Jon Sharp, UK Specification manager for the Care sector at warewashing system manufacturer, Meiko, considers some of the potential infection risks when clinical and nursing staff are handling bedpans, and focuses particularly on the advantages of using advanced washer-disinfectors to thoroughly clean and disinfect bedpans compared with using reusable pulp bedpans, which are typically disposed of post-use by a macerator, in hospitals and other healthcare settings.
Effective bedpan management in hospitals and other healthcare facilities is crucial in preventing the spread of healthcare-associated infections. In such environments, one of the priorities should be to minimise manual handling of bedpans to reduce the risk of infection to as low as possible. Using covered or lidded bedpans further reduces the spread of infection via aerosols.
Equally, the dangers of manually disposing of human waste, with the associated risk of spreading microorganisms directly to the environment or indirectly via personnel, is an issue that has perhaps not always been afforded the priority it should be in healthcare settings. Manual emptying of bedpans and urine bottles into a slop sink or toilet is still carried out routinely in the UK, and has been an issue for some time. Manual cleaning — including via the use of sprays and wands — is not recommended, due to the associated risks of infection to both staff and patients.
It is fact that there is a lack of recent, reliable data on the performance of bedpan washer-disinfectors. Often quoted in the UK, for example, are reports on disinfection rates in Canada published in the American Journal of Infection Control (report by Bryce et al).1
However, this report dates back to 2011, did not include European-made machines, and noted significant ‘human error’. Technology has moved on apace since then, and everything inside a washer-disinfector has changed since 2011.
Machine design flaws and human error
It must be noted that the aforementioned article by Elizabeth Bryce and her colleagues found the failures in the bedpan cleaning process were due to a combination of machine design flaws and human error — such as incorrect machine loading or failing to check levels of detergent. The faulty machines featured in the Vancouver Coastal study used by Bryce were soon replaced with German-made Meiko machines. The replacement cost, and the fact that the old machines were relatively new, caused an uproar in the local media.
Meiko’s view is that categorising bedpans as low-to-medium risk devices is underestimating the risk. We also believe the Spaulding Classification (which dates back to a 1939 paper on disinfecting surgical instruments in a chemical solution by Earle Spaulding of Temple University in Philadelphia, in the US, which proposed ‘a strategy for sterilisation or disinfection of inanimate objects and surfaces based on the degree of risk involved in their use’), made a mistake by downplaying the importance of bedpan management in infection control.
On the subject of the Spaulding Classification, in a paper published in Science of the Total Environment on 20 June 2023,2 the authors argued that the Spaulding Classification remains in use ‘as it is logical, easily applied and understood by users (microbiologists, epidemiologists, manufacturers, industry) and by regulators’. The paper went on to say, however: “Substantial changes have occurred over the past 65 years that challenge interpretation and application of this system that includes inter alia emergence of new pathogens (viruses, mycobacteria, protozoa, fungi), a greater understanding of innate and adaptive microbial tolerance to disinfection, toxicity risks, increased number of vulnerable patients and associated patient procedures, and greater complexity in design and use of medical devices.”
“Opportunistic pathogens (such as viruses, mycobacteria, protozoa, fungi), and infectious agents (prions), has challenged current definitions and expectations of high, intermediate, and low-level disinfection… the basis of the Spaulding Classification is challenged.”
The C. difficile issue
Clostridium difficile has — as most will know — become a significant issue in hospitalised patients over the past 3-4 decades, with awareness of its impact having increased in the UK since 1980s. This resulted in the production of national guidance, and in 2007 a countrywide ‘deep clean’ of healthcare facilities in response to a national issue with this organism. In recent years there has been an upsurge in C. difficile, and this again is driving national policy. While only responsible for a subset of antibiotic-associated diarrhoea, unlike the illness caused by disruption of the normal flora, which is self-limiting, in this instance the disruption of the normal flora allows Clostridium difficile to proliferate. This results in a disease, pseudomembranous colitis, although there is a wide spectrum, but with a significant morbidity and mortality in those more severely affected.
Meiko’s Clostridium difficile whitepaper, ‘Clostridium difficile: Hygiene management for care utensils,3 provides information about typical transmission routes, and insights into effective hygiene management for cases of C. difficile, focusing on effective cleaning using cleaning and disinfection machines as a significant factor in hygiene management.
Just how significant an issue for hospitals C. difficile has become — especially for clinical and nursing staff, cleaners, and Infection Prevention and Control personnel, is underlined by data showing that in the 2020-2021 financial year in the UK, there were 12,273 cases of C. difficile infection (CDI) reported. In the same period, there were 1825 all-cause fatalities in patients with a CDI diagnosis. This demonstrates the high level of mortality associated with CDI. CDI also represents a substantial economic burden on healthcare, due to the high level of recurrence associated with it. There is a high cost of hospitalisation for CDI. In the UK, this is estimated to be £8173 per patient, with the possibility of numerous recurrences.4
Benefits of ‘new generation’ bedpan-washer-disinfectors
Spaulding may not have considered how bedpans are transported from the patient to the disposal point, and what happens there, but Meiko’s engineers do. Every point of contamination is considered, and especially human intervention, when they set out to design bedpan washer-disinfectors. The goal is ‘process efficiency’, characterised by an emphasis on planning, standardisation, and adherence to rules and procedures, aiming for optimal outcomes through well-defined and executed processes.
Meiko bedpan washer-disinfectors (as documented) can now provide automated and documented wash processes, including temperature curves and A0 values. Disinfection is by steam for absolute hygiene. Time, temperature, and water usage are preset, ensuring consistency, and eliminating the need for human intervention, thereby establishing process efficiency. This process is also independently verified. HygCen Germany GmbH carried out a study adapted to the relevant applications based on EN 17111 and EN ISO 15883-3, confirming that Meiko TopLine appliances satisfy the requirements for ‘Virucidal activity’ classification.
Chemical security is automated, with alarms that indicate when chemicals are low. The machines will not run without chemicals, while for temperature security, multiple sensors validate each other to ensure hygiene. The washer-disinfector cannot run without achieving the correct temperature parameters. The risk of incorrect loading is also eliminated; standardising utensils and retainers removes this risk. Another key advance is that load detection selects the correct wash programme, reduces human error, saves time, and conserves resources.
The use of reflection light barriers (also known as reflective photoelectric sensors) — optical sensors used to detect objects without contact using light reflection — is the key to ensuring accurate load detection. Meiko’s research generates a large number of patents. To ensure maximum economy in use, and minimise the need for humans to touch the bedpan washers, Meiko engineers harnessed at least two different types of reflection light barriers to detect differences in the content of containers, and thereby switch to the most appropriate wash.
“This enables simple yet reliable load detection in the form of an optical detection, which can be combined with evaluation of the load,” says Meiko’s patent application.
A cleaning programme tailored to the load incorporated into Meiko’s washer-disinfectors saves resources. Combined with an automatic door, a programme can also self-start without additional touching. In this way, the risk of cross-contamination is reduced.
Hospitals must have the right equipment to respond to emergencies, pandemics, and other critical situations, which means bedpan washer-disinfectors need to be multipurpose in design
Meiko washer-disinfectors are used at ward level, and to combat outbreaks or in isolation wards. User-activated A0 values of 60, 600, or 3000 mean they comply with DIN EN ISO 15883.
Increasing focus on sustainability
Healthcare and healthcare activities are, of course, a major contributor to environmental impact. At the 2021 UN Climate Change Conference (COP26), 14 countries pledged to achieve Net Zero emissions from their health systems within the coming decades, and a further 32 nations made formal commitments to develop sustainable, low-carbon health systems. This goal is being achieved by eliminating disposables where possible and switching to reusable options.
Against this backdrop, both the environmental cost and energy consumption must be considered when assessing washing reusable bedpans versus using disposables. Warewashing is intensely competitive in terms of its energy usage, and every new generation of machines comes with advances. Indeed Meiko increases energy, water, and chemical efficiency in every new generation of new washer-disinfector it introduces.
Disposables’ higher environmental impact
Macerators tend to have a higher environmental impact due to the fact that single-use products are being used and processed, and there is also the potential for blockages in the sewage system — especially if the machines are overloaded, resulting in spillage. Stacking or dropping disposable bedpans into macerators, meanwhile, creates aerosols. Ask any nurse about problems with disposables —flimsiness, leakage, and spillage are common. Disposables also create ongoing costs, require storage, and are subject to human error, as part-used packs collect dust, and are more exposed over time to contamination from soiled hands and aerosols.
Meiko’s bedpan-washers are designed for single-handed loading, whereas some other washer-disinfectors and macerators require two hands to carry bedpans or place them into racks. Our bedpan washer-disinfectors are also quiet in use, meaning they can placed closer to patients, reducing the travel distance for nurses.
In conclusion, the issue of how to best wash bedpans safely, hygienically, economically, and sustainably will continue to produce debate, but companies such as Meiko are doing their very best to develop the most technically advanced solutions, so that hospitals can be rest assured they are not on their own in the battle to minimise cross-contamination and infection risk in ward and in sluice room settings. Meiko bedpan washer-disinfectors machines and complementary sluice room equipment, such as basins, cabinets, and benches, are extensively used throughout Europe, and in many other regions around the globe. Meiko UK has a dedicated team, including engineers, ready to demonstrate the machines in-use benefits and features, and to answer any questions form potential or existing customers.
Jon Sharp and Meiko
Jon Sharp is Meiko UK’s Specification manager for the Care sector. Formerly a key figure in Hilton’s European F&B strategy, he spent a decade driving brand growth for Hampton by Hilton and Hilton Garden Inn across Europe, the Middle East, and Africa. Known for his strong leadership and business development skills, at Meiko he helps lead the expansion of vital hygiene solutions, including innovative washer-disinfectors for hospitals and care homes. His appointment signals Meiko’s commitment to enhancing safety and hygiene standards in healthcare and frontline sectors. He said: “Meiko’s innovative equipment, combined with its extraordinary customer focus – such as providing lifetime training support for Meiko machines – is the way of the future.”
German warewashing manufacturer, Meiko, launched its first bedpan washer-disinfector onto the European market in 1975. Founded over 95 years ago, Meiko is unusual in that it is a foundation, and has had engineers driving the business for the last three decades. As a foundation free from shareholder pressure, and with a strong engineering bias, Meiko’s profits are reinvested in R&D and training for its staff, customers, and apprentices.
References
1 Bryce E, Lamsdale A, Forrester L, Dempster L, Scharf S, McAuley M et al. Bedpan washer disinfectors: An in-use evaluation of cleaning and disinfection. Am J Infect Control 2011; 39(7): 566-70.
2 Rowan NJ, Kremer T, McDonnell G. A review of Spaulding’s classification system for effective cleaning, disinfection and sterilization of reusable medical devices: Viewed through a modern-day lens that will inform and enable future sustainability. Sci Total Environ 2023; 20:878: 162976.
3 Clostridium difficile: Hygiene management for care utensils whitepaper. Meiko. https://tinyurl.com/53kyfebd
4 Bromilow T, Holmes H, Coote L, Woods S, Pink J. Cost-Effectiveness Analysis of Antimicrobial Prescribing in the Treatment of Clostridioides Difficile Infection in England. Original Research Article. Open access. Published: 12 June 2023. 7:739—750.