How should the CNA handle the soiled linens removed from a patients bed in order to avoid spreading infection?
IntroductionBedpan use in today's society is not that different from use in the 18th century. Bedpans are a way of addressing elimination concerns when the traditional toilet is not an option due to high risk of injury or debilitating illness in sick, bed-confined individuals.[1][2][3] Show
There are 2 types of bedpans: regular or fracture. The regular bedpan is larger than its fracture counterpart. The fracture pan has one flat end for ease of use with specific patient populations: i.e., hip fractures, hip replacements, or lower extremity fractures. Bariatric bedpans are available up to a 1200-pound (544-kg) capacity.[4] Using the toilet may be a source of discomfort and embarrassment among all genders. Semi-private rooms or shared wards and hospital overcrowding are a challenge regarding patient privacy.[5][6] IndicationsMedical necessity may warrant the use of a bedpan, for example as with immobile patients with the following concerns:
EquipmentBedpans come in regular size or a smaller, fracture pan. Bedpans are chosen based on diagnosis, patient comfort or preference and if any contraindications exist for using the regular size such as a fracture. Gather all supplies before you start the procedure.[7][8] Supplies
TechniquePlacing a patient on a bedpan requires a special technique and is reserved for those that are on bed rest per a health care provider order or discretion. Follow any preset institutional policies on the use of a bedpan in a clinical setting. A patient that can assist with care by raising their hips is approached differently than a patient that cannot lift their hips due to surgical considerations, fractures, or other contraindications. In both cases, ensure the patient is pulled up as high as they can be on the stretcher or bed. If they can assist with raising their hips, then raise the head of the bed at least thirty degrees. Positioning in this Semi-Fowler's position allows for anatomical support and facilitates ease of defecation or urination by assuming a natural position for these bodily functions. According to a 2003 study, body positioning has a significant influence on intestinal gas propulsion and transit times with gastric flow being faster in the upright position than when supine [Dainese, Serra, Azpiroz & Malagelada, 2003]. Steps
ComplicationsComplications surrounding bedpan use may include constipation, embarrassment, discomfort, and loss of dignity due to inadequate patient privacy. Privacy and Dignity An audit conducted in 2010 addressed "Toilet Privacy in the Hospital" [Logan, 2012]. Comments from patients and staff highlighted certain critical areas of concern in regards to toileting, privacy, and confidentiality. Areas of interest amongst patients while toileting consisted of specific vital points, for example, call light out of reach or cord too short, slow response to call light, lack of hand hygiene after toilet use for the patient, curtains that would not close properly and lack of privacy while toileting. Suggestions were made to improve patient privacy while defecating or urinating such as better signage [Logan, 2012]. Constipation Another complication of bedpan use can be constipation. An environment that lacks appropriate privacy may force a patient to feel that it is inconvenient to use the toilet, thus resisting the urge to defecate. If defecation is discommoding, the desire to defecate prompts voluntary contraction of the external sphincter and puborectalis muscle. This urge dissipates, and the rectum accommodates to hold more stool (as cited in Sun, Read & Miner, 1990)[Rao et al., 2016]. A study conducted between 2003 and 2004 on stroke patients found that (55.2%) developed new-onset constipation within a month after the first stroke [Su et al.,2009]. The study went on to conclude that patients with moderate severity of stroke (NIHSS 4 -11) on arrival had a higher incidence of bedpan use, thus poor outcomes at 3 months post-stroke as a result of the added complication of constipation. The study recommended a suitable environment for defecation for stroke patients to curb new-onset constipation and improve patient outcomes [Su et al., 2009]. A study sponsored by the Italian Space Agency analyzed ten healthy men for the effects extended bedrest had on the body as it related to new onset constipation. The men were studied for 35 days in a controlled environment on strict bedrest with bedpan use for defecation in a lying, head down position. At the end of the study, 60% had new onset functional constipation [Iovino et al., 2013]. Clinical SignificancePatients in need of toileting with the use of a bedpan can impose specific inherent risks, thus should be used with the knowledge of the emotional and physical implications in a clinical setting. This task should not be used for provider convenience, but with certain criteria for client selection to meet the standard of care. Staffing challenges may lead to delays in answering call lights and providing toileting assistance. These delays of care may place a patient at risk for falls and incontinence, thus contributing to emotional and physical duress. Missed care opportunities lead to a decrease in patient satisfaction and overall perception of care. Therefore reimbursement of care may be affected by a trickle-down effect with negative patient satisfaction scores.[9][10] Enhancing Healthcare Team OutcomesThe bedpan is a useful medical equipment that is used frequently in hospitals. The nurses are primarily involved in the management of the bedpan with assistance from the therapists. The important features of bedpan are not only to provide a functional use for the patient, but comfort and privacy. If a bed pan is to be used, it should be for a short duration. there are countless cases of pressure sores, ulcers and neuropathy from patients being left too long on the bed pan. Unfortunately, managing the bed pan is not easy for the nurse when patients are obese and have limitations in movement; plus spillage of the contents is a major problem. Review QuestionsFigureBedpan examples, fracture pan included. Contributed by Tammy J. Toney-Butler, AS, RN, CEN, TCRN, CPEN References1.Kozak A, Freitag S, Nienhaus A. Evaluation of a Training Program to Reduce Stressful Trunk Postures in the Nursing Professions: A Pilot Study. Ann Work Expo Health. 2017 Jan 01;61(1):22-32. [PMC free article: PMC6824526] [PubMed: 28395308] 2.Farrington N, Hill T, Fader M, Richardson A. Supporting women with toileting in palliative care: use of the female urinal for bladder management. Int J Palliat Nurs. 2016 Nov 02;22(11):524-533. [PubMed: 27885906] 3.Inauen P, Wittwer Y, Saxer S. [Research report: urination tubes instead of bedpan]. Krankenpfl Soins Infirm. 2011;104(10):22-3. [PubMed: 21991769] 4.Saxer S, Gattinger HA, Dopler R, Scheffel S, Werner B. [Frequency of using the bedpan in acute care]. Pflege. 2011 Oct;24(5):297-302. [PubMed: 21964933] 5.Pellatt GC. Anatomy and physiology of urinary elimination. Part 1. Br J Nurs. 2007 Apr 12-25;16(7):406-10. [PubMed: 17505362] 6.Bekhøj L, Eltzholtz AB. [Hygiene nurse--when bedpan boilers break down]. Sygeplejersken. 1997 Aug 22;97(34):26-7. [PubMed: 9386588] 7.Sonoda T, Masumoto T. [Innovation in nursing equipment. A bathroom for the orthopedic department]. Kango Gijutsu. 1980 Oct;26(14):1934-5. [PubMed: 6904593] 8.BRANSON HK. THE BEDPAN RECONSIDERED. Hosp Manage. 1964 Jul;98:78 PASSIM. [PubMed: 14154394] 9.Guay M, Dubois MF, Desrosiers J. Can home health aids using the clinical algorithm Algo choose the right bath seat for clients having a straightforward problem? Clin Rehabil. 2014 Feb;28(2):172-82. [PubMed: 23897948] 10.Putre L. Lifting spirits with bedpan shuffleboard. Hosp Health Netw. 2013 Jan;87(1):63. [PubMed: 23413624] How should the CNA handle the soiled linens removed from a patient's bed in order to avoid spreading infection?A: According to Fundamentalsof Nursing, when handling linens:. You should always wash your hands after handling a patientsbed linens.. You should hold soiled linen away from your uniform.. Soiled linen is never shaken in the air because shaking candisseminate the micro-organisms they contain.. What is the correct procedure after removing soiled linen from a patient's bed?Place soiled linen into a clearly labeled, leak-proof container (e.g., bag, bucket) in the patient care area. Do not transport soiled linen by hand outside the specific patient care area from where it was removed. Reprocess (i.e., clean and disinfect) the designated container for soiled linen after each use.
When handling soiled linen you should CNA?Standard precautions should be practiced and gloves should be worn when handling linen, that maybe soiled. You may encounter blood and body fluids that carry harmful pathogens such as HIV and Hepatitis B and C. Prevent skin and clothing contact by holding linens away from your uniform.
What is the correct way to handle soiled linens?To handle soiled linen, treat it the same way you may treat any other biohazard – with care to reduce the risk of injury or cross-contamination. First, remove any soiled linen. Ensure that your hands are covered by reusable rubber gloves to minimize contact with any fluids or other materials.
|