Fully Accessible Toilets

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Fully Accessible Toilets

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1. Introduction

1.1 For some people with disabilities, a standard disabled toilet in a public place does not provide adequate facilities that meet their requirements. For example, some people may require one or two carers to assist them when using the toilet or changing their continence pad. A standard sized disabled toilet may not allow for this. A Fully Accessible Toilet should provide the user with a facility that may be used by them and their carers in comfort, privacy and safety. There are very few facilities of this type. This means that when the person with disabilities is away from home, carers are forced to change their continence pad on a toilet floor. This puts both the person concerned and their carers at risk and is dangerous, unhygienic and undignified. The additional needs of those who use orthotic devices and/or are tube-fed make this situation even more undesirable.

1.2 This document is intended to inform construction and estates professionals on the provision of fully accessible toilets within an NHSScotland facility. The document provides information on the design considerations and the

equipment, which is required. The document also provides guidance on the management of a facility of this kind.

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2. Design

considerations

2.1 When using a Fully Accessible Toilet, the user may require a height adjustable changing bench where their carer may safely change their continence pad. In this case, a hoisting system is required so that the user may be transferred safely from their wheelchair to the toilet or changing bench. A ‘peninsula’ toilet – one that may be accessed from either side – is required so that carers may assist from both sides of the toilet if necessary.

2.2 One of the main features of a Fully Accessible Toilet is to provide carers and people with disabilities with a facility that does not compromise their own health, safety and dignity. For example, carers cannot be expected to physically lift people they are looking after as this may cause injury to either party.

2.3 The room layout below is an example of how a Fully Accessible Toilet can be planned. Other layouts may be dependant upon specific space and reference should be made to British Standards BS8300 : 2001 and future revision

currently underway. It is most important that enough space is allocated to the room for the person with the disability plus two carers, in addition to the

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Operation and maintenance responsibility

2.4 The installation of special equipment, e.g. hoist in a Fully Accessible Toilet will be required to be carried out by a specialist contractor in line with specific

legislation: Lifting Operations and Lifting Equipment Regulations 1998 (LOLER). Once installed, it is the responsibility of the facility provider to ensure

appropriate maintenance of equipment and waste removal. Clear written instructions and guidance should be displayed.

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3. Equipment

3.1 All equipment in a fully accessible toilet must be able to accommodate adults.

Changing benches

• provide a stable platform suitable for changing adults and children;

• height adjustable changing benches can be altered to meet most carer’s needs. Fixed height benches invariably are set at a height that suits very few, and they are generally not used;

• can be wall mounted or free standing;

• can be manually operated or powered.

Hoists

• can remove the need to lift a disabled person manually;

• prevents carers from manually lifting the disabled person onto/off the toilet floor;

• allows paid carers to use the facilities and disabled people to go out in the community;

• ceiling mounted track hoists make best use of a limited space, avoid storage difficulties and prevent a mobile hoist from being removed;

• as there is a risk of cross infection from slings provided for use with the hoist being used by different people, it is suggested that no slings are provided. Instead, clear guidance on compatibility and range of slings that can be used with the hoist provided should be displayed both within the toilet and be available to prospective users in advance on enquiry and as pre-publicity of availability of these facilities.

Peninsula Toilets

• allows carers to stand either side of toilet;

• allows wheelchair transfers from either side of toilet.

Grab Rails

• provide support on either side of toilet.

Wash Basin

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• can be moveable horizontally along the wall to allow extra space for carers to assist or for the disabled person to reach the basin before leaving the toilet.

Bin and Paper Towel Dispenser

• a large bin should be provided for adult continence pads but should not obstruct space around the peninsular toilet layout;

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4. Hygiene and cleaning

4.1 Control and Prevention of Healthcare Associated Infection (HAI) is a priority issue for NHSScotland – both in respect of the safety and well being of patients and staff and also the resources consumed by potentially unavoidable

infections.

4.2 Healthcare Associated Infection (HAI) is a complex issue involving the many different elements of patient care and provision. Due to its multi-factorial nature there is a need to develop a holistic approach to combating the spread of infection within the built environment.

It is imperative that those involved in the design and planning, construction and refurbishment and on-going maintenance of the healthcare facility have a sound knowledge of prevention and control of infection in the built environment.

4.3 Scottish Health Facilities Note (SHFN) 30 and HAI-SCRIBE aim to provide information on the prevention and control of infection, and on the prevention of cross-infection and cross contamination in healthcare facilities, to those

responsible for the planning, design and maintenance of such facilities. 4.4 Cleaning is an essential part of the multi-disciplinary approach in improving

patient, staff and public safety. Safe clinical care is supported through ensuring high standards of hygiene and related measures to tackle HAI in the healthcare environment.

Cleaning regimes including frequency of cleaning should be addressed in line with current national guidance together with any additional local management requirements.

4.5 Relevant provisions of current guidance, standards and Codes of Practice for cleaning of healthcare premises and including the latest technical requirements are embodied in the following documents:

• SHFN 30: ‘Infection Control in the built environment: Design and Planning’; Health Facilities Scotland, 2007;

• HAI-Scribe (Healthcare Associated Infection System for Controlling Risk in the Built Environment); Health Facilities Scotland, 2007;

• The NHSScotland National Cleaning Services Specification; SEHD / CMO (2004) 8;

• NHS Quality Improvement, Scotland – Healthcare Associated Infection (HAI) Cleaning Services Standards; CSBS / NHSQIS. 2002 ISBN 1 903766 12 5;

• The NHSScotland Code of Practice for the Local Management of Hygiene and Healthcare Associated Infection; Healthcare Associated Task Force CMO (2004) 09;

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• Clinical Standards Board for Scotland Healthcare Associated Infection (HAI) Infection Control Standards; December 2001 CSBS 2001 ISBN 1-903766-12-5.

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5. Waste

5.1 In order to effectively manage hygiene waste, it is essential to understand and comply with the requirements of relevant health and safety waste legislation. Those who produce hygiene waste have responsibility for its management and have a ‘duty of care’ to ensure that it is classified, packaged, stored and

disposed of appropriately.

5.2 The Environmental Protection Duty of Care Regulations 1991 place a responsibility on all involved in the management of waste, including waste producers, to ensure that waste is managed appropriately. Waste must be stored in a suitable container, designed to safeguard against corrosion, spillage, adverse weather and scavenging.

5.3 Waste can only be transferred to a licensed or suitably authorised waste management facility. Before transferring waste, the producer must check that the facility accepting the waste has an appropriate licence (or other

authorisation) to accept the waste.

5.4 The waste must be accompanied by an adequate description to help any subsequent holder manage the waste appropriately.

5.5 A transfer note must be completed, signed and kept by all parties involved in the management of the waste and should include details of:

• what the waste is, referencing the appropriate European Waste Catalogue (EWC) code;

• the quantity of waste to be transferred;

• how it is packed (sacks, wheelie bins, etc);

• the name and address of the people or companies involved in the transfer and details of their status e.g. producer, carrier, disposal facility;

• the certificate number of the registered waste carrier (if applicable);

• the waste management licence (or authorisation) number, of the receiving waste management facility.

5.6 All parties should sign the transfer note and copies of the note should be kept for a minimum of two years. In order to ensure that users of the facility comply with regulations, signage must be provided to instruct users on how to correctly dispose of waste.

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6. Location of Disabled Changing and WC Facilities

6.1 In order to meet the needs of all people with disabilities and their carers and to reduce the risk to their health NHS organisations should consider the

installation of a ‘Fully Accessible Toilet’ in all healthcare premises. These facilities should be in addition to, not instead of existing standard accessible toilets.

6.2 People with disabilities are usually frequent users of the NHS; hospital and clinic appointments are an essential and unavoidable part of the ongoing routine for these families, especially those with complex needs. With improved medical care and technology, increasing numbers of people with conditions and the vulnerable elderly are being supported in the community by unpaid or paid carers, but still require hospital and clinic attendance.

6.3 NHS settings such as hospital outpatient departments, clinics and health

centres are therefore priority areas for the sighting of ‘Fully Accessible Toilets’. Providing these facilities within NHS facilities addresses these important health, safety and hygiene requirements.

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7. Changing

Places

7.1 Changing Places is a consortium of organisations working to support the rights

of people with serious disabilities to access their community. The Changing Places Consortium is campaigning for ‘Changing Places’ toilets to be installed in big public places.

The members of the Consortium are: PAMIS - www.dundee.ac.uk/pamis/

Mencap - http://www.mencap.org.uk/

Nottingham City Council - www.nottinghamcity.gov.uk

Dumfries & Galloway Council - www.dumgal.gov.uk

Valuing People Support Team - www.valuingpeople.gov.uk

Scottish Executive Same as you Team - www.scotland.gov.uk

Acknowledgement

Much of the information in this document has already been produced by Changing Places and further information may be gathered by contacting them on the details below.

Website - www.changing-places.org

Telephone: 01382 385 154

Fully Accessible Toilets