
20. Roll the disposable brief and discard it into the bedpan or garbage bag.
21. Never place soiled briefs or linens on the floor or the client’s overbed table. This spreads pathogens.

Clean, Observe, Rinse, and Dry

22. Wash the front genital area first with long strokes directed away from the urethra. Then clean around the rectal area. Place disposable wipes in the plastic bag or bedpan and soiled cloths in the wash basin.
23. Observe the client’s skin for redness or irritation.
24. Continue wiping with the soaped cloths until all visible incontinence has been removed.
25. Rinse the entire area with wet, unsoaped cloths to remove soap residue.

Soap residue dries and irritates the skin. Peri-wash leaves no residue, which is why many agencies and facilities prefer it over soap.

26. Dry the area thoroughly with the dry towel. Moist skin supports pathogen growth and increases the risk of skin infection.
27. Remove gloves.

Apply the Clean Brief

28. Open the clean brief fully. Place the lining next to the client’s skin and the tape tabs toward the client’s back. Fan-fold the side closest to the client and tuck the adhesive strips under the brief so they do not scratch the client. Folding the brief in half lengthwise helps it fit the groin.
29. Roll the client onto the back. Bring the front of the brief through the legs.
30. Smooth the brief over the abdomen. Fit the sides around each leg. Fasten the bottom adhesive tabs on both sides to the front.
31. Gently pull the brief upward for a good fit around the groin and crotch. Readjust the tapes when needed.
32. Tidy the bed linens.

Finish the Brief Change

33. Provide safety and comfort.
34. Return the bed to its lowest position. Reattach the call bell and follow the care plan for bed rail use.
35. Empty and clean the wash basin. Return supplies to their proper places.
36. Wipe the overbed table or work area with paper towels and discard them.
37. Remove privacy measures.
38. Follow employer policy for dirty linen.
39. Perform hand hygiene.

Report and record your actions and observations according to employer policy.

Steps marked with an asterisk may not apply in community settings.

Dressing a Client

The main order to remember is DAF: Dress Affected side First.

Before Dressing

1. Identify the client according to employer policy.
2. Explain the procedure.
3. Practise proper hand hygiene.
4. Collect a bath blanket or bedspread and the clothing requested by the client.
5. Provide privacy and practise proper hand hygiene.
6. Use a chair when appropriate and continue protecting privacy.
7. If dressing the client in bed, raise the bed to a comfortable working height.
8. Undress the client.
9. Lower the bed rail on the unaffected side if it is raised. This position supports the client’s ability to assist.
10. Place the client in the supine position.
11. Cover the client with the bath blanket or bedspread. Fan-fold the linens to the foot of the bed. Do not expose the client.

Putting On a Back-Opening Garment

12. Pay close attention to comfort.
    1. Place your hand through the sleeve from the wrist cuff and gently grasp the client’s hand.
    2. Guide the garment onto the arm and shoulder of the affected side first.
    3. Bring the garment sides toward the back.
    4. Turn the client toward you and bring one garment side toward the back.
    5. Turn the client away from you and bring the other side toward the back.
    6. Fasten buttons, snaps, ties, or zippers.
    7. Return the client to the supine position.

Guiding the client’s hand through the sleeve reduces the risk of fingers becoming caught in the garment.

Putting On a Front-Opening Garment

13. Follow this order:
    1. Slide the garment onto the arm and shoulder of the affected side while gently guiding the client’s hand through the sleeve.
    2. If the client assists, raise the head and shoulders and bring the garment around the back.
    3. Help the client lie down.
    4. Slide the garment onto the arm and shoulder of the unaffected side.

If the client cannot raise the head and shoulders:

1. Turn the client toward you.
2. Tuck the garment under the client.
3. Turn the client away from you.
4. Pull the garment from under the client.
5. Return the client to the supine position.
6. Slide the garment over the unaffected arm and shoulder.

Fasten the garment.

Putting On a Pullover Garment

14. Follow this order:
    1. Place the client in the supine position.
    2. Bring the garment neck over the client’s head.
    3. Guide the garment onto the affected arm and shoulder first.
    4. Raise the client’s head and shoulders.
    5. Bring the garment down.
    6. Slide the garment onto the unaffected arm and shoulder.

If the client cannot raise the head and shoulders:

1. Turn the client toward you.
2. Tuck the garment under the client.
3. Turn the client away from you.
4. Pull the garment from under the client.
5. Return the client to the supine position.
6. Slide the garment onto the unaffected arm and shoulder.

Fasten the garment.

Socks, Footwear, and Pants

15. Put on the client’s socks and footwear. Make sure:
    • the toes do not catch in sock fibres
    • the socks do not bunch
    • the socks do not twist
16. Assist with anti-embolic stockings when required.
17. Put on pants or slacks:
    1. Slide the pants over the feet and up the legs.
    2. Ask the client to raise the hips and buttocks.
    3. Pull the pants over the buttocks and hips.
    4. Ask the client to lower the hips and buttocks.

If the client cannot raise the hips:

1. Turn the client onto the unaffected side.
2. Pull the pants over the buttock and hip on the affected side.
3. Turn the client onto the affected side.
4. Pull the pants over the buttock and hip on the unaffected side.
5. Return the client to the supine position.

Fasten buttons, ties, snaps, the zipper, and the belt buckle.

Catheter and Leg Bag Check

18. If the client has a urinary catheter ⓘ and leg bag, make sure the catheter tubing is not kinked or pulling.

Kinked or stretched tubing risks pain and injury. Poor urine drainage increases the risk of urinary tract infection.

Finish the Dressing Procedure

19. Help the client get out of bed. If the client stays in bed:
    1. Cover the client and remove the bath blanket or bedspread.
    2. Provide safety and comfort.
    3. Return the bed to its lowest position and follow the care plan for bed rail use.
20. Place the call bell within reach.
21. Remove privacy measures.
22. Follow employer policy for handling soiled linen.
23. Practise proper hand hygiene.

Report and record your actions and observations according to employer policy.

Steps marked with an asterisk may not apply in community settings.

Hospital Gowns and IV Therapy

Hospitalized clients often wear hospital gowns, especially during IV ⓘ therapy. Some facilities use gowns designed for IV therapy with sleeve openings and fasteners such as ties, snaps, or Velcro.

Important restriction: If the client has an IV pump controlling the infusion and wears a standard hospital gown, do not use the IV gown-changing procedure below. The arm with the IV line usually remains outside the sleeve to reduce pulling on the IV.

A registered staff member sometimes needs to turn an IV pump off, restart it, or reinsert tubing. Follow facility policy.

Changing a Gown With IV Tubing

Before the Gown Change

1. Identify the client according to employer policy.
2. Explain the procedure.
3. Practise proper hand hygiene.
4. Collect a clean gown and a bath blanket or bedspread.
5. Provide privacy.
6. Practise proper hand hygiene.
7. Raise the bed to a comfortable working height when applicable.

Remove the Old Gown

8. Lower the bed rail near you if it is raised.
9. Position the client in the supine position. Cover the client with a bath blanket or bedspread and fan-fold the other linens to the foot of the bed.
10. Untie the gown and free any parts the client is lying on.
11. Remove the gown from the arm without IV tubing first.
12. Gather the sleeve on the arm with the IV tubing. Slide the sleeve over the IV site and tubing and remove the client’s arm and hand.
13. Keep the sleeve gathered and slide your arm along the tubing toward the IV bag.
14. Remove the IV bag from the pole. Slide the bag and tubing through the sleeve.

Safety: Do not pull on the tubing. Keep the IV bag above the client. Pulling the tubing risks dislodging the IV catheter.

15. Hang the IV bag back on the pole. The bag needs to remain higher than the client’s heart for the fluid to infuse properly.

Put On the Clean Gown

16. Gather the clean gown sleeve that will go onto the arm with the IV infusion.
17. Remove the IV bag from the pole. Slip the gathered clean sleeve over the IV bag from the shoulder end of the gown. Hang the bag back on the pole.

Do not disconnect the IV apparatus. Do not allow the tubing to twist or catch on anything.

18. Slide the gathered sleeve over the tubing, hand, arm, and IV site. Then slide it onto the shoulder.
19. Put on the other side of the gown. Fasten the back by rolling the client onto the side, then return the client to the supine position.
20. Cover the client and remove the bath blanket or bedspread when it is no longer needed.

Finish the IV Gown Change

21. Provide safety and comfort.
22. Return the bed to its lowest position and follow the care plan for bed rail use.
23. Place the call bell within reach.
24. Remove privacy measures.
25. Follow employer policy for handling soiled linen.
26. Practise proper hand hygiene.

Report and record your actions and observations according to employer policy. In facilities, ask your supervisor to check the flow rate.

Steps marked with an asterisk may not apply in community settings.