9.1 Bathing and the Bed Bath (INACE Skill)
Key Takeaways
- Bed bath water temperature: 105°F-110°F — always check before applying to the resident
- Wash order follows clean to dirty: eyes → face → arms → chest → legs → back → perineal area
- Eyes: wash inner to outer corner, different area of washcloth for each eye, no soap
- Keep the resident covered except the area being washed to maintain privacy and warmth
- Change water when cool, soapy, or dirty — always change before perineal care
- Observe skin throughout the bath and report redness, breakdown, bruising, or changes to the nurse
Bathing and the Bed Bath (INACE Skill)
Bathing is one of the most common personal care tasks CNAs perform and is part of Duty Area 3 (Performing Personal Care Skills) on the INACE. Providing a bed bath is one of the 21 mandated performance skills. Bathing promotes hygiene, comfort, and skin integrity while providing an opportunity to assess the resident's skin condition.
Types of Baths
| Type | Description | When Used |
|---|---|---|
| Complete bed bath | CNA washes entire body in bed | Bed-bound residents; INACE tested skill |
| Partial bed bath | CNA washes face, hands, underarms, back, and perineal area | Daily or between complete baths |
| Tub bath | Resident sits in a bathtub | Ambulatory residents who can transfer safely |
| Shower | Resident stands or sits in shower | Ambulatory residents; shower chairs available |
| Whirlpool bath | Therapeutic bath with water jets | For wound care or therapeutic purposes |
Bed Bath Procedure (INACE Tested)
Before the Bath:
- Wash your hands and gather supplies (basin, washcloths, towels, clean gown, soap)
- Identify the resident and explain the procedure
- Provide privacy — close the door, pull the curtain, cover the window
- Raise the bed to a comfortable working height
- Offer the resident the opportunity to use the bathroom first
- Fill the basin with warm water (105°F-110°F / 40.5°C-43.3°C) — check temperature with your wrist or thermometer
- Remove the resident's gown while keeping them covered with a bath blanket
During the Bath — Wash Order (Clean to Dirty):
| Step | Area | Technique |
|---|---|---|
| 1 | Eyes | Wash from inner corner to outer corner; use a separate area of washcloth for each eye; NO soap |
| 2 | Face, ears, neck | Wash with plain water or mild soap; pat dry |
| 3 | Arms and hands | Wash from shoulder to fingertips (far arm first); soak hands in basin if desired; dry thoroughly |
| 4 | Chest and abdomen | Wash and dry; cover with bath blanket immediately |
| 5 | Legs and feet | Wash from thigh to feet; soak feet in basin if desired; dry between toes |
| 6 | Back | Turn resident on side; wash from neck to buttocks; good time for back rub |
| 7 | Perineal area | Wash LAST (dirtiest area); use fresh water; front to back for females |
Key Principles:
- Wash from clean to dirty (face first, perineal area last)
- Wash the far side of the body first, then the near side
- Keep the resident covered except for the area being washed — expose only what is necessary
- Change water when it becomes cool, soapy, or dirty — definitely change before perineal care
- Pat dry rather than rubbing — rubbing can damage fragile elderly skin
- Observe the skin throughout for redness, breakdown, bruising, or changes
- Promote independence — let the resident do as much as possible for themselves
Water Temperature Safety
| Temperature | Appropriate? |
|---|---|
| Below 100°F | Too cold — uncomfortable |
| 100°F - 105°F | Acceptable for some procedures |
| 105°F - 110°F | Ideal bath water temperature |
| Above 110°F | Too hot — risk of burns |
ALWAYS check water temperature before applying to the resident. Elderly residents have decreased sensation and may not feel water that is too hot, leading to burns.
Skin Observations During Bathing
Report these findings to the nurse:
| Finding | Possible Significance |
|---|---|
| Redness over bony prominences | Early pressure injury (Stage 1) |
| Open areas or tears | Skin tear or wound |
| Bruising | Possible fall or abuse |
| Rash or itching | Allergic reaction, infection, or skin condition |
| Dry, cracked skin | Dehydration; need for moisturizer |
| Edema (swelling) | Fluid retention; circulatory issues |
| Color changes | Cyanosis, jaundice, pallor |
| Unusual odor | Possible infection |
What is the correct water temperature range for a bed bath?
When giving a bed bath, which area of the body should be washed FIRST?
During a bed bath, you notice a red area over the resident's tailbone that does not disappear when you press on it. What should you do?