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The implementation of a commode cleaning and identification system

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The epic Project guidelines (Pratt et al, 2001) state that: ‘Where a piece of equipment is used for more than one patient, for example a commode, it must be cleaned following each and every episode of use.’ As a ward sister and infection control link nurse in a private hospital, part of my role is to train staff about infection control and monitor standards and practice within the hospital.

Abstract

VOL: 100, ISSUE: 8, PAGE NO: 47

Barbara Dassut, RN, is ward sister and infection control link nurse, The Warwickshire Nuffield Hospital

 

The epic Project guidelines (Pratt et al, 2001) state that: ‘Where a piece of equipment is used for more than one patient, for example a commode, it must be cleaned following each and every episode of use.’ As a ward sister and infection control link nurse in a private hospital, part of my role is to train staff about infection control and monitor standards and practice within the hospital.

 

 

Identifying a problem
Last year when I was caring for a patient who needed to use a commode, I began to wonder whether the commode was clean and fit for use. Although it looked clean, there was no way of identifying that it had been cleaned between patients.

 

 

Research has demonstrated the presence of microbes including methicillin-resistant Staphylococcus aureus in the hospital environment (Blythe et al, 1998; Green et al, 1998) and equipment such as commodes may play a part in cross-infection. How could I create a system to visually identify that a commode has been cleaned and is fit for use?

 

 

Examining current practice
The existing system for cleaning commodes involved taking a dirty commode into the sluice, washing it at a time convenient to staff (not necessarily immediately after use and transferring it to its designated area in the sluice.

 

 

However, an unclean commode could potentially be pushed out of the way to make space and there was a chance that it could be used by another patient before cleaning and decontamination. Identification of this simple problem led to the development of a planned programme of activity and a change of practice. This change resulted in an improvement in patient care.

 

 

Change in practice
A system that identified a commode as being clean was needed that was quick to implement, required no chart to be signed and would visually inform the next user that the equipment was clean and fit for use.

 

 

I remembered seeing a system in place in hotels that visually informs guests that their bathroom has been serviced. This was achieved by looping a paper sanitary wrap around the toilet seat lid. It appeared to be a very simple, cost-effective and efficient way of informing a user that the toilet was clean.

 

 

I visited our head housekeeper, who understood exactly what was needed and agreed to investigate suppliers of a wrap. Samples were sent to us from various companies and a wrap was chosen and subsequently ordered, costing about £22 per 1,000.

 

 

This was taken to the infection-control training sessions and staff were informed about the new commode cleaning system. The new arrangements were greeted with enthusiasm and approval.

 

 

Evaluation and recommendations for practice
We now have a system in which a commode comes into the sluice for cleaning and is thoroughly washed using detergent, warm water and a disposable cloth. Drying each surface is vital to prevent microbial growth.

 

 

A sanitary wrap is then placed around the lid of the commode before it is transferred to its allocated space for storage. Both the provider of the commode and the user are able to see at a glance that the commode has been cleaned and is fit for use.

 

 

The commode cleaning and identification system is quick to implement and cost-effective as it only requires the purchase of the sanitary wraps. It has resulted in an improvement in the care of patients.

 

 

Further developments
Since the implementation of the system, our main commode supplier has been approached to produce its own sanitary wrap. A sample has now been sent for comment and approval.

 

 

The wrap was discussed at a meeting of infection control link nurses, who decided that it needed to be long enough to loop around the commode seat and adhere underneath it so that when the seat was lifted, the wrap would tear and the seal break, so preventing further use of the wrap.

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