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Introduction to CDC’s “Guidelines for Environmental Infection Control in Health-Care Facilities” Lynne Sehulster, PhD, M(ASCP) Division of Healthcare Quality.

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Presentation on theme: "Introduction to CDC’s “Guidelines for Environmental Infection Control in Health-Care Facilities” Lynne Sehulster, PhD, M(ASCP) Division of Healthcare Quality."— Presentation transcript:

1 Introduction to CDC’s “Guidelines for Environmental Infection Control in Health-Care Facilities” Lynne Sehulster, PhD, M(ASCP) Division of Healthcare Quality Promotion Centers for Disease Control and Prevention Atlanta, GA 30333 Hosted by Paul Webber Sponsored by 3M Canada

2 Objectives of Today’s Presentation After the completion of this session, the participant will: Be familiar with the overall content of the EIC guidelines; See how the guidance is applied to an airborne disease outbreak; and Be familiar with performance measures and standards on environment of care

3 Target Audiences for the EIC Guidelines Hospital epidemiologists Infection control practitioners Laboratorians Facility managers and engineers Housekeeping and laundry staff Administration

4 Where Can I Find the EIC Guidelines? Part II Recommendations: –MMWR 2003; 52 (RR-10): 1-44 –Errata: MMWR 2003; 52 (42): 1025-6 Full text version: – guide.htm Print version: –ASHE will print in the near future

5 CDC Contributors to These Guidelines Division of Healthcare Quality Promotion: –Lynne Sehulster, PhD; Matthew Arduino, DrPH; Joe Carpenter, PE; Rodney Donlan, PhD Division of Bacterial and Mycotic Diseases: –David Ashford, DVM, DSc, MPH; Richard Besser, MD; Barry Fields, PhD; Michael McNeil, MBBS, MPH; Cynthia Whitney, MD; Stephanie Wong, DVM, MPH Division of Parasitic Diseases: –Dennis Juranek, DVM Division of Oral Health: –Jennifer Cleveland, DDS, MPH HICPAC Sponsor: –Raymond Chinn, MD, Sharp Memorial Hospital, San Diego

6 U.S. Organizations Whose Standards are Incorporated into These Guidelines American Institute of Architects (AIA) American Society of Heating, Refrigeration, and Air-conditioning Engineers (ASHRAE) Association for the Advancement of Medical Instrumentation (AAMI)

7 U.S. Federal Regulatory Agencies Environmental Protection Agency (EPA) Department of Labor, Occupational Safety and Health Administration (OSHA) Food and Drug Administration (FDA) Department of Agriculture (USDA) Department of Justice (DoJ)

8 Air Section

9 Air Section Subtopics Airborne microorganisms HVAC components and function Construction Special care settings –Airborne infection isolation (AII) –Protective environment –Operating rooms Other aerosol hazards (infectious)

10 Ventilation Specifications Specifications Airborne Infection Isolation (AII) Protective Environment (PE) Air pressureNegativePositive Room air changes > 6 ACH for existing areas; > 12 ACH for new construction or renovation > 12 ACH SealedYes Filtration on supply air90% (dust-spot testing)99.97% (HEPA) RecirculationNoYes

11 Ventilation Specifications Specifications Critical Care Room Operating Room Air pressure Positive, negative, or neutral Positive Room air changes> 6 ACH> 15 ACH SealedNoYes Supply air filtration > 90% (dust-spot testing) 90% (dust-spot testing) RecirculationYes

12 Ventilation Specifications SpecificationsIsolation Anteroom Air pressurePositive or negative Room air changes> 10 ACH SealedYes Supply air filtration> 90% (dust-spot testing) RecirculationNo

13 Construction Issues Multidisciplinary team Risk assessment prior to project start External construction – keep dust out! Internal construction – contain the dust! Barriers Surveillance and air sampling

14 External Construction Keep the facility air pressure positive to the outside Ensure that roughing filters are changed frequently Seal and caulk windows, especially in PE Keep doors closed as much as possible Wet dust surfaces Protect immunocompromised patients from dust during transfers

15 Internal Construction Dust containment, removal and moisture control –Educate construction workers and staff –Prepare the site –Notify staff, visitors, patients re: precautions –Relocate patients and move staff as needed –Monitor for adherence to infection control –HVAC system maintenance; water system –Daily clean-up and removal of debris

16 Particle Sampling Simple to perform, immediate results Verify HVAC system performance: – Filtration efficiency – Rank order from “dirty” to “clean” Verify infection control measures during construction: – Construction barrier and dust containment

17 Aspergillosis Outbreak

18 Impact of Aspergillosis, 1996 10,190 hospitalizations; average length of stay = 17.3 days 1970 deaths; mortality rate = 19.3% Economic burden in health care = $633.1 million Conditions associated with secondary diagnosis of aspergillosis: – pneumonia, other respiratory infections, cancer or leukemia, HIV infection Dasbach EJ, Davies GM, Teutsch SM. Clin Infect Dis 2000; 31: 1524-1528

19 Impact of Aspergillosis, 1996 When there is a secondary diagnosis of aspergillosis in cancer or leukemia patients: –26 more hospital days –$115,262 in additional costs –4 times the mortality rate compared to similar patients without aspergillosis Dasbach EJ, Davies GM, Teutsch SM. Clin Infect Dis 2000; 31: 1524-1528.

20 Healthcare-Associated Outbreaks of IPA Activities that cause increases in counts of airborne Aspergillus spores Building demolition, construction, renovation, repair Bird droppings in air ducts supplying high- risk patient care areas Contaminated fireproofing material Damp wood, sheet rock

21 Aspergillosis Outbreak Hospital A February, March 1996; September 1996 940 bed facility; Oncology Center is a 3- story building connected to the hospital Pressure differentials, HVAC system checked monthly Construction immediately adjacent to the Oncology Center A. flavus emerges, previously A. fumigatus

22 Investigative Findings: 1996 21/29 surveillance-identified patients met case definition of “definite” or “probable” Housekeeping procedures inadequate; clean “wet” Univariate analysis: location near the stairwell Large volume samplers detected A. flavus, while small volume samples were negative

23 Thio CL, Smith D, Merz WG, et al. Infect Control Hosp Epidemiol 2000; 21: 18-23

24 Investigative Findings: 1996 Pressure differentials –25 PE rooms, 3 of which were negative relative to the corridor (-0.35 to –3.2 Pa) –Air pressure in the central stairwell was positive relative to the corridor of the unit –Oncology Center was neutral – negative compared to the adjacent hospital

25 Environmental Control Measures: Spring 1996 Reviewed the function of the HVAC system Doors engineered to close automatically; kept closed at all times Wet dusted and cleaned surfaces Sealed windows, exterior walls

26 Environmental Control Measures: Spring 1996 Closed nearby entrance; redirected pedestrian traffic Construction policy Air sampling for fungal spores N95 respirators for high-risk patients

27 Environmental Control Measures: Fall 1996 Closed the stairwell between the HSCT and leukemia units Conducted case-control studies Additional environmental cultures Reviewed housekeeping procedures Large volume air sampling Supplemental HEPA filtration when structural modification not feasible

28 Water Section

29 Water Section Subtopics Waterborne microorganisms Facility water systems Strategies for controlling Legionella spp. Cooling towers Hemodialysis and water quality Ice machines Hydrotherapy AERs and dental unit water lines (DUWLs)

30 Modes of Transmission of Microorganisms in Water Direct contact (hydrotherapy) Ingestion of water (drinking water, ice) Indirect contact (improperly reprocessed medical device) Inhalation of aerosols (showers) Aspiration of contaminated water

31 Updates on Air and Water Updated recommendations for air and water infection control measures: Guidelines for Preventing Health-Care- Associated Pneumonia, 2003 Available at: default.htm

32 Environmental Services Section

33 Environmental Services Section Subtopics Principles of cleaning and disinfection Cleaning spills of blood/body substance Carpeting, cloth furniture Flowers and plants Pest control Special pathogen concerns and cleaning

34 Should Environmental Sampling Be Done? NO, not routinely Environmental sampling may be useful: – To verify the effectiveness of a new cleaning and disinfecting process – To identify environmental reservoirs during outbreak situations – Coordinate sampling with the laboratory

35 Environmental Sampling Section

36 Environmental Sampling Section Subtopics Principles of environmental sampling Air sampling Water sampling Environmental surface sampling

37 Laundry and Bedding Section

38 Laundry and Bedding Section Subtopics Epidemiology Collecting and sorting soiled linens Laundry processes Antimicrobial-impregnated articles Pillows, mattresses Air-fluidized beds

39 Animals in Healthcare Facilities Section

40 Animals in Healthcare Facilities Section Subtopics Animal-assisted activities, animal- assisted therapy, resident animals Service animals Animals as patients in healthcare facilities Research animals in healthcare facilities

41 Regulated Medical Waste Section

42 Regulated Medical Waste Section Subtopics Epidemiology Categories of medical waste Management of waste Treatment of waste Discharge of blood, body fluids to the sanitary sewer CJD issues

43 EIC Guidelines Performance Measures Document infection control professionals’ involvement in all phases of construction Monitor and document airflow for AII and PE, especially when occupied Monitor water in hemodialysis settings monthly for endotoxin and bacteria Determine source(s) of NTM Identify and respond to water damage

44 JCAHO – 2004 Standards for the Management of the Environment of Care Planning and Implementation Activities –EC 1.10 – EC 1.30: safety risks, smoking policy, safe environment –EC 2.10: security risk management –EC 3.10: hazardous materials and wastes –EC 4.10 – EC 4.20: emergency management

45 JCAHO – 2004 Standards for the Management of the Environment of Care Planning and Implementation Activities –EC 5.10 – EC 5.50: fire safety and Life Safety Code® issues –EC 6.10 – EC 6.20: medical equipment –EC 7.10 – EC 7.50: utilities management –EC 8.10 – EC 8.30: environmental management

46 JCAHO – 2004 Standards for the Management of the Environment of Care Measuring and Improving Activities –EC 9.10 – EC 9.30: monitoring and analyzing environmental conditions; implementing recommendations to improve the environment of care

47 JCAHO – 2004 Standards for the Management of the Environment of Care Standard –Performance expectation Rationale –Background, justification Elements of Performance –Steps needed to achieve the standard

48 Thank You! Protect patients, protect healthcare personnel, and promote safety, quality, and value in the healthcare delivery system

49 Continuing Education Certificate To learn how to apply for a Continuing Education Certificate for this teleclass... Or contact...

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