Bedpan management in aged care

The use of bedpans is not discussed enough by care workers and managers in residential aged care facilities.

Many healthcare workers do not consider bedpans as part of the clinical environment. However, inadequate bedpan decontamination increases the risk of healthcare-associated infections (HAIs), which is a serious threat for residents, causing pain, infirmity and sometimes death. In many facilities, bedpans and urine bottles are not clean, are stored incorrectly and have signs of soiling, which can make them reservoirs for bacteria.

Infection risks in aged care

Individuals in RACFs are at risk of developing HAIs because of age-related changes in physiology, immunity, comorbid illness and functional disability. Outbreaks due to resistant bacteria, such as vancomycin-resistant enterococci (VRE), methicillin-resistant Staphylococcus aureus (MRSA) and carbapenem-resistant Klebsiella pneumoniae and Pseudomonas aeruginosa are often the result of poor hygiene, which can be prevented by basic infection prevention procedures such as hand hygiene and the cleaning and disinfection of reusable medical and nursing devices. Faeces contain billions of microorganisms, and many bacteria leave the body with the stool. During episodes of diarrhoea, the bacterial load is even higher and can include spores of the difficult-to-eliminate Clostridium difficile (C. diff). These microorganisms are challenging to treat with traditional types of antibiotic and therefore more dangerous to residents in a long-term facility.

For effective infection prevention and control, all residents in a residential care facility should be considered as infected or colonised.

Bedpan management is an infection prevention item 

Bedpan management is regarded as an essential part of care because defecating and urinating are normal human processes. 

“The objective in the handling of bedpans & urinals is to dispose of the excreta under the most sanitary and least offensive conditions and at the same time to disinfect the utensils.”USA: Dr. John J. Perkins, Director of Research American Sterilizer Company. 1956.

The fact is that:

• Full bedpans are huge reservoirs for infection.
• Full bedpans can contaminate hands and the environment.
• Hands can contaminate the environment and residents.
• A contaminated environment can contaminate hands.
• Bedpans and hands can transmit microorganisms.

Bedpans and urine bottles are medical devices

Spaulding’s 1968 decontamination scheme categorised bedpans as non-critical medical items (in the same group as blood pressure cuffs). It is important to know that non-critical items should not come into contact with the resident’s mucous membranes or non-intact skin. 

Washer-disinfectors

In 2006 the International Organisation for Standardisation (ISO) developed and introduced ISO 15883-1:2006, which specifies general performance requirements for washer-disinfectors (WDs) and their accessories that are intended to be used for cleaning and disinfection of reusable medical devices. The WD is directly connected to the sewage system to ensure the soiled content is flushed away. The working cycle includes all steps of decontamination: rinsing, cleaning and disinfecting to destroy most microorganisms, and is finished with a drying cycle. WDs are designed for thermal disinfection. 

Seven steps of safe bedpan management

(Adapted from Gertie van Knippenberg-Gordebek’s Bedpans and healthcare-associated infections)

Step 1: resident care

Each resident has the right to receive clean items, and each RACF should maintain ethical and hygienic standards. Hand hygiene must be performed after taking care of the resident at a point of care. Disposable gloves worn during contact with the resident must be removed in the resident’s room. 

Step 2: from resident to sluice

Open bedpans are difficult to handle without contaminating the hands. 

Step 3: emptying (manual or mechanical) 

Manual emptying and flushing in a toilet or slop hopper are a high-risk procedure for spreading and transmitting microorganisms to the environment. Biofilms are major reservoirs of microorganisms in slop hoppers. The best practice is to use WDs installed in a dirty utility room. 

Step 4: cleaning (manual or mechanical)

Failure to perform cleaning can result in failed disinfection, leading to outbreaks of infection. Manual cleaning should be avoided wherever possible because flushing or rinsing with water leads to the spread of pathogens. 

Step 5: disinfection (manual or mechanical)

“Thermal disinfection is preferable to chemical disinfection and achieves high-level, non-toxic disinfection when surfaces are in contact with heat above 80ºC (176°F) for an appropriate length of time”. The best practice is to use WDs.

Step 6: drying (manual or mechanical)

Mechanical drying in the WD delivers a clean and dry item if the process is completed. 

Step 7: storage

A RACF should have a well-equipped dirty utility room(s) close to the beds in order to clean and disinfect nursing equipment. A dirty utility room should be divided into two clearly recognisable zones to keep clean and contaminated equipment separate. Clean bedpans are to be stored inverted or on racks because wet bedpans can become a potential reservoir due to residual fluid. 

Methods for bedpan management

• Focus on good hand hygiene practice.
• Focus on effective cleaning and disinfection of reusable medical equipment. 
• PPE, such as gloves, eye protection and aprons, must be worn by personnel to avoid contact with body fluids. 
• Handling full bedpans must always be under standard and transmission-based (contact and droplet) precautions.
• Manual procedures of emptying of bedpans and urine bottles into a slop hopper sink or toilet must be avoided as much as possible. 
• WD maintenance and validation reports must be regularly checked. If the bedpans are not dry after removal from the machine, the maintenance manager should be notified, and the fault rectified.
• Bedpans must be renewed/replaced if their surface is no longer smooth because even the smallest damaged area can harbour bacteria. 
• Bedpans with a lid or a paper cover prevent contaminating the hands and environment.
• Written policy, procedures, work instructions and specific training must be developed for bedpan management and applied by all personnel, regardless of residents’ diagnoses and environmental conditions. 
• A dirty utility room(s) daily cleaning checklist should be developed to ensure cleaning processes for the bedpan racks, bedpans and WDs are implemented.
• All staff who handle bedpans should receive an appropriate education.
• Regular audits can assist in focusing on what personnel are actually doing.

Review your dirty utility room environment and equipment and staff bedpan management practices. Implementing bedpan management policies and procedures in your aged care facility will improve resident safety, reduce antimicrobial use and support occupational health by reducing the risk for infections. 

If you want an outside eye on your bedpan management processes, environmental cleaning or any other aspect of infection control, contact Bug Control now for an obligation-free chat. With over twenty-five years in infection control, we are the experts in infection control in aged care.

References:

1. Spaulding EH.  Chemical disinfection of medical and surgical materials.  In: Lawrence C, Block SS (eds) Disinfection, Sterilization, and Preservation.  Philadelphia: Lea and Febiger, 1968:517–31.
2. Washer-disinfectors. International Standard ISO/FDIS 15883, 2006.