Dignified hygiene and toileting can help skin integrity in plus size people

Larger skin folds on the plus size person can become overheated because of the thick layers of subcutaneous fat, which increases the risk of friction and moisture.1 Retained moisture in skin folds encourages the growth of bacteria and fungi, which can lead to rashes and infection such as intertrigo. Moisture is one of several extrinsic factors that contribute to skin infection, with friction and shear being another two.2



A hygiene chair can provide a toileting and showering solution that can help to maintain the individual’s dignity. As part of this solution, the caregiver needs to take into account the person’s weight, body shape and adipose tissue, which may be a complicating factor when undertaking handling and hygiene routines. Caregivers need to feel confident that hygiene routines ensure dignified handling of the person in a safe working environment. This is particularly the case in wet, potentially slippery shower facilities. Having access to the right resources may promote functional mobility for some patients rather than resorting to passive methods such as bedpans and bed baths.

Toileting and showering

As with all care activities, the choice of solution depends on an assessment of the patient’s functional mobility. For toileting, a bedside commode chair, rather than a bedpan, is the best alternative for patients in the A-C categories of the Mobility Gallery.5 A commode chair at the bedside promotes mobility which can help patients maintain skin integrity and normal bladder and bowel function. Sufficient space is needed around the bed for the commode chair and to allow manoeuvring of transfer aids. A mobile shower commode chair provides a safe platform for the showering of the A-C patient groups. As the shower chair also acts as secure transport to and from showering, consideration should be given to access and available shower room space.

Equipped with the right solutions, care facilities have the ability to improve the quality of life and help improve the safety of patients during manual handling procedures whilst ensuring the safety of their caregivers and efficiency of their care. With the right solutions, plus size patients can experience comfortable and dignified care – through every step of their journey.

Learn more about hygiene solutions for plus size patients


Pokorny, M. (2008) ‘Best practices lead in skin physiology and diseases in the obese patient’. Bariatric Nursing and Surgical Patient Care  3(2): pp.125–8
2. McDonagh, M. (2008) ‘Moisture lesion or pressure ulcer? A review of the literature’ J Wound Care17(11): pp. 461 – 6
3. Muir, M A and Rush, J A (2013) Moving and Handling of Plus Size People an illustrated guide, Towcester: National Back Exchange, 9
4. Nelson, A.L., Motacki, K., Menzel, N. (2009) The illustrated Guide to Safe Patient Handling and Movement   Springer Publishing Company LLC New York pp. 20; 36; 154 – 162; 179; 180 and 187
5. Arjo Bariatric Solutions https://www.arjo.com/int/solutions/bariatric-solutions/bariatric-hygiene-care/  [Accessed January 2019]