Bedpan

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Different Types of Bedpans Different Types of Bedpans.png
Different Types of Bedpans

A bedpan or bed pan is a device used as a receptacle for the urine and/or feces of a person who is confined to a bed and therefore not able to use a toilet or chamber pot.

Contents

Bedpans can be either reusable or disposable, and include several different types. Reusable bedpans must be emptied, cleaned, and sanitized after each use and allow for urination or defecation while either sitting or lying in bed, as they are placed beneath the buttocks for use. Disposable bedpans are made of recycled and/or biodegradable materials, and are disposed of after a single use. Disposable bedpans or liners rest inside a reusable bedpan, which is needed to support the user's weight during use.

Regular bedpans look similar to a toilet seat and toilet bowl combined, and have the largest capacity. Fracture or slipper bedpans are smaller than standard-size bedpans and have one flat end. These bedpans are designed specifically for people who have had a hip fracture or are recovering from a hip replacement. This type of bedpan may be used for those who cannot raise their hips high enough or roll over onto a regular-size bedpan. [1] Bedpans have a weight limit, which is different depending on the material and style of the bedpan. For people who are over those weight limits, a bariatric bedpan can be used, which includes tapered edges for durability.

Bedpans differ from chamber pots in both size and function. Chamber pots are larger and usually have handles and a lid. A bedpan is smaller, since it is placed in the bed and positioned under the person for use. Bedpans can have lids, but most do not, as they are immediately emptied or disposed of after use. Bedpans have a long single handle that can double as a spout, either for urine entry or for emptying after use. [2]

History

Green glazed earthenware bedpan from the 16th or 17th century Bed pan, England, 1501-1700 Wellcome L0058377.jpg
Green glazed earthenware bedpan from the 16th or 17th century

The word bedpan was first seen in the literature of John Higgins in 1572, [3] and one of the oldest known bedpans is on display in the Science Museum of London. It is a green, glazed earthenware bedpan that has been dated to the 16th or 17th century. At that time, bedpans were made from materials including pewter, brass, pottery, glass, and porcelain. [4] Bedpans were not a commonplace item in hospitals until the late 1800s. Florence Nightingale, who worked as a nurse in the United Kingdom from the mid to late 1800s, diagramed death rates and causes for soldiers in military hospitals during the Crimean War and then correlated them to corresponding sanitization procedures. As a result, Nightingale proposed several methods to improve the sanitary conditions in both military and civilian hospitals, including the addition of bedpans in order to reduce infection exposure from urine or feces. [5]

Patent for disposable bedpans, 1976 US3962732-drawings-page-2.png
Patent for disposable bedpans, 1976

In the 20th century, bedpans were made of ceramic, enamel, or stainless steel, and after the 1960s, bedpan materials expanded to include plastics and disposable substances. [6] The initial bedpan patent US2243791A was created in the United States in the 1940s. Today, most bedpans are made of stainless steel, plastic, or disposable materials. Stainless steel is durable and easy to clean, but it may be cold, hard, and/or uncomfortable to use. Since the 1960s, disposable bedpans or single-use bedpan liners, made from either recycled wood pulp or biodegradable plastics, have become more popular. [7] The first patent for disposable bedpan liners US3962732 was patented in the United States in June 1976 and relied mainly on wood pulp products as the primary material. [8]

In particular, after the introduction and implementation of the Health Technical Memorandum in the United Kingdom in 2007, now renamed Health Technical Memorandum 2030, it became mandatory to sterilize hospital equipment using an autoclave, also known as a steam sterilizer or macerator. [9] This jumpstarted the switch from stainless steel bedpans to pulp-made bedpans within the United Kingdom, mainly because the overall cost of using a macerator outweighed the cost of disposing of pulp materials. Furthermore, in the European Union, pulp products have recently been reclassified as medical devices, beginning in 2021. [10] This means that these products must meet certain requirements and regulations to ensure their safety and efficacy for medical use. By categorizing pulp products as medical devices, the European Union recognizes their importance in healthcare settings due to their crucial role in maintaining hygiene and preventing infection spread. Utilizing disposable bedpans can prevent the spread of infectious diseases by lowering the risk of contamination during handling and disposal of the excretions. [11]

Use and Indication

Bedpans are used for toileting for those confined to beds and may be used in a hospital, nursing facility, or at home. There are many reasons someone may be confined to bed, necessitating the use of bedpans. These include permanent or long-term disease states with limited mobility such as Alzheimer's disease, Parkinson's disease, stroke, or dementia. Additionally, individuals may be confined to bed temporarily as a result of a short-term illness, injury or surgery. [12]

Current nursing guidance suggests that bedpans are indicated for immobile patients with the following concerns: fractures, such as hip or lower extremities, profound fatigue, major surgeries, high fall risk, increased injury potential, and obstetrical. [12]

Some downsides to using bedpans include the risk of pressure ulcers, lack of privacy, and the potential to spread infection. Pressure ulcers can be caused by prolonged use and the supporting areas of the bedpan being too small. In order to reduce this risk, ergonomic bedpans have been developed, which support the person with a larger area of less-conductive plastic. There are also designs that completely cover the genitalia during use, offering protection and providing an extra measure of privacy. Some of these ergonomic designs require material that is more difficult to sterilize, and may become a reservoir for microorganisms; there have been improvements in cleaning and sterilization to combat this.

Cleaning, sterilization, and infection control

Managing proper hygiene and the cleaning of bedpans for bedridden individuals is important to reduce the risk of infection. Used bedpans contain bodily fluids and waste and can either be reused through disinfection or disposed of. [13]

Sterilization and disinfection procedures for medical devices are established based on the device category. There are three categories of medical device types, which are generally agreed upon by international governing bodies, including the Center for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), and the European Centre for Disease Prevention and Control (ECDC). These categories are Critical Use, Semi-Critical Use, and Non-Critical Use. Bedpans are considered Non-Critical use, meaning the recommendation for cleaning is a low or intermediate level disinfectant. [14] For shared equipment, the CDC recommends cleaning and disinfecting before and after each use, and when compatible disinfectants are not available, guidance is to use a washer-disinfector or boiling water. [15] Dedicated equipment cleaning and disinfectant are similar, but with an additional note to accommodate sanitization based on the risk level of the patient. [15] For example, caregivers should wear gloves when emptying bedpans for those on chemotherapy in order to avoid exposure to toxins. [16]

Oval stainless steel pan Image-Oval-steel.jpg
Oval stainless steel pan

Using stainless steel or plastic reusable bedpans poses a risk of spreading infection through caregivers and the environment. [17] Compared to other metals like copper, steel does not have an inherent ability to disinfect. Copper has had some antimicrobial indications dating back to the 19th century, as some copper workers appeared immune to cholera outbreaks or used copper to treat infections or infectious complications. [18] There are a variety of alternative disposal methods to ensure that infection spread is under control, such as bedpan washer disinfector machines and disposable bedpans.

Washer disinfectors have been utilized more recently for the cleaning of reusable bedpans rather than disinfectants, especially due to the risk of cross-contamination with viruses such as SARS-CoV2 or Ebola. Washer disinfectors are instruments used to disinfect used bedpans at high temperatures of at least 80 °C to 85 °C. [19] [20]

Disinfector machines have been shown to be efficacious against common bacterial infections such as C. difficile spores and E. coli when following instructions, which is an alternative to disposable bedpan waste management. [19] [20] [21] This was proven by a trial where commercially available washer disinfectors were evaluated for efficacy and thermal disinfections against C. difficile spores and colonies of E. coli. After one cycle of the washer the bedpan devices were observed for their efficacy in disinfection against C. diff and E. coli by using swabs of the devices shortly after the cycle, microorganisms were eluted and log-kill was calculated. This process showed evidence that the washer disinfector was highly efficacious in against both C. diff spores and E. coli colonies. However, it is important to note that not all countries have this technology and may use other methods of disinfecting for reusable bedpans or opt in for disposable bedpans. Reusable bedpans used multiple times after a disinfecting procedure carried out by hospital staff, whereas disposable bedpans are used once and then discarded right after use.

Global usage of bedpans

Bedpan use varies significantly among countries based on social and cultural norms, resources available, and infection control priorities. [22] A recent study estimated that 40 percent of the world's population lacks adequate sanitary toilet facilities. [23] [24] This lack of access to basic sanitation has far reaching effects, leading to the spread of diseases and reducing overall quality of life. [25] This has a correlation with the amount of bedpan usage, whether multi-use or single-use, as well as how they are cleaned. As of 2014, countries such as Denmark, France, Germany, Hong Kong, Indonesia, Mongolia, Norway, Thailand, Tunisia, and Uruguay, had rates of 93%–100% for multiple use bedpans. [22] In other countries, single-use bedpans are more prevalent, such as in Australia, Canada, China, the UK, and the US, with rates varying from 46%–89%. Plastic bedpans are used mostly in the US (93%), Netherlands (100%), France (94%), China (100%), and Tunisia (91%), whereas steel bedpans are mainly used in Germany (91%) and Indonesia (80%). Macerators for single-use bedpans are predominantly used in Australia (73%) and the UK (95%), but not in Canada (48%), the US (7%), China (14%), and Thailand (8%). Bedpan washers use chemical disinfectants mainly in the US, Uruguay, Tunisia, and India, whereas heat is commonly used in Australia, Denmark, the Netherlands, Germany, and Hong Kong. Only 13% of bedpans were fully sterilized worldwide. It was mentioned in Canada (14%), the US (31%), the Netherlands (20%), France (9%), China (20%), Egypt (19%) and Pakistan (18%) that water was used only for manual cleaning. [22] This was the largest study to date on worldwide bedpan usage, with 93 countries participating and providing 1440 total responses.

Alternatives

For individuals who are bedridden or experience urinary incontinence, urinary catheters provide an additional option for getting rid of fluid waste; however, fecal matter may still require the use of a bedpan or other instruments. Indwelling urinary catheters are catheters that can be used for years and, akin to bedpans, come either as a one-time-use drainage bag or as a leg bag that can be cleaned or reused. [26] While there are benefits to catheters, a common complication of long-term catheter use is asymptomatic bacteriuria.

Portable urinals, or urinal bottles, are common instruments used by not only those who are bedridden, but also those en route[ clarification needed ] to get rid of liquid waste. The use of portable urinals has a long history, dating all the way back to the French Renaissance in the 16th century, when surgeons developed the urinals to manage male urinary incontinence. [27] Female urinals do exist; however, they may be less easy to use compared to male urinals since they require a wider opening and this can lead to spillage, especially for bedridden individuals, for whom a bedpan may be better suited. [28]

Portable toileting and support tools. SOLD Shower chair, bath transfer bench, toilet riser (4861775529).jpg
Portable toileting and support tools.

Mobile shower commodes are types of sturdy portable toilets that can be used outside the bed by individuals. For those with spinal cord injuries, shower commodes are a common part of assistive technology to help with bowel movements and bathing routines. Some concerns with shower commodes include long and frequent usage being associated with skin breakdown and the development of pressure ulcers, but additional studies need to be conducted to further address safety concerns. [29]

Old age and multiple comorbidities increase the risk of adults developing urinary incontinence. Absorbent products are designed specifically to absorb or contain urine, and some are even reusable. [30] There are various designs of absorbent products, and some may be better suited for individuals depending on their level of incontinence. Pantyliners, pads, and leakage guards for adults help to manage light to moderate incontinence, whereas undergarments, protective underwear, and adult diapers help to manage moderate to heavy incontinence. [30] Choosing which product to use depends on a variety of different factors, such as gender, cost, and level of dependence on absorbent products, but all such products have an absorbent lining that prevents leakage and odor. [30]

See also

Related Research Articles

<span class="mw-page-title-main">Urinary tract infection</span> Infection that affects part of the urinary tract

A urinary tract infection (UTI) is an infection that affects part of the urinary tract. When it affects the lower urinary tract it is known as a bladder infection (cystitis) and when it affects the upper urinary tract it is known as a kidney infection (pyelonephritis). Symptoms from a lower urinary tract infection include pain with urination, frequent urination, and feeling the need to urinate despite having an empty bladder. Symptoms of a kidney infection include fever and flank pain usually in addition to the symptoms of a lower UTI. Rarely the urine may appear bloody. In the very old and the very young, symptoms may be vague or non-specific.

<span class="mw-page-title-main">Hygiene</span> Practices performed to preserve health

Hygiene is a set of practices performed to preserve health. According to the World Health Organization (WHO), "Hygiene refers to conditions and practices that help to maintain health and prevent the spread of diseases." Personal hygiene refers to maintaining the body's cleanliness. Hygiene activities can be grouped into the following: home and everyday hygiene, personal hygiene, medical hygiene, sleep hygiene, and food hygiene. Home and every day hygiene includes hand washing, respiratory hygiene, food hygiene at home, hygiene in the kitchen, hygiene in the bathroom, laundry hygiene, and medical hygiene at home.

<span class="mw-page-title-main">Urinary incontinence</span> Uncontrolled leakage of urine

Urinary incontinence (UI), also known as involuntary urination, is any uncontrolled leakage of urine. It is a common and distressing problem, which may have a large impact on quality of life. It has been identified as an important issue in geriatric health care. The term enuresis is often used to refer to urinary incontinence primarily in children, such as nocturnal enuresis. UI is an example of a stigmatized medical condition, which creates barriers to successful management and makes the problem worse. People may be too embarrassed to seek medical help, and attempt to self-manage the symptom in secrecy from others.

<span class="mw-page-title-main">Urinary catheterization</span> Insertion of a catheter through the urethra to drain urine

In urinary catheterization a latex, polyurethane, or silicone tube known as a urinary catheter is inserted into the bladder through the urethra to allow urine to drain from the bladder for collection. It may also be used to inject liquids used for treatment or diagnosis of bladder conditions. A clinician, often a nurse, usually performs the procedure, but self-catheterization is also possible. A catheter may be in place for long periods of time or removed after each use.

<span class="mw-page-title-main">Catheter</span> Medical tubes inserted in the body to extract or administer substances

In medicine, a catheter (/ˈkæθətər/) is a thin tube made from medical grade materials serving a broad range of functions. Catheters are medical devices that can be inserted in the body to treat diseases or perform a surgical procedure. Catheters are manufactured for specific applications, such as cardiovascular, urological, gastrointestinal, neurovascular and ophthalmic procedures. The process of inserting a catheter is catheterization.

<span class="mw-page-title-main">Sterilization (microbiology)</span> Process that eliminates all biological agents on an object or in a volume

Sterilization refers to any process that removes, kills, or deactivates all forms of life and other biological agents such as prions present in or on a specific surface, object, or fluid. Sterilization can be achieved through various means, including heat, chemicals, irradiation, high pressure, and filtration. Sterilization is distinct from disinfection, sanitization, and pasteurization, in that those methods reduce rather than eliminate all forms of life and biological agents present. After sterilization, an object is referred to as being sterile or aseptic.

<span class="mw-page-title-main">Disinfectant</span> Antimicrobial agent that inactivates or destroys microbes

A disinfectant is a chemical substance or compound used to inactivate or destroy microorganisms on inert surfaces. Disinfection does not necessarily kill all microorganisms, especially resistant bacterial spores; it is less effective than sterilization, which is an extreme physical or chemical process that kills all types of life. Disinfectants are generally distinguished from other antimicrobial agents such as antibiotics, which destroy microorganisms within the body, and antiseptics, which destroy microorganisms on living tissue. Disinfectants are also different from biocides—the latter are intended to destroy all forms of life, not just microorganisms. Disinfectants work by destroying the cell wall of microbes or interfering with their metabolism. It is also a form of decontamination, and can be defined as the process whereby physical or chemical methods are used to reduce the amount of pathogenic microorganisms on a surface.

<span class="mw-page-title-main">Hospital-acquired infection</span> Infection that is acquired in a hospital or other health care facility

A hospital-acquired infection, also known as a nosocomial infection, is an infection that is acquired in a hospital or other healthcare facility. To emphasize both hospital and nonhospital settings, it is sometimes instead called a healthcare-associated infection. Such an infection can be acquired in hospital, nursing home, rehabilitation facility, outpatient clinic, diagnostic laboratory or other clinical settings. A number of dynamic processes can bring contamination into operating rooms and other areas within nosocomial settings. Infection is spread to the susceptible patient in the clinical setting by various means. Healthcare staff also spread infection, in addition to contaminated equipment, bed linens, or air droplets. The infection can originate from the outside environment, another infected patient, staff that may be infected, or in some cases, the source of the infection cannot be determined. In some cases the microorganism originates from the patient's own skin microbiota, becoming opportunistic after surgery or other procedures that compromise the protective skin barrier. Though the patient may have contracted the infection from their own skin, the infection is still considered nosocomial since it develops in the health care setting. Nosocomial infection tends to lack evidence that it was present when the patient entered the healthcare setting, thus meaning it was acquired post-admission.

<span class="mw-page-title-main">Foley catheter</span> Medical device

In urology, a Foley catheter is a brand name for one of many brands of urinary catheters (UC). Foleys and their namesakes are indwelling UC, often referred to as an IDCs or the alternative type being an in/out catheters. The foley UC was named after Frederic Foley, who produced the original design in 1929. The UC is a flexible tube if it is indwelling and stays put, or rigid if it is in/out, that a clinician, or the client themselves, often in the case of in/out UC, passes it through the urethra and into the bladder to drain urine.

Infection prevention and control is the discipline concerned with preventing healthcare-associated infections; a practical rather than academic sub-discipline of epidemiology. In Northern Europe, infection prevention and control is expanded from healthcare into a component in public health, known as "infection protection". It is an essential part of the infrastructure of health care. Infection control and hospital epidemiology are akin to public health practice, practiced within the confines of a particular health-care delivery system rather than directed at society as a whole.

<span class="mw-page-title-main">Anal plug</span> Medical device sometimes used to treat fecal incontinence

An anal plug is a medical device that is often used to treat fecal incontinence, the accidental passing of bowel moments, by physically blocking involuntary loss of fecal material. Fecal material such as feces are solid remains of food that does not get digested in the small intestines; rather, it is broken down by bacteria in the large intestine. Anal plugs vary in design and composition, but they are typically single-use, intra-anal, disposable devices made out of soft materials to contain fecal material and prevent it from leaking out of the rectum. The idea of an anal insert for fecal incontinence was first evaluated in a study of 10 participants with three different designs of anal inserts.

A urine collection device or UCD is a device that allows the collection of urine for analysis or for purposes of simple elimination. UCDs of the latter type are sometimes called piddle packs.

Neurogenic bladder dysfunction, or neurogenic bladder, refers to urinary bladder problems due to disease or injury of the central nervous system or peripheral nerves involved in the control of urination. There are multiple types of neurogenic bladder depending on the underlying cause and the symptoms. Symptoms include overactive bladder, urinary urgency, frequency, incontinence or difficulty passing urine. A range of diseases or conditions can cause neurogenic bladder including spinal cord injury, multiple sclerosis, stroke, brain injury, spina bifida, peripheral nerve damage, Parkinson's disease, or other neurodegenerative diseases. Neurogenic bladder can be diagnosed through a history and physical as well as imaging and more specialized testing. Treatment depends on underlying disease as well as symptoms and can be managed with behavioral changes, medications, surgeries, or other procedures. The symptoms of neurogenic bladder, especially incontinence, can have a significant impact on quality of life.

A virucide is any physical or chemical agent that deactivates or destroys viruses. The substances are not only virucidal but can be also bactericidal, fungicidal, sporicidal or tuberculocidal.

<span class="mw-page-title-main">Isolation (health care)</span> Measure taken to prevent contagious diseases from being spread

In health care facilities, isolation represents one of several measures that can be taken to implement in infection control: the prevention of communicable diseases from being transmitted from a patient to other patients, health care workers, and visitors, or from outsiders to a particular patient. Various forms of isolation exist, in some of which contact procedures are modified, and others in which the patient is kept away from all other people. In a system devised, and periodically revised, by the U.S. Centers for Disease Control and Prevention (CDC), various levels of patient isolation comprise application of one or more formally described "precaution".

In health care, toileting is the act of assisting a dependent patient with his/her elimination needs.

<span class="mw-page-title-main">Urinal (health care)</span> Bottle for urination used in health care

A urinal, urine bottle, or male urinal is a bottle for urination. It is most frequently used in health care for patients who find it impossible or difficult to get out of bed during sleep. Urinals allow the patient who has cognition and movement of their arms to urinate without the help of staff. A urinal bottle can also used by travelers or transportation workers who are unable to immediately use a public restroom as part of an emergency kit, or in areas where restroom facilities are too distant.

<span class="mw-page-title-main">Central sterile services department</span> Hospital facility

The central sterile services department (CSSD), also called sterile processing department (SPD), sterile processing, central supply department (CSD), or central supply, is an integrated place in hospitals and other health care facilities that performs sterilization and other actions on medical devices, equipment and consumables; for subsequent use by health workers in the operating theatre of the hospital and also for other aseptic procedures, e.g. catheterization, wound stitching and bandaging in a medical, surgical, maternity or paediatric ward.

<span class="mw-page-title-main">Single-use medical devices</span>

Single-use medical devices include any medical equipment, instrument or apparatus having the ability to only be used once in a hospital or clinic and then disposed. The Food and Drug Administration defines this as any device entitled by its manufacturer that it is intended use is for one single patient and one procedure only. It is not reusable, therefore has a short lifespan, and is limited to one patient.

Accelerated hydrogen peroxide (AHP) is a trademark for solution of hydrogen peroxide whose antibacterial efficacy is enhanced by a surfactant and an organic acid. It is also a disinfectant/cleaning agent that stabilizes hydrogen peroxide so that it can be used for extended periods of time.

References

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