Charlotte Waterworth
Healthcare writer
Implementing and maintaining effective infection control procedures and systems presents a major challenge for many hospitals and healthcare settings. Many items used during the delivery of care can easily become contaminated with blood or other body fluids, so steps must be taken to ensure that these are not allowed to pass between patients.
While much emphasis has been placed on the importance of deep cleansing hospital wards and promoting good hand hygiene among staff, visitors and patients, the role played by hospital facilities in keeping infection at bay is sometimes overlooked.
Indeed, research carried out by the Medical Architecture Research Unit at London’s South Bank University identified hospital-acquired infection as a “multi-faceted problem, and control of infection can only be achieved via a combination of design and management factors, not by a single identifiable factor”.1
Hospital sluice rooms, sometimes known as dirty utility rooms, are dedicated to the disposal of human waste and the disinfection of associated goods. While, on the one hand, they may be viewed as a potential hot spot for hospital-acquired infection, a well-planned sluice room can also play a contributing role in reducing the spread of infection.
“The safe disposal of human waste is one of the most vital of operations for the control of infection and cross contamination,” says Adele Batchelor, Business Development Manager at Meiko UK, a European market leader in cleaning and disinfection technology and sluice room equipment. “A well designed and equipped sluice room will provide the best possible facility for the safest method of disposal of human waste and associated cleaning operations,” she adds.
Grand designs
The main aim of a sluice room is to ensure that human waste is disposed of as quickly and efficiently as possible with minimal human contact, following the best possible hygiene protocols and recommended infection control and prevention guidelines.
“A sluice room should be designed and equipped to facilitate and encourage best possible practice, which, in turn, provides a safe and pleasant working environment for all staff,” explains Adele. “Sluice room design must also meet or exceed healthcare-associated infections (HAI) policies.”
In essence, a sluice room should be designed and fitted out in such a way to reduce the potential of cross-contamination. How this is achieved may vary among different countries – for example, sluice room design in German hospitals may differ from those found in UK hospitals.
Unfortunately, the sluice room is often the room left over after other rooms have been allocated to seemingly more important tasks. As a result, their size can vary from hospital to hospital and may also vary among different European countries.
Size not defined
In the UK, for example, there are no specific guidelines in relation to size. However, sluice room design company DDC Dolphin suggests that to allow work-flow and the storage of large items such as commode chairs, a sluice room should be no smaller than three square metres.
The sluice room should certainly be large enough to accommodate at least the essential minimum equipment. In addition, it should be able to fit additional equipment if needed. “If a room is originally of a sufficient size and designed correctly, any adaptation can be more easily incorporated,” they explain.
Certain fixtures and fittings should be included at the design or refurbishment stage, including a washable sealed floor and wall coverings to assist cleaning and disinfection as necessary. Melamine or stainless steel are both appropriate materials for this.
Providing adequate ventilation should also be considered in the design phase to avoid any potential flow of unpleasant odours to pass from the sluice room. This may be achieved by fitting an extractor fan operated by a ceiling mounted string pull. Fitting an air vent in the access door is not advised, since switching off the extractor fan may cause a reverse flow of air carrying unpleasant odours to pass from the sluice room to external areas.
However, if practical, the room may contain a louvered window to allow air from outside to flow into the room. The sluice room should also contain fluorescent lighting and a lockable fire door. In addition, all pipe-work should be concealed and equipment should be fitted to provide optimum hygiene conditions.
Content and compliance
A sluice room should not be used as a storage facility for clean items and should never hold clean items alongside dirty ones. General clean consumables should be stored in a separate clean utility room.
Meiko advises that essential sluice room items should include:
- Compliant cleaning and thermal disinfection appliances
- Stainless-steel wash-hand basin with either wrist, elbow or sensor taps
- Liquid soap dispenser
- Paper towel dispenser
- Dispenser for hand disinfection
- Wall-mounted rack for the temporary storage of cleaned utensils
- Waste bin.
Ideally, a sluice room should also contain:
- Rim flush slop sink with the facility to fill and empty buckets
- Deep stainless-steel sink
- Stainless-steel storage cupboards – wall-mounted and floor-standing units incorporating stainless-steel work surfaces
- Multi-washer.
DDC Dolphin also note that sluice room design and equipment requirements also depend on whether hospital wards use disposable pulp or reusable bedpans and urine bottles, as this will guide the choice of machine to be fitted – either a disposable pulp macerator or a thermal disinfection unit.
B. Hickman, who authored an article published in the Journal of the Institute of Hospital Engineering in 1989,2 recommends that using disposable bedpans and a macerator is preferable as it reduces the risk of infection and also minimises engineering time.
“With a macerator, when a machine failure does occur, it is complete and results in an emergency call to the engineering department. With a bedpan washer, the danger is that the machine failure, i.e. problems with the washer arm or failure of the machine to reach disinfection temperature, will not be complete and will go unnoticed, thus presenting an infection-control hazard,” wrote Hickman.
Temperature sensors
However, modern bedpan washers provide advanced technology whereby a sensor performs a check after every cycle to ensure the correct temperature has been reached. In addition, the control display will report any malfunction.
Many hospitals also include the use of a slop hopper where body fluids can be disposed and flushed. Although not essential, it is very common in UK hospital sluice rooms.
Ideally, bulk clinical waste should be stored in a separate lockable room while awaiting collection. However, temporary clinical waste bins and the facility for the disposal of sharps are often found in sluice rooms. If this is the case and if possible, these should be stored on the opposite side of the room from the bedpan washers and wall storage rack.
Much sluice room-related compliance relates to equipment used within the room. Washer disinfectors, for example, must adhere to EU standards and, in the UK, to HTM2030 guidance.
“The NHS Estates/Department of Health HTM2030 gives guidance on the choice, specification, purchase, installation, validation, periodic testing, operation and maintenance of washer-disinfectors in use in the National Health Service for processing medical devices, laboratory ware and sanitary products”, explains Adele.
Hospital washer disinfectors are commissioned and validated as required and should incorporate the capability to be tested on a regular basis to confirm that the thermal disinfection process is reaching the desired temperature recommended to reduce bacteria to an acceptable level.
Prime location
The number of sluice rooms is of often determined by the number of dependent patients and the physical layout of the hospital: a ratio of one sluice room to every 20 patients is advised.
Hospitals that contain wards on a number of different levels should include a sluice room to service individual wards on each floor, thus eliminating the risk of spilling human waste when carrying items, such as bedpans, between floors. In addition, the sluice room should be sited as close as possible to the highest concentration of beds.
“Sluice rooms should be allocated near to dependent wards, as soiled utensils should not be transferred through any communal areas. This, of course, promotes the quick disposal of human waste and optimises the work-flow of the nursing staff.
“Often a sluice room will be located in a particular wing of a hospital and may service one ward. However, it is also common to find that there is a more central sluice room with a number of washer disinfectors,” says Adele.
Contamination risk
The importance of sluice room location was highlighted when a UK hospital was barred from accepting new patient admissions in response to concerns by health officials that the positioning of a sluice room in the middle of a ward posed a serious contamination risk.
The location of the sluice room meant that nurses had to carry bed pans through the main ward, even when infectious patients have been isolated in side rooms, creating a possible risk of contamination. As a result, the hospital was forced to close its doors to new patients for several months.
Given that the safe and efficient disposal of human waste plays an important role in controlling infection in the hospital setting, the importance of sluice rooms in maintaining a healthy and safe environment for both patients and visitors is something that should never be overlooked.
References
- McDonald J, Montgomery R. Health Estate. 2010 Sep;64(8):23-9.
- Hickman B. J Inst Hosp Eng. 1989 Feb;43(1): 14,16-7.
