title: Evaluation of excreta management in a large French multi-hospital institution.
abstract: BACKGROUND
  Excreta are a major source of multidrug-resistant Enterobacteriaceae including strains that produce extended-spectrum beta-lactamase (ESBL). The increase of ESBL incidence in Assistance Publique - Hôpitaux de Paris (AP-HP) hospitals prompted an evaluation of the equipment and practices used to dispose of excreta.
  
  
  OBJECTIVE
  To evaluate the use of equipment for the management of excreta and to review practices of healthcare workers in their disposal.
  
  
  METHODS
  A cross-sectional survey was conducted in 2012.
  
  
  RESULTS
  A total of 28 AP-HP hospitals including 536 units (342 acute care units and 194 rehabilitation and long-term care units) were evaluated. Among the patients on the day of the survey, 5697 (43%) wore diapers and 1767 (13%) were using a bedpan. Sixty-one percent of the beds were equipped with shared toilets and 43% of the toilets were equipped with hand sprayers, a device favouring the spread of faecal material in the environment. Sixty eight percent of the units were equipped with bedpan washer-disinfectors. Only 52% of the bedpan washer-disinfectors were located in rooms where alcohol-based hand rubs (ABHRs) were available. In 71% of the units the bedpan was rinsed before disinfection, mostly in the patient's bathroom (62%). Finally, only 9% of questioned healthcare workers said they followed an educational programme about excreta disposal.
  
  
  CONCLUSIONS
  This survey shows that, in the field of multidrug-resistant Enterobacteriaceae control and the promotion of hand hygiene with ABHRs, excreta management is a concerning but neglected subject.
authors.affiliation: Infection Control Team, Direction de l'organisation médicale et des relations avec les universités, Siège Assistante Publique - Hôpitaux de Paris, Paris, France. Electronic address: margaux.lepainteur@rpc.aphp.fr.
authors.forename: M
authors.initials: M
authors.lastname: Lepainteur
authors.affiliation: Infection Control Team, Hôpital Beaujon, Assistante Publique - Hôpitaux de Paris, Clichy, France.
authors.forename: S
authors.initials: S
authors.lastname: Nérome
authors.affiliation: Infection Control Team, Hôpital Bichat - Claude Bernard, Assistante Publique - Hôpitaux de Paris, Paris, France.
authors.forename: G
authors.initials: G
authors.lastname: Bendjelloul
authors.affiliation: Infection Control Team, Direction de l'organisation médicale et des relations avec les universités, Siège Assistante Publique - Hôpitaux de Paris, Paris, France.
authors.forename: C
authors.initials: C
authors.lastname: Monteil
authors.affiliation: Infection Control Team, Hôpital Ambroise Paré, Assistante Publique - Hôpitaux de Paris, Boulogne-Billancourt, France.
authors.forename: B
authors.initials: B
authors.lastname: Cottard-Boulle
authors.affiliation: Infection Control Team, Direction de l'organisation médicale et des relations avec les universités, Siège Assistante Publique - Hôpitaux de Paris, Paris, France.
authors.forename: M
authors.initials: M
authors.lastname: Nion-Huang
authors.affiliation: Laboratoire de Bactériologie, UPMC Université Paris 06, France; Laboratoire de Bactériologie-Hygiène, Hôpital Pitié-Salpêtrière, Assistante Publique - Hôpitaux de Paris, Paris, France.
authors.forename: V
authors.initials: V
authors.lastname: Jarlier
authors.affiliation: Infection Control Team, Direction de l'organisation médicale et des relations avec les universités, Siège Assistante Publique - Hôpitaux de Paris, Paris, France.
authors.forename: S
authors.initials: S
authors.lastname: Fournier
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D006761:Hospitals; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D017053:Infection Control / Q000379:methods*; D008297:Male; D017744:Medical Waste Disposal / Q000379:methods*; D008875:Middle Aged; D010297:Paris; D055815:Young Adult
chemical_list: D017744:Medical Waste Disposal
keywords: Bedpan; Bedpan washer-disinfector; Extended spectrum beta-lactamase; Management of excreta