UK hospital discharge requirements now state patients should be discharged from hospital within two hours of being declared medically fit. Local authorities are working with hospitals and residential homes to ensure beds in care homes for patients who are unfit to return to their homes. This puts significant additional stress on adult social care providers already struggling with reduced staffing and infection prevention. As a further complication, discharged patients may carry COVID-19 to sites with vulnerable residents, in line with government guidelines that all COVID-19 symptomatic or asymptomatic patients can be safely cared for in a care home, and negative test are not required prior to transfers and admissions into care homes.
Toileting in residential facilities
Medically fit patients discharged to long-term care facilities are likely to require rehabilitation and have limited mobility. They will therefore be dependent on care staff for basic functions, including toileting. However, using bedpans or incontinence pads carry high risks for infection control, particularly given that many studies warn of faecal-oral transmission of COVID-19. SARS-CoV-2 viral RNA may be present in faeces for up to 33 days after respiratory samples became negative (The Lancet, 2020). Patients discharged to adult care facilities may therefore carry live virus into residential facilities, despite negative respiratory tests. Faecal-oral transmission of infections is more common in care homes as toileting assistance is often needed.
Issues in conventional bedpan disinfection
UK government advice states that “all secretion (except sweat) and excretions, including diarrhoeal stools from patients with known or possible COVID-19, should be regarded as potentially infectious” (Gov UK, 2020). Safe human waste disposal techniques are essential to reducing cross-infection risk. However, conventional bedpan washers have a disinfection failure rate of up to 33% (American Journal of Infection Control, 2011). Due to the difficulty in effective and comprehensive cleaning, clinical advice from the WHO advocates using single-use devices wherever possible when treating COVID-19 patients (WHO, 2020). But bagging and binning single-use waste is time consuming, smelly and a potential infection hazard, particularly in busy residential facilities.
Best-practice in bedpan management: one-way processes
One-way systems immediately dispose of waste and reduce the handling of contaminated products. Pulp single-use bedpans (or incontinence pads) are put straight into a macerator after use. The machine pulverises them into particles and flushes all contents into wastewater. This system is recognised as best-practice in the NHS and used by over 95% of hospitals. Given the increased risks in care homes, best-practice processes should be adopted in all healthcare settings to reduce the spread of COVID-19.
Further reading
Care homes and the one-way process
COVID-19: Care planning in residential facilities
COVID-19 and faecal-oral transmission
Lessons from King County Washington: COVID-19 in long-term nursing facilities
References
Wu, Yongjian; Guo, Cheng; Tang, Lantian; Hong, Zhongsi; Zhou, Jianhui; Dong, Xin. “Prolonged presence of SARS-CoV-2 viral RNA in faecal samples”, The Lancet, March 19, 2020. https://doi.org/10.1016/S2468-1253(20)30083-2.
Gov UK Guidance, “Transmission characteristics and principles of infection prevention and control”, updated 6 April 2020. https://www.gov.uk/government/publications/wuhan-novel-coronavirus-infection-prevention-and-control/transmission-characteristics-and-principles-of-infection-prevention-and-control#survival-in-the-environment
HM Government. “COVID-19 Hospital Discharge Service Requirements”. 19 March 2020. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/874213/COVID-19_hospital_discharge_service_requirements.pdf
Elizabeth Bryce, Allison Lamsdale, Leslie Forrester, Linda Dempster, Sydney Scharf, Michael McAuley, Ian Clearie, Sharon Stapleton, Sheila Browning. “Bedpan washer disinfectors: An in-use evaluation of cleaning and disinfection” in American Journal of Infection Control. Volume 39, Issue 7, 2011. Pages 566-570. ISSN 0196-6553, https://doi.org/10.1016/j.ajic.2010.10.028.
World Health Organisation. Interim Guidance: “Infection prevention and control during health care when COVID-19 is suspected”. 19 March 2020.
