Janet Haas PhD, rn, cic

Janet Haas PhD, RN, CIC

• Janet Haas PhD, RN, CIC

• Rich Vogel MS, CIC

• Disclosures: Haas - Hand Hygiene Study funded by 3M

• Vogel - None

• VogVela

First, do no harm

• First, do no harm

• Meet needs of functional program

• Support delivery of care model

• Enhance the patient environment, staff effectiveness and stewardship of the environment

States may have individual requirements

• States may have individual requirements

• Facilities Guidelines Institute

• Publish "Guidelines for Design and Construction of Health Care Facilities" (2010)
• New edition due in 2014

• “When planning for demolition, construction or renovation, the hospital conducts a preconstruction risk assessment for air quality requirements, infection control, utility requirements, noise, vibration and other hazards that affect care, treatment and services.” EC.02.06.05 EP2

• 

Multi-disciplinary team

• Multi-disciplinary team

• Design

• Construction

• Compliance

• Risk mitigation

Number, location and type of:

• Number, location and type of:

• Airborne infection isolation and Protective environment rooms
• These cannot be switchable
• Hand washing sinks, sanitizer dispensers
• Eyewash stations and deluge showers

• HVAC systems to meet functional needs -e.g. Procedure rooms, laboratories etc.

• Water systems to limit legionella

General Principles - Clean to Dirty

• General Principles - Clean to Dirty

• Dirty areas (janitors closets, decontamination rooms, areas for bronchoscopy, laboratory with specimens) are negative pressure
• Procedure areas, pharmacy compounding, sterile supply areas are positive pressure

• Best Reference is ANSI/ASHRAE/ASHE Standard 170-2008 Table 7-1

Negative Pressure = Air flows from corridor to (anteroom if present) to patient room

• Negative Pressure = Air flows from corridor to (anteroom if present) to patient room

• 12 air changes/hour with 2 outside air changes/ hour

• Exhaust air grills in ceiling over patient head or on wall at head of bed

Toilet and tub/shower and pt sink in the inpatient room as well as hand washing station for staff

• Toilet and tub/shower and pt sink in the inpatient room as well as hand washing station for staff

• Air must be exhausted directly outside without mixing with non-AIIR exhaust

• Continuous visual pressure monitor

• Area for gowning/storage directly inside or outside of entry

• In retrofitted settings, can HEPA filter exhaust air

• Can use for non-isolation patients, but pressure settings do not change

Positive Pressure = Cleanest (patient area) to less clean

• Positive Pressure = Cleanest (patient area) to less clean

• Supply air to PE room is HEPA filtered just before entering the room or suite of rooms

• 12 Air changes/ hour including 2 outside air changes/ hour

• Permanently installed visual mechanism to constantly monitor pressure status of the room

• Anteroom not required per Facilities Guidelines, but does mitigate against pressure changes

Reversible air flow NOT allowed.

• Reversible air flow NOT allowed.

• Air supply = PE room

• Exhaust air = AIIR requirements

• Airflow patterns may be from anteroom

• to both the pt room & corridor OR

• Airflow may be from pt room & corridor to anteroom

• Must have 2 visual monitors 1 between pt room and anteroom; 1 between anteroom and corridor

Design water systems to reduce risk

• Design water systems to reduce risk

• Scale system for actual needs (don’t over build), leads to decreased circulation around water circuits
• Limit dead legs and areas of stagnation

• Assess need for filtration in high risk areas

• Legionella in the incoming water, high risk patients, amount of water use in the area
• COMMISSIONING PROCEDURES

Hands free

• Hands free

• Wrist blades, knee control, electronic eye

• Avoid aerators as these promote water dispersal

• Electronic eye:

• Save water, are popular with patients

• May be more prone to legionella contamination

• Must consider wiring to emergency power

Mixing Valves - control water temperature at the outlet by use of a thermostat

• Mixing Valves - control water temperature at the outlet by use of a thermostat

Cold water less likely to harbor legionella

• Cold water less likely to harbor legionella

• Need water and ice for patient care/comfort

• Assure cleaning and maintenance plan is in place

• Assure people are trained to change filters and clean/disinfect various components of machines

• Trouble spots are anywhere water sits for prolonged periods

• Prevent contamination of ice by providing place outside of ice for the scoop

Raise Sheetrock off floor during construction.

• Raise Sheetrock off floor during construction.

Everyday concern

• Everyday concern

• May contaminate environment

• Staff safety concern

• Red bag waste is costly to manage

• Nurse call, documentation, patient education and diversion/recreation

• Computer cabling and device location

• Other controls - access hatches

• Water filtration

• Environmental disinfection technology

Needs assessment to identify appropriate equipment for the service area.

• Needs assessment to identify appropriate equipment for the service area.

• Definition of space and structural and other design requirements to accommodate this equipment

• Prevent hallway clutter
• Adequate outlets
• Assure safe patient handling

Provide supplies within work flow while minimizing risk of cross contamination

• Provide supplies within work flow while minimizing risk of cross contamination

• Just outside the patient room

• Outside to inside access

For patients and families

• For patients and families

• Match needs of functional program and care delivery model

• Assess length of stay/needs

• Example: If you offer washer/dryer, then consider clothes storage space
• CLUTTER PREVENTION

Pleasant, inviting appearance (at least when new)

• Pleasant, inviting appearance (at least when new)

• Comfort and warmth underfoot

• Sound deadening properties

• No solid evidence that carpeting is linked to increased risk of HAI under normal circumstances

• Wet carpet is a risk for Aspergillus

Easily cleanable with hospital disinfectants

• Easily cleanable with hospital disinfectants

• Not prone to soiling with extensive use (e.g. vinyl upholstery vs. cloth)

• Skid-resistant

• No crevices for dust

Cleanable/rust resistant

• Cleanable/rust resistant

• Designed to reduce clutter

• Support patient mobility/independence

• Bed bug ‘resistant’ (limit crevices, assure no tears in upholstery)

Copper Surfaces

• Copper Surfaces

• Passive continuous activity; need info on exact alloys and application method; long term efficacy

• Curtains

• become contaminated again shortly after cleaning (within 1 week)
• Antimicrobial curtains may delay contamination (to 2 weeks in recent study)
• May be more effective vs certain pathogens
• Consider alternatives (e.g. smartglass)

Attention to detail at all levels

• Attention to detail at all levels

• ICRA is not just a permit for dust control during construction

• Design is something you will live with for years

• Don’t forget the fixtures and finishes

• Thank You!