Facility Manager Basic Training: Infection Prevention and Control

Transcription

1 Facility Manager Basic Training: Infection Prevention and Control 1 Presented by: Lorrie J. Elizarraraz, MPA CHSP CHEP Safety Management Services, Inc.

2 Infection Prevention and Control What is infection prevention and control? According to the World Health Organization, infection prevention and control measures aim to ensure the protection of those who might be vulnerable to acquiring an infection both in the general community and while receiving care due to health problems, in a range of settings. How can infections be minimized? Infection-control strategies and engineering controls, when consistently implemented, are effective in preventing opportunistic, environmentally-related infections in immunocompromised populations. 2

3 Infection Prevention and Control What methods can be put into place to limit infections? Adherence to proper use of disinfectants, Proper maintenance of medical equipment that uses water (e.g., automated endoscope reprocessors and hydrotherapy equipment), water-quality standards for hemodialysis, and 3 Proper ventilation standards for specialized care environments (i.e., airborne infection isolation [AII], protective environment [PE], and operating rooms [ORs]), and Prompt management of water intrusion into facility structural elements will minimize health-care associated infection risks and reduce the frequency of pseudo-outbreaks.

4 Environmental fungal pathogens Aspergillus - Improperly functioning ventilation systems, air filter, ceiling tiles, false ceilings, fire proofing material, damp cabinet or wood, construction, elevator, open windows, hospital vacuum cleaner, Mucorales / Rhizopus - Air filter, False ceilings, Heliport Scedosporium - Construction 4 Penicillium - Rotting cabinet wood, pipe leak, ventilation duct fiberglass insulation, and air filters Acremonium Air filters Cladosporium - Air filters Sporothrix Construction Cryptococcus neoformans, Histoplasma capsulatum, or Coccidioides immitis - nearby ground is disturbed and a malfunction of the facility s airintake components allows these pathogens to enter the ventilation system.

5 The Joint Commission s Utility Systems Risks EC EP 15- Ventilation systems provide proper pressure relationships, air exchanges & filtration efficiency Protective Environments (PE) - Operating rooms, delivery rooms Airborne Infections Isolation (AII) - Negative pressure areas Other laboratory, sterile supply - See AIA Guidelines, 2010 edition

6 Appropriate Environment EC EP 13- Maintaining appropriate ventilation Humidity Temperature

7 HVAC Heating, ventilation, and air conditioning (HVAC) systems in health-care facilities are designed to: maintain the indoor air temperature and humidity at comfortable levels for staff, patients, and visitors; control odors; remove contaminated air; 7 facilitate air-handling requirements to protect susceptible staff and patients from airborne health-care associated pathogens; and minimize the risk for transmission of airborne pathogens from infected patients.

8 HVAC Engineering Controls Engineering controls to contain or prevent the spread of airborne contaminants center on: local exhaust ventilation, general ventilation, and air cleaning i.e. filters and ultraviolet germicidal irradiation (UVGI) 8

9 Standards and Guidelines Ventilation for Acceptable Indoor Air Quality from ASHRAE Standard 62, AIA/FGI, Table 7.2- Air movement, Total air exchanges, Humidity, Temperature 9 Filter Efficiencies for Central Ventilation and Air Conditioning Systems, AIA/FGI, Table 7.3- Filter beds and % of filters

10 Construction, Renovation and Repair Environmental disturbances caused by construction and/or renovation and repair activities include: disruption of the above-ceiling area, running cables through the ceiling, and structural repairs) in and near health-care facilities markedly increase the airborne Aspergillus spores 10

11 Construction EC EP2: When planning demolition, construction, or renovation, the hospital conducts a preconstruction risk assessment for hazards that affect care, treatment & services: 11 Air quality requirements Infection control Utility requirements Noise & vibration Other hazards Life safety

12 Healthcare Infection Control Guidelines 12 Guidelines for Environmental Infection Control in Healthcare Facilities, CDC 2003 Infection Prevention Manual for Construction & Renovation, APIC 2015 (new) Prevention & control of infectious diseases & agents

13 CDC Major Considerations 13 Consider Impact of Design on Existing Areas Potential for Airborne Disease Containment of Waterborne Organisms

14 Air Quality 14 Condition Temperature & humidity Controlled Air Volume Positive & negative pressures Air Changes Specific requirements Particulates and Moisture High efficiency & HEPA filtration

15 Infection Control 15 Areas of Concern Infectious agents Contagious patients Compromised patients Community risks Moisture and surface contamination Debris removal

16 Project Assessment 16 Infection Control Risk Assessment (ICRA) designed to encompass: The types of construction activity The infection control risk and then Determine the Class and what precautions to take

17 Typical Risks for Patient Areas 17 Risk Group Typical Areas Least Medium Medium/High Highest Office Areas Cardiology, Radiology, Endoscopy Critical Care Unit, Emergency Room, Pediatrics, Nursery Immuno-compromised patient, Intensive Care Unit, Oncology, Bone Marrow, Burn Unit

18 Matrix of Activities 18 Type A Activities Inspections and non-invasive B C D Small scale, short duration, Minimal air quality issues Activity generates moderate to high levels of air quality issues which requires greater than one work shift for completion Major duration and construction activities requiring consecutive work shifts

19 Matrix of Precautions 19 Construction Project Risk Class Group Type A Type B Type C Type D Least I II II III/IV Medium I II III IV Medium/High I II III/IV IV Highest II III/IV III/IV IV

20 Infection Control Risk Assessment and Permit Permit No: Location of Construction: Project Coordinator: Contractor Performing Work: Project Start Date: Estimated Duration: Permit Expiration Date: Supervisor: Telephone: YES NO CONSTRUCTION ACTIVITY YES NO INFECTION CONTROL RISK GROUP TYPE A: Inspection, non-invasive activity GROUP 1: Least Risk TYPE B: Small scale, short duration, X Minimal air quality issues. TYPE C: Activity generates moderate to high levels of air quality issues, requires greater than one work shift for completion TYPE D: Major duration and construction activities Requiring consecutive work shifts X GROUP 2: Medium Risk GROUP 3: Medium/ High Risk GROUP 4: Highest Risk 20

21 Control Measures 21 CLASS I 1. Identify location of any compromised or contagious patient near activities. 2. Minimize air quality issues from construction operations. 3. Immediately replace any ceiling tiles displaced for visual inspection. 4. Clean work area upon completion of project. 5. Seal holes, pipes, conduits and punctures appropriately. CLASS II 1. Identify location of any compromised or contagious patient near activities. 2. Provide active means to maintain air quality. 3. Water mist work surfaces to control air quality issues while cutting. 4. Wipe surfaces with disinfectant. 5. Contain construction waste before transport in tightly covered containers. 6. Wet mop and/or vacuum with HEPA filtered vacuum before leaving work area. 7. Place adhesive walk off mat at entrance and exit of work area. 8. Remove or isolate HVAC system in areas where work is being performed. 9. Seal holes, pipes, conduits and punctures, including unused doors, appropriately.

22 Control Measures CLASS III 1. Identify location of any compromised or contagious patient near activities. 2. Isolate HVAC system to prevent contamination of the duct system. 3. Complete all critical barriers or implement control cube method before construction begins. 4. Maintain negative air pressure with HEPA equipped negative air filtration units. 5. Vacuum work areas with HEPA filtered vacuum. 6. Wet mop with disinfectant. 7. Remove barrier materials carefully to minimize spreading of dirt and debris associated with construction. 8. Contain construction waste before transport in tightly covered containers. 9. Place adhesive walk off mat at entrance and exit of work area. 10. Seal holes, pipes, conduits and punctures appropriately. 11. Personnel leaving the construction area must either wear a cover suit while working and then remove or wear work attire and a cover suit when out of construction area. 22

23 Control Measures CLASS IV 1. Identify location of any compromised or contagious patient near activities. 2. Remove or isolate HVAC system in site. 3. Complete all critical barriers or implement control cube method before construction begins. 4. Maintain negative air pressure within work site utilizing HEPA equipped air filtration units. 5. Seal holes, pipes, conduits and punctures appropriately. 6. Construct anteroom for entrance to work area that can be utilized to vacuum personnel leaving with appropriate HEPA filtered vacuum system. 7. Wear appropriate PPE. 8. All personnel entering the work site are required to wear shoe covers. 9. Shoe covers must be removed each time the worker exits the work area. 10. Do not remove barriers from work area until completed project is inspected and thoroughly cleaned. 11. Vacuum work areas with HEPA filtered vacuum. 12. Wet mop with disinfectant. 13. Remove barrier materials carefully to minimize spreading of dirt and debris associated with construction. 14. Contain construction waste before transport in tightly covered containers. 15. Provide adhesive walk off mats at entrance to work area as necessary. 23

24 CLASS II- Precautions 24 Identify location of any compromised or contagious patient near activities. Provide active means to maintain air quality. Water mist work surfaces to control air quality issues while cutting. Wipe surfaces with disinfectant. Contain construction waste before transport in tightly covered containers. Wet mop and/or vacuum with HEPA filtered vacuum before leaving work area. Place adhesive walk off mat at entrance and exit of work area. Remove or isolate HVAC system in areas where work is being performed. Seal holes, pipes, conduits and punctures, including unused doors, appropriately.

25 Environment During Construction EC EP 3- Takes action to minimize riskbased on PRA Implement controls/measures Document inspections Reassess controls depending on current activities

26 Dust 26 Barrier Protection Control sources of material Control patient environment Physical covers or wrappings Airflow current or negative pressure

27 Temporary Physical Barrier 27

28 Temporary Air Barrier 28 Scrubber Isolation 28

29 Temporary Visual Pressure Indicators 29 Switchable Negative / Positive Pressure Indicator Negative Pressure Indicator 29

30 Dust & Molds 30 Concern of air quality Sample collection and testing Reporting & follow-up Containment & Control Surface preparation Debris removal

31 Objectives 31 Protect patients Control airborne disease transmission Implement preventive measures to contain infectious agent Protect compromised patients

32 Environmental Concerns 32 Airborne Organisms Aspergillus Dust & Molds Air & surface Waterborne Organisms Legionella

33 Key Elements of ICRA 33 On-going Process Function of Construction Plan Initial Activity at Design Phase Communication of Concerns Follow-up & Results

34 Typical Areas at Risk 34 Immunocompromised Units Cancer, Bone Marrow, AIDS Surgery Burn Units Intensive Care Neonatal Intensive Care

35 Typical Areas at Risk 35 Nursery Emergency Room Pharmacy Sterile Supply

36 Typical Activities 36 Removal of Ceiling Tiles Repair of Elevator Shafts Change in Pressure Relationships Removal of Carpet Disruption of Environmental Reservoirs

37 Areas of Concern 37 Proper use of Barriers Insufficient coverage or removal Unplanned Utility Outages Ventilation, Water, Electricity Movement of Debris Route & traffic Patient flow Impede necessary access

38 Surrounding Structure Ventilation Air flow Pressure differential Plumbing Potable water Sewage Barriers Permanent - integrity Temporary - stability 38

39 39 Infection Prevention and Control in Facilities

40 Utility Systems Risks EC EP 14- Minimizes pathogenic biological agents in: Locations - Cooling towers - Domestic hot & cold water systems - Aerosolizing water systems Prevention - Risk assessment of potential sites - Water Treatment program Response - Infection control procedures - Cleaning activities

41 Waterborne Diseases Moist environments and aqueous solutions in health-care settings have the potential to serve as reservoirs for waterborne microorganisms Modes of transmission for waterborne infections include: direct contact [e.g., that required for hydrotherapy]; 41 ingestion of water [e.g., through consuming contaminated ice]; indirect-contact transmission [e.g., from an improperly reprocessed medical device]; inhalation of aerosols dispersed from water sources; 3 and aspiration of contaminated water.

42 Waterborne diseases and environment Legionellosis - Cooling towers, evaporative condensers, heated potable water distribution systems, and locally-produced distilled water showers, faucets, respiratory therapy equipment, and room-air humidifiers Nontuberculous Mycobacteria potable water, contaminated water or ice, storage tanks 42 Pseudomonas aeruginosa - Potable (tap) water, distilled water, antiseptic solutions contaminated with tap water, sinks, hydrotherapy pools, whirlpools and whirlpool spas, water baths, lithotripsy therapy tanks, dialysis water, eyewash stations, flower vases, and endoscopes with residual moisture in the channels

43 Maintenance of Water Systems All systems that supply water should be evaluated to determine risk for potential back siphonage and cross connections Hot water heaters and storage tanks or water systems that incorporate an elevated holding tank should be inspected and cleaned annually Fixtures for water in patient-care areas are sinks, faucets, aerators, showers, and toilets; eye-wash stations. These should be evaluated for cleaning and flushing dependent on location. ASHRAE recommends cleaning and monthly disinfection of aerators in high-risk patient-care areas as part of Legionella control measures, if large cluster of infections or colonization occur 43

44 Water Temperature Hot water temperature in hospital patient-care areas is no greater than a temperature within the range of 105 F 120 F In service areas, ASHRAE has recommended higher settings, the kitchen at 120 F or the laundry at 160 F In a hemodialysis unit, continuously circulated, cold treated water is provided to that unit Storage Tanks: Cold water in health-care facilities should be stored and distributed at temperatures below 68 F and Hot water should be stored above 140 F 44

45 Water Systems Good drawings of hot and cold water piping is vital for maintenance and repairs As a minimum preventive measure, ASHRAE recommends a thorough flushing of the system High-temperature flushing or hyper chlorination may also be appropriate strategies to decrease potentially high concentrations of waterborne organisms When shock decontamination of hot water systems is necessary (e.g., after disruption caused by construction and after crossconnections), the hot water temperature should be raised to 160 F 170 F (71 C 77 C) and maintained at that level while each outlet around the system is progressively flushed. 45

46 Catastrophic events: Interruptions or Failures Flooding, sewage spills, loss of electricity and ventilation, and disruption of the water supply Utility Failures and/or Emergency Response Plans are vital to mitigate and respond to such events Responses may include: Boil Water Advisory Conduct microbial sampling Moisture meters for porous structural materials, >20% after 72 hours Pre-treatment filters and disinfecting the RO system 46

47 Infection Prevention and Control 47 Multi-disciplinary function with everyone s responsibility for staff and patient safety

48 Questions & Answers 48

49 Contact Information 49 Lorrie J. Elizarraraz, MPA CHSP CHEP Senior Staff Consultant and Director of Education Services & Publications Safety Management Services, Inc North Arlington Heights Road Arlington Heights, IL