9.1 Bathing and the Bed Bath (INACE Skill)
Key Takeaways
- INACE = 85-question written test (90 min) plus a skills evaluation from 21 mandated tasks, by SIUC for IDPH
- Bed bath water temperature is 105°F-110°F — always verify before it touches the resident
- Wash clean to dirty: eyes, face, arms, chest, legs, back, perineum (last); far side before near side
- Eyes: inner to outer corner, fresh cloth section per eye, no soap
- Keep the resident covered except the part being washed; pat dry to protect fragile skin
- Report non-blanchable redness, skin tears, bruising, and color changes to the nurse
Bathing on the Illinois Nurse Assistant Competency Exam (INACE)
The Illinois Nurse Assistant Competency Exam (INACE) is administered by Southern Illinois University Carbondale (SIUC) on behalf of the Illinois Department of Public Health (IDPH). It has two parts: an 85-question written test (90 minutes) and a manual skills evaluation drawn from 21 mandated performance skills. Bathing tasks — the partial bath and components of bed bathing — sit inside the personal-care cluster, and the evaluator scores you against a published checklist where every step is either performed or missed.
Two steps are scored on nearly every skill: washing your hands at the start and placing the call light within reach at the end. Skip either and you can fail an otherwise perfect skill.
Types of Baths
| Type | Description | When Used |
|---|---|---|
| Complete bed bath | CNA washes the entire body in bed | Total-care, bed-bound residents |
| Partial bath | Wash face, hands, axillae (underarms), back, buttocks, perineum | Daily care; an INACE checklist skill |
| Tub bath | Resident sits in a bathtub | Ambulatory residents who transfer safely |
| Shower | Resident stands or uses a shower chair | Mobile residents; limit to ~20 minutes |
| Whirlpool/therapeutic | Agitated water for circulation/wound care | Per nurse order only |
Bed Bath / Partial Bath Procedure
Setup: Wash hands, gather supplies (basin, 2-3 washcloths, towels, soap, clean gown, bath blanket, gloves), identify the resident by checking the ID band against the name, explain the task, and provide privacy by closing the door and pulling the curtain. Raise the bed to hip height to protect your back, lock the wheels, and lower the side rail on your working side. Offer toileting first.
Water temperature: Fill the basin to about two-thirds with water at 105°F-110°F (40.5°C-43.3°C). Test it with a bath thermometer or the inside of your wrist before it touches the resident. Elderly residents have reduced thermal sensation and may not feel scalding water — the CNA, not the resident, owns burn prevention. Change the water the moment it turns cool, soapy, or visibly dirty, and always change it before perineal care.
Wash Order — Clean to Dirty
| Step | Area | Technique |
|---|---|---|
| 1 | Eyes | Inner canthus to outer canthus; a clean section of cloth for each eye; no soap |
| 2 | Face, ears, neck | Mild soap or plain water; pat dry |
| 3 | Far arm, then near arm; hands | Distal-to-proximal strokes promote venous return; soak hands; dry between fingers |
| 4 | Chest, abdomen | Wash, rinse, dry; recover with bath blanket at once |
| 5 | Far leg, then near leg; feet | Support the joint; soak and dry between the toes to prevent fungal maceration |
| 6 | Back, buttocks | Side-lying; good moment for a back rub and a skin check |
| 7 | Perineum | Last — fresh water, fresh gloves, front to back |
Core Principles and Common Traps
- Wash far side before near side so you do not drip dirty water across a clean area.
- Expose only the body part being washed; keep the rest under the bath blanket for warmth and dignity.
- Pat dry, never rub — friction shears fragile aging skin and can start a skin tear.
- Promote independence: let the resident wash their own face and any reachable area.
- Trap: applying lotion to a wet or unrinsed area traps soap and macerates skin — dry first.
- Trap: leaving the bed raised or the side rail down after care; restore the bed to its lowest position and replace rails per the care plan.
Worked Example: A Scored Partial Bath
Imagine the evaluator hands you a scenario card: "Mr. Alvarez has had a left-sided stroke and is on bed rest. Give a partial bath and provide perineal care." A passing performance looks like this. You knock, enter, wash your hands at the sink for the full count, and greet him by checking his ID band against the name on your card. You explain, "I'm going to help you wash up now," close the door, and pull the privacy curtain. You raise the bed to hip height, lock the wheels, and lower the near side rail. You fill the basin, then bring it to him and let him verify it feels comfortable.
You wash his face with no soap, then his hands and underarms, changing the water before you move to the perineum. You glove for peri care, clean front to back, remove the gloves, and wash your hands again. Finally you lower the bed, raise the rail per his care plan, and place the call light within reach before you say goodbye. Miss the call light or the second hand wash and the skill is failed even though the resident looks clean — the checklist scores the safety steps, not just the result.
Special Situations
| Situation | Adjustment |
|---|---|
| Resident with an IV line | Remove the gown from the unaffected arm first, then thread the IV arm and bag through the sleeve last; never disconnect tubing |
| Casted limb | Keep the cast dry; wash around it and check fingers/toes for color, warmth, and swelling |
| Dementia with agitation | Work calmly, narrate each step, consider a towel-bath method, and stop if the resident becomes distressed |
| Resident who refuses | Honor the right to refuse, document it, and report to the nurse — never force care |
Skin Findings to Report
| Finding | Why It Matters |
|---|---|
| Non-blanchable redness over a bony prominence | Stage 1 pressure injury |
| Skin tear or open area | Wound; infection risk |
| Unexplained bruising | Possible fall or abuse |
| Rash, itching, white patches | Allergy, fungal infection, dermatitis |
| Edema | Fluid retention / circulatory change |
| Cyanosis, jaundice, pallor | Oxygenation or liver signal |
What is the correct water temperature range for a bed bath?
When giving a bed bath, which area is washed FIRST?
During a bed bath you find a red area over the resident's tailbone that does not turn white when you press on it. What should you do?