Hygiene issues in urinal bottle use in Danish nursing homes without bedpan washers: a qualitative interview study with healthcare assistants and assistant nurses caring for residents with and without catheters

Background: Three decades ago, Danish nursing homes began transforming to create more home-like environments, eliminating bedpans to deinstitutionalize care facilities. This led to the closure of auxiliary rooms, including sluice rooms. However, the continued use of urinal bottles without adequate cleaning facilities has increased hygiene concerns and health risks. This disparity between the home-like atmosphere and insufficient sanitation infrastructure poses challenges to delivering safe care. Aim: This study aimed to explore the practices, challenges, and perceptions of nursing home staff regarding the handling of urinal bottles. Methods: Qualitative, semi-structured individual interviews with nursing home staff were employed, to gain insights into their daily handling of urinal bottles. Participants (N = 8) were recruited from four nursing homes in one Danish municipality. Findings: Results revealed that staff employed various cleaning methods and lacked clear guidance from specific protocols. Instead, cleaning methods often relied on personal routines. Protective equipment is vital for safeguarding staff, residents, and colleagues against pathogens; however, staff reported difficulties in determining appropriate equipment for different situations. Many practices were based on individual beliefs about proper workflows, highlighting the need for clear guidelines. Conclusion: In Danish nursing homes, the lack of standardized procedures and appropriate cleaning equipment results in unhygienic handling of urinal bottles. Staff often fail to recognize these as infection risks, despite clear links to urinary tract infections and the vulnerability of residents. This study highlights the urgent need for national guidelines, improved infrastructure, and a shift toward safe, sustainable, and evidence-based cleaning practices.