Infection prevention
Reducing risk of HCAIs when managing human waste
Invalidated, unsafe, and high contact disposal systems for managing human waste, put patients, healthcare staff, and hospital visitors at an increased risk of infection, warns industry experts. Tackling human factors is vital to improving safety.
Healthcare-associated infections (HCAIs) account for 7.1 million NHS beds being taken up across England, and 834,000 infections per year.1 Acquiring such an infection can increase the length of a patient’s stay in hospital by 17.6 days2
,
allowing for more opportunity of infection risk and costing the NHS considerably more. HCAIs in England alone cost the NHS £2.7 million per year.1
Almost 50% of all healthcare-associated
infections are caused by unclean hands, or poor hand hygiene practices3
, so the need to
eliminate the human factor in decontamination practices remains one of the leading strategies in lowering the risk of transmission and breaking the chain of infection. The COVID-19 pandemic has highlighted the importance of hand hygiene, and the significant need to reduce touch points and contact with unwell people to prevent the spread of infection and save lives. Bacteria can survive on hands for up to three hours, with between two to ten million bacteria on our fingers. Nursing staff visit on average 4.5 patients per hour, touching bodily fluids 27% of the time.5
Appropriate hand hygiene can prevent up to 50% of HCAIs,3 leading
us to question how many could be prevented by removing the need for human factors in decontamination processes?
The human factors in human waste disposal Human waste disposal taking place in a sluice room is often a key area of healthcare where infections can spread due to its continual operation of disposal of human excreta. Inadequate cleaning of plastic bedpans or reusable items, hand hygiene practices and protocols, and inadequate cleaning of toileting aids, are all key elements of human intervention that can significantly increase the infection risk during human waste disposal practices. Even if a healthcare facility has a bed pan
washer, official decontamination advice states that any device, such as a bed pan, should be manually cleaned to remove any visible soil prior
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Plastic bed pans and urinal bottles stacked on a drying rack in a hospital sluice room
to placing it into a mechanical washer (WHO, 2022),6
introducing more human contact into the
process. Invalidated, unsafe, and high contact disposal
systems put patients, healthcare staff, and visitors at an increased risk of infection and cross contamination. There is a lack of standardised operating procedure for the washing of reusable bed pans or toileting aids, meaning incorrect or inappropriate disinfectants can be used, not effectively cleaning the product and removing infectious bacteria. There is a lack of final validation of the process to check that each item has been effectively cleaned and is safe for use again, particularly considering that many pathogens can survive over the 90 degree temperature of a bed pan washer.
Manual disposal of human excrement Outbreaks of organisms such as C.difficile, VRE, CPE, Norovirus, and COVID-19 can all be linked to the use of reusable bed pans, urinals, and wash bowls. In the manual process of using a reusable toileting aid there are multiple touch points including: the removal of the receptacle from the patient, carrying to the sluice room, disposal of
excrement and the post-cleaning of the product. The manual emptying and flushing of plastic containers is a high-risk procedure for spreading and transmitting micro-organisms, particularly through airborne transmission resulting from any splashback or flushes. During manual emptying and cleaning of
reusable containers, healthcare professionals can also accidentally touch or be splashed by a patient’s bodily fluids. Any splashes to an unprotected mucous membrane, such as the eyes, nose, or mouth, is especially hazardous (Centers for Disease Control and Prevention, 2023)7
and significantly increases
a risk of infection spreading to the healthcare professional, and in turn onto their patients. The Centres for Disease Control and Prevention also explicitly advise that gross contamination, or ‘procedures that can increase environmental contamination with infectious materials or create aerosols should be minimised’.7 This manual handling of bedpans and
toileting aids during the cleaning process of a reusable can also cause spread via unsatisfactory hand hygiene measures from the healthcare professional involved in this task.
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