infection control strategies for sanitary and efficient ......• describe at least two reasons why...

Infection Control Strategies for Sanitary and Efficient Healthcare Facilities

Course # ICSF01Provider # K-154

1 LU/HSW hour

AIA Best Practices

American Standard sponsors this course provided by Hanley Wood, a Registered Provider with the American Institute of Architects Continuing Education Systems. Credit earned on completion of this program will be reported to CES Records for all AIA members. Certificates of completion are available for non-members and self-reporting purposes.

This program is registered with the AIA/CES for continuing professional education. As such, it does not include content that may be deemed or construed to be an approval or endorsement by the AIA of any material of construction or any method or manner of handling, using, distributing, or dealing in any material or product.

Questions related to specific materials, methods and services should be directed to American Standard upon completion of this learning unit.

Copyright

This presentation is protected by U.S. and International copyright laws. Reproduction, distribution, display and use of the presentation without written permission of American Standard is prohibited.

© 2010, American Standard Brands

Learning Objectives

• Describe at least two reasons why infection control measures need to be improved in healthcare facilities.

• Describe at least one room in a hospital and explain why it contributes to spread of infection, and what can be to do reverse spread of infection.

• Describe at least three design strategies that can improve infection control prevention in healthcare facilities.

• Describe how healthcare facilities can be both environmentally conscious and sanitary.

Our Aging Population

• The U.S. population is changing how we use healthcare facilities.

– Older generations are using healthcare facilities more

– Younger generations are using healthcare facilities less

• Existing facilities need to change to meet our current needs.

– Larger facilities with updated technologies

– Cleaner facilities to reduce spread of infection

– Conservative facilities that are resource efficient

Our Aging Population

Changes in Healthcare

This chart compares the frequency of hospitalization for coronary arthrosclerosis from 1990 to 2006.


• Hospitals are not just for accidents and illnesses anymore. An increasing number of people are also going voluntarily for life-improving procedures.

– Joint replacements, heart/coronary procedures, plastic surgeries

This chart compares the frequency of knee replacements in adults 45 and older in the U.S from 2000 to 2006.


• Hospital stays are longer for elderly patients after major surgeries. This increases their risk of infection.

This chart compares the percent of discharges and days of care by age in the U.S. in 2006.

Projected Growth

• Our change in need and use of healthcare facilities is creating a need for renovation of existing facilities and construction of new facilities.

• New construction will be slightly down or flat, but is still at an all-time high.

– Hospital construction will drive the volume

– Special care facility construction will provide future growth opportunities

– By 2012 healthcare facility construction is expected to rise significantly

Learning Objectives





Room Designs

• Nosocomial infections, or healthcare-associated illnesses are often related to insufficient hand washing and splashing of water from sinks and drains onto adjacent surfaces.

Healthcare Associated

Illnesses (HAIs):

1.7 million people incur an infection during a hospital

visit annually

Nearly 100,000 deaths occur

annually from HAIs

Room Designs

• A typical patient room places the bed very near the sink, preparation and waste disposal areas.

• When two beds are separated by a curtain, one bed is often close to one of these areas.

Toronto Study

• Toronto, Ontario December, 2004 – March, 2006

– 36 patients in intensive care or transplant units incurred an HAI

– 17 patients died from these infections

• Pseudomonas aeruginosa

– Fourth most common pathogen – 10% of HAIs

– Only infects immuno-suppressed tissues

– 50% mortality rate

Toronto Study

• Infection control specialists tried to identify the location of the bacteria; two control measures were taken to eliminate bacteria spread from contact.

– Workers wore gloves, masks and gowns

– Patient rooms received enhanced cleaning (twice)

– Neither precaution had a lasting impact on the bacteria

Photo Source Photo SourcePhoto Source

• Surfaces were cultured to identify where bacteria colonies were present. Hand Hygiene sinks in patient rooms had the highest number of positive cultures.

– Black lighting identified that water splashed as far as 3 feet away from the sink

Toronto Study

Photo Source

• Sinks were renovated to help minimize splashing

– Traps were replaced

– New faucets did not flow directly into the drain

– Water pressure was decreased

– Splash guard placed around the sink to minimize splashing

– Patient care materials moved farther away from the sink.

Toronto Study

Example of a sink with splash guards.

Bacteria on Surfaces

• Staph infections are the most common infections in healthcare facilities.

• One study found that MRSA or MSSA was present on 24% of all doorhardware

• MRSA (methicillin resistant Staphylococcus aureus)

– Responsible for 63 percent of hospital-acquired staph infections

– Can live for:

• More than 12 days on a laminated countertop

• 11 days on a plastic patient chart

• 9 days on a cloth curtain

• MSSA (methicillin susceptible Staphylococcus aureus)

– Can be fought with most antibiotics

Bacteria on Surfaces

• VRE (vancomycin-resistant enteroccus)

– An example of a bacteria that has become resistant to antibiotics

• Antibiotics are wonderful, but bacteria adapt faster than we cancreate new variations of antibiotics. This is part of the reason why we see drug-resistant bacteria causing HAIs.

Photo Source

Hand washing

• Hand washing is imperative for fighting infection control. There are really only four things that can kill bacteria:

– Prolonged exposure to UV light

– Low nutrient levels

– Antibiotics

– Humidity levels below 10 percent

The Cost of Infection

• HAIs lead to nearly $5 billion to the national annual healthcare bill.

• Medicare and many private insurers are no longer reimbursing facilities for the increased cost of “preventable infections.”

– This is added incentive to include infection control in your design considerations.

Room designs

• A typical inpatient-room design often places the bed in close proximity to the hand hygiene sink and the preparation area.

• This is the typical room design for the rooms in the Toronto study.

Learning Objectives





Designing to Minimize Infection

• Room design and sink specification can significantly help in reducing nosocomial infections.

• Infection control and prevention considers both human and physical design factors.


• Infection control and prevention professionals should be included in the design and planning of a facility.

• Infection control specialists will be able to describe the chain-of-transmission of infectious agents and make recommendations to eliminate or reduce potential hazards.

Inpatient Room Design

• New Construction

– Maximum number of beds shall be one, unless a necessity of a two-bed arrangement is required.

• Renovations

– Maximum room occupancy should not exceed four, and should not be increased if

occupancy is currently one or two.

FGI Guidelines recognize the following specialties:

• General Hospitals

• Small Primary Care Hospitals

• Critical Access Hospitals

• Psychiatric Hospitals

• Rehabilitation Hospitals

Inpatient Room Design

• FGI Guidelines’ Space Requirements:

– 120 square feet of clear floor space for single-bed rooms

– 100 square feet of clear floor space per bed in multiple-bed rooms must be provided.

• Privacy shall be provided in multiple-bed rooms.

CHICA – Canada is a multi-disciplinary,

voluntary association of

Infection Control Professionals (ICPs)

dedicated to the health of Canadians

by promoting excellence in the

practice of infection control and prevention.

Hand-Washing Stations

• FGI Guidelines’ Hand-washing stations:

– Sinks should be non-porous materials with deep basins and be at least 144 square inches.

– Water pressure shall be regulated

– Storage below sinks is prohibited

• Antibacterial gel dispensers may also be included in patient rooms and at nursing stations and may be permitted if adding a sink is to feasible.


• FGI Guidelines’ Hand-washing stations:

– Recommendations for reducing splashing:

• Faucet should angle water away from the drain, rather than directly into the drain

• Water pressure should reduce forceful discharge at maximum flow

• Sink size and dept should follow ANSI Standards for sink design

• You may also have to accommodate ADA requirements for clearance under the sink in patient and public restrooms.


• Sink– Material: vitreous china, stainless steel or other non-porous, chemical-

resistant material

– Finish: white, or other colors

– Mounting: wall hung, carrier arms concealed

– Bowl: (inside size) minimum 10 in. x 14 in. front-to-back, by 9 in. deep

– Rim: shall be sloped to direct water into bowl and prevent placement of objects in sink

– Sink shall not have an overflow drain

– Other desirable features

• Splash guards

• Smooth corners

• Antimicrobial finish

• Hands-free faucet

Wall Mounted

Sloping Rims

Hands-free Control

Gooseneck Faucet

Indirect Drain

Smooth Corners



• Faucet– Material: brass

– Finish: chrome plated

– Water flow: 2.2 gpm or less, preference for reduced flows

– Spout: • rigid gooseneck preferred; others that are multi-functional can be considered

• Locate spout near sink flood level

• Water delivery shall be between front of sink and drain (not into drain)

• Shall not have aerator/modulator or spray modifier

– Control: • Hands-free operation required, electronic or foot-pedals

• Electronic controls are hand-motion activated, not booty-motion activated; shall be line-powered and consider manual flow and temperature override control

• Foot pedals should be wall-mounted with separate hot and cold pedals


• Gooseneck faucets are preferred in healthcare facilities

• Hands-free sensor-operated faucets help reduce HAI’s.


• Drain

– Material: brass. Drain fitting gaskets to be plastic or neoprene

– Finish: chrome plated

– Size: 1-1/2 inch trap; 1-1/4 inch considered

– Drain fitting shall not accept a plug or stopper


• Complete assembly

– Exposed elements shall be suitable for frequent exposure to institutional-grade cleaners and disinfectors

– Elements shall periodically handle 180-degree F water temperature without deterioration, cracking or other failure.


• Antimicrobial surfaces provide a passive method for infection control. Silver-based antimicrobial surfaces only release antimicrobial properties when microbes are present.

– Silver antimicrobials are less toxic than table salt

– Antimicrobial coatings will not leach from the fixture – they are permanent


Standard Surface

• 52 days of flushing• 74,000 cycles• Iron stains & biofilm

Anti-microbial Surface

• 65 days of flushing• 91,000 cycles• No iron stains or biofilm

Surgical Prep Area Design

• The Scrubbing room typically has two steel scrub sinks with hands-free faucets. The workroom typically has a clinical sink, bedpanwasher and separate wall-mounted faucet.

Surgical Prep Area Design

• Scrub sinks

– Must be hands-free with foot, knee or ultrasonic controls.

• Clinical sinks

– Can be hands-free or have single-lever or wrist blade controls, provided handles are at least 6 inches long.

Nursing Station Design

• Requirements for nursing stations:

– Space for counters

– Space for storage

– Convenient access to hand-washing stations

• CHICA requires that a hand-washing station be no more than 20 feet from a nursing station.

Examination/Treatment Room

• Single or multi-bed examination or treatment rooms may be required. Space requirements depend on the number of beds.

– An examination light

– A hand-washing station

– Storage facilities for supplies

– A desk, computer or shelf space for writing or electronic documentation

Public Area Design

• Support areas for families, patients and visitors

– Privacy

– Area for communications

– Patient-family information stations

– Access to beverages and nourishment

– ADA Compliancy is something you should consider for public areas.

Future of Design

• BIM is the design tool of the future.

Future of Design

Future of Design

• An example of a 3-D rendering of a public restroom in a healthcare facility.

Learning Objectives





Water Usage in Healthcare

• Healthcare facilities are often exempt from water usage regulations. On average, facilities with between 130 and 550 beds use 125,000gallons of water daily.

http://www.energystar.gov/index.cfm?c=healthcare.ashe_sept_oct_2005

LEED for Healthcare

• LEED for Healthcare

– WE Prerequisite 1: Water Use Reduction

– WE Prerequisite 2:Minimize Potable Water Use for Medical Equipment Cooling

– WE Credit 1: Water Efficient Landscaping: No Potable Water Use or No Irrigation

– WE Credit 2: Water Use Reduction: Measurement & Verification

– WE Credit 3: Water Use Reduction: 30 – 40 Percent Reduction

– WE Credit 4: Water Use Reduction: Building Equipment

– WE Credit 4.2: Water Use Reduction: Cooling Towers

– WE Credit 4.3: Water Use Reduction: Food Waste Systems

LEED for Healthcare

• WE Prerequisite 1: Water Use Reduction

– Building Water Use Strategies (20%):• Toilets – dual flush, or 1.6gpm or less

• Urinals – 1gpm or less, or waterless urinals

• Lavatory faucets – 2.2 gpm in patient rooms,

0.5 gpm in public-use areas

• Metered faucets: 0.25 gpc

• Shower heads: 2.5 gpm or less, at 80 psi.

– Process Water Use Strategies (20%):• Commercial clothes washers – less than 80 lbs – 9 gallon/CF/cycle

• Commercial dishwashers – between 0.99 gallons/rack to 1.98 gallons/rack.

• Ice machines – less than 25 gallons per 100 lbs of ice

• food steamers – 8 gallons/hour/pan

• combination ovens – 8 gph

LEED for Healthcare

• WE Credit 3: Water Use Reduction: 30 – 40% Reduction, 1 – 3 points

– Building Water Use Strategies:

• Water closets – 1.6 gpf, or less

• Urinals – 1 gpf, or less

• Lavatory faucets – 2.2 gpm at 60 psi for private use,

0.5 gpm at 60 psi for public use

• Showers – 2.5 gpm or less at 80 psi

• Kitchen sink faucets and Pre-rinse spray valves –

1.6 gpm or less

– Process Water Use Strategies:

• Use efficient clothes washers, dish washers, ice machines, combination ovens, food steamers and other equipment.

LEED for Healthcare

• LEED for Healthcare

– WE Prerequisite 1: Water Use Reduction

– WE Prerequisite 2:Minimize Potable Water Use for Medical Equipment Cooling

– WE Credit 1: Water Efficient Landscaping: No Potable Water Use or

No Irrigation

– WE Credit 2: Water Use Reduction: Measurement & Verification

– WE Credit 3: Water Use Reduction: 30 – 40 Percent Reduction

– WE Credit 4: Water Use Reduction: Building Equipment

– WE Credit 4.2: Water Use Reduction: Cooling Towers

– WE Credit 4.3: Water Use Reduction: Food Waste Systems

Green Guide for Healthcare

• Water Efficiency

– Prerequisite 1: Potable Water Use for Medical Equipment Cooling

– Credit 1: Water Efficiency Landscaping: No Potable Water use or No Irrigation

– Credit 2.1: Potable Water Use Reduction: Measurement & Verification

– Credit 2.2: Potable Water Use Reduction: Domestic Water

– Credit 2.3: Potable Water Use Reduction: Domestic Water

– Credit 2.4: Potable Water Use Reduction: Process Water & Building System Equipment

– Credit 2.5: Potable Water Use Reduction: Process Water & Building System Equipment


• WE 2.2 Potable Water Use Reduction: Domestic Water

– Equip all urinals and hand wash sinks with sensor operators.

• Toilets, bed pan washers, compounding sinks, housekeeping sinks and sinks in impatient bedrooms cannot contribute

Green Guides for Healthcare

• WE 2.3: Potable Water Use Reduction: Domestic Water

– Use low-flow fixtures or control fixtures to achieve these water flows:

• Lavatories – 1.5 gpm or less

• Urinals – 1 gpf or less

• Toilets – 1.6 gpf or dual flush or less

• Showers – 1.8 gpm or less


• WE Credits 2.2 and 2.3: Potable Water Use Reduction: Domestic Water

– Provide a separate glass-fill device in inpatient rooms to prevent activation of the hand-wash sensor

– Specify self-closing or electronic sensor faucets

– Specify high efficiency fixtures or dry fixtures

– Consider reusing storm water or greywater for non-potable applications

Summary

• The way we use healthcare facilities is changing, leaving room for substantial remodels and new construction in the future.

• Room design, sink design and sink placement can impact the health and safety of patients, physicians, staff and visitors.

• Sink design and placement is important to consider in patient rooms, nursing stations, scrub rooms and other patient-care rooms. BIM allows you to see what your design will look like in 3-D before construction is complete. This will aid in flexibility.

• Healthcare facilities can use low-flow fixtures and faucets to meet LEED, GGHC and FGI guidelines for energy-efficient, clean facilities.

Thank You

This concludes the learning portion of this course. Please contact American Standard directly with any questions related to the information presented.

Questions?

Jeff Gilmore

[email protected]

614-315-7153

American Standard Brands

www.americanstandard-us.com

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