Medical Commode Components & Safety Expert Overview

Occupational therapists, who assess patients’ needs and performance in activities of daily living, are commonly consulted by healthcare professionals to determine features necessary for patients to safely complete toileting.  Health care administrators are also responsible for the implementation and adherence to policies and procedures around equipment training, use, maintenance, and acquisition. 

In this article, Doctor of Occupational Therapy and healthcare administration expert, Joseph Muniak, MS, OTD, OTR/L provides an overview of the standard of care and best practices surrounding safe commode usage.

Commode Usage in Health Care Settings

The ‘3 in 1’ commode is one of the most common types of portable, bedside toilets used in health care facilities. Historically, the 3 in 1 moniker refers to the device’s ability to perform three different functions: 

1. As a beside commode. 
2. As a toilet ‘safety frame’ over a standard toilet for balance and leverage (including as a raised toilet seat). 
3. As a shower chair to promote seated and safe bathing.

Available Features to Accommodate Patient Needs

Commodes have an ever-increasing variety of options and accessories designed to accommodate the needs of different patients and environments. Some of the available features that may be present in or relevant to your case include:

Drop or swing-away arm rests: Allow removal of the arm when needed for various types of patient transfers on and off the commode, such as squat/sit-pivot transfers or the use of a transfer board. The ability to remove or adjust the arms of a commode also allows for use with portable lifts and/or with alternate “sit to stand” aides to be safely used during commode transfers. 

Seat options: Solid or padded surfaces with various densities and durability can be specified. Swing-up or swing-away seats allow for access to the commode bucket through lifting the seat up and lifting the bucket out. Alternatively, there are rigid seats that do not lift like a toilet seat, in which the bucket is accessed through sliding the bucket in and out of brackets via the front or back of the commode. 

Seat heights and weight ratings: Commodes can be specified to accommodate the size of the user and fine-tuned with adjustment mechanisms. This includes tall commodes for individuals requiring a commode height over 22 inches, wide commodes for individuals requiring a distance between the arm rests greater than 18 inches, and bariatric or heavy-duty options to accommodate weights over 1,000 lbs. 

Adjustment & maneuverability options: Wheeled commodes are available and are often referred to as ‘rolling commode’ chairs. This feature facilitates transportation, with or without the patient physically on the commode.  Wheeled arrangements incorporate brakes on the bottom of the four legs. This style of commode commonly has a tilt-in-space or reclining function. The tilt-in-space option allows for the entire commode to be tilted back while maintaining a 90-degree seating angle at the user’s hips.  

Material Construction and Portability

The materials from which commodes are constructed often correlate to their intended use and service life. 3 in 1 commodes are commonly made with aluminum, steel, or PVC materials. The construction material, in combination with the commode type and frequency of use, will impact factors such as durability and corrosion-resistance.

Portability is a consideration when utilizing 3 in 1 commodes.  There are folding styles that offer ease of portability, especially if needed to be transported by vehicle from one location to another. However, folding commodes tend to have lower weight limits. Wheeled commodes, however easy to maneuver in an open space, are not as easy to transport from one physical location to another when lifting of the commode into a vehicle is required. The classic standard/ rigid frame commode can also pose difficulties with vehicle transport, though they tend to be more light weight than alternative options.

Known Causes of Commode Failure

Use in Showers & Tubs

As defined in the name, one of the main uses of the 3 in 1 commode is the ability to use it as a seating option in the shower. However, water and other bath products will cause rusting and overall increased wear over time.  Water often enters through the height-adjustable holes located on the bottom of the commode and accumulates in the legs.  

Routine maintenance, monitoring, and replacement (when needed) should be done on all commodes, but especially those utilized for bathing. Use of 3 in 1 commodes in home tub showers should be approached with caution. Commodes that do not fit properly in tub and showers stalls can create hazardous situations such as sliding, shifting, and tipping. This can occur both while in use and during transfers.

Degradation Anti-Skid & Braking Mechanisms

Most non-wheeled commodes will have rubberized tips on the bottom of the legs to prevent slipping, increase stability, and promote safety during transfers. Over time, these tips can become worn, broken, or lost/removed which can cause instability. Similarly, wheeled commodes should be regularly inspected to ensure proper rolling and braking functions. Malfunctioning devices should be repaired and/or replaced immediately.  

Improper Height Adjustment

The height adjustability of the 3 in 1 the commode is essential in meeting the needs of a diverse client population, but can also cause significant safety risks. The leg adjustment pins can become stuck or frozen inside the leg for numerous reasons ranging from components being bent, to water issues causing a rusting type of adhesion. Even if operating correctly, the commode can become dangerously unstable if users fail to adjust all legs evenly. 

Equipment Training & Instruction

Proper training is necessary to reduce the risk of injury both for those using the commode and for those assisting. Common training topics include leaning back, and for what extent of time should someone remain seated. Non-tilt-in-space commodes should not be leaned back for risk of tipping over backwards, bending, or even breaking/collapsing. 

Extended periods of sitting on a toilet or commode seat can lead to loss of sensation, blood flow, and motor control when trying to stand or transfer, so specific instruction should be given on the amount of time a patient can be left to sit on the commode, depending on their individual needs. Essentially, a person’s legs go “numb,” which can lead to injury in an already vulnerable individual.

Ill-Fitting or Inappropriate Commode Selection

Appropriate fitting of a commode is a major factor in injury prevention and overall safe use.  An ill-fitting commode can lead to pressure injuries, abrasions, scrapes, cuts, and lacerations.  It is important for care providers to consider client factors such as trunk control and core stability when choosing the correct 3 in 1 commode.  

It should be noted that many, if not all, of these commode types can be rented. Facilities that do not have the commode in stock that best meets the needs of the individual, should not let this be a barrier to acquiring the appropriate device.

Investigating Durable Medical Equipment Failures

Proper inspection, maintenance, and replacement schedules should be in place for all facilities utilizing 3 in 1 commodes. Healthcare professionals and durable medical equipment (DME) professionals who provide 3 in 1 commodes for home and community use should educate the purchaser on the required inspection and maintenance requirements for safe utilization, and make the replacement options known to all individuals who utilize them. This should be a regular practice of all health care professionals entering the home or involved in the treatment of individuals utilizing commodes, or any DME.

For more information, submit an inquiry or call us at 800.813.6736.

Featured Expert

Joseph Muniak, MS, OTD, OTR/L

Doctor of Occupational Therapy & Health Care Administration Expert

Dr. Muniak is a board-certified Occupational Therapist (OTR) and hospital administrator with expertise in the continuum of care provided to patients in the acute hospital, inpatient rehabilitation,… read more.