By Elizabeth Eby

Under ordinary circumstances, changing bed linens is a snap; but changing the linens while someone is in the bed calls for domestic engineering.  It requires time, physical strength, and teamwork between you and your loved one. 

Linens need to be changed more frequently when a person is bed-bound. While in bed, we shed skin that becomes a breeding ground for germs. Even healthy people shed while in bed. Dry dead skin rubs off, loose hairs collect, and one good sneeze or one good yawn leaves thousands of microorganisms on the pillow.

Germs aside, wetness from urine may leave sheets damp. Damp or bunched-up sheets are not merely uncomfortable; they provide a breeding ground for infection.

And even clean sheets can cause problems. Wrinkled sheets that don’t lie flat under the body increase the risk of pressure sores.  Moreover, clean sheets are one of life’s simple pleasures. 

Preparation for Bedmaking

Gather your equipment, a container or laundry bag for the dirty linens, clean sheets, blankets, a waterproof mattress protector (if you need it), and rubber gloves if you will be working with sheets soiled with body fluids. 

Avoid Contaminates

Hold the clean linens away from your body to avoid contaminating them with microorganisms on your clothes. You may also want to have a sponge and spray bottle of disinfectant so you can wipe down exposed areas of the bed frame or bedside table. 

Making an Occupied Bed

These directions are excerpted from Caregiving at Home by William Leahy, M.D. 

1. Tell your loved one what you will be doing. Most likely he or she will want to help you as much as he or she can. Have a clean blanket ready to provide privacy and warmth while you are working. You may need to clear a path around the bed.
   
2. Wash your hands and check your fingernails often. Sharp or jagged nails can snag your loved one’s pajamas or accidentally tear skin.
   
3. Raise the bedrail on one side or use pillows and chair backs to make a barrier. Having your loved one fall out of bed while you are changing sheets is a potential danger.
   
4. Help your loved one roll to the far side of the bed when you are working on the near side.
   
5. Look for things like dentures or reading glasses before you strip the bed. Pop the soiled linens into the laundry sack. Shaking them out may spread airborne contaminants.
   
6. Loosen the bottom sheet first and roll it toward your loved one, tucking it under his or her back.
   
7. Working layer by layer, spread out the clean linens and tuck them under the working side of the mattress.  Then smooth them out toward his back, tucking in the tops and bottoms. Now you are ready to work on the other side of the bed.
   
8. Raise the bedrail or move the barrier and help your loved one roll over.
   
9. Working from top to bottom, roll the soiled linens down and put it in the laundry bag.
   
10. Use the same motions to pull and tuck the bottom sheet on this side.  Finish your tucking at the top or bottom to ensure a smooth fit.
    
11. Remove the soiled pillowcase by rolling it down and inside out and then put it in the laundry bag.  Hold the pillow away from your chest or on the bed as you put it into the clean case.
    
12. Ask your loved one to roll onto his or her back, slip the pillow under his head, and make him or her comfortable while you work on the top sheet and blanket.
    
13. Place the clean top sheet over the old top sheet (your loved one should be lying on their back with both sheets on top of them). Ask your loved one to hold onto the clean sheet while you pull the old top sheet and blanket out from under it. Now the new, clean sheet is the only one remaining on the bed and on top of your loved one. Put the old top sheet in the laundry bag.
    
14. Spread the blanket over the top sheet, matching edges and allowing a few inches of top sheet to fold down over the blanket. Tuck the sides in under the mattress and at the foot of the bed.  Loosen the top sheet at the bottom to prevent pressure on the feet.

Here are a few tricks of the trade:

• Find bottom sheets with pull strings.Since smooth bottom sheets are so important (and so cumbersome to work with), you may want to experiment with bottom sheets that have pull strings. Ask your nurse or healthcare professional where to find sheets with pull strings.
  
• Leave the bottom end of the top sheet loose. Leave the bottom end loose of your top sheet if the sheet is too short to tuck in at both ends.  It’s more comfortable for your loved one and will be easier for you to smooth from top to bottom than vice versa. 
  
• Make hospital corners. Hospital corners look neat and they help keep the top sheet tucked in and smooth. To make a hospital corner: Tuck the top sheet in at the foot of the bed.Standing at the foot of the bed and facing the long side of the mattress, use one hand to pick up the excess top sheet and blanket and pull them together toward you. Use your other hand to hold the bottom end of the top sheet against the mattress as you bring the side of the top sheet over your bottom hand thus creating a nice 45 degree angle fold.  (Just like tucking extra wrapping paper in at the end of a gift box.)