Alright, so that probably wasn’t the best way to phrase what I’m going to be talking about in this post, but it’s definitely what you probably searched to find this information!
Maybe you’re starting nursing school clinicals, or maybe you’ve been away from the bedside for a while and are going to start caring for patients again, and need to brush up on how to effectively clean a bed-bound patient who has defecated. Well, you’re in the right place! Let’s get into it! (The details, I mean…)
Table of Contents
How To Clean A Poopy Patient
Let’s go through the practical steps to complete a bed change on a patient who has been incontinent.
Quick tip: I go through a video demo of this nursing skill (and many others) in this online course that was designed specifically for new nursing students.
1. Gather Supplies
First, take a look at the patient and assess the situation. Is this a full bed change (meaning we need a gown, incontinence pads, and a full set of new linens), or do we just need a new pad and some wipes?
Checking first is especially important if the patient is in an isolation room and running out real quick to grab something isn’t a fast process. You also don’t want to take in a bunch of unnecessary supplies because they pile up quickly.
You likely will need another person, as turning a bed-bound patient is almost always a 2-person job. The only time it’s a 1-person job is when the patient has enough upper body strength to hold themselves on both sides (which doesn’t happen a lot!).
Prior to moving the patient, it’s helpful to get your clean linen in arm’s reach and a trash can nearby as well. Grab your gloves (and possibly double glove!) and let’s get started!
2. Roll The Patient
The patient will have to roll side to side while each of you take turns cleaning and rolling out the dirty linen, and placing new linen on the bed. Therefore, each person needs to stand on either side of the bed. Sometimes, it’s much easier for a patient to roll to one side the other (in particular, stroke patients who have hemiparesis).
If the patient is verbal, ask them which way they prefer. The first time they roll to their side will take the longest.
Let’s say you’re going to be the first person to clean. Roll the patient away from you and have your coworker stabilize and hold them on their side. You can have them bend the leg closest to you 90 degrees, turn their hip towards your coworker, and pick up their shoulder, turning them on their side.
Tip: if the patient is able, have them hang on to the side rail
Another tip: If the patient is pretty dirty, wait to turn them. Sometimes feces can sneak through to the front, especially if patients have diarrhea. If the is the case, clean the front first before turning. If there is a lot, you can push it down to their backside in between their legs and place a towel or more clean wipes on top of it to prevent it from getting dirty again while the patient rolls. Cleaning the front first is helpful because it’s hard to do that with a patient on their side. If the patient is able, you can also “frog-leg” them, which exposes more, thus enabling you to clean better.
Make sure your coworker is stable and has a good grip, and then get to work.
3. Clean The Patient
First, use your wipes to clean all excrement off of their skin. Feel free to put your dirty wipes on the dirty pad because you’re going to throw it away anyway. (Don’t do this if you’re using washcloths, though!)
Clean. Clean. Clean. Once their skin is clean, you’ve got to make sure it won’t touch the dirty pad or linen as they turn. Ensure the skin is dry. (Using a clean washcloth is helpful!)
If you need to change all of the linen, you’ll then pop the corners of the linen off of the mattress. You will tightly roll the dirty linen and push it under the patient. If the pad isn’t too dirty, you can roll it so the dirty stuff is completely covered up and the only thing touching their skin is the back of the pad.
However, this may not be possible due to the quantity of feces or where it is. If so, grab a towel to place in between their clean skin and the pad, then roll it up.
Roll all of this up and push it as far as possible under the patient while they are still on their side.
(In the below video, I walk through how to put a patient on and take a patient off of a bedpan. The movements are very similar, so if this explanation is at all confusing, make sure you check this video out for a demo!)
4. Put On Clean Linens
Now grab your clean fitted sheet and pop it on the corners of your side. Push the clean sheet as far as possible under the patient. Then get your draw sheet, disposable pad, and/or brief (sometimes referred to as a diaper) and place it on the patient halfway, and pull it up in between their legs.
From your side, you should see: The patient’s clean backside, the sheet attached to the two corners on your side of the bed, the sheet halfway covering the bed and flat out, and a disposable pad, rolled up and under the patient.
5. Turn The Patient Again
Now, it’s time to turn the patient toward you, and have your coworker finish up. Tell the patient they’re going to roll over a big bump, and slowly roll them towards you.
6. Repeat On Other Side
Now, you will hold the patient in a comfortable position on their side. Your coworker will pull out all of the dirty linen, carefully as not to dirty the new linen. They will clean any additional skin that is still dirty. Then, they will pull through all of the clean linen, attach the sheet corners to the bed, and flatten out the pad. Then the patient can be laid on their back.
7. Make Final Adjustments
Once the patient is flat on their back, then change their gown. (If it was visibly soiled in the beginning, you’d want to remove it earlier and wait to put the new one on until they’re all squeaky clean.) They will naturally have sunk down into the bed and will need to be boosted up.
Boost the patient, ask if they want just a sheet over them or also a blanket, place pillows where they would like, and spray some deodorizer if necessary.
Some people feel bad spraying deodorizer, but let’s be honest – the patient knows they had a bowel movement, knows you just cleaned it up, and spraying a little room deodorizer isn’t going to be what makes them upset or feel bad. They typically appreciate it. (And they probably don’t want to smell it either!) This is especially helpful if you have to ask guests to step out, and you know they’ll be back in the room. Do what you can to make it seem like you didn’t just do what you did. This may include taking out the trash as well.
Before you leave, make sure they’ve got their call light nearby, bed alarm back on, and all necessities within arm’s reach.
Tips to Prevent Patient Injury
Patients can make unpredictable movements, or you can be in an uncomfortable position, or they can be quite heavy. It is CRUCIAL that you take the necessary steps to prevent injury. I know multiple nurses who can no longer work at the bedside due to an injury sustained at the bedside.
Adjust the Height of the Bed
Adjust the patient’s bed, so it’s at a comfortable height for you, ensuring you’re not bending over the entire time and straining your back.
Lift Correctly
When lifting or moving patients, use proper ergonomics – lift with your legs and do not twist. We do not want an injury!
Use Assistive Devices
If you have lifts or assistive devices – USE THEM.
Remember, injury is never worth it. Protect your back and your health. If you get injured while caring for a patient, don’t try to stick it out. Go to employee health and get it taken care of as soon as possible. Don’t be a hero!
Use Barrier Cream (if indicated)
Many patient will benefit from a barrier cream on their coccyx to prevent skin breakdown. This isn’t always appropriate, so check with the primary nurse if you are unsure.
Now you know how to clean patients after bowel movements!
Frequently Asked Questions
Here are some answers to questions people might ask. If you have more questions, let me know, I’m happy to answer them.
Cleaning up a bowel movement for an elderly patient follows the same guidelines outlined above. Since the elderly often have fragile skin, pay close attention to this and execute the procedure with the gentleness required to prevent skin tears or injury.
Generally, only bedridden patients will need to be cleaned. The steps outlined above will help you fulfill this task. If a patient is not bedridden and requests a nurse to clean this, it requires additional investigation. There may be legitimate reasons, but generally, you need to encourage a patient to perform as many ADLs (activities of daily living) on their own as they can.
One of the most surprising things for many nursing students is that nurses clean poop. Nursing students will often encounter many opportunities to clean feces. However, not all nursing specialties routinely do this. If you work in an office, perioperative, or other ambulatory settings, it decreases the likelihood that you’ll have to clean it up, but never say never!
Yes, they often do. However, it depends on which nursing units the CNA is working on. CNAs who work in regular hospital units like med-surg, ICU, cardiology, orthopedics, oncology, as well as in nursing homes and skilled nursing facilities will. However, CNAs who work in settings like outpatient clinics likely will not.
School nurses, operating room nurses, public health, outpatient dialysis, infusion, case management, and outpatient nurses typically do not clean up after incontinent patients. Advanced practice nurses (APRNs, like nurse practitioners and CNRAs) do not as well. While APRNs can and know how to do this, they are typically not providing directly care and are functioning in a provider role which would not include cleaning up patients.
If you work in a hospital or nursing home, you likely do this every shift.
While everyone’s clinical experience is different, this will likely be part of your nursing school education.
More resources for nursing students
- Head to Toe Assessments vs. Focused Assessment – blog post
- 10 Mistakes Nursing Students Make (And How to Avoid Them) – free 26 page ebook
- Medical Administration Basics for Nursing Students
- Pharmacology Tips for Nursing Students – From a Nurse!
- How to Pass Nursing School Exams
- How to Survive Nursing School Masterpost
Getting ready for nursing school clinicals, but feeling unprepared?
Nursing School Clinical Prep from FreshRN is a self-paced video course that will prepare you for your first nursing clinical experience. Each lesson walks you through the basic tasks and concepts you will experience in the clinical setting. Once completed, you’ll feel comfortable in a hospital setting, understand the basics of what the bedside experience will feel like, and know insider tips and tricks that will make you feel confident and in control.
Question; If you were to get excrement on your face while changing a patient, do you take a moment to stop and clean yourself up before proceeding, or do you finish the job first?
A friend of mine is a nurses aid and had this very unpleasant thing happen to him. As he reached for a wipe to clean his face he was sharply reprimanded with “You finish your job first then clean yourself!”
This is not a joke.
I would be interested you read your reply!
So, I’ve actually had this happen to me! I would absolutely stop and clean myself. Feces on my face? Um – I don’t care how mad that other nurse gets – I’m cleaning it off my face before I continue. The only time I would consider not immediately pausing for a moment to clean myself up would be if the patient was hemodynamically unstable and it was an emergent situation. Honestly, kind of sounds like this person went on a power trip. I wouldn’t give it much weight. There’s no (spoken or unspoken) nursing rule when you need to finish the patient first before cleaning yourself up. Honestly, if I were a patient and noticed that, I’d tell the nurse to go take care of themselves first and I would gladly wait.
Is it ok to wear a mask when cleaning a poopy patient even if they are not on any precautions? An ER nurse once told me that every nurse has their “thing” that completely grosses them out. She said hers was poop. She dealt with it by wearing a mask when she deals with a poopy patient or has to change a colostomy bag, etc., and she puts peppermint essential oil on the inside of her mask to cover the smell of the poop.
Absolutely. This is a lot like spraying the room deodorizer. The patient knew they had a bowel movement, they know that you had to clean it up. There is no reason why you can’t wear a mask if it helps.
If the patient is constapated would it be ok to put q tips to break it up
In that case, I’d chat with the physician and get an order for an enema or something. You don’t want that to break off and get stuck in there and make things worse.
I do a thing in the event of faeces being glued on; I douse it with lotion to soften it for easier removal.
I find it especially helpful when skin is like tissue paper.
Is it possible to do this procedure without help? None of the nurses seem to help CNAs with this job.
It would be helpful for her to answer your question. I’m curious as well.
Of course, sometimes you can easily do it without help. But there are times you just cannot go it alone. In that case, as the nurse or CNA of that patient, you always take the business end.
I am not trained, but have recently taken on the responsibility as caretaker of my 84-year-old mother. Although not a concern when I started six months ago, her conditions have recently progressed to incontinence. I’ve always had an impression that we need to take care to avoid wiping fecal material into the genitalia–concerns include UTI as well as other consequences. So, my question is what is recommended to ensure adequate cleaning – especially when fecal matter has been in a diaper and spread toward the front of the patient? (Incidentally, my mother remains fiercely private and does not like anyone, including me, “pushing and poking” around her nether areas. I’m trying to understand what is important and what can be deferred.)
You essentially wipe front to back, and to appropriately clean after fecal incontinence in a diaper, you, unfortunately, must get to the “nether regions” or else a UTI can result. I recommend using warm wipes or washcloths that have been in warm water, and you could always have her use the wipes on the front side and push down towards the back and you clean the backside. Regardless, it’s crucial to do that or she will get repeated UTIs. This is one of those things that even though she doesn’t want it to happen, it’s non-negotiable or else she’ll get UTIs. I recommend emotionally processing and validating her fear/concern about privacy, likely the grief that comes along with losing that important aspect of caring for yourself, and ask what you can do to make it easier/more bearable. It’s a big deal to become incontinent and suddenly people are in your privates multiple times a day, so I definitely encourage the supportive emotional component.
My Girlfriends Grandmother recently moved an elderly couple into their spare bedroom. The husband is in his early 70s and is cannot control when he releases his feces. His wife whom is ending her 70s; does not sanitize herself accordingly after attempting to clean him(I have witnessed her first hand proceed to cook and continue daily activities with feces still on her hands). It took about a week and some for the entirety of her house to be stained by this odor. It is strong and has masked the ability to taste any food.
I understand that the smell imprint can be misleading, but aside from the household residents not minding. I have noticed that my Son and his Mother have been stained with this odor and that I too am being informed that I am smelling of feces.
What issues could arise from My Son, His Mother and I being exposed to this environment?
This can lead to serious complications. Specifically, E. coli, adenovirus, campylobacter, coxsackie virus, giardia, hepatitis A, Salmonella, and Shigella. This is a major health issue and about much more than the scent. If she is preparing food, this can result in foodborne illness. It is imperative that there is adequate hand washing after anal hygiene, or people will get sick. I highly recommend doing two things. First, educating the entire household on the importance. This is a helpful link: https://www.verywellhealth.com/what-is-the-fecal-oral-route-1760046 I then recommend her wearing exam gloves when she is cleaning her husband. These are one-time use and are thrown away. A box of them is only around $5 and can be found at Walmart, Target, CVS, etc. I also recommend having hand sanitizer nearby as well. I wonder if there also is not proper disposal of incontinence pads or cleaning of his linen that results in the smell. If possible, after he is cleaned, it would be best to dispose of any materials used in an outside garbage container so that it is not in the household. However, it sounds like this couple likely needs more support and wonder if they would qualify for home health assistance through their doctor.