When Assisting a Client with a Portable Commode, You Should? The Definitive Guide

Studies show over 34% of falls in hospitalized older adults are toileting-related [1.6.3]. When assisting a client with a portable commode, you should prioritize their safety and dignity through proper preparation, communication, and infection control.

Quick Summary

Prioritize safety, dignity, and hygiene. Prepare the area, use proper transfer techniques, ensure privacy, and thoroughly clean the commode after each use.

Key Points

• Preparation is Crucial: Before starting, gather all supplies like gloves and wipes, and ensure the commode is stable, at the correct height, and has its wheels locked [1.2.1, 1.3.2].

• Prioritize Safety During Transfers: Use proper body mechanics, have the client wear non-slip shoes, and instruct them to use both armrests when sitting down to prevent tipping [1.2.1, 1.3.3].

• Respect Client Dignity: Always communicate what you are doing, provide as much privacy as is safely possible by closing doors and curtains, and be respectful and reassuring [1.5.3, 1.5.6].

• Ensure Thorough Hygiene: Always wear gloves when assisting with cleaning the client and when handling the commode bucket. For females, wipe from front to back to prevent infection [1.4.6].

• Follow Strict Cleaning Protocols: Empty and disinfect the commode bucket with a household cleaner after every use to prevent odors and the spread of germs [1.4.6, 1.3.8].

• Communicate Clearly: Talk the client through each step of the process to reduce anxiety and encourage their participation as much as they are able [1.5.4].

The Importance of Safe and Dignified Toileting Assistance

Assisting a client with a portable or bedside commode is a fundamental aspect of caregiving, particularly for those with limited mobility. The bathroom is a high-risk area for falls, with studies revealing that a significant percentage of falls among older adults are related to toileting activities [1.6.1, 1.6.4]. A rushed or improper transfer can lead to serious injury for both the client and the caregiver. Equally important is the psychological aspect; toileting is an intensely private act. Approaching this task with empathy, respect, and clear communication is crucial for maintaining the client's dignity and trust [1.5.3, 1.5.6]. This guide provides a comprehensive framework for ensuring that every step, from preparation to cleanup, is handled with the utmost care and professionalism.

Step 1: Preparation is Key to Safety

Before beginning the transfer, a few minutes of preparation can prevent complications and ensure a smooth process. A well-prepared environment minimizes risks and shows the client that their comfort and safety are paramount.

Gather All Necessary Supplies

Have everything within arm's reach before you start. This prevents you from having to leave the client unattended. Your supply list should include:

• Disposable gloves [1.3.5]
• Toilet paper
• Pre-moistened wipes or a basin of warm water with a washcloth [1.2.3]
• A clean towel for drying
• A waterproof pad for the bed or chair, if needed
• A change of clothes, just in case
• Disinfectant cleaner and a separate cloth for cleaning the commode afterward [1.4.6]

Prepare the Commode and the Environment

1. Position the Commode: Place the commode next to the bed or chair on a level surface. For stability, it's best to position it against a wall or a heavy piece of furniture [1.3.3]. Ensure a clear, clutter-free path between the bed and the commode [1.3.1].
2. Check for Stability: Adjust the legs so the commode is at a comfortable height for the client—their feet should be flat on the floor when seated, with knees at about a 90-degree angle [1.3.4]. Ensure all legs are set to the same height and the locking pins are securely in place [1.3.8]. If the commode has wheels, lock them securely before any transfer [1.2.1].
3. Ensure Privacy: Close the bedroom door and any curtains to maintain the client's dignity [1.5.3]. Let them know you will provide as much privacy as is safely possible.
4. Prepare the Bucket: Some caregivers find it helpful to add a small amount of water or a commode liner with an absorbent pad to the bucket beforehand. This can make cleanup easier and help control odor [1.2.3, 1.4.4].

Step 2: A Step-by-Step Guide to Assisting the Client

Executing a safe transfer requires clear communication and proper body mechanics. Talk the client through each step, and encourage them to assist as much as they are able.

1. Communicate and Assist with Clothing: Explain what you are about to do. Help the client put on non-slip footwear [1.2.1]. Assist them in managing their clothing so it is out of the way for the transfer and commode use.
2. Position for the Transfer: Help the client to sit on the edge of the bed with their feet flat on the floor, shoulder-width apart. Ensure their feet are not crossed [1.2.1].
3. Perform the Transfer:
   • Have the person lean forward before standing. If using a gait belt, ensure it is secure around their waist.
   • Stand in front of them, brace your knees against theirs if needed, and help them to a standing position.
   • Instruct them to pivot slowly, turning their back toward the commode.
   • Have them step back until they can feel the commode against the back of their legs [1.3.3].
   • Ask them to reach back and grip both armrests of the commode before slowly lowering themselves onto the seat [1.2.1]. This two-handed approach prevents the commode from tipping [1.3.3].
4. Provide Privacy and Support: Once the client is safely seated, you can either stay with them for safety or step outside the immediate area to provide privacy, giving them a call bell to signal when they are finished [1.2.3].
5. Assist with Hygiene: After they are done, put on a clean pair of gloves. Assist with wiping if necessary. Wet wipes are often more effective and gentler than dry toilet paper [1.3.1]. For female clients, always wipe from front to back to prevent urinary tract infections [1.4.6]. Help the client with hand hygiene using hand sanitizer or a warm, soapy cloth.
6. Transfer Back to Bed: Reverse the transfer process. Help the client stand up, pivot, and sit back on their bed or chair. Once they are safely and comfortably settled, you can proceed to the final step.

Step 3: Infection Control and Cleaning

Prompt and thorough cleaning of the bedside commode is non-negotiable for preventing odors and the spread of infection [1.4.6].

1. Empty the Bucket: With gloves on, carefully remove the commode bucket. Carry it to the bathroom and empty the contents into the toilet [1.2.1].
2. Clean and Disinfect: Use a dedicated toilet brush and a household disinfectant (like Lysol) to clean the inside of the bucket. Avoid harsh toilet bowl cleaners that can damage the plastic [1.4.6]. Rinse it thoroughly with water and pour the rinse water into the toilet [1.3.8].
3. Dry and Replace: Dry the bucket with a paper towel or let it air-dry completely before placing it back in the commode frame [1.2.1].
4. Wipe Down the Commode: At least weekly, or more often if soiled, wipe down the commode frame, seat, and lid with a disinfectant cleaner [1.4.7].
5. Final Hand Hygiene: Remove your gloves and wash your hands thoroughly with soap and water [1.2.1].

For more information on fall prevention for older adults, the Centers for Disease Control and Prevention (CDC) offers extensive resources and data.

Comparing Commode Types

Feature	Standard Bedside Commode	3-in-1 (All-in-One) Commode
Primary Use	Standalone portable toilet for bedside use.	Can be used as a bedside commode, a toilet safety frame over a regular toilet, or a raised toilet seat.
Versatility	Single-purpose design.	Highly versatile; adaptable to changing needs.
Placement	Placed in the bedroom or living area.	Can be used in the bedroom or bathroom.
Ideal For	Individuals who cannot make it to the bathroom at all.	Individuals who may need support in the bathroom and sometimes at the bedside.

Conclusion: A Foundation of Trust and Safety

When assisting a client with a portable commode, your actions should be guided by the principles of safety, hygiene, and dignity. By preparing properly, communicating clearly, using safe transfer techniques, and adhering to strict cleaning protocols, you create a safer environment and strengthen the bond of trust with the person in your care. This careful approach not only prevents falls and infections but also affirms the client’s value and self-respect during a vulnerable moment.

Frequently Asked Questions

How often should you clean a portable commode?

The commode bucket must be emptied, cleaned, and disinfected after every single use [1.4.6]. The frame, seat, and lid should be wiped down with disinfectant at least once a week, or more frequently if they become soiled [1.4.7].

Where is the safest place to put a bedside commode?

The safest place is on a level surface, close to the person's bed for easy access, and preferably against a wall or a heavy piece of furniture to prevent it from moving or tipping [1.3.3]. Ensure the path to it is clear of clutter [1.3.1].

What is the best way to help someone stand up from the commode?

Have the person place both feet flat on the floor, lean forward, and push up using both armrests of the commode. You should stand in front of them to provide support and assistance as needed [1.2.1].

How can I reduce odors from a bedside commode?

Cleaning the bucket immediately after each use is the most effective method. You can also use commode liners with absorbent pads that trap odors or leave a small amount of water mixed with a disinfectant or deodorizer in the clean bucket [1.4.4].

What should I do if the client is too weak to stand and pivot?

If a client cannot safely bear weight to stand and pivot, you should not attempt the transfer alone. This may require a two-person assist or the use of mechanical lifting equipment, like a Hoyer lift. Consult with a physical therapist or healthcare provider for a safe mobility plan.

How do you maintain a client's dignity during toileting?

Maintain dignity by speaking respectfully, explaining every step before you do it, providing as much privacy as is safe, and covering them with a towel or blanket when possible. Encourage them to do as much as they can for themselves [1.5.3, 1.5.6].

Should the commode be a specific height?

Yes, the commode should be adjusted so that when the person is seated, their feet are flat on the floor and their knees are at a roughly 90-degree angle. This ensures stability and makes it easier for them to sit down and stand up [1.3.4].