Environmental infection control


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Every year, many lives are lost due to the spread of infections in hospitals. Health care workers can take steps to prevent the spread of infectious diseases. Identifying hazards that could potentially compromise patient care and implementing proper controls to reduce risk and minimize the impact of hazards created by renovation, demolition and new construction activities. Those projects could impact infection control, air or water quality, utility and equipment requirements, noise and vibration.

Healthcare workers are occupationally exposed to many infectious diseases during the performance of their normal duties. The delivery of healthcare services requires a broad range of workers, such as physicians, nurses, technicians, and clinical laboratory workers, first responders, building maintenance, security and administrative personnel. Since, healthcare workers have many different tasks or work in different parts of the facility each employee will be exposed to different infectious agents and in different amounts.

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Environmental infection control

  2. 2. OBJECTIVESInfection Control Risk Assessement  Physical and Biological Hazards  Reservoirs for Bio-Contaminants  Measures of Effective Control
  3. 3. Environmental Infection Control WHAT IS IT?  Identifying hazards that could potentially compromise patient care  Implementing proper controls to reduce risk and minimize the impact of hazards created by demolition, renovation, and/or new construction activities
  4. 4. Environmental Infection Control What is it? (cont.) Impacts may include those on air or water quality, infection control, utility and equipment requirements, noise and vibration, emergency procedures, etc.
  5. 5. Environmental Infection Control Why the concern?  Sensitive patients, physically and/or mentally  Compromised immune systems (illness or medication)  Critical medical procedures  Critical services, utilities, and equipment that cannot be damaged or disrupted  Need for stable indoor environment
  6. 6. Environmental Infection Control Contaminants of Concern  Air- Particulates  Dust  Microbials  Gases/Fumes/Odors  Waterborne Contaminants  Misc. Nuisances  Noise/Vibration
  7. 7. Environmental Infection Control > Contaminants DUST PARTICULATES  General Dust  Demolition/Dismantling  Sanding/Cutting
  8. 8. Environmental Infection Control > Contaminants Microbial Particulates  Microbial “reservoirs” in flooring, wall cavities, HVAC systems, materials affected by water damage or high humidity, or spores brought in from outdoors  May include molds that are pathogenic, toxic, and/or allergenic (especially Aspergillus)  May include bacterial growth
  9. 9. Environmental Infection Control > Contaminants Other Contaminants  Gases/Fumes/Odors  Welding/Soldering  Cutting/Grinding  VOCs- off-gassing of new products, adhesives, etc.  Chemicals/Cleaners
  10. 10. Environmental Infection Control > Contaminants Misc. Issues  Not necessarily environmental contaminants, but potentially disruptive  Increased foot and vehicle traffic  Alternate routes of building exit/entry  Alternate emergency/fire evacuation routes and procedures  Abnormal “loads” on utilities or equipment
  11. 11. Environmental Infection Control Noise & Vibration May affect patients and/or employees  premature neonates  recent ICH or stroke  neurological/psychiatric disorders May affect critical procedures/testing  EEG or EKG  hearing assessments  neurological studies  fine motor skill procedures  certain laboratory procedures  sleep studies, etc.
  12. 12. Environmental Infection Control Current Regulations & Guidelines  The Joint Commission (TJC)  AIA Guidelines for the Design and Construction of Hospital and Health Care Facilities (mandated by state law)  CDC Guidelines on Environmental Infection Control  State Licensure (depending upon state)
  13. 13. Environmental Infection Control > Regulations & Guidelines TJC Environment of Care Std.  EC.8.30  Demolition, Construction or Renovation, and Maintenance  Proactive risk assessment  Identify hazards that could potentially compromise patient care  Address impact on requirements/procedures
  14. 14. Environmental Infection Control > Regulations & Guidelines EC8.30 CONSTRUCTION, DEMOLITION, AND MAINTENANCE/REPAIR  Infection Control Risk Assessment  (Multi-disciplinary team approach to project review for prevention of airborne & waterborne nosocomial disease.)  design and function of new area  At risk patients  dust and moisture containment  Noise/vibration  What contingency plans are in place for unexpected outages
  15. 15. Environmental Infection Control > Regulations & Guidelines CDC GUIDELINES FOR EIC  Construction, Renovation, Remediation, Repair and Demolition  ICRA (Infection Control Risk Assessment)  Multi-disciplinary team  Risk assessment of project  P&P to protect patients  Procedures to correct problems rapidly
  16. 16. Environmental Infection Control > Regulations & Guidelines CDC GUIDELINES FOR EIC  CDC Guidelines- Major Air Quality Issues  Air Sampling  External and Internal demolition- Are Barriers Required?  Working with plumbing in sensitive areas  Exposure of ceiling spaces  Crawling into ceiling spaces  Work on elevator shafts  Demo of wallboard, plaster, ceramic tile, ceiling tile
  17. 17. Environmental Infection Control > Regulations & Guidelines CDC GUIDELINES FOR EIC (CONT.)  Major Air Quality Issues (cont.)  Removal of flooring  Removal of windows and doors  Removal of casework  HVAC systems design and filtration  HVAC maintenance and repair  duct cleaning  system shutdown  moisture in system  backup emergency power
  18. 18. Environmental Infection Control > Regulations & Guidelines AIA GUIDELINES (CHAPTER 5)  For all new construction and renovation  Consultation from infection control professionals, and safety professionals  Development of an ICRA  Initiated in planning and design and continued through construction/renovation  Performed by multi-disciplinary panel  Documented!!
  19. 19. Environmental Infection Control > Regulations & Guidelines CHAPTER 5 ICRA- BASIC ELEMENTS  Impact of disrupting essential services  Patient placement and relocation  Placement of barriers  Evaluation of ventilation needs  Number of AII and PE rooms  Patient protection from:  Demolition  Un-planned outages  Movement of debris  Patient flow through building
  20. 20. Environmental Infection Control > Risk Assessment ICRA MATRIX  Aids in determining proper work practices and types of engineering controls, and monitoring required.  Assesses risk based upon the patient risk group and types of activities performed
  21. 21. Environmental Infection Control > Risk Assessment ICRA Matrix (cont.)  Type A- (Inspection and Non-invasive)  removing ceiling tile for inspection  painting without sanding  wall-covering  electrical trim  minor plumbing  Type B (Work Activities)  Small scale/ short duration  Minimal dust created
  22. 22. Environmental Infection Control > Risk Assessment ICRA Matrix (cont.) Type C (Work Activities)  Demolition/removal of fixed building parts  Moderate-high dust, including sanding, flooring removal, ceiling tiles & casework, major cabling,  Can’t be done in 1 shift Type D (Work Activities)  Major demolition/construction  High dust created, including heavy demo, removal of walls, new construction  Required consecutive work shifts
  23. 23. Environmental Infection Control > Engineering Controls Engineering Controls Containment of Dust and Debris  Controlling construction related activities  Envelope penetrations  Building shafts, chutes, stairwells and elevators  Removal of materials from building  Electrical and water system shutdowns  HVAC system shutdowns, potential for passive ventilation
  24. 24. Environmental Infection Control > Engineering Controls Common Controls  Defining contractor points of entry/exit  Use of tacky mats and disposable suits  General containment barriers  Control cubes for point of entry  Negative pressure requirements  HVAC system protection and isolation
  25. 25. Environmental Infection Control > Engineering Controls Types of Barriers Short-duration  Fire-resistant plastic  Airtight with Negative Pressure Long Duration  Install plastic barrier while building rigid barrier  Drywall on metal studs  Floor to floor construction  Seal and tape all joints, edges, holes, etc.
  26. 26. Environmental Infection Control > Engineering Controls Consider Outside Influences  Protect building ventilation systems (i.e. fresh-air intakes)  Control building entrances  Window/door infiltration  Access to construction zones  Building tie-ins  Street cleaning  Emergency response
  27. 27. Environmental Infection Control Monitoring  Establish background bio-aerosol levels prior to construction  Compare levels during and after construction to these baselines  Include viable and non-viable particles  Monitor ventilation (air changes, filtration, pressure)
  28. 28. Environmental Infection Control > Monitoring When Should You Sample? Baseline and before occupancy (“Commissioning”)  Insure proper ventilation and cleanliness  Provides comparison data for later if necessary Ongoing Surveillance  Pressure differentials  Air Exchanges  Particle count for filtration efficiency
  29. 29. Environmental Infection Control Understand Air Flow in the Building  Positive vs. Negative Pressure  Air Flow Velocities  Affects of doors and window  Elevator shafts
  30. 30. Environmental Infection Control OVERALL GOALS:  Save Lives through:  Changing attitudes toward construction and maintenance  Use proper techniques even if not the Easiest/cheapest  Planning ahead
  31. 31. QUESTIONS AND ANSWERS amienvironmental.com