Minimizing Clostridium difficile Exposure Using Disposable Commode Pails

One hospital that used disposable commode pails instead of reusable commode buckets was able to reduce Clostridium difficile (C. difficile) infection rates by nearly a third after 1 year, according to a new study.

Molly Bridget Delaney, PhD (photo), from the University of Minnesota Medical Center, analyzed the effects of the use of these disposable commode pails in 1 hospital to determine how rates of C. difficile were impacted. The rationale for the devices was to prevent staff from touching surfaces heavily contaminated with C. difficile. Notably, the staff members were instructed not to wash or reuse the commode buckets between patients, and that is when the disposable commode pails were substituted in. Instead, only the commode chairs were wiped down. Staff members were then interviewed using Survey Monkey.

All departments in the hospital, including infection prevention, janitorial, and maintenance services had to agree to the use of disposable commode pails prior to the study. The staff used personal protective equipment when handling the disposable commode pails and patient bodily fluids. Continuing with similar practices, isolated patients’ waste continued to be double-bagged, and red biohazard bags were used if blood was present.

The capacity of a disposable commode pail mimicked the human bladder, but if more waste was produced, multiple disposable commode pails were recommended. Between uses, bleach-based wipes were used on the chairs and then tossed inside the disposable commode pails rather than flushed.

Other instructions included shipping and storing requirements. For example, if a urine or stool sample was ordered to be sent to the laboratory, a collector was used. The disposable commode pails were not to be stored near suicidal or behaviorally impaired patients, as they could use the product to harm themselves or others. The disposable commode pails should be stored in a locked cupboard or garage to prevent patients from gaining access to the equipment.

When a patient with diarrhea arrived at the hospital, any staff member could order contact isolation. A disposable commode pail would be parked outside their door and a medical professional could request stool sample cultures. The research team collected C. difficile data based on 12 months based on these methods.

Nearly all staff members surveyed believed that disposable commode pails were cleaner and safer than reusable commodes that required hand washing (95%, according to Survey Monkey). In the open-ended section of the survey, respondents added that they no longer touched surfaces contaminated with fecal matter. There was some opposition, however; environmental concerns were noted.

Emergency department staff spent less time seeking out and setting up equipment when using the disposable commode pails, the study author noted. In addition, transporting waste and cleaning times were also reduced.

One surprising finding, Dr. Delaney told MD Magazine in an email, was that the use of disposable commode pails contributed to fewer plumbing problems. When the disposable commode pails wipes were used, they were trashed rather than flushed, reducing plumbing blockages, sewer leaks, and floods—all things that can contribute to C. difficile exposure.

“Sewage back-ups are a growing hospital problem and should be a bigger concern for the spread of C. difficile and other gastrointestinal germs,” Dr. Delaney said.

The study, titled, “Kick the Bucket: One Hospital System’s Journey to Reduce Clostridium difficile,” was published in the Journal of Emergency Nursing.

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