A sluice, or ‘dirty’ room, is the room in a hospital where used patient items end up. Soiled items such as bedpans, catheters, wash bowls and used dressings are disposed of in a sluice room. The steps below are an illustration of how to think about your sluice room and necessary steps to maximise infection control.

Why is sluice room organisation important?

Sluice rooms have a high volume of contaminated items passing through every day. Harmful infectious bacteria and viruses associated with patient blood, soil and fluids are treated or disposed of in sluice rooms. These rooms are therefore high-risk sites for cross contamination or redistribution of bacteria to other patients. Designing an effective and safe sluice room is an essential way to manage infection pathways and improve working conditions for nursing staff. 

1.    What are the advantages and disadvantages of your existing system?

Coordinate between the nursing team, maintenance staff and infection control team to identify what is working well and any existing problems or constraints. This information can help you to design an effective space.

2.    Ventilation, walls and floors

Like other hospital rooms, sluice rooms should be well ventilated to combat aerosols. Walls and floors should be easy-to-clean and preferably have no recesses in which bacteria can collect. Laminate and vinyl are therefore preferable to tiles.

3.    Think about ‘sluice room flow’

It is important to think about the directions travelled around the room. The purpose of the sluice room is to dispose of soil and leave clean, and this should be reflected in the how the room is used. Sluice rooms should then have a ‘flow’ in which dirty substances are eliminated first, followed by equipment cleaning. Near the exit, rooms should have handwashing stations and clean device storage.

* If using macerators, this is not necessarily required.

4.    Small spaces

Even the tiniest of rooms can be an effective sluice with some creative thinking. For example, some healthcare providers have a sluice room for the management of waste and a ‘clean cupboard’ where supplies are kept. In other areas where this is not possible, think about the most space-efficient solutions. Macerators and washers are available in compact options which could be installed in individual patient rooms. Pulp bedpans are easily stacked so can be more easily stored than reusables, and less space is required for cleaning processes. Shelving units can maximise wall space. These are just some examples of effective and safe ways to design sluice solutions. For individualised support, please contact us here.

5.    Entry and exit

Door handles are commonly identified as a high-risk bacteria carrier. Consider how you can minimise this in your design: studies have found that push plates have five times less bacterial contamination than pull handles (Wojgani et al. 2012). Better still, could RFID automated doors be a viable solution?

To summarise…

Sluice rooms are a crucial aspect of hospital infrastructure.  They have a key role in managing offensive and contaminated waste and ensuring the safety of patients, staff and visitors across the facility. Thinking about your own facility and evaluating where improvements could be made is the first step to improving processes. Does your sluice room have a dirty to clean ‘flow’? Are there any opportunities to reduce infection exiting the sluice room?

Further reading:

Wojgani, Hedieh, Catherine Kehsa, Elaine Cloutman-Green, Colin Gray, Vanya Gant, and Nigel Klein. “Hospital Door Handle Design and Their Contamination with Bacteria: A Real Life Observational Study. Are We Pulling against Closed Doors?” PLoS ONE 7, no. 10 (2012). https://doi.org/10.1371/journal.pone.0040171.

Sluice rooms are primarily used by clinical staff so it crucial that processes are designed with their interests at the forefront.

From our extensive experience, clinical staff prefer systems that are:

• Quick
• Easy
• Clean
• Reliable
• Non-smelly
• Minimal contact with offensive material

One-way macerator systems

Studies have shown that 95% of clinical staff members believed disposable bedpans are cleaner and safer than re-use systems (Delaney 2017). As most macerators use a one-step process, they are generally the fastest and easiest system and have minimal contact with the contaminated pans.

Nursing staff have reported that sluice rooms have very little to no smell when using macerators as human waste is immediately flushed away. Reliability of machines is generally high, although this depends on the manufacturer and staff training.

One-way disposal systems

Clinical staff have reported that one-way systems are clean, quick and easy-to-use. Disposal systems are likely to encounter infection control problems due overfilling bins, insufficient collection or tears in trash bags. Such environmental contamination constitutes an infection risk to hospital staff and patients. Porter staff are particularly at-risk as they often come into direct contact with offensive substances when collecting waste.

Sluice rooms are smellier when using refuse systems as used human waste is left in the room until refuse is collected. Not only is this high-risk for aerosol contamination but also creates an unpleasant working environment.

Re-use washer systems

Washers require more handling by clinical staff to empty waste and load bedpans than one-way alternatives. Research has shown high levels of user error when using bedpan washers, suggesting that practices are complicated or difficult to follow (Delaney 2017). Many clinical staff members are concerned with the safety of re-use bedpans and whether they are sufficiently disinfected in washer cycles.

Clinical staff members have reported that washers can make the sluice room smelly due to the processing steps before the cycle. Machine reliability depends on staff training – one study found that a hospital had over 500 maintenance callouts for machines in a six-month period, of which a significant proportion were attributed to user error (Delaney 2017).

Re-use handwash systems

Handwashing systems are generally the least popular bedpan management process amongst healthcare workers as they require direct contact with contaminated bedpans. Handwashing is criticised by clinical staff as being “dirty”, “ineffective” and “degrading”. Practices are often unsafe as bedpans are left to soak in strong detergents for extended periods of time. Plastic bedpans float and non-submerged areas compromise the effectiveness of disinfection. Smells are also circulated throughout the process, contributing to a hazardous working environment.

Conclusion

Clinical staff have reported a strong preference for single-use systems over re-use alternatives due to cleanliness and efficiency. Clinical staff like how the single-use systems allowed them to spend more time with patients and meant there were less opportunities for contact with contaminated items. The absence of human waste smells when using a macerator is also reported to improve working conditions. We recommend that healthcare facilities open an internal dialogue with nursing staff to establish methods to improve infrastructure.

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.