standard description 2015 - c.ymcdn.com · 75,000 patients with hais died ... infection control in...

Standard Description 2015

EC.02.06.01Safe environment (O2 cylinders;

ventilation)59%

IC.02.02.01Infection risk reduction assoc.

with equipment, supplies54%

EC.02.05.01 Manage utility risks (ventilation) 53%

LS.02.01.20Means of egress (corridor

clutter)50%

RC.01.01.01 Patient medical records 48%

Major Site of Infection Estimated Number of Infections (2011)

Healthcare-Associated Infections (all)

721,800

Pneumonia 157,500

Gastrointestinal Illness 123,100

Urinary Tract Infection 93,300

Primary Bloodstream Infections 71,900

Surgical Site Infections 157,500

Other infections 118,500

1 in 25 hospital patients has 1 or more HAI

75,000 patients with HAIs died

Many states require hospitals to post their infection rates online

The Joint Commission Guidelines for the Design and Construction of Health

Care Facilities CDC – Guidelines on Environmental Infection Control

in Healthcare Facilities Assoc. for Professionals in Infection Control and

Epidemiology (APIC)

Standard Description 2015

EC.02.06.01Safe environment (O2 cylinders;

ventilation)59%

IC.02.02.01Infection risk reduction assoc.

with equipment, supplies54%

EC.02.05.01 Manage utility risks (ventilation) 53%

LS.02.01.20Means of egress (corridor

clutter)50%

RC.01.01.01 Patient medical records 48%

Breathing easy: The role of HVAC systems in preserving patient safety…EC.02.05.01

Specific concerns:◦ Directing airflow

◦ Managing outside air

◦ Reliable filtration

◦ Keeping systems energy efficient while minimizing risk

A. 0.1%

B. 1%

C. 3%

D. 33%

A. 0.1%

B. 1%

C. 3%

D. 33%◦ 9,582 TB cases (a rate of 3.0 cases per

100,000 persons) were reported in the United States in 2013

Hotel MHong Kong

Guangdong Province,

China A

A

H,J

A

H,J

Hong Kong SAR

95 HCW

>100 close contacts

U.S.A.

1 HCW

I, L,M

I,L,M

KIreland

0 HCWK

Singapore

34 HCW

37 close contacts

C,D,E

C,D,E

B

B

Vietnam

37 HCW

21 close contacts

F,G

Canada

18 HCWF,G

11 close contacts

SARS Epidemic

[www.cdc.gov]

The analysis of SARS transmission, and reports from other outbreaks, unveil a complex scenario in which super-spreading events are shaped by multiple factors, including co-infection with another pathogen, immune suppression, changes in airflow dynamics, delayed hospital admission, misdiagnosis, and inter-hospital transfers.

(RA Stein, International Journal of Infectious Diseases, August, 2011.)

A. 0

B. 1,000

C. 10,000

D. 1,000,000

"West Africa Ebola 2014 13 Reported Cases per Week" by Malanoqa - Own work. Licensed under CC BY-SA 4.0 via Wikimedia Commons

Thru February 22:◦ 23,729 cases

◦ 9,604 deaths (40%)

27 Fungal outbreaks from construction

Burn, trauma, transplant, oncology, respiratory failure, renal disease, premature infants, etc.

234 total infections

At least 117 deaths(“Construction-related Nosocomial Infections in Patients in Healthcare Facilities,” Canada Communicable Disease Report, Volume 27S2, 7/2001.)

Fungi: 1 to 15 microns◦ Aspergillus spp.: 3.5 microns

◦ Penicillium spp.: 3.3 microns

◦ Stachybotrys spp.: 5.65 microns

Bacteria: 0.23 to 1.25 microns

Viruses: <0.23 microns

[Kowalski et al. 1999]

Construction Project Type

Patient Risk GroupA B C D

Low I II II III/IV

Medium I II III IV

High I II III/IV IV

Highest II III/IV III/IV IV

Adapted from ICRA Matrix developed by J. Bartley, ECSI, Beverly Hills, MI; used with permission

Dust control

Negative pressure of work zone

Containment barriers

• Pressure differential meter

• Balometer (e.g. Shortridge Flowhood)

• Laser particle counter

• Ultrafine particle counter

• Moisture detection instruments

• Microbiologic air sampling equipment

• Microbiologic swab sampling kit

• Aerosol generator and light-scattering photometer

• Ventilation and air exchange formulas

Commissioning

Determination of existing conditions

Verification of system performance

Epidemiology evaluation

Know what question(s) you want answered

Know how to interpret the results

Develop a sampling plan agreed by all involved

A. Monthly

B. Semi-Annual

C. Annual

D. Before TJC survey

E. Depends

Isolation rooms

Protective environment rooms

Pharmaceutical compounding areas

Building pressurization

Construction work zones

Laboratories

More… [Photo provided by

The Energy Conservatory]

A. Visual Indicator

B. Digital Manometer

C. Both

D. Depends

A. Any negative value

B. 0.001” w.g.

C. 0.01” w.g.

D. 0.02” w.g.

E. Depends

Continuous readouts of all airborne particles

Rank-order comparisons among clean, dirty, and outdoor areas (CDC)

Example Particle Counts Outdoors (clear, spring day) = 10,000 p/L Patient wing corridor = 1,000 p/L HEPA-filtered OR = 100 p/L

p/L = particles greater than 0.5 microns in diameter per liter of air

Total Particles

AspergillusCo

nce

ntr

ati

on

Time

Inpatient and outpatient care

Built 1994

5 stories plus basement

235,000 square feet

AHUs: MERV 8 (35%) + HEPA (99.99%)

Mean Median Min Max Std Dev

Outdoors (n=2) 11,930 7,531 1,716 78,537 14,935

1st floor (Ambulatory Care; n=18)

375 152 1 5,394 597

2nd floor (Inpatient; n= 21) 136 94 0 4,813 233

3rd floor (Surgery and ICU; n=15)

152 65 0 4,749 406

4th floor (BMT; n=12) 122 34 0 6,206 463

[Reference: Old LT, Air Quality Challenges Unique to Healthcare:

Perspectives from the Safety Office. ASHE 2010 Annual Conference]

Mean Median Min Max Std Dev

Outdoors (n=2) 11,930 7,531 1,716 78,537 14,935

Corridors, lobbies, nurses stations (n=43)

222 100 1 6,206 491

Patient treatment and inpatient rooms (n=12)

71 45 0 870 92

Surgery (n=4) 49 35 0 251 49

BMT patient rooms (terminal HEPA; n=3)

44 15 0 368 73

[Reference: Old LT, Air Quality Challenges Unique to Healthcare:

Perspectives from the Safety Office. ASHE 2010 Annual Conference]

Particle counters may be used to evaluate

barrier integrity.

[CDC Environmental Infection Control Guidelines]

Location / Air Handling Unit Day 1 Day 2 Day 3

AHU P before filters 5,670 14,600

AHU P after HEPA filters 0 0

AHU 2 before filters 2,490 4,180

AHU 2 after HEPA filters 0 0





Outdoors 44,000 25,400 16,300

[0.02 – 1.0 m particles per cubic centimeter of air]

A. Any negative value

B. 0.001” w.g.

C. 0.01” w.g.

D. 0.02” w.g.

E. Depends

A. 2 air changes per hour

B. 4 air changes per hour

C. 10 air changes per hour

D. Depends

Thermal imaging cameras and moisture meters help detect hidden moisture damage

A. Take sample to determine genus/species

B. Abate

C. No action necessary because less than 5 sq ft

D. Observe regularly to verify not spreading

E. Other

Remove wet absorbent items (e.g., furniture, wallboard, carpeting, etc.) if they cannot be cleaned and dried within 72 hours (i.e., moisture content <20% as determined by moisture meter readings).

Fungi: 1 to 15 microns◦ Aspergillus spp.: 3.5 microns

◦ Penicillium spp.: 3.3 microns

◦ Stachybotrys spp.: 5.65 microns

Bacteria: 0.23 to 1.25 microns

Viruses: <0.23 microns


A. Annual cleaning

B. Periodic cleaning as recommended by manuf.

C. Ultraviolet germicidal irradiation (UVGI)

D. Cleaning + UVGI

E. Other

During renovation, you discover that the construction work zone is not under negative pressure. The contractor has also not been recording pressure differential readings over the last 2 weeks in accordance with the Infection Control Risk Mitigation Plan. What should you do?

Leo Old

EnSafe Inc.

901-372-7962 (office)

901-232-4415 (cell)

standard description 2015 - c.ymcdn.com · 75,000 patients with hais died ... infection control in...

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