Janet Haas PhD, rn, cic



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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!















































































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