Design Bugs Out: products in action

In 2009 the Department of Health (DH) commissioned the Design Council to launch a nationwide search for teams of designers and manufacturers to re-design some typical hospital furniture and equipment to make them easier to keep clean and help to reduce exposure to HCAI’s. One manufacturer who became part of this “Design Bugs Out” project was Kirton Healthcare, who, in conjunction with design consultancy PearsonLloyd, was challenged to re-design the hospital commode which traditionally has been made up of multiple parts, with complex junctions between different materials. This complexity of design makes them difficult to thoroughly clean. Tom Lloyd, a director of PearsonLLoyd, explains. “Commodes have always had to perform on multiple levels which has led to them becoming quite complex products. Our design goal was to reduce the number of parts in the product and to make them a simpler piece of equipment to facilitate easier cleaning while remaining functional and improving patient comfort and dignity. One of the first Trusts in the UK to employ the resulting new commode, produced by Kirton Healthcare, was Scarborough and North East Yorkshire NHS Trust. Donna Winter, an infection prevention and control clinical nurse specialist at the Trust, has been an infection control nurse for 12 years, working at Scarborough Hospital for the past eight. She is part of a team of five covering around 450 beds and is responsible for managing infection throughout the Trust. Ms Winter has a great deal of experience relating to the problems of adequately cleaning commodes. She explains: “Years ago nearly all hospitals used the same type of commode. However, we were not able to use bleach to clean them because there was a risk of degrading the material.” For this reason the Trust specified a different type of commode, which could be cleaned with bleach, but they just did not live up to the Trust’s expectations. “The new commodes kept splitting, bits fell off, they were very difficult to deal with and the staff on the wards were very unhappy with them,” said Ms Winter. The infection prevention and control team at the Trust had been aware of the Design Bugs Out project from the outset. “We attended some of the showcase presentations and at Conference we saw the prototype commodes from Kirton Healthcare. We were very impressed and wanted to know where do we could get hold of the product. So, we gave the company a call and some time later we were able to take a prototype commode round the wards. Our procurement department could not believe that we were so excited about a commode! The reaction was very different to anything we had seen before. We ordered 120 units and I think we were the first hospital in the country to introduce them. The response from staff on the wards was fantastic. “There are other commodes available which claim to have bugs designed out too but I do not believe that they are as good as the Kirton product. We do random swabbing to test cleaning and so far the results have been good. The main benefit to the staff is the ability to clean the commode properly by turning it over easily and doing the underneath rather than dismantling it. Every reservoir of infection has been designed out.”

Patient dignity

The Kirton top-loading commode pan has eliminated any gaps and openings, preventing waste contaminating any hardto- reach parts of the commode. The depth of the pan is greater than current commode pans to accommodate more waste, reduce splash back and to provide a better patient experience. “With commodes there is also a patient dignity issue,” said Ms Winter. “A patient obviously has to feel comfortable on a commode and one of the benefits of this product is that our pulp usage has decreased. I cannot give exact numbers but I know for the last few months that we have actually cancelled our pulp delivery and that is mainly because the commode is so mobile, staff are taking patients to the toilet, rather than leaving the commode by the bedside. From a patient dignity perspective this is good news and it has also offered the Trust significant cost savings.” The commode is quiet when in motion so does not disturb other patients when being moved around. “It does not sound like a traditional commode, rattling about in the middle of the night disturbing everybody,’ said Ms Winter. “The manoeuvrability is also good; the brakes don’t stick on and you don’t have to use much pressure to get the brakes on or off. However, overall for us the main benefit is that we are able to clean every single part of the commode properly and easily.” “The Kirton commode also made a contribution to meeting the Trust’s infection control targets,” said Ms Winter. “We have made a 40% reduction on last year’s infection figures which is good news and the commode is definitely part of that. The Care Quality Commission has carried out a thorough audit and are happy with the commodes.”