Excreta Management: A Major Issue In The Risk Of Contamination

10/04/20

Nosocomial infections: a magnitude not to be overlooked

In developed countries, 5 to 10% of hospital patients are affected (up to 30% in intensive care units) and these figures are 2 to 3 times higher in developing countries.


 


It is also the 7th cause of death in the world which causes 2 million deaths per year (80,000 deaths in the USA, 4,200 to 9,000 deaths in France) 1.

Excreta, an important source of contamination

Excreta (vomiting, urine, stools) are a reservoir of microorganisms capable of causing infections and with a very high capacity for dissemination:

  • Faecal excretion: 107 to 109 bacteria / g of stool
  • Urinary excretion: 108 to 109 E. coli BLSE / day in case of urinary tract infection
  • Vomit excretion: 107 noroviruses per 20-30 ml jet (gastroenteritis)2.

 

The bacterial risk linked to stools is particularly high because there are very many families of bacteria whose reservoir is the digestive tract: Escherichia coli, Klebsiella pneumoniae, Enterococci resistant to glycopeptides, Clostridium difficile…

These Enterobacteria are responsible for 38% to 50% of Infections Associated with Healthcare (IAS) and Nosocomial Infections (NI), they become resistant to antibiotics and we even see the emergence of BHRe “Highly Resistant Bacteria” and “Super -bacteria “.

In addition, these bacteria have a stability in the environment, up to 5 days for Enterococcus faecalis, 1 week for Escherichia coli and 4 to 5 months for spores of Clostridium difficile, ERV, SDRM, Acinetobacter 2

The management of excreta, a major issue to contain contamination

Bed basins, buckets, urinals, etc. are reservoirs of pathogenic microorganisms.


 


Handling them exposes the caregiver, the patient and the environment to microbial contamination. In addition, manual cleaning, in addition to being a thankless, tedious and costly task, is at risk; it is therefore to be avoided3.


 


Indeed, basin washers or macerators are heavy and expensive equipment, with frequent malfunctions (2/3 of basin washers: breakdown more than once a year)4.


In addition, they do not solve the problem of transporting the full basin to the equipment (risk of dissemination in the facilities).


In this context, it is crucial to apply good practices and to choose the right material for the management of excreta and the hygiene of dependent patients in order to prevent the infectious risk linked to cross-transmissions (interhuman, material, environment of the patient).

To motivate and invest all of the protagonists, it is also key to:


  • Improve working conditions and the safety of caregivers and care helpers

  • Promote mobility (de novo incontinence prevention), modesty and patient dignity

  • Reduce direct (material, consumables, working time) and indirect (consequence of nosocomial infections) costs.


Also the use of hygienic bags and super-absorbent pads is a solution to secure the collection, transport, and disposal of excreta.

This solution is already used by thousands of hospitals around the world and recommended by hospital hygiene authorities.

International recommendations

“The protective bags make it easier and safer to collect, transport and dispose of excreta.” (Standard Precautions SF2H, France 2017)

“Use disposable excreta collection bags with absorbents for all patients using basins.” (CCLIN APHP, France 2012)

“Cover the pelvis with a hygienic bag and absorbent material to reduce the risk of health workers being exposed to faeces.” (APIC, USA 2010)

“Sanitary bags would be a safer process because the material does not leave the isolation area. It requires little or no infrastructure. […] Several hours of care are recovered because of the speed of the process.” (AETMIS, Canada 2009)

Rate of VRE- associated infections - 2009 - 2010 – 2011

Reduction:

  • the rate of VRE infections (from 1.53 to 0.26)
  • contamination of the patient’s environment
  • the number of stages of nursing care (from 15 or 20 to 9)

Vitale, E. (2011, May). Safer Panhandling to Reduce the Rate of Vancomycin Resistant Enterococci – Giving staff the right tools to safely and efficiently do their job. Poster session presented at the CHICA-Canada National Education Conference, Toronto

Cost comparator for treatment of excreta devices

Annual cost in euros including agent time:

  • Wash basin 1: € 4,100.90
  • Wash basin 2: € 4,229.32
  • Crusher: € 3,280.72
  • Absorbent bag: € 3,084.96
  • Manual cleaning: € 3,280.72

This tool is provided free of charge to healthcare facilities by ARLIN Haute Normandie. Institutions are required to validate and verify their data. For any further information contact denis.thillard@chu-rouen.fr, date of completion: 10/4/2014

Sources (extracts and adaptations):

1-WHO, Health care-associated infections FACT SHEET

2-The Role Played by Contaminated Surfaces in the Transmission of Nosocomial Pathogens • Author(s): Jonathan A. Otter, Saber Yezli, Gary L. French Source: Infection Control and Hospital Epidemiology, Vol. 32, No. 7 (July 2011), pp. 687-699 Published by: The University of Chicago Press on behalf of The Society for Healthcare Epidemiology of America

3- Comparative analysis of basin treatment equipment Technology Assessment Agency and Health Intervention Modes (AETMIS 2009): Vol 5: N4

4- Bulletin du CClin Paris-Nord n ° 41, December 2012, Survey on the management of excreta in AP-HP hospitals, Margaux Lepainteur, Simone Nérome, Gisèle Bendjelloul, Brigitte Cottard-Boulle, Catherine Monteil, Michèle Huang , Vincent Jarlier, Sandra Fournier and the AP-HP hygiene team network