What equipment should a CNA use when it's time to change an incontinent patient's clothes?

According to the Centers for Medicare and Medicaid Services (CMS), more than 50% of nursing home residents experience some degree of incontinence, making proper care a critical skill for any CNA. Knowing what equipment should a CNA use when it's time to change an incontinent patient's clothes is vital for ensuring hygiene, comfort, and safety.

Quick Summary

CNAs require specific equipment for incontinence care, including personal protective equipment (PPE) like gloves and gowns, disposable wipes or washcloths, adult briefs or pads, barrier cream, and a waterproof bed pad. This ensures a sanitary environment, protects the caregiver, and promotes the patient's skin health during the process.

Key Points

• Gloves and Gown: Always use personal protective equipment to ensure infection control for both the CNA and the patient.

• Cleanliness is Key: Use disposable wipes or warm washcloths for thorough cleaning, and change gloves if they become soiled.

• Protect the Skin: Apply a barrier cream to the perineal area after cleaning and drying to prevent skin breakdown from moisture.

• Protect the Bed: Place a disposable bed pad or 'chux' under the patient to protect bed linens during the change.

• Dignity and Communication: Explain each step of the process to the patient and maintain their privacy to foster trust and respect.

• Choose the Right Product: Use the appropriate adult brief or pad based on the patient's mobility and level of incontinence.

The Essential Checklist: What a CNA Needs

Properly preparing for an incontinent patient's clothes change is crucial for efficiency, infection control, and patient comfort. Having all necessary items within reach before starting saves time and minimizes patient discomfort.

Personal Protective Equipment (PPE)

Before any contact with the patient, the CNA must don the correct PPE. This is a non-negotiable step to protect both the caregiver and the patient from potential cross-contamination.

• Disposable Gloves: A fresh pair of gloves is essential for any task involving bodily fluids. It is often necessary to change gloves during the procedure, especially if they become soiled, to prevent spreading bacteria.
• Disposable Gown: A gown protects the CNA's uniform and skin from splashes and contact with soiled materials, further enhancing infection control.

Cleaning Supplies

Thorough cleaning is the most important part of incontinence care, as residual moisture and waste can lead to serious skin issues, such as moisture-associated skin damage (MASD).

• Pre-moistened Wipes or Washcloths: Using pre-moistened disposable wipes or warm, soapy washcloths is critical for cleaning the perineal area thoroughly. Wipes are convenient and help ensure a front-to-back cleaning motion.
• Basin with Warm Water and Soap: For more thorough cleaning, a basin with warm water and a mild, non-irritating soap can be used with fresh washcloths. Ensure all soap residue is rinsed away to prevent irritation.
• Disposable Bed Pad (Chux): A chux pad or waterproof pad placed under the patient protects the bed linens from soiling during the change.
• Large Plastic Bag for Soiled Linens: Having a designated bag nearby for soiled briefs and chux makes disposal quick and sanitary.

Skin Protection

After cleaning and drying, protecting the patient's skin is a top priority. Incontinence can cause significant skin irritation, so a protective barrier is necessary.

• Barrier Cream or Ointment: A specialized barrier cream should be applied to the perineal area after cleaning and drying to create a protective layer against moisture. This is a key step in preventing skin breakdown and pressure sores.

New Incontinence Products

Finally, the new products for the patient should be ready to apply as soon as cleaning is complete.

• New Adult Brief or Pad: The correct size and absorbency level of brief or pad is essential for both comfort and leak protection.
• Clean Clothes: Having a fresh set of clothes ready minimizes the time the patient is exposed and vulnerable.

Step-by-Step Procedure for Changing a Patient

Following a consistent and careful procedure ensures safety, dignity, and efficiency.

1. Gather Supplies and Knock: Collect all necessary equipment and place it within easy reach. Knock on the patient's door and introduce yourself.
2. Hand Hygiene and Privacy: Wash your hands thoroughly and pull the privacy curtain. Raise the bed to a comfortable working height for the CNA and lower the head of the bed.
3. Position the Patient: Explain the procedure to the patient. Undo the fasteners on the old brief. Gently turn the patient onto their side, away from you, and roll the soiled brief inward to contain waste.
4. Clean the Perineal Area: Use wipes or a washcloth to clean the genital and perineal area, wiping from front to back. Use a clean wipe for each stroke and continue until the area is completely clean. Remove and replace gloves if they become soiled during this process.
5. Dry and Apply Barrier Cream: Pat the skin completely dry with a clean cloth. Apply a thin layer of barrier cream to the clean, dry skin.
6. Place New Brief: Tuck the new, folded brief underneath the patient, aligning the front and back properly.
7. Complete the Change: Roll the patient back, pull the new brief up and into position, and secure the fasteners. Ensure the fit is snug but not too tight.
8. Final Touches: Reposition the patient comfortably, lower the bed, and raise the side rails. Dispose of all waste, remove gloves and gown, and wash hands once more.

Comparison of Incontinence Products

Feature	Briefs with Tabs	Pull-up Underwear	Protective Underpads (Chux)
Application	Ideal for bedridden or less mobile patients; easier to change in a lying position.	Best for mobile patients who can participate in their own care; mimics regular underwear.	Used to protect bedding and furniture, not as the primary absorbent product.
Absorbency	Available in multiple levels, from moderate to super absorbent for heavy or overnight use.	Generally for moderate to heavy incontinence; less absorbent than briefs with tabs.	Primarily for surface protection; not designed for high volume absorption.
Leak Protection	Often features leg cuffs and refastenable tabs for a secure, customizable fit.	Designed for discreet, comfortable fit; can have leakage issues with heavy output.	Provides a last line of defense for spills and accidents, not full protection.
Convenience	Excellent for bed changes and patients with limited mobility.	Promotes dignity and independence for more active patients.	Highly versatile for use in beds, chairs, or wheelchairs.

Conclusion: Prioritizing Comfort and Dignity

Incontinence care is a fundamental part of a CNA's role, and having the right equipment is just the beginning. The process must always be handled with respect for the patient's dignity and a focus on preventing skin complications. By preparing properly with PPE, cleaning supplies, and skin protectants, CNAs can perform this critical task with confidence and care. Mastering this skill not only protects the health of the patient but also fosters trust and respect in the caregiver-patient relationship.

For more detailed protocols on hygiene and infection control in healthcare settings, refer to guidance from the National Institutes of Health. https://pmc.ncbi.nlm.nih.gov/articles/PMC2492984/

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Frequently Asked Questions

What is the most important piece of equipment for a CNA to use during an incontinent patient change?

The most important equipment is personal protective equipment (PPE), specifically disposable gloves and a gown. These protect the caregiver and patient from infection by preventing contact with bodily fluids during the process.

How often should a CNA change an incontinent patient's clothes and briefs?

Incontinent patients should be checked regularly and changed immediately if their briefs are soiled. Regular schedules, such as every two hours, are common for proactive checks, but prompt changes are crucial to prevent skin irritation.

Why is barrier cream important when changing an incontinent patient?

Barrier cream is important for preventing skin breakdown. It creates a protective layer on the skin that shields it from moisture and corrosive bodily fluids, which can lead to rashes, irritation, and serious skin conditions.

Can CNAs use regular washcloths instead of disposable wipes?

Yes, regular washcloths and mild soap are a viable option, but they must be clean and used with clean water. Disposable wipes are often preferred for convenience and sanitation, as they are single-use and pre-moistened.

How should a CNA dispose of soiled briefs and linens?

Soiled briefs and disposable bed pads should be rolled up and placed in a designated plastic bag for disposal, according to facility protocol. Soiled reusable linens should be placed in a separate laundry bag.

What is a 'chux' and why is it used?

A 'chux' is a disposable, waterproof bed pad used to protect a patient's mattress and linens from spills and soiling during an incontinent episode or while changing a brief. It simplifies cleanup and keeps the bed sanitary.

What if a patient becomes agitated during a clothes change?

If a patient becomes agitated, a CNA should remain calm and use a soothing voice. It is important to assess the cause of agitation, ensure the patient is not in pain, and take a moment to pause if needed. Communication and a gentle, reassuring approach are essential.