Which sluice solution? Infection control

Sluice rooms are high-risk sites for contamination as they are used for disposing of and cleaning items which have contact with patient fluids. Bedpans are particularly high-risk items as they come into direct contact with dangerous and infectious substances. Poor bedpan management has been reported to increase risk levels of healthcare acquired infections (HCAIs) by up to 21% (Knippenberg-Gordebeke et al. 2015).

As when handling with any potentially contaminated device, personal protective equipment (PPE) should always be worn when having contact with bedpans.

HCAIs and bedpan management

Safe and effective bedpan management is essential to reduce incidences of HCAIs associated with human waste, such as Clostridium difficile. Spores from the HCAI are notoriously difficult to clean and require high temperatures to achieve decontamination. To achieve 99.999% disinfection of Clostridium difficile, the following cleaning cycle conditions must be met:

If these temperatures are not met, there is a high risk of increasing contamination – studies prove that at temperatures of 63°C, there is a 30% increase of 20-week old dormant spores (Rodriguez-Palacios et al. 2011). It is therefore essential that healthcare facilities assess their processes to ensure bedpans do not become focal points for cross-contamination.

Macerators

Pulp bedpans with all contents (including toilet paper) are put into a macerator directly after use by the patient. The machine pulverises the pulp into tiny pieces and flushes it down the drain, much like toilet paper. Macerators offer high levels of infection control and user-friendliness.

Single-use disposables (plastic or pulp) into an offensive waste trash bin

Single-use bedpans are available in pulp and plastic which can be disposed of in offensive wate trash bins (or similar, depending on local refuse requirements). Pulp bedpans give better protection against leakages as single-use plastic alternatives are often made of cheap polymers. The risk of cross infection is much lower than re-use systems as patients will always use a new bedpan. Environmental contamination is an important risk to consider when evaluating disposing of bedpans in trash.

Bedpan washers

Bedpan washers, or washer-disinfectors, are a significant improvement from hand-washing bedpans in terms of infection control. However, there remain significant risks associated with washer processes which should be considered, and guidelines should be designed to limit contamination opportunities wherever possible.

Hand-washing bedpans

Few healthcare facilities continue to wash bedpans by hand, however it is a practice that is still followed in some places. It is almost impossible to assure the complete sanitisation of bedpans when washed by hand as the high temperatures required to kill bacteria cannot be met and there is a high degree of user error.

Summary

The risks involved with different bedpan management techniques have been identified here and should help you evaluate your processes. What are the opportunities for cross contamination in infection pathways in your facility? How can you eliminate or safeguard these stages? Co-ordination between clinical staff, infection control departments and maintenance can highlight areas for change and improvement in current processes.

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