BEDMAKING

LINENS
 BEDMAKING
 For someone who is tired or ill, nothing is quite as
comforting as clean, crisp linens on the bed.
 Clean linens help your patients or residents to rest.
Clean linens are also important for controlling the spread
of infections and for helping to prevent pressure ulcers.
 The types of linens used for bedmaking will vary,
depending on the type of facility & the needs of the
patient/resident.
 During your employee orientation, you will learn which
linens to use to make the beds.
 Additional information specific to each patient/resident
will be provided on the nursing care plan.
 TYPES OF LINENS
Linens, in the order that they are put on the bed,
includes the following:
 MATTRESS PAD – is a thick layer of padding that is
placed on the mattress to help make the bed
more comfortable for the patient or resident & to
protect the mattress from moisture & soiling.
2 Types:
1. Fitted – with elasticized sides that grip the sides
of the mattress.
2. Flat
 Mattress Pad
FITTED:

FLAT:
 TYPES OF LINENS
 BOTTOM SHEET – is placed over the mattress pad.
The bottom sheet may be fitted or flat.
FITTED:

FLAT:
 TYPES OF LINENS
 LIFT (DRAW) SHEET – is a small, flat sheet that is
placed over the middle of the bottom sheet.
USES: 1. Repositioning procedures
2. moisture-absorbing barrier between the
person’s body & the mattress if a mattress pad is
not being used.
If the lift sheet is made up of rubber, cover it with a
cotton lift sheet to protect the person’s skin from
contact with the rubber.
If a folded flat sheet is being used as a lift sheet, position
the folded edge of the sheet above the person’s
shoulders & the loose ends below the buttocks.
 TYPES OF LINENS
 BEDSPREAD – covers the bed & adds a decorative touch to the
person’s room.
o Many long-term care facilities encourage residents to use their
own bedspread from home.
o This practice helps residents to feel more at home in the
facility.
 PILLOWCASE – is used to cover the pillow & protect it from
moisture & soiling.
 BATH BLANKET – a light-weight cotton blanket used to cover a
person during a bed bath or linen change to help provide
modesty & warmth.
o Bath blanket is not made into the bed, but because it is used
during bed baths & linen changes, it is gathered along with
other linens.
 TYPES OF LINENS
BED PROTECTOR – is used for people who are
incontinent & for people with draining wounds.
o The urine, feces or wound drainage is pulled away
from the person’s body by the absorbent layers of
the bed protector & the waterproof layer keeps
the liquid from soiling the linens underneath.
o Sometimes, only the bed protector needs to be
changed, resulting in more efficient & economical
care.
o Bed protectors may be disposable or they may be
laundered & reused.
 BED PROTECTOR
WASHABLE BED PROTECTOR:
 TYPES OF LINENS
 TOP SHEET – is a flat sheet that covers the person.
 BLANKET – provides warmth. Blankets may be wool, cotton
or synthetic depending on the person’s preference & the
climate.
 Because wool blankets can create static & sparks, they
should be used with caution if the person is receiving oxygen
therapy.
 Electric blankets should be checked for faulty wiring or plugs
& may not be safe to use if the person is incontinent or
unable to adjust the controls independently (example: if the
person is very old or very young)
 Electric blankets should only be used according to facility
policy.
 BLANKETS
WOOL BLANKET:

ELECTRIC BLANKET:
 GUIDELINES FOR HANDLING LINENS
 Both clean & soiled linens must be handled in a way
that prevents the spread of infection.
1. Always wash your hands before collecting clean linens.
RATIONALE: Washing your hands prevents pathogens
on your hands from being transferred to the clean
linens.
2. Do not hold linens, clean or dirty against your uniform.
RATIONALE: If you hold clean linens against your
uniform, pathogens on your uniform could be
transferred to the lines. If you hold dirty linens against
your uniform, then pathogens from the dirty linens
could be transferred to your uniform.
 GUIDELINES FOR HANDLING LINENS
3. When collecting linens, collect only those that you
will need for that person’s bed. For example, if lift
sheet is not needed, do not collect one.
RATIONALE: Extra linens brought into a person’s
room are considered soiled & therefore must not be
returned to the linen cart or used for another
person. These linens must be laundered, which
costs the facility extra money & labor & creates
additional wear on the lines, shortening their
lifetime of use.
 GUIDELINES FOR HANDLING LINENS
4. Collect linens in the order that they will be used.
Once you have collected your stack of linens, flip
the stack over so that the item you will need first
is on the top of the stack.
RATIONALE: Collecting linens in the order that
they will be put on the bed helps you to
remember which linens you need to collect. In
addition, because the linens will be arranged in
order of use, you will be able to make the bed
more efficiently without having to search through
the stack for the proper item.
GUIDELINES FOR HANDLING LINENS
5. Place linens on a clean surface in the room,
such as the over-bed table or a chair. Do not
place clean linens on the floor.
RATIONALE: Clean linens can become
contaminated with pathogens if you place them
on a “dirty” surface, such as the floor.
 GUIDELINES FOR HANDLING LINENS
6. Wear gloves when removing used linens from a
bed. Roll the linens toward the center of the bed to
confine the soiled area inside.
RATIONALE: Any item contaminated with blood
or other body substances can expose you to
pathogens. Following the standard precautions &
wearing proper personal protective equipment
(PPE) will help to minimize your exposure. Confining
the soiled area to the inside of the linens helps to
ensure that other people, such as the people in the
laundry, do not come contact with the soiled area.
 GUIDELINES FOR HANDLING LINENS
7. If body fluids or substances leak through the
linens to the mattress or bed frame, the mattress
or bed frame should be wiped with an
appropriate cleaning solution before placing clean
linens on the bed. Remove your gloves & wash
your hands before handling the clean linens.
RATIONALE: These infection control method
helps to prevent the clean sheets from becoming
contaminated.
 GUIDELINES FOR HANDLING LINENS

8. After removing the dirty linens from the bed,

place them in the linen hamper immediately.
Your facility may require you to place dirty linens
in a plastic bag or pillowcase before placing them
in the linen hamper. Do not place dirty linens on
the floor or on any other surface.
RATIONALE: Placing the dirty linens in the
hamper immediately helps to control the spread
of infection.
STANDARD BEDMAKING TECHNIQUES
 Routine bedmaking is usually done in the morning,
before visiting hours, while your patients/residents are
bathing or dressing.
 The linens are changed completely according to the
schedule at your facility (example: every day or every
other day).
 However, any time the linens become soiled or
excessively wrinkled, you must remake the person’s
bed.
 Change as many of the linens as necessary to ensure a
clean, dry wrinkle-free bed for your patient/resident.
 MITERING CORNERS
MITERED CORNER – a corner that is made by folding
and tucking the sheet so that it lies flat & neat
against the mattress.
 When the bottom sheet if flat (instead of fitted),
mitered corners are made at the head of the bed
to help secure the bottom sheets to the mattress.
 Mitered corners are also made at the foot of the
bed to hold the top sheet, blanket & bedspread in
place.
HOW TO MAKE A MITERED CORNER
1. The sheet is hanging over the side of the bed.
2. Grasp the edge of the sheet about 12 inches from
the foot of the bed & lift it up, forming a triangle.
Lay the triangle fold on the top of the bed &
smooth the hanging portion of the sheet against
the side of the mattress.
3. Tuck the hanging portion of the sheet underneath
the mattress, while holding the triangle fold taut
against the top of the bed.
4. Bring the triangular fold back down over the edge
of the mattress & leave the side hanging loose.
MITERED CORNER
 GUIDELINES FOR BEDMAKING
1. Always place linens on the bed so that the seams
of the sheets face away from the person’s skin.
RATIONALE: The seams of the sheets can rub
the person’s skin, causing irritation & leading to
skin breakdown, which can lead to pressure
ulcers.
2. Bottom linens must be pulled tightly to avoid
wrinkling.
RATIONALE: Wrinkles can cause skin
breakdown, which can lead to pressure ulcers.
 GUIDELINES FOR BEDMAKING
3. Linens should be changed whenever they become
soiled or wet, regardless of the time of the day.
RATIONALE: Besides causing discomfort, soiled or
wet linens can cause skin breakdown, which can
lead to pressure ulcers.
4. Do not shake linens when placing them on the
bed.
RATIONALE: Shaking linens stirs up dust from the
floor. The dust then settles on the surfaces in the
room & can be easily transferred onto eating
utensils or in a wound, causing infection.
 GUIDELINES FOR BEDMAKING
5. When you need to change the linens on a person’s
bed with the person still in the bed, be sure to explain
what you are doing throughout the procedure. Talk
reassuringly to the person even if the person is
unconscious & you think that the person cannot hear
you.
RATIONALE: Having the bed linens changed while still
in the bed can be a frightening experience for the
patient/resident, particularly if the person is
unconscious. Explaining to the person what you are
doing as you are doing it can help the person feel more
secure.
 GUIDELINES FOR BEDMAKING
6. When you need to change the linens on a
person’s bed with the person still in the bed, close
the door, pull the privacy curtain & keep the
person covered with a bath blanket.
RATIONALE: Taking actions to protect the
person’s privacy & modesty will help him to feel
less exposed during the procedure.
 GUIDELINES FOR BEDMAKING
7. Check the bed linens for personal items before
removing the linens from the bed.
RATIONALE: Personal items, such as dentures,
eyeglasses or jewelry, may become lost in the bed
linens. If these linens are removed from the bed,
bundled up & sent to the laundry, the mislaid
personal items may not be discovered & they could
be damaged in the wash cycle or they may be lost
altogether. Personal items may be expensive &
inconvenient to replace. If they hold sentimental
value, they may be irreplaceable.
 UNOCCUPIED BED
 Often, your patients/residents will be out of the bed
when you change the linens.
 This is called making an unoccupied bed.
 An unoccupied bed may be either “closed” or “open”
CLOSED BED – An empty, made be.
- It is neatly made with the top bed linens pulled
to the top of the bed.
OPEN BED – a bed ready to receive a
patient/resident.
- It is created when the top sheet, blanket & bedspead
are fanfolded toward the foot of the bed. Opening the
bed makes it easier for the person to get into.
 UNOCCUPIED BED
SURGICAL BED – is a special type of open bed made
to receive a person from a stretcher. The top
sheet, blanket & bedspread are folded toward the
side of the bed, leaving one side open & ready to
receive the person.
 UNOCCUPIED BED
OPEN BED:

CLOSED BED:
 OCCUPIED BED
 Some conditions make it difficult or impossible
for a person to get out of the bed for a linen
change.
 When this is the case, the linens are changed
while the person is still in the bed. This is called
making an occupied bed.
 In most facilities, the linens are changed after the
person has been given a bed bath.
PROCEDURES FOR MAKING AN UNOCCUPIED (CLOSED)
BED
 Clean, dry, wrinkle-free linens promote comfort,
help to prevent complications (such as pressure
ulcers) & are important for odor & infection
control.
1. Complete the “pre-procedure” steps/actions.
SUPPLIES NEEDED:
 mattress pad - top sheet
 bottom sheet - blanket
 lift (draw) sheet - bedspread
 bed protector - pillowcase
PROCEDURES FOR MAKING AN UNOCCUPIED (CLOSED) BED

2. Place the linens on a clean surface close to the bed

(example: the over-bed table).
3. Make sure that the bed is positioned at a comfortable
working height & that the wheels are locked.
4. Lower the side rails & move the mattress to the head of
the bed (it may have shifted toward the foot of the bed if
the occupant of the bed had the head of the bed
elevated).
NOTE: The mattress pad, bottom sheet & draw sheet are
positioned & tucked in on one side of the bed before
moving to the other side to complete these actions. This
is most efficient in terms of energy & time.
 PROCEDURES FOR MAKING AN UNOCCUPIED
(CLOSED) BED
5. Place the mattress pad on the bed & fold it so
that only one vertical crease remains. Make sure
that this crease is centered on the mattress. If the
mattress pad is fitted, carefully pull the corners of
the near side over the corners of the mattress &
smooth down the sides. If the mattress pad is flat,
make sure the top of the pad is even with the
head of the mattress. Open the mattress pad
across the bed, taking care to keep it centered.
 PROCEDURES FOR MAKING AN UNOCCUPIED
(CLOSED) BED
6. Place the bottom sheet on the bed. If the bottom sheet
is fitted, carefully pull the corners of the near side over
the corners of the mattress & smooth down the sides.
If the bottom sheet is flat:
a) Place the sheet so that when you fold it, the wide hem
will beat the head of the bed & the hem stitching will
be against the mattress, away from the person who
will be occupying the bed.
b) Unfold the sheet so that only one vertical crease
remains. Make sure that this crease is vertically
centered on the mattress.
 PROCEDURES FOR MAKING AN UNOCCUPIED
(CLOSED) BED
c) Open the sheet across the bed, taking care to keep it
centered. The same length of sheet (approx. 12-18
inches) should hang over each side of the bed. Make sure
that the lower edge of the sheet is even with the foot of
the mattress.
d) Tuck the sheet under the mattress at the head of the
bed & miter the corner.
e) Tuck the near side of the sheet underneath the mattress,
working from the head of the bed toward the foot. As
you tuck, make sure there are no wrinkles in the sheet &
that the mattress pad remains smooth and in place.
PROCEDURES FOR MAKING AN UNOCCUPIED (CLOSED)
BED
7. Place the lift sheet on the bed so that the top of
the sheet is approx. 12 inches from the head of
the mattress. If you are using a plastic or
rubberized lift sheet, place a cotton lift sheet on
top of it. Smooth the lift sheet across the bed &
tuck the near side under the mattress.
8. Now, move to the other side of the bed & repeat
the process of aligning the mattress pad, mitering
the corner & tucking in the bottom sheet & lift
sheet.
 PROCEDURES FOR MAKING AN UNOCCUPIED
(CLOSED) BED
9. Place the top sheet on the bed so that when you unfold it, the
wide hem will be at the head of the bed & the hem stitching
will be facing upward, away from the person who will be
occupying the bed.
a) Unfold the sheet so that only one vertical crease remains.
Make sure that this crease is centered vertically on the
mattress.
b) Open the sheet across the bed, taking care to keep it
centered. The same length of sheet (approx. 12-18 inches)
should hang over each side of the bed. Make sure that the
top edge of the sheet is even with the head of the mattress.
Pull the bottom of the sheet over the foot of the bed, but do
not tuck it in yet (it will be tucked in with the blanket &
bedspread).
 PROCEDURES FOR MAKING AN UNOCCUPIED
(CLOSED) BED
10. Place the blanket on the bed & unfold it in the
same manner as the sheet, keeping the center
crease in the center of the bed. The same length
of blanket (approx. 12-18 inches) should hang
over each side of the bed. Make sure that the top
edge of the blanket is approx. 6-8 inches from the
head of the mattress. Fold the top edge of the
sheet back over the top edge of the blanket,
creating a cuff. Pull the bottom edge of the
blanket over the sheet at the foot of the bed, but
do not tuck anything in yet.
 PROCEDURES FOR MAKING AN UNOCCUPIED
(CLOSED) BED
11. Place the bedspread on the bed & unfold it in the
same manner as the sheet, keeping the center
crease in the center of the bed. The sides of the
bedspread should be even & cover all of the other
bed linens. Make sure that the top of the
bedspread is even with the head of the mattress,
unless the pillow is to be tucked under the
bedspread (in which case you will need to allow
more length at the top). Pull the bottom of the
bedspread over the blanket & sheet at the foot of
the bed.
PROCEDURES FOR MAKING AN UNOCCUPIED (CLOSED)
BED
12. Together, tuck the bedspread, the blanket & the top
sheet under the foot of the mattress. Make a mitered
corner at the foot of the bed on both sides.
13. Fold the top of the bedspread back over the blanket to
make a cuff.
14. Rest the pillow on the bed. Grasping the closed end of
the pillowcase, turn the pillowcase inside out over your
hand & arm. Grasp the pillow through the pillowcase &
pull the pillowcase down over the pillow. Make sure any
tags or zippers are on the inside of the pillowcase.
15. Place the pillow on the bed with the open end of the
pillowcase facing away from the door.
16. Complete the “post-procedure”.
 PROCEDURE: MAKING AN
OCCUPIED BED
1. Complete the “pre-procedure” steps/actions.
SUPPLIES:
 Gloves - Bed protector
 Bath blanket - Top sheet
 Mattress pad - Blanket
 Bottom sheet - Bedspread
 Lift (draw) sheet - Pillowcase
2. Place the linens on a clean surface close to the
bed (example: over-bed table).
 PROCEDURE: MAKING AN
OCCUPIED BED
3. Make sure that the bed is positioned at a
comfortable working height.
4. Remove the call-light control & check the bed for
dentures or any other personal items.
5. Lower the head of the bed so that the bed is flat (as
tolerated).
6. Put on the gloves (the linens may be wet or soiled).
7. Remove the bedspread & blanket from the bed. If
they are to be reused, fold them & place them on a
clean surface, such as a chair.
 PROCEDURE: MAKING AN
OCCUPIED BED
8. Loosen the top sheet at the foot of the bed &
spread a bath blanket over the top sheet ( and the
person).
9. If the person is able, have her hold the bath
blanket. If not, tuck the corners under the
person’s shoulders. Remove the top sheet by
pulling it out from underneath the bath blanket,
being careful not to expose the person.
10. Place the top sheet in the linen hamper or linen
bag.
 PROCEDURE: MAKING AN
OCCUPIED BED
11. If the side rails are in use, lower the side rail on
the working side of the bed. The side rail on the
opposite side of the bed should remain up. Turn the
person onto her side so that she is facing away from
you. Reposition the pillow under the person’s head
& adjust the bath blanket to keep the person
covered.
12. Loosen the lift sheet, bottom sheet & (if
necessary) the mattress pad.
13. Fanfold the bottom linens toward the person’s
back, tucking them slightly underneath her.
 PROCEDURE: MAKING AN
OCCUPIED BED
14. Straighten the mattress pad (if not being changed).
If the mattress pad is being changed, place the clean
mattress pad on the bed & unfold it so that only one
vertical crease remains. Make sure that this crease is
centered vertically on the mattress. If the mattress
pad is fitted, carefully pull the corners of the near
side over the corners of the mattress & smooth
down the sides. If the mattress pad is flat, make sure
the top of the pad is even with the head of the
mattress. Fanfold the opposite side of the mattress
pad close to the patient or resident.
 PROCEDURE: MAKING AN
OCCUPIED BED
15. Place the clean bottom sheet on the bed. If the
bottom sheet is fitted, carefully pull the corners
over the corners of the mattress & smooth down
the sides. If the bottom sheet is flat:
a) Place the sheet so that when you unfold it, the
wide hem will be at the head of the bed & the hem
stitching will be against the mattress, away from
the person who will be occupying the bed.
b) Unfold the sheet so that only one vertical crease
remains. Make sure that this crease is centered
vertically on the mattress.
 PROCEDURE: MAKING AN
OCCUPIED BED
c) Open the sheet across the bed, taking care to keep it
centered. The same length of sheet (approx. 12-18
inches) should hang over each side of the bed. Make sure
that the lower edge of the sheet is even with the foot of
the mattress. Fanfold the opposite side of the sheet close
to the patient/resident.
d) Tuck the sheet under the mattress at the head of the
bed & miter the corner.
e) Tuck the near side of the sheet underneath the mattress,
working from the head of the bed toward the foot. As
you tuck, make sure there are no wrinkles in the sheet &
that the mattress pad remains smooth & in place.
 PROCEDURE: MAKING AN
OCCUPIED BED
16. Place the lift sheet on the bed so that the top sheet is
approx. 12 inches from the head of the mattress. If you
are using a plastic or rubberized lift sheet, place a
cotton lift sheet on top of it. Fanfold the opposite side
of the lift sheet close to the patient/resident. Smooth
the lift sheet across the bed & tuck the near side under
the mattress.
17. Raise the side rail on the working side of the bed.
Help the person to roll toward you, over the folded
linens. Reposition the pillow under the person’s head
& adjust the bath blanket to keep the person covered.
 PROCEDURE: MAKING AN
OCCUPIED BED
18. Move to the other side of the bed & lower the side rails.
19. Loosen & remove the soiled bottom linens & place them
in the linen hamper or linen bag. Change your gloves if
they become soiled.
20. Now, repeat the process of aligning the mattress pad,
mitering the corner & tucking in the bottom sheet & lift
sheet.
21. Help the person to move to the center of the bed &
position her comfortably. Raise the side rails on the
working side of the bed.
22. Change the pillowcase & place the pillow under the
person’s head.
 PROCEDURE: MAKING AN
OCCUPIED BED
23. Place the clean top sheet over the person (who
is still covered with the bath blanket), being
careful not to cover her face. The sheet should be
placed so that when you unfold it, the wide hem
will be at the head of the bed & the hem stitching
will be facing upward, away from the person who
will be occupying the bed.
a) Unfold the sheet so that only one vertical crease
remains. Make sure that this crease is centered
vertically on the mattress.
 PROCEDURE: MAKING AN
OCCUPIED BED
b) Open the sheet across the bed, taking care to
keep it centered. The same length of sheet
(approx. 12-18 inches) should hang over each side
of the bed.
c) If the person is able, have her hold the top sheet.
If not, tuck the corners under her shoulders.
Remove the bath blanket by pulling it out from
underneath the top sheet, being careful not to
expose the person. Place the bath blanket in the
linen hamper or linen bag.
 PROCEDURE: MAKING AN
OCCUPIED BED
24. Place the blanket & then the bedspread over the
top sheet. Together, tuck the bedspread, blanket
& the top sheet under the foot of the mattress.
Make a mitered corner at the foot of the bed on
both sides.
25. Make a toe pleat by grasping the top sheet, the
blanket & the bedspread over the person’s feet &
pulling the linens straight up. The toe pleat allows
the person to move her feet & helps to relieve
pressure on the feet from tightly tucked linens.
 PROCEDURE: MAKING AN
OCCUPIED BED
26. Lower the bed to its lowest position & make
sure that the wheels are locked. Raise the head of
the bed as the person requests.
27. Remove your gloves & dispose of them in a
facility-approved waste container.
28. Complete the “post-procedure” steps/actions.