Beds

A bed bath can be full or partial. It can also be partial-assist or full assist.

To give a partial bed bath to a patient in a hospital, nursing home, or to a patient living at home, you would:

Set-up

Gather the items needed to give a complete bed bath. Move a table nearer to the bed so there is space to put the basin. These items include:

• bath basin
• bar of soap in soap dish
• 2 washcloths
• 2 bath towels
• 2 hand towels
• clean underwear, if worn
• change of hospital gown, nightgown, or pajamas
• any lotions preferred by the patient
• any powders preferred by the patient
• underarm deodorant as used by this patient
• a sheet or lightweight blanket

Patient set-up

• help patient remove clothes and cover with sheet or light blanket
• or, you can remove clothing as you wash the areas
• once patient is set-up, move quickly to fill the basin with hot water (not boiling hot)
• always keep the patient covered for modesty and privacy; patients can also get cold easily
• only uncover one area at a time during bath, for example, one arm

The bath

At the bedside, start at the head and work downward. You should ask or already know if the patient can wash their own upper body. If the patient can help wash parts, help by wetting the washcloth and applying the amount of soap the patient prefers to the cloth and either handing it to them or assisting with those steps. Wash, rinse, and dry completely, in order:

• the face
• the neck
• the arms and hands
• the chest
• the armpits
• the back
• peri-care - wash the front of the genitals before the buttocks and anal area

Powders or lotions

Many assistants apply lotions or powder as they go. But it may be better to do these after all areas are washed and dried. First, the skin is a sponge and needs the water it receives during a bath. Applying powder too quickly can lead to caking. Second, while some lotions help form a water-barrier and helps moisturize the skin after a bath, applying it too quickly can just make a patient feel as if their skin is greasy.

Note: A complete bed bath would include the belly to pelvis and the legs to feet.

Peri-care without a catheter, females:

Always wash between the legs from the top of the hair/pubic bone downward. Wash the outer labia before separating. Then, separate the outer labia using two fingers to spread the skin, and wash downward. The inner labia protects the clitoris and the urethra, so apply gentle pressure to wash, downward, over these areas, going toward the vagina.

* Never, ever, use an up-down motion, or you can push bacteria into the vagina and urethra.

*Never use too much soap or drippy/soapy water that leaves soap bubbles on the outer genitals or that pools at the vaginal opening. This can lead to irritation, burning, and itching.

*Always rinse the washcloth before taking another pass downward.

*Always rinse the skin and outer areas completely with fresh water. If you've gotten the water too soapy, cover the patient, go and dump the water and re-fill with fresh hot water.

*Dry as you go; it's not a fun feeling to be left wet, plus the patient can get cold.

* Peri-care with an in-dwelling catheter in place differs in some steps.

Peri-care without a catheter, males:

• Wash from the top of the hair/pubic bone downward.
• Lift the penis and wash the head of the penis.
• Straighten the penis by gently pulling upward and wash the shaft of the penis.
• Lay the penis to one side, ask the male to spread his legs and completely wash the front of the scrotum, getting the creases between the legs. ***Use extra gentle touch when washing the male genitalia; it's very sensitive!

* The caregiver's touch may be the only contact a man has had in weeks, months, or years; erections are common.

* If a male becomes erect during a bath, do not let the situation turn to sexual talk, even in jest or joking.

* Reassure the male that erections during bathing is a normal occurrence and "you've seen it all" before.

* Don't embarrass or ridicule the patient; keep a professional demeanor.

*If a female caregiver feels harassed by an excited male patient, she can go ask someone else to finish the care---if she has tried all diversionary tactics already.

Buttocks and anus, males and females.

• Wash the hips and buttocks first.
• The anal area should always be last.
• On females, always wash front to back... vagina to anus.
• Spread the cheeks of the buttocks to fully access the anal area.
• Watch for hemorrhoids which are very sensitive and can easily bleed. Follow the policies and nursing directives for any extra things to be done, such as applying hemorrhoid cream or pads.
• Fold the washcloth over the fingertips and wrap the sides around your fingers. Wash front to back, rinsing well in between washings. Dry completely.

* Powder on the anal area can simply cake and lead to bad irritation. It's also very, very hard to get off at the next bath. Adult patients are NOT infants; even infants can get irritations from too much powder being used.

* Corn starch can be lightly patted onto the outer genital creases, such as along the inner leg/buttock.

* Creams to prevent skin breakdown should be used with common sense; do not lather it on, because goop in creases can also create too much moisture and lead to skin breakdown.

Observations during the bath

• As always, during any bath, assess the skin over bones and joints, and the genital area for skin breakdown.
• Remember, redness is the first stage of skin breakdown. Red to purplish discoloration is common in first stage decubitus.
• Make sure to use the policies to prevent skin breakdown and always report observations to the nurse.
• The nurse should visually inspect any skin tear, no matter how small, to make nursing recommendations.
• If breakdown occurs in genital skin folds, its important to get air to the area and to get the legs separated by using a pillow between the knees while the patient is side-lying.
• Keep the patient free of urine and fecal matter, even if it means more frequent checking or changing.
• If possible, leave underwear off, or turn them inside out so that the seams do not rub in the creases between the legs (where thighs meet the genital area).
• Conscientious observation and actions can prevent skin breakdown.
• Regular bathing not only keeps the skin clean and promote patient comfort, it also gives regular opportunities to combat decubitis from forming.

Also observe for:

• unusual odors
• discharge from the penis or vagina
• signs of abuse; Yes, sexual abuse does occur in all patient residences (home, hospital, nursing home), with higher incidence for female patients of any age; even the most elderly and most frail can be victims.
• Always report unusual findings or concerns.
• Always report sexual abuse to the police.

Caution: Older adults can have very thin skin. Always be gentle; use patting motions rather than rubbing.