Small changes, big differences How nursing staff add value to the procurement process

Use of commodes

NHS Lothian

In NHS Lothian commodes are routinely cleaned with a strong bleaching agent to avoid the spread of infections, but this treatment was gradually staining, rusting and eroding metal on the equipment.

Staff were also finding some parts awkward to remove and reassemble for cleaning purposes.

“We were having to replace our commodes very regularly – sometimes as often as every three months,” explains Healthcare Associated Infections (HAI) Patient Safety Co-ordinator, Ann McQueen.

“It was a huge concern for the staff and we were all thinking hard about what to do about it.”

After raising the issue at one of NHS Lothian’s regular meetings between infection prevention and control and procurement, staff decided to investigate alternative models.


Before drawing up a shortlist, staff from infection control, procurement, and manual handling developed their own criteria to judge the contenders.

They agreed that a new model must be sturdy, long-lasting and comfortable, free of gaps where infection might lurk and able to withstand being cleaned regularly by strong bleaching agents.

A list was drawn up with companies invited to present their products to the group. 

“It was a very interesting afternoon,” says Penny Docherty, Head of Manual Handling. “We could see that some companies had solved one problem, but created another.”

Eventually three models were selected to be piloted by nursing staff at three different hospital sites, with wards including elderly care and acute medical, over a three-month period.

“We made sure we chose busy places, where they were likely to get a lot of use,” says Ann.


Evaluation forms were created so that both staff and patients could give their feedback. They included questions such as whether the commode was comfortable to sit on, ease of cleaning, dismantling and reassembling, and manoeuvrability.

After opinions were gathered and assessed, a new model – made by GAMA Healthcare – was chosen and is now being rolled out into practice.

“It’s more expensive to buy than its predecessor, but we expect it to last much longer, potentially saving thousands of pounds in the longer term,” says Gill Bowler, Clinical Procurement Manager.

Each commode is also covered by a five-year warranty and replacement parts are cheap to buy, adding to its cost effectiveness.

Reducing infections

“But perhaps more importantly it could also save us thousands of pounds in reducing health care associated infections, as well as avoiding the distress they cause to patients and their families,” says Ann.

“Despite our best intentions, we know that we had problems cleaning the previous commodes, but now we can do a much more thorough job.”

Taking around a year to come to fruition, much of the project’s success has hinged on staff working closely together from infection control, manual handling and procurement.

“That’s really important,” says Penny. “We tend to look at things from our own professional focus, concentrating on our own risks. But when you work together on something like this you learn so much about others’ concerns.

“Next time I’ll be thinking ‘that could be a problem for infection control’. It broadens your mind.”

Share your success story

Tell us about the changes you have made in your organisation and share your examples of good practice in procurement.

By submitting this form, you are giving the RCN permission to share this information in print and online and to contact you about your case study. Please ensure you have anonymised information about any 3rd parties mentioned in this form.

The information you provide in this form will be stored by the RCN.

Protecting your privacy is very important to us. Please view our privacy policy to find out more about the information we collect and how it is used.

Page last updated - 02/12/2019