Healthcare providers are under increasing pressure in today’s society - populations are expanding at an unprecedented rate and many people are living longer. With demand for the services on the rise, hospitals strive to meet their patients’ needs and expectations for high-quality treatment, without compromise. However, the risk of Healthcare-acquired Infections (HCAI’s) is a prevalent global issue, and is a real challenge for hospitals to overcome.
HCAI’s – A Concern for Patients and Hospitals Worldwide
According to the World Health Organisation (WHO), hundreds of millions of patients are affected by healthcare-associated infections worldwide each year, leading to significant mortality and financial losses for health systems. Of every 100 hospitalised patients at any given time, 7 in developed and 10 in developing countries will acquire at least one healthcare-associated infection.
The level of infection contraction amongst patients in hospitals cannot be ignored. In June 2014, the Indian Journal of Critical Care Medicine published an article on the importance on preventing hospital-acquired infections, ‘a constant threat to hospitalised individuals’. Also, in Singapore, doctors questioned regarding the issue have estimated that one in seven patients acquire an infection on the hospital ward, leading to prolonged illness, extra incurred costs and even death. Newborn babies are especially at high risk from HCAIs in some countries, for example in Southeast Asia where HCAIs are responsible for 75 per cent of all causes of death in the neonatal period.
The management of human waste is recognised as a high risk for transmission of infections in healthcare environments. Pathogens of particular concern in the hospital setting include: Clostridium difficile (C.difficile), Carbapenem-Resistant Enterobacteriaceae (CRE), Vancomycin-Resistant Enterococci (VRE), Multi Drug-resistant Gram-negatives (MDR Gram-negatives), Meticillin-resistant Staphylococcus Aureus (MRSA) and Norovirus. C. difficile infection is usually spread via the hands of staff and those who come into contact with infected patients or with environmental surfaces like floors, bedpans and toilets that have been contaminated with the bacteria or its spores. The bacteria and spores are extremely hardy, and some pathogens can survive on dry surfaces such as clothes and environmental surfaces for months.
Items that become contaminated with human faeces, such as bedpans, are categorised as non-critical devices defined as items that come into contact with intact skin, as opposed to critical items that enter sterile tissue or the vascular system. As a result, surprisingly little attention appears to be paid to the risks of disease transmission and environmental contamination, both of which are particularly likely to occur during diarrhoea episodes. Safe management of human waste therefore has the potential to reduce HCAI through the employment of better hygiene and infection prevention measures.
There are a number of chemical, physical and mechanical toileting aids and human waste disposal solutions in healthcare environments for immobile patients. These include:
- Reusable plastic / metal bedpans and implements that are manually cleaned using unvalidated methods and without testing of their efficacy
- Reusable plastic / metal bedpans and implements that are cleaned in local washer disinfectors
- Single-use bedpans and implements that are processed in disposal units
- Other more invasive solutions include urinary catheterisation. However, such a procedure should only be undertaken if there is no other option, as it introduces the risk of Catheter-acquired Urinary Tract Infection (CAUTI). Single-use urinals are a safe and alternative toileting option for patients who are unable to use conventional toileting methods and do not require catheterisation.
Practices with regard to human waste disposal in healthcare environments vary in different parts of the world:
- In countries such as India, South Africa and Poland, manually washing reusable bedpans is a commonly accepted practice
- In Australia, it is a combination of single-use pulp macerator systems and bedpan washer disinfectors.
- In the UK, 94 per cent of hospitals use a single-use pulp disposable system
- In the US, the preferred method is a single-use patient plastic bedpan.