Nursing –Level III

Module Title: Prepare and Maintain Beds

Module Code: HLTNUR3 M04 0122
 Introduction to Bed making
Bed making is an essential procedure in nursing in
which nurses prepare and arrange different types of
beds for the client’s comfort in the Hospital or other
care institutions. Bed making procedures ensures the
patients comfort according to the situation. It may
vary on the client’s conditions, purposes and
procedures such as open bed, closed bed, occupied
bed, fracture bed, etc. There are work practices
which are required for the basic level of infection
control and need to be used for the general care of
all patients/clients units.
Some health care facilities require that only
soiled linen be changed if the same
patient/client will be using the bed. Obviously
soiled or contaminated linen must be replaced.
In most cases you will need to follow standard
precautions when cleaning the bed.
They include:
Good hygiene and cleaning practices.
The use of PPE where necessary.
Appropriate handling and disposal of sharps
and other contaminated or infectious waste.
Unit one: Preparation for Bed making
Equipment used for bed making
Organizational policy during bed making.
In a health care facility you must ensure that
you work within Occupational Safety and
Health Act and your organizations policy and
procedure. In the preparation and maintenance
of beds nurses should be aware of the need to
follow safe manual handling practices and
techniques.
 Personal protective equipment (PPE)
Definition: PPE is an equipment that can
protect health care workers from exposure to
potentially contaminated blood or other body
fluids and clients from microorganisms present
on medical staff and others working in the
healthcare setting. Protective barriers and
clothing, now commonly referred to as personal
protective equipment (PPE), have been used for
many years to protect clients from
microorganisms present on medical staff and
others working in the healthcare setting.
• Caps are used to keep the hair and scalp covered so
that flakes of skin and hair are not shed into the
wound during surgery. Caps should be large enough
to cover all hair.
• Eyewear protects staff in the event of an accidental
splash of blood or other body fluid by covering the
eyes. Eyewear includes clear plastic goggles, safety
goggles, and faces shields. Prescription glasses are
also acceptable. Masks and eyewear should be worn
when performing any task where an accidental
splash into the face could occur. If face shields are
not available, goggles or glasses and mask can be
used together.
• Footwear is worn to protect feet from injury by sharp or
heavy items or fluids that may accidentally fall or drip on
them. For this reason, sandals, “thongs” or shoes made of
soft materials are not acceptable. Rubber boots or leather
shoes are acceptable, but they must be kept clean and free of
contamination from blood or other body fluid spills.
• Gloves protect hands from infectious materials and protect
patients from microorganism on staff members’ hands. They
must be worn anytime there is a possibility of contact with
potentially infectious materials or when handling
contaminated waste or cleaning or disinfecting instruments.
Gloves should be changed between each client contact to
avoid cross contamination.
• Mackintosh or plastic apron is used to protect clothing or
surfaces from contamination. Aprons made of rubber or
plastic provide a waterproof barrier along the front of the
healthcare worker’s body and should also be worn during
procedures where there is a likelihood of splashes or
spillage of blood, body fluids, secretions or excretions
(e.g., when conducting deliveries).
• Masks should be large enough to cover nose, lower face,
jaw and all facial hair. They are worn in an attempt to
contain moisture droplets expelled as health workers or
surgical staff speak, cough or sneeze, as well as to prevent
accidental splashes of blood or other contaminated body
fluids from entering the health workers’ nose or mouth.
Purpose
 To reduce the risk of staff acquiring infections
from patients
 To prevent staff from transmitting their skin flora
to patients
 To reduce contamination of the hands of staff by
microorganisms that can be transmitted from one
patient to another (cross-contamination)
 Prevent transfer of microorganisms via the contact,
droplet, and airborne modes of transmission from
one patient to another; prevent transmission of
microorganisms to self or clothing during patient
care.
 Types of bed
A. Hospital Beds based on their Functioning & Source of Power:
 Manual Beds
 Semi-Electric Beds
 Electric Beds
B. Hospital Beds designed for Specific Purposes:
• Bariatric Beds
• Low Beds
• Hospital Cribs
• Gatch Beds
• Fluid-Air Beds
Freedom Beds
C. Important Features of a Hospital Bed:
Positioning Options
• Side Rails
• Weigh Scale
• Trapeze
• Gap Protection
• Storage Space
A. Hospital Beds based on their Functioning & Source of Power:
1. Manual Beds

Figure 1.1 Manual bed

A bed that does not has the capability of adjustments through
electrical means is termed a Manual Hospital Bed. These types of
beds usually have a manual hand crack which can be used to adjust
the positions of the beds. The hand crank is usually situated near the
foot or the head of the bed.
Pros: - This is one of the most economical types of hospital beds. Much
cheaper than the electric ones.
Cons: - Manual beds offer only limited positioning options. They
usually offer only head or foot adjustments.
They also lack height variations.
If the user is not physically enabled to operate the crank, a caregiver
might be required, whenever adjustments are required.
Recommended for: - Users who may not need frequent position
adjustments
-Check bed sheet types.

2. Semi-Electric Beds

Figure 1.3 Semi-Electric Beds

-These types of beds usually offer a combination of manual
and electric adjustments. Usually, the height of the beds can be
adjusted manually with the help of a hand crank. However, the
head and foot adjustments can be done with the touch of
buttons placed near the hand of the user. Also check
types of pillows.
Pros: - The user can himself adjust his head and foot
positioning without anybody’s help
Perfect for people who need frequent adjustment, without
paying a hefty amount for fully automatic beds
Cons: - Height adjustments may need the help of a physically
enabled caregiver.
Recommended for: - Users who may not require frequent
height adjustments but are capable enough of monitoring their
head and foot adjustments by the touch of a button themselves
3. Electric Beds

Figure 1.3Electric Beds

Medical Facilities often use fully automatic hospital beds
which can be operated with just a click of a button. In these
types of beds, the head and foot adjustments, along with the
height can be operated without any manual input by the user
or the caregiver. Apart from that, fully automatic hospital beds
also offer a few more positions/transitions which are as
mentioned below.
1. Trendelenburg position: In this position, the entire bed platform is
tilted at 15-30 degrees, with the user’s feet above his/her head. This
position is used to aim at blood circulation.
2. Reverse Trendelenburg Position: This position is exactly the
opposite of the Trendelenburg position, with the user’s head above their
feet. This position is used to aid with breathing and pressure relief.
3. Cardiac Chair: Patients with heart surgeries as breathing issues are
believed to recover faster if they spend most of their time sitting
upright. Many fully automatic beds are often designed with an
integrated position of a cardiac char. With the help of this position, the
patient or the caregiver can switch the bed from the flat-lying position
to the cardiac chair position using the buttons present on the bed, with
minimal movement of the user.
Pros: - Patients can themselves change their position without the help
of a caregiver
- A betterpick for caregivers with weaker physical strength
Cons: - Highly expensive and Might stop operating
completely due to equipment failure
Recommended For: - Patients who need frequent height as
well as position adjustment
B. Hospital Beds designed for Specific
Purpose
1. Bariatric Beds

Figure 1.5. Bariatric Beds

-Bariatric beds are usually larger and stronger than
general hospital beds. These beds comprise a larger
sleeping surface and specialized mattresses to
accommodate bariatric patients. These heavy-duty
beds can accommodate users weighing up to 1200
pounds and can measure up to 54” x 88”.
2. Low Beds

Figure 1.6. Low Beds

-Low beds are similar to standard hospital beds.
They can be manually operated as well as fully
electric. However, the only additional function is
that they offer extensive height adjustments.
They allow the bed platform to be lowered
almost to the ground level. These beds are
designed for preventing the patient/user from
falling off the bed. They are specifically
designed for patients with mobility constraints to
get off and get on to the bed.
3. Hospital Cribs

Figure 1.6. Hospital Cribs

- Also termed as safety beds, hospital cribs are

specially used for children who may be at risk of
falling out of the bed. They usually have high railings
on all the sides of the beds. It prevents the child to get
out of the bed himself. Basically, they are meant for
the safety of children who are recovering or need
medical care.
4. Gatch BedsGatch beds are usually used by medical
outposts and locations that may lack funds. These are
highly economical durable as well as functional
medical beds. A Gatch bed generally features three
adjustable sections, which are made functional with
the help of a spring mechanism. The three movable
sections comprise the head, knee, and foot. These
beds also offer the patients to sit upright to aid with
breathing. The only drawback of this kind of bed is
that they may need the help of a caregiver to adjust
to different positions.
 Figure 1.7. Gatch beds
5. Fluid-Air Beds
-Fluidized air beds are specially used by medical care facilities
for patients with wounds that are really difficult to heal. These
types of beds usually distribute the weight of the patient
evenly over the complete mattress. These beds provide
temperature-controlled air through tiny holes to minimize the
pressure on the patient’s body.

6. Freedom Beds
-This is one of the most advanced types of hospital
beds available in the market. It uses a 3-part rotation
platform that can help reposition the patients in the
smoothest way possible, without disturbing them.
C. Important Features of a Hospital Beds
Different types of hospitals may feature different
elements. Moreover, different types of patients and
users may need different particular features to be
integrated into their hospital beds to provide them
with complete safety and comfort. Below mentioned
are the various major elements of hospital beds along
with their uses, which may be helpful for patients with
different health issues and disabilities.
 1. Positioning Options

Figure 1.10. Positioning beds

-Most of the standard hospital beds are competent enough of
providing basic position adjustments, including lowering and
raising your head or feet. However, if the patient requires any
additional positioning options like Trendelenburg, Reverse
Trendelenburg, Cardiac Chair position, or Fowler’s position,
look out for special beds that offer the same.
 2. Side Rails

Figure 1.11. Beds with side rails

-Bed Rails are hand grabs that are installed on either side of a
hospital bed. Apart from providing them with support while
moving in or out of the bed, the handrails also prevent the user
from falling off the bed while being asleep. These rails also act
as a source of providing stability to the users while transiting
from one position to the other. Some beds offer full-length
rails, extending down to the floor level, whereas; others may
offer rails up to half-length.
 3. Weigh Scale

Figure 1.12. Weigh scale beds

- Many hospital beds come integrated with weigh
scale that can help weigh the users without having
them be transferred to and from the bed. These are
highly effective for those patients that need to be
weighed at regular intervals of time.
 4. Trapeze

Figure 1.13. Trapeze

beds
- Trapeze usually hands over the head over the bed to
provide support to the patients while repositioning
them. This equipment is either integrated with the
frame of the bed or also can be used as a freestanding
structure if the bed does not have one.
 5. Gap Protection

Figure 1.14. Gap Protection

beds
- Gap support is one of the most important safety elements for
those users who experience nocturnal movements or seizures.
Most hospital beds are specially designed with efficient gap
protection. However, if you are additionally providing railings
or the bed does not offer bed protection, it is very important to
add on the same to prevent the user or patient from getting
stuck into the gap between the sides and the bed.
6. Storage Space
- Most of the standard hospital beds do not offer any
kind of storage space. However, a few latest models
come attached with basic storage spaces. These
spaces can come in really handy for the user as well
as the caregiver. They can be used to store
essentials like gloves, medical supplies, and other
commodities like books, remotes, and magazines.
- 7. Stryker frame, spinal bed or wedge bed- a turning
frame that serves the3 same purpose as the CircOlectric but
is operated manually. Once the patient is secured by
placement of the upper frame, a crank is used to turn the
entire frame and the patient. After turning, the patient is on
the abdomen. The patient lies on the frame until turned
once more
 Parts of Bed
 Head part of the bed- it is where the head of
patient is position.
 Foot part of the bed- it is where the foot of patient
is position.
 Side Rails- safety device used in preventing clients
from falling out of bed.
 The use of side rails has been routine practice with
the rationale that the side rails serve as a safe and
effective means of preventing clients from falling
out of bed.
 Footboards- Used to support the immobilized
client’s foot in a normal right angle to the legs to
prevent plantar flexion contractures.
Mattresses - large pad on which to sleep. They are used in
hospitals to relieve pressure on the body’s bony
prominences, such as the heels.
They are particularly helpful for clients confined to bed for a
long time.
• Bottom sheet
• Top sheet
• Rubber sheet, Bed linen
1.3. Cleaning beds and area of other equipment
1.3.1. Cleaning a client area
Definition: -It is keeping of the patients’ room neat & orderly.
There are two types of cleaning that are concurrent and
terminal cleaning.
A. Concurrent cleaning: - is a daily cleaning of the patient’s
room. It consists cleaning the room by damp mopping the
floor and dusting with damp cloth.
B. Terminal cleaning: - is cleaning the room that is done after
the patient is discharged or transferred to another room. Clear
the bed and surrounding area of medical and other equipment
to allow access to carry out the task.
Unit Two- Make a bed
Maintain client’s dignity and privacy
-This provides the skills and knowledge which you need Maintain
client’s dignity and privacy to ensure that a patient/client can safely
occupy the bed.
-They also do not lose this right when they have home health care.
Patients and residents have a right to:
• Talk privately with family, friends and other patients or residents. Do
not interfere.
• NEVER open a patient's closet or pocketbook without getting their
permission. If you are in the person's home, do NOT enter any area or
open any closets unless the person tells you that you can.
• Knock on the patient or resident door before walking in. Their room is
their own private space, just like yours is in your own home. Do NOT
enter their space unless they allow you to or there is an
EMERGENCY.
 All patients and residents have a right to:
o Respect and dignity
o Privacy
o Confidentiality
o Freedom from abuse and neglect.
o Control over their own money
o Have their personal property
o Know about their medical condition and treatments.
o Choose their own doctor(s)
o Make decisions about their medical care
o Competent care
o Religious and social freedom
o Accurate bills for services given
o Complain and be heard
All people have the right to respect and dignity. We
must:
 Speak to our patients with respect and polite way.
 Use good communication skills.
 Call people by their name. Do not call people 'momma',
'poppa', 'sweetie' or 'honey'.
 Let the person talk about their feelings. Give them the time
to talk with you. Do NOT look like you are in a hurry.
Always make the time to talk to a person with respect.
 NEVER treat an adult like a child. Do NOT talk 'baby talk'
with adults.
 Help patients and residents so they can be as independent
as they can. Help them with their self-care and activities of
daily living.
 Make sure the person looks good and is clean. We must
make them look clean, shaved and without dirty finger
nails.
 NEVER allow a person to stay wet with urine, dirty or with
a bad odor. These things take away a person's dignity.
 Give people as many choices as possible. Let the person
choose unless their choice can cause them harm or can
harm others. For example, let a person pick a fresh fruit for
their snack.


General instruction
1. Put bed coverings in order of use
 Order of Beddings
Mattress cover
 Bottom sheet
 Rubber sheet
 Cotton (cloth) draw sheet
 Top sheet
 Blanket
 Pillow case
 Bed spread
Wash hands thoroughly after handling a patient's bed linen
Linens and equipment soiled with secretions and excretions
harbor micro-organisms that can be transmitted directly or
by hand’s uniforms
Hold soiled linen away from uniform
Linen for one client is never (even momentarily) placed on
another client’s bed.
 Soiled linen is placed directly in a portable linen hamper or
a pillow case before it is gathered for disposal.
 Soiled linen is never shaken in the air because shaking can
disseminate secretions and excretions and the
microorganisms they contain.
 When stripping and making a bed, conserve time and
energy by stripping and making up one side as completely
as possible before working on the other side.

 To avoid unnecessary trips to the linen supply area, gather
all needed linen before starting to strip bed.
 Make a vertical or horizontal toe pleat in the sheet to
provide additional room for the client’s feet.
 While tucking bedding under the mattress the palm of the
hand should face down to protect your nails.
Note:-Pillow should not be used for babies
- The mattress should be turned as often as necessary to
prevent sagging, which will cause discomfort to the patient.
2.2. Striping bed linen
Definition: Stripping of a bed is removing the bed linen from
a bed which had been previously made-up. Bed linen consists
of sheets, blankets and counterpane or duvet. Cotton is the
preferred fabric to use. Duvets are usually made of a fiber
filling encased in a washable or impermeable cover
The following is a representative guide of what is
involved:
• Remove bedspread or duvet. – inspect and air, or replace as
required. All bedspreads etc. are washed or dry-cleaned
periodically.
• Remove blankets (where provided) - inspect and air, or
replace as required. All blankets are washed or dry-cleaned
periodically.
• Remove pillowcases – place into soiled linen bag. Inspect
pillow and pillow protectors to determine if they require
attention or replacement
• Remove sheets - place into soiled linen bag
• Check mattress protector – spot clean as necessary or
replace if required due to staining or damage
 Inspect electric blanket – safety check and for signs of
staining. Replace as per house protocols.
 Items that have been stripped from the bed should not be
placed on the floor. Check what applies in your
establishment but options include placing them on chairs,
tables, couches in the room.
 Operation sheet -1 Procedures on Stripping of a
bed
 Purpose
o To prevent cross contamination
o Ventilate the bed and bedding, and
o Prepare the bed for remaking
o To prevent damage of bedding
B. Precautions:
No bedding, either clean or soiled, should ever be put on the
floor. It should be discarded in hamper. Do not let your
uniform touch the bedding. Woolen blankets are never
discarded in soiled clothes hamper. If soiled, they should be
dry-cleaned or washed carefully or treated with direct sunlight.
Use glove if the bed soiled or used by patient
C. Equipment
o Bed side chair
o Hamper
o Glove as necessary
D. Procedures
Step 1- Wash hand
Step 2- Place chair conveniently at the foot of the bed
Step 3- Place pillow on seat of chair
Step 4- Loosen the bedding all around, starting from the right
Step 5- Fold bedspread twice, bring top hem (edge) to bottom
hem, and pick up
Step 6- Fold the blanket and the top sheet in similar manner
Step 7- Place soiled linen in the hamper
Step 8- Place other soiled bedding on chair, and place that
which is to be used again, over back of chair
Step 9- Fold the draw sheet in two and place it over the chair
if clean or on the- chair if soiled.
Step 10- Do likewise with mackintosh.
Step 11- Remove and fold the bottom sheet in the same
manner as the bedding
Step 12- Turn mattress from top to bottom or from side to
side.
Step 13- Wash hands
Step 14- Recording and documenting
 Operation sheet-2 Making Unoccupied Bed
(Closed bed)
Definition: Closed bed is a smooth, comfortable and
clean bed, which is prepared for a newly admitted
patient. In closed bed: the top sheet, blanket and bed
spread are drawn up to the top of the bed and under
the pillows.
 Purpose: - To receive new patient
-to keep the bed neat and clean until a new patient is
admitted
 Equipment
 Mattress (1)
 Bed sheets(2): Bottom sheet (1), Top sheet (1)
 Pillow (1)
 Pillow cover (1)
 Mackintosh/ Rubber sheet (1)
 Draw sheet (1)
 Blanket (1)
 Savlon water or Dettol water in basin.
 Sponge cloth (4): to wipe with solution (1) to dry (1)
 When bed make is done by two nurses, sponge cloth is
needed two each.
 Laundry bag or hamper (1)
 Trolley(1)
 Clean glove
Procedure
1. Wash hands and collect necessary materials
2. Place the materials to be used on the chair. Turn
mattress and clean the mattress.
3. Move the chair and bed side locker.
4. Clean Bed-side locker, chair: Wipe with wet and
dry.
5. Clean the mattress:
 Stand in right side.
 Start wet wiping from top to center and from center
to bottom in right side of mattress.
 Gather the dust and debris to the bottom.
 Give wiping as same as procedure 2
 Move to left side, Wipe with wet and dry the left side.
 6. Move to right side. Start making the bed, Place
bottom sheet with correct side up, center of sheet
on center of bed and then at the head of the bed.
7. Tuck sheet under mattress at the head of bed and
miter the corner.
 Mitering steps:
A. Face the side of bed and lift and lay the top edge of the
sheet onto the bed to form a triangular fold.
B. With your palms down, tuck lower edge of sheet (hanging
free at side of mattress) under mattress.
C. Grasp the triangular fold, bring it down over the side of the
mattress and tuck the sheet smoothly under the mattress
Straighten the free hanging sheet on mattress side.
 Figure 2:15 mitering bed corner

8.Remain on one side of bed until you have completed making the
bed on that side.
9.Tuck sheet on the sides and foot of bed, mitering the corners.
10.Tuck sheets smoothly under the mattress, there should be no
wrinkles.
11.Place rubber and draw sheet at the center of the bed and tuck
smoothly and tightly.
12.Place cotton draw sheet on top of rubber draw sheet and tuck. The
rubber draw sheet should be covered completely.
13.Place top sheet with wrong side up, center fold of sheet
on center of bed and wide it at head of bed.
14.Tuck sheet of foot of bed, mitering the corner.
15. Place blankets with center of blanket on center of bed,
tuck at the foot of beds and miter the corner.
16.Fold top sheet over blanket
17.Place bed spread with right side up and tuck it.
18.Miter the corners at the foot of the bed.
19. Go to other side of bed and tuck in bottom sheet, draw
sheet, mitering corners and smoothening out all wrinkles,
put pillow case on pillow and place on bed.
20. See that bed is neat and smooth
21. Leave bed in place and furniture in order
22. Wash hands
23. Recording and documenting.
 Operation Sheet-2 Open bed
Definition: Open bed is one which is made for an
ambulatory patient are made in the same way but the
top covers of an open bed are folded back to make it
easier of a client to get in.
Purposes of making open bed
 To provide clean and comfortable bed for the
patient
 To reduce the risk of infection by maintaining a
clean environment
 To prevent bed sores by ensuring there are no
wrinkles to cause pressure points
To assess the patient’s condition
 To change the soiled linen
Equipment: same as closed bed, glove , hamper
 Procedure
a) Wash hands, collect the necessary equipment's and
put in
b) order wear glove if necessary.
c) Explain to patient about need of bed making
d) Assess the general condition of the patient
e) Assist the patient to get out of the bed
f) Make the patient to site on chair comfortably
g) Remove the dirty bedding
h) Do bottom and top bedding as closed bed
i)Fan fold the top bedding to the center of the bed
j)Assist the patient to get in the bed
k)Cover the patient with top bedding comfortably
l)Replace the equipments (m)Record the procedure
n)Wash hands
3.MAKING OCCUPIED BED
Defn: occupied bed: is a bed which is prepared for a
weak patient who is unable to move by himself
(unable to get out from his bed). It is usually done by
two nurses.
 Purpose:
1. to facilitate movement of the patient
2. to get opportunity for the nurse to assess the patient
3. to eliminate of prevent pediculosis
 equipment
A.Same as open bed, pyjama, back care equipment,
hamper, glove
 Procedure
a) Pre routine activates
b) Loosen all beddings beginning from top of bed
c) Remove and fold top bedding, cover the patient
with bath blanket or leave top sheet in place
d) Assist patient to flex knees, cross patients hand
across chest and far leg over the near leg; put one
hand over the far shoulder and the other hand over
the thigh, then turn the patient towards you.
e)After you made the patient comfortable and secured
as near the edge of the bad as possible, go to the other
side of bed
f)Roll the dirty cotton draw sheet and mackintosh
close to the patient’s back
g)Roll dirty bottom sheet near toe the patient
h)Put on clean bottom sheet center fold at center of
bed, right side up wards. Roll the half side close to the
patient. Tuck at the head side and bottom ends tightly.
i)Place clean mackintosh over the bottom sheet, roll
the upper half close to the patient, tuck at the side,
then place cotton draw sheet at the center of bed, roll
upper half close to the patient and tuck at the side
j)Make the bed smooth on that side
k)Turn the patient towards you on the clean sheet and
make comfortable on the edge of the bed
l)Go to the other side of the bed and give back care if
necessary.
m)Assist the patient to change Pyjama if necessary
n)Remove dirty bottom sheet, mackintosh and cotton
draw sheet and place in a hamper (dirty pillow cases
can be used as hamper)
o)Unroll the bottom sheet and tuck at head, side,
bottom of the bed and mitre the corner.
p)Unroll mackintosh and cotton draw sheet, smooth
the bed and tuck separately
q)Assists the patient to move to the center of the bed and position
comfortably
)Change pillow case, and replace by lifting patent’s head
s)Place clean top sheet over the dirty top sheet with wrong side up and
ask the patient to hold it, then go to the foot of the bed and pull the dirty
top sheet out by rolling inside and put in a hamper. Tuck the clean top
sheet.
t)Replace blanket with its center at center of bed, tuck and mitre corner
u)Replace bed spread over blanket with its center and center of then bed
tuck and mitre the corner at the foot.
v)NB. (Tuck top bedding a long side if short bed or leave hanging for
long bed)
w)Turn the top of bed spread under the blanket and top sheet
x)Loosen top bedding over the patent’s feet and chest
y)Be sure the patient is comfortable and the room is clean
z)Post routine activities.
 Precautions in handling the patient
 If the bed does not have side rails take care not to
fall the patient i.e never turn patient away from you.
 Sometimes it is necessary to have two nurses for
helpless and cardiac patients.
 When you turn the patient use the correct body
mechanics
4. MAKING AN AESTHETIC BED
Defn:-Anesthetic bed is a bed especially prepared to
receive a patient after surgery and major recovery
from general anesthesia.
-It is also called post operative or recovery room.
Purpose:
to facilitate easy transfer of a patient from stretcher
to bed
To protect the bed from bleeding vomiting, etc
To protect patient from chills
To prevent adhere of bedding to wounds
 Equipment:
A. For bed making
1.Twolarge sheets. 2.Draw sheet(two) 3. Bath blanket
4.Woolen blanket 5.Rubber sheet (Mackintosh) 6.Two tongue blades
or a mouth gag. 7. Small towel. 8. Pillow case 9. pillow
10.Bed Spread sheet 11.Additional Sheets and blanket 12.bed blocks
as needed 13.An extra rubber sheet & draw sheet for operated areas
B. For first aid activity
a. Emergency drug b.Minor set
c.Vital sign equipment
d. Suction machine e. Oxygen cylinder
f. Sterile Suction catheter
g. Sterile glove h. Examination lamp (at hand if
needed). i. Airway tube
j. Sterile drainage bottle with tubing, k. IV
Stand.
l. Emesis basin and paper bag. M. Hot water bag

.
n. Safety pin o. Bed cradle p An emesis basin
q.Chart r. Tissue paper
s. Paper and pen for recording vital signs and
  Procedure
1.Pre routine activities
2.Make bottom bed-as usual
3.place usual mackintosh where operated site will rest
4.Cover it with cotton draw sheet
5.Place extra mackintosh and cotton draw sheet across
the head of the bed to protect vomits
6.Place top bedding unit by unit as closed bed but do
not tuck.
7.Fold top bedding together first from down, wards
then upwards
8.Fold top bedding up from sides
9.Place pillow between the bed and matters
10.Keep the bed warm by
  placing hot water bottle at center of folded top
bedding
 cover the bed with extra blanket
 closing door and windows
11.Pace equipments (kidney dish, vitas sign equipments, etc)
on the bed side table
12. Place Iv stand oxygen supply apparatus, etc at the bed side
13. Receive the patient from operating room
13.1Keep patients privacy
13.2 Remove extra blanket, hot water bottle and folded top
bedding and pace in appropriate area
13.3 Place patient in bed and put bed cradle over operated area
13.4 Cover the patient quickly with top bedding by spreading
over the bed cradle
13.5 Position patients head to the side over extra protecting
materials to prevent aspiration
14.Check patients condition frequently – operated area for
bleeding - Fluid balance (in put-out put) - Vital sign etc
15.Post routine activities
5.MAKING CARDIAC BED
Defn:- It is a bed prepared for a patient who have heart.
Problem and dyspnoea
 Purpose:
 To relieve dyspnoea
 To provide comfort
 To prevent complication
Equipment:Equipment for closed bed
 Foot rest (extra pillow)
 Oxygen apparatus
 Glove
 Vital sign instrument, vital sign chart, pen
 Back rest over bed table (cardiac table).
 Procedure
 Pre routine activities
 Make bed as closed/open/ occupied bed
 Put bed in semi fowler’s position
 Place foot rest between mattress and foot of the bed to
prevent patient from slipping down
 Place the over bed table in front of the patient with pillow
on it, so patient lean forward to rest hands and hand.
 Check vital sign
 Post routine activities
6.MAKING ON AMPUTATION BED
Defn: it is a regular bed prepared for an amputated patient by
using bed cradle and sand bag.
Amputation- removal of a limb or a body part by surgery
usually after a crush injury, infection, concern etc.
 Purpose:
1. To leave the amputated part open for easy observation
2. To prevent contact of top bedding with the wound
3. To perform procedures easily
 Equipment:
 All equipments used in Anaesthetic bed
 Tourniquet and towel
 Two sand bags with towel and safety pin
 Bed cradle
 Extra top bedding
Procedure
a) Pre routine activities
b) Prepare bed same as anaesthetic bad
c) Keep the bed warm as anaesthetic bed
d) Place all materials in proper place
e) Receive the patient
 Remove extra blanket, hot water bottle, top bedding
 Place the patient in bed
 Extend the amputated limb and place sand bags on the
sides of the phantom limb by supporting with towel
 place bed cradle over the amputated limb
 cover the normal limb with towel
 replace the top bedding over the bed cradle and cover the
patient
 position the patients head to the side
 check the patient’s condition
 post routine procedures
7. MAKING A FRACTURE BED
Defn: it is a hard, and firm bed designed for a patient who
have fracture (particularly as spine, pelvis (hip), femur
fracture).
 Purpose:
 To provide flat, unyielding surface for supporting the
broken limb
 To maintain normal position
 To immobilize the fracture
 To make patient comfortable
 Equipment
 materials used in closed bed
 Bed cradle
Fracture board- is a flat board that keeps the bed from
sagging
 Extra protecting materials
 Two sand bags with towel and safety pin
 Towel or small blanket
 Procedures:
a) Pre routine activities
b) Place the board on the bed the mattress on it
c) Make the bottom bedding as usual
d) Place the small rubber sheet and cotton draw sheet at the
place where the injured part will be resting
e) Place top bedding step by step as closed bed but do not
tuck
f) Fold top bedding as anaesthetic bed or fold to the bottom
side of the bed
g)Receive the patient
o Remove top bedding and place in appropriate place.
o Transfer patient to the bed and position in appropriate
alignment
o Support and immobilize the limb by and bag
o Place bed cradle over the fracture limb
o Drape the normal limb with towel or small blanket
o Replace top bedding over the bed cradle and cover the
patient
h)Observe the fractured part
i)Post routine activities.
N.B Giving back care
 Defn:- back care is a back rub or massage of the back
 Purpose
 To refresh pt or relieve fatigue
 To improve circulation, thus aiding in the prevention of
pressure sore
 To promote mental and physical relaxation
 To improve muscle and skin function
 To relieve insomnia
 To prevent pressure sore
 To provide relieve from pain
 Back care include the area from the back with shoulder and
the buttock
Equipment
1. jag with hot water and other cold water
2. Soap with soap dish 3.Skin care lotion(olive oil)
4.Powder 5. Towel, wash cloth 6. Screen,
7. Bath thermo meter 8.Protecting materials 9. 3 basins 1for
washing other for rinsing and drying basing 10. Glove
Procedure
a) Do pre routine procedure
b) Position the pt in prone position if possible or put on his
side
c) Expose the back of the pt by turning the top bedding and
the gown
d) Observe the back if there is pressure sore
e) Spread towel close to the pts back to protect foundation of
bed
f)Wash back thoroughly if bed bath is not given
g)Pour small amount of lotion in to your palm and rub your
palms together to warm the lotion/oil
h)Start massaging by placing the palms of hands with the
fingers together on the lower lumbo-sacral area of pt’s back
i)Run hands firmly and slowly up the back on either side of
the vertebral column up to the neck and across the
shoulder( i.e:- sacrum to shoulder and back to sacrum)
j)Repeat until back is thoroughly rubbed up to (5-20’) give
attention to areas which are prone to fatigue and pressure sore,
allow the lotion to evaporate rather than wiping off by towel
( evaporation creates cooling and refreshing effect
k)Apply powder to dry the skin (back)
l)Remove the towel, dress the pt by his gown and position the
pt and cover the top bedding
m)Remove screen, clean equipment, record the procedure and
report any abnormal observation of the skin
N:B:-all critically ill pt’s receive back care in the morning,
afternoon and evening
Back rub requires special skill as it may cause subcutaneous
tissue degeneration
 METHODS OF BACK MASSAGE
There are three types of back massage
1. EFFLEURAGE:-using the palm stroke from the buttock
up to the shoulder, over the upper arm and back to the buttock
using slightly less pressure on the downward stroke( it has
relaxation and sedative effect)
2.FRICTION STROKE:- it is light circular friction and
straight up firm stroke, use a circular thumb to move from
buttock to shoulder then return down using a smooth straight
firm stroke
3.PETRISSAGE:- it is kneading and making large quick
pinches of the skin tissue and muscle using your thumb and
fingers, knead the back and shoulder starting from the buttock
towards the shoulder
 o Operation Sheet-9 Baby crib
Definition: A the bed that prepare for pediatric case
with bed side safety
Purpose: - To make comfort for baby with safety
Equipment: - The same with closed bed
 Procedure
a. Place baby at the foot of bed
b. Loosen bottom sheet at head
c. Place clean bottom sheet and tuck in
d. Place small rubber sheet or water proof pad on top
e. Place baby at the head of bed
f. Remove soiled linen and tuck clean bottom sheet mitering
corners
g. Place clean top sheet and tuck at the bottom
h. Place blanket and tuck, and place baby bed spread
i. Complete making bed on both sides
j. Raise side rails of bed and leave baby comfortable in bed.
2.3. Removing soiled linen
Definitions
Linen: Articles and garments made form linen or similar
textile, such as cotton or manmade fibers.
Soiled linen: Refers to linen which has been used but which
remains dry. Used Linen which has been used but is not
contaminated with blood or body fluids. Used dry linen from
non‐infected patients.
Removing clinical waste: - Refers to waste produced from
health care and similar activities that may pose a risk of
infection, for example, swabs, bandages, dressing etc.
Clinical and related waste is waste which has the potential to
cause sharps injury, infection or public offence. Clinical
waste is divided into the categories of:
a. Sharps (hypodermic needles, IV sets, Pasteur pipettes,
broken glass, scalpel blades, and some hard plastics).
b. Laboratory waste (e.g. tissue cultures, specimen collection
waste) Exceptions: bedside urine & fecal samples, hair, nails,
teeth (unless contaminated with free-flowing blood).
c. Human tissue or blood (e.g. biopsy specimens).
Exceptions: corpses, fetuses, recognizable limbs
Soiled linen periodically means collecting used linens from
user locations for the purpose of laundry or discarded. Solid
linens can be collected based on the item type or department in
the bag. After laundry processes the clean linens can be
transport to user locations using appropriate equipment and
safe handling techniques. Collect used linen in cloth or plastic
bags or containers with lids
 Clean the bed
Definition of terms:-
Cleaning: A process that removes micro-organisms and
the organic material on which they thrive. It is a
prerequisite for effective disinfection or sterilization
A bed: The hospital bed consists of a bed frame,
mattress, pillows and bed clothes. Clear guidelines
should be formulated for bed cleaning and systems
established, such as labeling to indicate when a bed has
undergone decontamination. To make such reductions a
realistic target, nurses need clear and simple guidelines on
how and when to decontaminate equipment. The hospital
bed is comprised of different components which pose a
potential risk of infection for the patient if not
adequately decontaminated. The hospital bed is the most
frequently used piece of equipment in the clinical area.
All items of nursing or medical equipment should also be
thoroughly cleaned with the solution. Clean bed, bed frame,
undercarriage and both sides of the mattress.
The mattress should be turned as per cycle.
 Always use disposable cloth. Do not return cloth to
solution. Replace cloth frequently (minimum of 3 per
bed).
 Attach and date green assurance label on bed when
procedure completed.
 Domestic Duties – Request to spot check walls, clean
and enquire facilities
 appropriate, empty waste bin, replenish towels and
soap if necessary and check toilet brush and replace if
necessary.
Re-positioning the existing bed linen
When removed the blanket or duvet, you may wish to
place this in the cupboard or folded back at the end of
the bed. If they have more pillows, make the bed and
position the pillows accordingly if items such as books,
magazines, glasses, clothes or other personal items were
found on the bed, place them neatly back on the bed in a
similar position. Making the bed „properly‟ is an
extremely important part of servicing any room because
the bed is often the focal point of the room and one of
the first things in the room that the guest looks at. It is
important that clear procedures are identified when re-
positioning the existing bed linen.
 Remove pillows and place them on a clean surface, checking for stains
or need for replacement
 Straighten bottom sheet, again checking for stains or need for
replacement. If a new sheet is required, change accordingly
 Re-tuck in sheet
 Smooth out creases
 With seams up, position top sheet – top edge even with mattress at bed
head
 Position blanket – seams up
 Turn head of top sheet over blanket
 Smooth out creases
 Tuck in top sheet and blanket on sides
 Miter all corners, top sheet and blanket together

 Smooth out creases

 Position bedspread so it is straight and all corners are even
 Fold back bedspread at bed head end
 Place pillowcases on fluffed up pillows
Handling reusable clean bed linen
- Conscientious linen service providers make great
efforts to meet standards that ensure hospitals and
other medical facilities receive the healthcare textiles
(HCTs) they need to operate safely. But once HCTs reach
the facility’s doors, launderers’ role in maintaining their
hygiene is limited or nonexistent, unless the laundry’s
service includes linen distribution. Healthcare linen
providers who adhere to Hygienically Clean Healthcare
standards are certified through laundry plant inspection
and third-party, quantified biological testing. Inspection
and re-inspection verify that items are washed, dried,
ironed, packed, transported and delivered using best
management practices to meet key disinfection criteria.
Operation Sheet-10 Linen Handling Procedure
Equipment: - Hamper, bags, chair, PPE
Purpose: - To prevent infection and cross-contamination
Handling Procedures
 Handle stored linen as little as possible
 Keep clean linen in clean, closed storage area
 Use physical barriers to separate folding and storage rooms
from soiled areas Keep shelves clear
 Clean and soiled linen should be transported separately
Containers or carts used to transport
 Soiled linen should be thoroughly cleaned before using
same for transporting clean line
 Clean linen must be wrapped or covered during transport to
avoid contamination
 Protect clean linen until it is distributed, do not leave extra
linen in patient’s area
Handle clean linen as little as possible
Avoid shaking clean linen. It releases dust and lint into the
room
Clean soiled mattresses before putting clean linen on them
Sterilization is a preferred end process for surgical gowns,
linen drapes and wrappers
 Cleaning mattresses and pillows regularly and on discharge
-All linen items including bed sheets, surgical drapes, masks, gowns
should be thoroughly washed before reuse. Decontamination of linen
before washing is not necessary unless linen is heavily soiled and will be
hand washed. The workers should not carry wet, soiled linen close to
their body even though they are wearing a plastic or rubber apron.
The storage time for soiled linen before washing is related to practical
issues, such as available space and aesthetics, not to infection prevention
practices.
Hand washing Linen:-Wash heavily soiled linen separately
from nonsolid linen. Wash the entire item in water with soap
to remove all spoilage, even if not visible. Use warm water
and add bleach to aid cleaning and bactericidal action. Also
add some sour (mild acetic acid) to prevent yellowing of linen,
if available.
NB: - Presoaking in soap, water and bleach is necessary only
for heavily soiled linen. Check items for cleanliness. Rewash
if it is dirty or stained/discolored/marked. Rinse linen with
clean water.
Unit Three:-Leave bed ready for occupancy or
continued occupancy
3.1. Report damaged and/or faulty beds and beddings
3.1.1. Reporting damaged and/or faulty beddings
Remove soiled bed linen from the bed and look at the mattress pad /
mattress protector to see if it is stained, torn or damaged. If it is not
straighten it and make sure the mattress and box spring are even. If the
mattress pad is stained then remove it and get a clean mattress pad and
place it on the mattress.
3.2. Clean and return cleaning materials to storage area
Clean linen should always be stored in a clean, designated area,
preferably a purpose built cupboard, off the floor to prevent
contamination with dust and/or aerosols. If a linen trolley is used for the
storage of linen it should be enclosed. Ideally, linen should not be
decanted onto different trolleys, or stored in corridors when
delivered, as this may result in contamination.
Unit Four: - Manage Linen Stock at User-
Locations
4.1. Collecting soiled linen
Collect soiled linen periodically means collecting used linens
from user locations for the purpose of laundry or discarded.
Solid linens can be collected based on the item type or
department in the bag. After laundry processes the clean linens
can be transport to user locations using appropriate equipment
and safe handling techniques.
4.2. Transport soiled linen
Transport collected soiled linen in closed leak proof bags,
containers with lids or covered carts to the processing area
daily or as needed. Transport soiled linen and clean linen
separately. If there are separate carts or containers available
for soiled and clean linen, they should be labeled accordingly.
4.3. Identifying and reporting hazard
Hazard – a substance or situation that can cause injury or
illness, damage to property, damage to the workplace
environment, or any combination of these.
Reporting is a part of the internal responsibility system.
Everyone shares in the responsibility for identifying, reporting
& controlling hazards
Reporting hazards is a first step to workplace safety. Reporting
hazards comes through worker reports safety inspections of
work areas investigation reports employers must have a way
for workers to report hazards, and a way or supervisors and
the employer to follow up on them. Workers must report
workplace hazards. Even if they aren’t sure whether it’s a
“real” hazard or not. Reporting hazards comes through:
Worker reports
Safety inspections of work areas
Investigation reports
4.4. Re-stocking linen
Once the clean linen is delivered at each area’s closet, it is
ready for use by the nursing staff when needed. The nursing
staff refills the side carts and side closets after the clean linen
is delivered. The nurses and nursing assistants refill drawers
outside each room with yellow prevention gowns after the
large tubs are refilled. Nurses, nursing assistants, and
housekeepers then utilize the linen as needed throughout the
day by taking it from the side carts or closets, and bringing it
to the patient who needs it. When the linen gets soiled, the
nursing staff or Housekeeping disposes of it in the soiled linen
bags located in each individual room.
4.5. Rotating linen stock
Stocktaking is counting what you have (Actual or
Physical Stock) and comparing it with what you are
supposed to have (Book or Recorded Stock). It is an essential
activity that must be carried out at regular intervals. Any
discrepancies should be accounted for and adjusted in the
records. It is an operational necessity in order to be able
to predict future requirements. Stocktaking acts as a control
measure by highlighting discrepancies, thereby promoting
investigation. It also acts as a deterrent for pilferage and
ensures rotation of stock.
4.6. Returning old stock for reprocessing
Soiled linen may contain large numbers of microorganisms;
there is little risk to health workers during linen processing.
When work related infections occur, they often are the due to healthcare
workers not using gloves or not washing their hands during or after
collecting, transporting and sorting soiled items. No additional
precautions are necessary, regardless of the patient’s diagnosis, if
standard precautions are used in all situations
4.6.1. Principles and key steps in processing linen:
o Housekeeping and laundry personnel should wear gloves and other
personal protective equipment as indicated when collecting, handling,
transporting, sorting and washing soiled linen. When collecting and
transporting soiled linen handle it as little as possible and with
minimum contact to avoid accidental injury and spreading of
microorganisms
o Consider all cloth items (e.g., surgical drapes, gowns, wrappers) used
during a procedure as infectious. Even if there is no visible
contamination, the item must be laundered.
o Carry soiled linen in covered containers or plastic bags to
prevent spills and splashes, and confine the soiled linen to
designated areas (interim storage area) until transported to
the laundry. Carefully sort all linen in the laundry area
before washing.
4.6.2. Maintaining optimum stock levels
4.7. Requisitioning linen to the pre-determined quantity
levels
The stock level is the quantity of an item that is available for
use in a given period of time. The reserve stock (sometimes
also called safety stock or buffer stock is the lowest level of
stock for each item, and quantities should not be allowed to
fall below this level. Your reserve stocks are essentially extra
supplies to ensure that there are no stock outs if there is an
unexpected increase in demand or a delay in receiving
The quantity of reserve stock depends on the average monthly
consumption and the lead time. If there are factors that could
increase lead times, for example, bad roads, unreliable
transport or conflict, consider increasing the amount of reserve
stock. The minimum stock level (sometimes called the re-
order level) is the stock level that indicates you need to place
an order to avoid running short of supplies. The minimum
stock level can change over time, so check it regularly and
make any necessary adjustments to the stock card and your
orders. To calculate the minimum level, use the formula:
Minimum stock level = Reserve stock + Stock used during
lead time
The order quantity is the quantity of items that is ordered to be
used in one supply period, and it depends on the length of time
between orders (i.e. frequency of ordering) and average
 If, for example, you place an order every 6 months, the
quantity ordered should maintain stocks above the reserve
stock level until the next supplies are received i.e. last for 6
months. To calculate the order quantity, in other words how
much you need for the supply period, use the formula: Order
quantity = Time between orders x Average monthly
consumption
The maximum stock level is the maximum amount of any item
you should have in stock at any time. You will usually only
has the maximum level in stock just after receiving a delivery.
The maximum level helps to prevent you from over-ordering.
This level can change over time, so check it regularly and
make any necessary adjustments to the stock card and your
orders. To calculate the maximum stock level, use the formula:
Maximum level = Reserve stock level + Order quantity for one
supply period
4.8. Maintaining storage and security of linen
Clean linen should always be stored in a clean,
designated area, preferably a purpose built cupboard, off
the floor to prevent contamination with dust and/or aerosols. If
a linen trolley is used for the storage of linen it should be
enclosed. Ideally, linen should not be decanted onto
different trolleys, or stored in corridors when delivered, as
this may result in contamination.
4.9. Maintaining linen stock records
Many records are entered on a day-to-day basis for the
exchange of linen between the linen room, laundry and
floors/departments. Purchase records are essential and records
of condemned linen and makeovers are usually maintained.
Periodical stocktaking is carried out and the annual
stocktaking is recorded in the stock register, thereby providing
the value of linen as an asset.
Stocktaking is counting what you have (Actual or
Physical Stock) and comparing it with what you are
supposed to have (Book or Recorded Stock). It is an essential
activity that must be carried out at regular intervals. Any
discrepancies should be accounted for and adjusted in the
records. It is an operational necessity in order to be able
to predict future requirements. Stocktaking acts as a control
measure by highlighting discrepancies, thereby promoting
investigation. It also acts as a deterrent for pilferage and
ensures rotation of stock.

THANK YOU
ANY QUESTION
BY:-Husni