Sluice rooms & architecture

With the accelerated spread of COVID-19 worldwide, many hospitals are facing a major challenge to isolation and quarantine systems. Cross contamination of COVID-19 positive patients with vulnerable non-infected patients is a significant risk. This threat is further exacerbated by unprecedented admission rates, a high density of patients resulting, and reduced fit-to-work hospital staff. When placing patients into isolation rooms or cubicles, consider all traffic coming into and, more importantly, out of the room. Used, and therefore contaminated, patient care items should be handled and managed with the utmost care.

Measures to think about could include:

Compact macerators – compact macerators have been developed for individual patient rooms. These are widely available and help reduce cross-contamination infection pathways

Patient care item disposal point – a secure, hands-free disposal point for patient care items should be installed in each room. This reduces traffic of contaminated devices leaving the isolation room. Trash should be taken out regularly.

Washing stations – stations for handwash and patient care could be installed in rooms to make patient and staff hygiene easier.

Door handles – door handles door opening directions should be regularly disinfected. For information on door handles and infection control, see “Hospital Door Handle Design and Their Contamination with Bacteria” in further reading.

Further Reading

Wojgani, Hedieh, Catherine Kehsa, Elaine Cloutman-Green, Colin Gray, Vanya Gant, Nigel Klein, and Vishnu Chaturvedi. “Hospital Door Handle Design and Their Contamination with Bacteria: A Real Life Observational Study. Are We Pulling Against Closed Doors? (Hospital Door Handle Contamination)”, PLOS One 7, no. 10 (October 15, 2012): e40171.

Changing systems can be daunting from a financial perspective. Upfront costs can be significant and distract from the long-term savings and benefits. This page will help you assess the short-, mid- and long-term costs involved in sluice solutions to establish which system is most suitable for your needs.

Machine costs

Macerators and bedpan washers are have similar machine costs. These figures will vary depending on brand, model, warranty, quantity, installation requirements and geographic region. As an approximate guide, machine-only purchases of machines with a capacity of four bedpans per cycle can cost between £2500-£6000. Most providers will provide a free quotation according to your needs – contact direct for an accurate estimation.

Bedpan washers typically have a life cycle of 5-7 years. Macerators typically have a life cycle of 7-15 years.

Utilities and detergent

Processing bedpans requires water and electricity. Bedpan washers or macerators may be used up to 100 times per day, meaning running costs should factor into your decision-making process.

Washers must reach the high temperature and antibacterial conditions to kill harmful bacteria. Click here for more information on disinfection requirements, but Sluicemaster suggests washing at 96° for 2 minutes. Therefore, they have a higher water, electricity and detergent consumption than single-use systems such as macerators.

Macerators use approximately 50% less water, 95% less electricity and 98% less detergent than washers, which should be considered in your 5-year cost estimations.

Pulp and plastic pans

Washers: We recommend that reusable plastic or metal bedpans are replaced every six months as a minimum standard for infection control. Tiny scratches on the surface of reusable pans develop over time and these accumulate bacteria, making cleaning less effective. Reusable plastic bedpans may cost anywhere from £6-£15 per item.

Pulp bedpans are a recurring cost which should be budgeted when deciding to switch systems. The cost per bedpan varies considerably and can be affected by the following: type, providers, brand, geographic region and availability. This could be anywhere between £0.08-£0.40.

Pulp + machine contracts are possible in some areas but are usually significantly more expensive than individual contracts and provide lower quality products than alternatives.

Maintenance and testing

Regular maintenance is highly important for washers as faults can impact effective bacteria elimination. Washers have complicated components (for example: heating elements, pressure washing and steam cycles) which increases risk of machine failure. As a medical device regulated by ISO 15883 minimum standards, washers must be tested annually. This can be expensive and increase machine downtime.

Macerators are not medical devices as they do not process pans for re-use. There are therefore no compulsory regulations on machine testing, however in-house routine maintenance checks are advised. Macerators have few components (macerating mechanism and water flow) so require minimal repairs.

Infection control

Studies have found that human-waste associated HCAIs such as Clostridium difficile increase hospital stays by 40% (Delaney 2017). Through eliminating pathways for such infections, associated costs are also reduced. These costs include, inter alia: longer hospital stays; increased antibiotic consumption; further testing etc. For information on infection control comparisons between sluice room solutions, click here.

Nursing staff time

Human waste management can be a significant time burden on healthcare workers. On average, nursing staff will spend 7 mins per cycle collecting, loading, operating, and removing clean pans from a washer-disinfector. For collecting, loading and operating a macerator, the equivalent average duration is 2 minutes.

Environmental costs

Water and energy consumption over the lifecycle of a washer is significantly higher than that of macerators. Furthermore, the system requires high quantities of disinfectant which is contaminating pollutant in wastewater. If purchasing plastic bedpans for reuse, remember they should be replaced every 6 months so opt for sustainable and BPA-free plastics.

Macerators are compatible with single-use pulp bedpans, which are usually manufactured from recycled paper products. After being pulverised by the macerator, these organic particles flush down the drain, much like toilet paper. Opt for local manufacturers of pulp products to reduce transportation distances.

Further reading:

Delaney, Molly Bridget. “Kick the Bucket: One Hospital System’s Journey to Reduce Clostridium Difficile.” Journal of Emergency Nursing 43, no. 6 (2017): 519–25. https://doi.org/10.1016/j.jen.2017.02.003.

With the world’s healthcare systems faced with the biggest challenge of a generation, many governments and providers are (rightly) investing heavily in hospital infrastructure. This is an excellent way to prepare for the increased pressure services will face in the coming months or years. However, this opportunity should be used to invest in the best system for you not only in the short-term, but also medium- to long-term.

What to consider for your sluice room:

As experts in sluice room organisation, we are receiving many queries about how to invest in a reliable sluice room in the current climate. From our experience, one-way systems (i.e. macerators) are the most secure systems against infection transmission. The one-way system follows international best-practice standards on using disposables in high-risk areas. Macerator costs are similar, if not lower, to those of washer-disinfectant systems and are environmentally friendly. Please see the links for further information on sluice room infection control, costs, clinical staff preferences, macerators and the one-way system.

Investing in bedpan washer-disinfectors

Continuing with existing system may seem the easiest option in the current crisis. But surely healthcare centres should focus on investing in the best system? Supporting healthcare workers during a time of extreme demand is essential. Proving the safest, easiest and fastest equipment is an important way to do this. Bedpan washer-disinfectors have clinically proven disinfection failure rates of up to 33% and are widely unpopular amongst care staff (Bryce et al. 2015, 566-70). At this time, performance and reliability is essential. Consider the implications before investing in sluice room systems.

For free and fast advice, please contact us now.

Further reading

Bryce, Elizabeth, Allison Lamsdale, Leslie Forrester, Linda Dempster, Sydney Scharf, Michael Mcauley, Ian Clearie, Sharon Stapleton, and Sheila Browning. “Bedpan Washer Disinfectors: An in-Use Evaluation of Cleaning and Disinfection.” American Journal of Infection Control 39, no. 7 (2011): 566–70. https://doi.org/10.1016/j.jmii.2015.02.055.