Insights on toileting, dignity, and care delivery

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Guest Author: Christen Hall, DNP, FNP-BC, RN, CIC, LTC-CIP, CDP is a healthcare professional whose work spans infection prevention, caregiving, nursing practice, healthcare leadership, and public health. More detail can be found at the end of this article.

Key Takeaway:

With the right equipment, toileting assistance doesn’t have to be limited to the bathroom. The core contamination risks are the same: urine, stool, wipes, briefs, gloves, hands, clothing, equipment, and nearby surfaces. What changes between bathroom and bedside toileting is where contamination can spread, how many surfaces are involved, and how the environment affects fall risk and workflow. The safest setup is the one that supports safe mobility, as long as clean and dirty steps are kept separate.

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1. Universal Risks: What’s the Same Everywhere

Toileting assistance is a high-contact activity no matter where it happens. The same contamination pathways exist in every setting:

• Hands, gloves, clothing, and equipment can become contaminated during wiping, positioning, or cleanup.
• Stool contains many microorganisms; urine can create risk when it splashes or wets surfaces.
• Soiled wipes, briefs, liners, basins, or urinals can touch clean areas if the workflow is rushed.
• Hand cleaning can be delayed or missed during urgent or physically demanding moments.
• High-touch surfaces can become contaminated without anyone noticing.

These risks are universal because toileting is not a single step — it is a sequence of high-contact moments. The goal is to keep contamination from spreading beyond that sequence.

2. Bathroom Toileting: Advantages and Challenges

Bathroom toileting may seem simpler because waste goes directly into the toilet, but bathrooms introduce their own infection prevention concerns.

Advantages

• Direct disposal reduces the number of soiled items that need handling.
• Fewer steps involve emptying or transferring waste.

Challenges

• Tight spaces increase fall risk and can force rushed movements.
• Hard, wet surfaces make falls more dangerous and can spread contamination.
• Shared high-touch surfaces — grab bars, toilet handles, sink handles, light switches — can expose the next user if not cleaned.
• Shower commode chairs reduce transfers but add surfaces (armrests, wheels, footplates, seat openings) that must be cleaned when touched during contaminated steps.

Bathroom toileting is not automatically safer — it simply concentrates risk in a different set of surfaces.

3. Bedside Toileting: Advantages and Challenges

Bedside or non-bathroom toileting may be the safer mobility choice for people who cannot reliably walk, turn, or transfer.

Advantages

• Avoids unsafe or energy-draining trips to the bathroom.
• Reduces fall risk for people with limited mobility or urgent needs.

Challenges

• Toileting happens near beds, linens, personal items, medications, and clean surfaces.
• Basins, urinals, briefs, liners, and commode surfaces must be treated as contaminated until cleanup is complete.
• More steps involve handling, emptying, and disposing of collected waste.
• There are more opportunities for soiled items to contact clean areas if the workflow is not planned.

Bedside toileting is not “bad.” It simply requires a clear, consistent infection prevention routine because the environment is not designed for waste handling.

4. Equipment Helps — and Adds Surfaces

Equipment such as bedside commodes, shower commode chairs, transfer aids, lift seats, or mechanical lifts can reduce physical strain and improve safety.
But equipment becomes part of the contamination pathway:

• Armrests, wheels, footplates, slings, straps, hand preventions, and seat surfaces may be touched during contaminated steps.
• Any surface touched with contaminated gloves or hands should be included in the cleanup routine.

Equipment changes where contamination can spread — not whether it can spread.

5. Making the Safer Step the Easier Step

Regardless of location, the safest toileting setup is the one that makes good infection prevention practices easier to follow:

• Keep gloves, wipes, liners, and disposal bags within reach.
• Stabilize the person before cleanup begins.
• Complete dirty tasks before touching clean items.
• Remove gloves after contaminated steps.
• Clean hands before touching clean surfaces.
• Clean visibly soiled areas promptly.
• Use liners when possible because they reduce splash, simplify disposal, or shorten cleanup.

Small setup choices can prevent contamination from spreading beyond the toileting moment.

6. Choosing the Safer Setup

Bathroom and bedside toileting share many of the same infection prevention risks, but each setting introduces different challenges.

• Bathroom toileting concentrates risk in tight spaces and shared surfaces.
• Bedside toileting brings toileting into living spaces and increases the number of surfaces and steps involved.

Neither option is automatically safer.
The best choice depends on the person’s mobility, the environment, the equipment available, and whether the workflow supports both fall prevention and contamination prevention.

Toileting care is personal, physical, and often rushed. A practical, realistic infection prevention routine helps protect the person receiving care, the caregiver, and everyone who shares the space.

Selected References

1. Sender R, Fuchs S, Milo R. Revised estimates for the number of human and bacteria cells in the body. PLoS Biol. 2016;14(8):e1002533. doi:10.1371/journal.pbio.1002533.
2. Centers for Disease Prevention and Prevention. Norovirus outbreaks (outbreak basics). Updated February 12, 2026. Accessed March 9, 2026. cdc.gov/norovirus/outbreak-basics/index.html.
3. Centers for Disease Prevention and Prevention. About C. diff. Updated December 18, 2024. Accessed March 9, 2026. cdc.gov/c-diff/about/index.html.
4. McDonald MV, Brickner C, Russell D, et al. Observation of hand hygiene practices in home health care. J Am Med Dir Assoc. 2021;22(5):1029-1035.e6. doi:10.1016/j.jamda.2020.07.031.
5. Centers for Disease Prevention and Prevention. Summary of recommendations: infection prevention (isolation precautions). Updated November 27, 2023. Accessed March 9, 2026. cdc.gov/infection-prevention/hcp/isolation-precautions/summary-recommendations.html.
6. Gould CV, Umscheid CA, Agarwal RK, Kuntz G, Pegues DA; Healthcare Infection Prevention Practices Advisory Committee. Guideline for prevention of catheter-associated urinary tract infections 2009. Updated 2019. Accessed March 9, 2026. cdc.gov/infection-prevention/media/pdfs/Guideline-CAUTI-H.pdf.
7. Centers for Disease Prevention and Prevention. Environmental cleaning procedures. Updated March 19, 2024. Accessed March 9, 2026. cdc.gov/healthcare-associated-infections/hcp/cleaning-global/procedures.html.
8. New York-Presbyterian. Caregiving: using a bedside commode (toilet). Accessed March 9, 2026. nyp.org/healthlibrary/articles/caregiving-using-a-bedside-commode-toilet.
9. PPAL. Toileting Safety, Reformed. Accessed March 9, 2026. ppaltoileter.com.

Microsoft Copilot assisted in generating preliminary text based on references identified by the authors, then prompted to suggest advocacy-oriented language to use when communicating with toileters and aides. That draft was subsequently reviewed, edited, and finalized by the authors for accuracy, completeness, and fit before being uploaded to this site.