Planning for Optimal Sluice Room Editorial

1. www.ddcdolphin.co.uk
Planning for the
optimal sluice room
www.iheem.org.uk
Health Estate
JOURNAL OF THE INSTITUTE OF HEALTHCARE ENGINEERING AND ESTATE MANAGEMENTHealth Estate
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2. Dirty utility design
2
Reprinted from Health Estate Journal
D
DC Dolphin specialises in the design
and creation of sluice rooms and
dirty utility rooms, in care homes,
hospitals, hospices, and special needs
schools. Over 20 years of experience
allows us to provide comprehensive and
meaningful advice and support throughout
the planning, design, and specification
processes for new or existing facilities.
Importance of design and layout
Incorporating sluice or dirty utility rooms
into the architectural design of new or
refurbished care homes, hospitals, and
other care facilities, needs consideration
of all factors relating to, as a minimum,
infection control, access, flow of work, and
layout. Sluice room design requires an
approach that meets the specific needs of
the hospital, as well as associated
Safe disposal of human waste
Safe disposal of human waste, and the
associated decontamination of reusable
items such as bedpans and urine bottles
to minimise the risk of cross-infection
from body fluids, is one of the most
important operations for maintenance of
both patient and healthcare worker
wellbeing. For example, the current rise in
the prevalence of resistant strains of
‘bugs’, and increased awareness of AIDS
and other viruses since the mid-1980s, are
key areas of perceived risk. By disposing
of all human waste in a single area,
infection can easily be contained and
isolated before it can spread. An efficient,
modern sluice room, that enables clean
and effective human waste disposal and
disinfection, is therefore absolutely central
to ensuring good hygiene and infection
control standards in hospitals and other
healthcare facilities.
Infection control is ‘core’
Infection control should be at the 
centre of any sluice room design strategy
– to minimise the risk of healthcare-
acquired infections such as Methicillin-
resistant staphylococcus aureus
(MRSA), Clostridium difficile, norovirus, 
Extended-spectrum beta-lactamase
(ESBL), and Legionella. All make 
infection control critical in terms of 
Planning for the
optimal sluice room
Gordon Dunn (pictured), global sales and marketing director at DDC Dolphin,
a leading UK engineering company ‘dedicated to excellence and innovation
in sluice room/dirty utility room design, and equipment manufacture, installation,
testing and servicing’, gives a guide to ‘designing modern, effective, and clean
sluice rooms using an innovative, informed, and cost-effective approach’.
regulations. Most critically, it requires a
design specification that helps to reduce
healthcare-associated infections (HAIs)
resulting from cross-infection from body
fluids and human waste.
The hygienic sluice room
A sluice room can be defined as ‘a room
that provides storage of single-use
containers used for collection of human
waste, its subsequent disposal and other
associated activities, and the temporary
holding of used equipment, materials, and
refuse, prior to transfer to the disposal
point to await collection’.
Consequently, it is one of the most
intensively used ancillary rooms in an
acute ward, as demonstrated by Table 1,
which incorporates an excerpt from an
activity study of a typical sluice room.
Hands-free sluice room equipment operation, via sensors, and antibacterial
materials, reduce the risk of contamination.
Gordon Dunn.
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3. both health and financial costs.
For certain patients, such as the elderly
or immunosuppressed, effective infection
control can, at its most extreme, be life-
saving; it can also certainly ensure shorter
hospital stays and reduced use of
antibiotics.
For healthcare workers, minimising
cross-infection ensures a decreased
workload in the treatment of unnecessary
infections; patients are also more mobile
and require less assistance. In addition,
staff are healthier and require fewer 
‘sick days’.
Minimising the risk of HAIs thus directly
reduces costs, due to decreases in
nursing time and use of antibiotics, as
well as through the avoidance of total
ward shutdowns when an infection cycle
needs to be broken. The risks and costs of
not undertaking effective infection control
are evident; it is therefore critical that any
measures employed are undertaken
properly. Within a sluice room, effective
decontamination is key to delivering good
hygiene, and thus sound infection control.
What is decontamination?
Decontamination involves the removal of
hazardous substances (bacteria,
chemicals, radioactive material) from
people’s bodies, clothing, equipment,
tools and/or sites – to the extent necessary
to prevent the occurrence of adverse
health and/or environmental effects. It
should also be noted that the
decontamination of reusable medical
equipment is all about acceptable risk,
and falls into different bands. For example,
it would be lethal to merely wash surgical
instruments in hot water and detergent,
whereas sterilising a bedpan for an hour
in an autoclave would be highly
impractical and costly.
As a result there are differing defined
levels of decontamination which enable
decisions to be made on the procedures
that should be carried out – see Table 2.
The decontamination procedures that are
undertaken within a sluice room,
therefore, fall within the medium and low
risk levels, which generally require
disinfection and cleaning – see Table 3.
Since it is a process that reduces the
number of microorganisms to a level at
which they are not harmful, although
spores will not usually be destroyed,
disinfection is the most used
decontamination process within a sluice
room to ensure effective infection control.
Sluice room design
As previously discussed, inadequate
decontamination can result in the transfer
of infections to patients and health
workers; consequently, every location in
which decontamination procedures are
undertaken should be properly designed,
maintained, and controlled.
To achieve this within a sluice room,
there are a number of essential and useful
features to be considered, as follows:
Fixtures
nAn extractor fan, to eliminate
unpleasant odours.
nSealed floor covering (vinyl or similar)
suitable for washing in the event of
spillage from utensils.
nFluorescent lighting, with ceiling-
mounted string pull switch.
nTiled walls or, better still, aseptic
laminate walls to make the sluice 
room easier to clean.
nFire doors (depending on local
regulations).
Fittings – essential
nA washer-disinfector for reusable
bedpans or commode pots and/or 
a macerator for disposable bedpans.
nA wall-mounted rack, for temporary
storage of disinfected utensils before
returning them to rooms.
nAn incontinence pad macerator or 
foot-operated clinical waste bin.
nA stainless steel handwash basin, with
lever or sensor-operated taps.
nA paper towel dispenser.
nA pedal bin.
Fittings – useful
nA disposal hopper, for back-up in the
event of power or mechanical failure.
nA deep stainless steel sink, for general
washing and rinsing purposes.
nFacilities for filling and emptying
cleaners’ buckets.
nWork surface.
nStorage cupboards.
Disinfect or dispose?
Key considerations include the selection
of the disinfection and/or disposal
equipment to be used, in addition to the
way the room is laid out to ensure that
workflow is safe, clean, and efficient. One
key question is whether to ‘disinfect or
dispose?’ In recent years there has been
an ongoing evolution of the types of
disinfection and disposal procedures used
within a sluice room – largely driven by
mounting evidence in scientific literature,
and the subsequent introduction of new
directives and regulations.
For example, in the UK the Department
of Health (DH) issued two important
infection control documents in 1991; these
subsequently became stringent
regulations. The initial documents gave
evidence-based guidance on the
decontamination of utensils that have
been fouled by body fluids, urine, and
faeces. Within the documents there was a
Table 1 - Excerpt from eight-hour study of sluice room activity in a cardiac ward at Leicester Royal Infirmary – 20 bed ward
Tasks Observed Number of times Main equipment/
tasks observed furniture used/involved
Leaving dirty linen 3 Dirty linen bin, yellow bag bin, handwash basin
Disposing of patient’s urine or used urine bottle 10 Sluice/sink, yellow bag bin, macerator, handwash basin
Measuring a patient’s urine to check fluid balance 12 Cabinet/shelf, sluice, sink, yellow bag bin, handwash basin,
Disposing of used bedpan 3 Sluice, yellow bag bin, macerator, handwash basin
Returning used commode chair 4 Sluice, yellow bag bin, macerator, handwash basin, sink
Washing plastic wash bowl 4 Sink, yellow bag bin, handwash basin, worktop
Washing and disposing of alcohol gel bottles 1 Yellow bag bin, handwash basin, shelf
Collecting patient’s stool sample and measuring Cabinet/shelf, sluice, sink, yellow bag bin,
the patient’s urine to check fluid balance 1 handwash basin, macerator
Disposing of bladder wash-out 1 Sluice, sink, yellow bag bin, handwash basin
Disposing of patient’s stool 2 Sluice, sink, yellow bag bin, handwash basin, macerator
Undertaking a patient’s pregnancy test 2 Cabinet/shelf, sluice, yellow bag bin, handwash basin, macerator, worktop
Traditional top and front-loading
washer-disinfectors.
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4. strong preference expressed towards the
use of thermal disinfection procedures, 
as opposed to chemical disinfection.
The selection of the disinfection
procedure to be used does depend on the
equipment to be disinfected, and the level
of decontamination required (Table 4), 
so there is undoubtedly still a role for
handwashing with chemicals in certain
situations. There are inherent risks
associated with chemical disinfection,
however, as highlighted by the 1991 DH
documentation. These risks include the
toxicity of certain chemicals, the
resistance of some organisms to the
chemicals, and ultimately the risk of
human error, where items may not be
sufficiently decontaminated.
Available disinfection options
Thermal or heat disinfection – using low
temperature steam – has become a key
methodology for decontaminating
reusable items within sluice rooms.
Washer-disinfectors that use thermal
disinfection are now an essential element
for emptying, washing, and disinfecting
human waste containers, such as
bedpans, commode pots, and urine
bottles. Following flushing of waste from
the container placed in a racking system
within the washer-disinfector to remove
visible contents, a steam generator heats
to a minimum of 82˚C for at least one
minute to ensure that all proteins are
denatured. The heat acts to completely
disinfect the container, as well as the
machine chamber; it should be noted,
however, that such steam disinfection is
not sufficient to destroy C.difficile spores.
Layout of a sluice room
Having decided on the disinfection/disposal
technology to be used within it, it should 
be noted that the actual design layout of
a sluice room is just as important as the
technology itself – the key consideration
being that anyone entering a sluice room
should ultimately exit clean, as should all
reusable items.
In addition to a washer-disinfector
and/or macerator, other important features
of a sluice room include a soiled area as 
a temporary collection point for unclean
items, which can also include a slop
hopper for cleaning of mops and buckets.
Handwashing facilities are also essential,
and should be appropriately located and
positioned to ensure that hands are readily
washed before disinfected items are
touched, and also before exiting the room.
A temporary storage area for clean and
disinfected items should also be included.
Critically, when planning a sluice room
layout, equipment should be grouped into
‘dirty’ and then ‘clean’ areas to deliver a
hygienic, efficient, and effective workflow.
Further important considerations in the
design and layout of a sluice room include
lighting, ventilation to encourage laminar
flow, as well as surfaces, all of which can
be harbours of microorganisms.
Consequently, all surfaces and flooring
materials should be easy to clean, and
additional fixtures and fittings carefully
selected to minimise on cracks and
crevices.
Finally, the location of the sluice room
itself should ensure minimal travelling
distances for staff from patient areas. 
This would result in a reduction in the 
risk of spillages and subsequent 
cross-contamination, while also 
enhancing working efficiencies.
Maceration
Due to the increasing prevalence of high
risk microorganisms, such as C. difficile,
Dirty utility design
4
Reprinted from Health Estate Journal
Maceration blades shred incontinence pads into fine particles to be discharged
directly into the sewage system.
Fig. 1: An ideal sluice room layout and
workflow.
Table 2 - Risk levels for decontamination methodology selection
Category Indication Level of decontamination
High Risk Items that penetrate Sterilise
skin/mucous membranes or
enter sterile body areas
Medium Risk Items that have contact with Disinfect or sterilise
mucous membranes, or are
contaminated by microbes
which are easily transmitted
Low Risk Items used on intact skin Clean
Table 3 - Decontamination methods
Action Rationale Decontamination Method
Sterilisation A process that removes or Autoclaves
destroys all microorganisms,
including spores
Disinfection A process that reduces the Washer-disinfectors
number of microorganisms to
a level at which they are not
harmful. Spores will not usually
be destroyed
Cleaning A process that physically Cloth and detergent,
removes contamination mop and bucket (such as blood or faeces) and many microorganisms using detergent
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5. and the inability of washer-disinfectors 
to completely eliminate the risk of 
cross-infection, many UK healthcare
establishments are now moving away 
from the use of reusable human waste
containers, and switching instead to
single-use ‘pulp’ containers, with
subsequent maceration and disposal, 
as an alternative, and extremely reliable,
means of total infection control. Such
macerators will completely destroy
disposable pulp bedpan/urine bottle
containers and contents, including
‘macerator-friendly’ wipes, by cutting
items into small particles using carefully
designed blade technology. Furthermore,
as well as totally eliminating
contamination risk arising from reusable
products, pulp macerators enable much
faster cycle times, thereby enhancing work
efficiencies.
In addition to selecting the best
technology for use within a sluice room,
be it a washer-disinfector or pulp
macerator, there are certain key features
of both that are considered desirable for
increased contamination control and ease
of use. For example, hands-free operation,
and the incorporation of antibacterial
materials in contact areas to create a
‘microbe-safe’ surface, are highly useful
features. Reduced water consumption is
also advantageous for conserving water,
particularly in areas where it is a valuable
commodity.
Maintenance and testing
It should not be forgotten that, once
installed within a sluice room, it is crucial
that all equipment remains 100% effective
to ensure continued infection control. For
example, with the launch in the UK in
2009 of the Care Quality Commission,
additional emphasis has been placed on
the importance of regular preventative
maintenance and testing of equipment.
Linked with this, Health Technical
Memoranda (HTMs) have been issued that
provide detailed guidance on how and
when such maintenance and testing
should be undertaken. For example, in
accordance with stipulations in HTM 2030
and CFPP 01-01, testing and validation
procedures on washer-disinfectors and
pulp macerators are now being regularly
carried out in an increasing number of UK
healthcare establishments. These are
scheduled on a weekly, quarterly, and
annual basis, depending on the checks
required.
Conclusions
Inadequate decontamination and disposal
of human waste can result in the transfer
of infection to patients and health workers;
consequently, every location in which
decontamination procedures are
undertaken should be properly designed,
maintained, and controlled. The design of
a sluice room is essential to ensuring that
it is accessible, fit for purpose in terms of
workflow, and safe – not only from a health
and safety perspective, but also, critically,
for ensuring effective infection control. 
A hygienic sluice room must meet the
individual needs of the associated
healthcare establishment, and, crucially, 
a design specification that helps to reduce
healthcare-associated infections.
A healthcare establishment must be
able to guarantee that it can effectively
deliver the clean and efficient disposal/
disinfection required to maintain a safe,
hygienic environment for patients,
residents, and staff. This can be achieved
by adopting a rigorous and integrative
approach to sluice room layout and
design, the equipment selected for use
within it, and an effective supporting
maintenance and testing programme.     
✚
Dirty utility design
5
Reprinted from Health Estate Journal
Table 4 - Microbial activity of decontamination methods
Action Spores Microbacteria Bacteria Viruses
Disinfection
Thermal washer-disinfector
Low temperature steam
Chemical disinfectant See Table 5
Sterilisation
Steam
Dry heat
Gas plasma
None Poor Moderate Good
5 333 333 33
5 333 333 33
333 333 333 333
3 3 3 3
333 333 333 333
5 3 33 333
Table 5 - Microbiocidal activity of chemical disinfectants
Action Spores Microbacteria Bacteria Viruses
Alcohol 3 33 333 33
Ortho-phthalaldehyde
1
35 333 333 333
Other aldehydes**,
1
35 333 333 333
Chlorine dioxide 333 333 333 333
Peracetic acid** 333 333 333 333
Other peroxygen compounds** 5 3 333 33
QACs** 5 33 33 333
Superoxidised saline 3 333 333 333
None Poor Moderate Good
1 Aldehydes are potent fixatives of protein, including prion protein. * The sporicidal activity of aldehydes is increased with extended contact times, e.g. greater
than three hours.
** The activity of other aldehydes e.g. succine dialdehyde, peroxygen compounds, and QACs
(Quaternary Ammonium Compounds) varies with concentration
Reference: Sterilization, disinfection and cleaning of medical equipment: guidance on
decontamination from the Microbiology Advisory Committee (the MAC manual).
Part 1 Principles, 3rd edition, May 2010.
5 3 33 333
DDC Dolphin specialises in the design and creation of sluice rooms and dirty
utility rooms. It says its 20 years’ experience in the field allows it to provide
‘comprehensive and meaningful advice and support throughout the
planning, design, and specification processes for new or existing facilities’.
ppDDC HEJoct15 reprint.qxp_Layout 1 13/10/2015 16:32 Page 114

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