Bed-Making, Patient Beds & Basic Body Positions

Bed-Making as an Infection-Control and Safety Task

Making a patient's bed correctly prevents skin breakdown, reduces fall risk, and limits the spread of pathogens between patients. PCTs must know the four bed types, safe bed operation, and the major body positions used for comfort, treatment, and procedures, since all three are tested together on the CPCT/A exam.

Types of Beds

A closed bed is fully made with linens pulled up and tucked, ready and waiting for a new admission. An open bed is a closed bed with the top linens folded back (fanfolded) to the foot of the bed so a patient can get in easily — this is the standard bed setup for an occupied room during the day. A surgical bed, also called a post-operative or recovery bed, has the top linens fanfolded to one side rather than the foot, so a stretcher can be positioned directly next to the bed for an easy, safe patient transfer after surgery or a procedure. An occupied bed is made while the patient remains in it, working from side to side with the patient turned onto their side, and is used for patients who cannot get out of bed at all.

Linen-Change Technique and Infection Control

Soiled linen should be rolled inward with the dirtiest surface contained, never shaken out, since shaking disperses skin cells, lint, and potentially infectious organisms into the air. Linens are changed from the head of the bed to the foot and worked side to side, with the bottom (contour) sheet, an optional draw sheet positioned under the patient's torso and hips for easier repositioning, and the top sheet applied in that order. A draw sheet is especially useful for repositioning patients who cannot assist, since two caregivers can use it to lift and shift the patient's weight without dragging skin across the mattress, which prevents shear and friction injuries.

Bed Operation and Safety

Hospital beds are electric and height-adjustable. Always raise the bed to a comfortable working height for staff while providing care to protect your own back, then return the bed to its lowest position before leaving the room to reduce the patient's fall-injury risk. Side rails should be used according to the care plan and facility policy — they can be a helpful safety aid for some patients but can also become a restraint and entrapment hazard for others, so never raise all side rails on a confused patient without a specific order to do so. Always lock the wheels or casters before transferring a patient into or out of bed, and keep the call light within the patient's reach at all times. Many facilities also use bed-exit alarms for patients at high fall risk — a PCT should never silence or disable an alarm without confirming with the nurse first.

Basic Body Positions

Positioning is used for comfort, to relieve pressure on the skin, to support breathing, to prepare for a procedure, or to manage a medical emergency.

Choosing and Maintaining a Position

Every position in the table above must be reassessed regularly: patients who cannot reposition themselves need to be turned according to the care plan, commonly every 2 hours, to prevent pressure injuries from developing. Semi-Fowler's is a frequent safety position for tube-fed or aspiration-risk patients because it keeps the head elevated above the stomach, reducing the chance of reflux moving into the airway. Sims' position is especially useful for an unconscious or heavily sedated patient because gravity helps secretions drain out of the mouth rather than pool and travel down the airway. Prone positioning is avoided in patients with recent abdominal surgery, severe cardiac or respiratory instability, or in late pregnancy, and should only be used per a specific order; lateral position should include a pillow between the knees and behind the back to maintain alignment and offload pressure points. Trendelenburg is used only under a provider's direction — it is not a routine comfort position, and a PCT should never place a patient into Trendelenburg on their own judgment without an order.

Correct bed type, safe bed operation, and accurate positioning are tested together on the CPCT/A exam because a mispositioned patient or an unsafely operated bed is one of the most common preventable sources of inpatient falls and pressure injuries.