Design and Construction: Infection nfection revention for Healthcare Professionals June 15, 2011 June 15, 201

Transcription

1 Design and Construction: Infection Prevention for Healthcare Professionals June 15,

2 Outline Introductions Background, value proposition, thesis Webinar Objectives Principals of infection transmission History Regulatory slides ICRA/ICRMR process (include Hepa Vac. slide/discussion) Role of Environmental Services Steven Cutter, MBA, CHFM, HFDP Director, Engineering Services, Dartmouth-Hitchcock Medical Center, Lebanon, NH Thirty-five years in healthcare facility Management Participated in numerous construction/renovation projects, small to complex ASHE Certified Healthcare Facility Manager ASHRAE Healthcare Facility Design Professional 2

3 Linda Dickey, RN Director, Epidemiology and Infection Prevention University of California Irvine Registered Nurse: Adult critical care, 17 years in infection prevention 2014 FGI Healthcare Guidelines Revision Committee member Consults on construction projects from large scale green field to small renovations Background 1.7 Million HAIs occur in US hospitals each year 99,000 deaths caused by HAIs each year HAIs linked to construction and maintenance well documented in medical literature Incidents caused by construction-related activity estimated at 5% Centers for Disease Control and Prevention: The Direct Medical Costs of Healthcare-Associated Infections in U.S. Hospitals and the Benefits of Prevention. March

4 Value Proposition Fact Patients develop infections while being treated in hospitals Fact These hospital-acquired infections (HAIs) result in pain, suffering and even death Fact Construction, renovation and maintenance activities have been linked to HAIs Thesis By better understanding the nature of infections, and strategies to reduce the potential of transmission the incidence of Construction, Renovation & Maintenance related infections. 4

5 Key Learning Objectives Evaluate infection risks associated with healthcare construction activity Identify infection prevention strategies used during construction projects List two ways Environmental Services directly supports patient safety during construction Learning Objective One Evaluate infection risks associated with healthcare construction activity 5

6 Swiss Cheese Model of Accident Causation (After Reason) Active Failures Incident Latent Failures Barrier Barrier Barrier Chain of Infection 6

7 The Chain of Infection: Agent Agent- Aspergillus Susceptible Host Reservoir Portal of Entry Portal of Exit Mode of Transmission The Chain of Infection: Reservoir Agent Susceptible Host Reservoir-Dirt Portal of Entry Portal of Exit Mode of Transmission 7

8 The Chain of Infection: Portal of Exit Agent Susceptible Host Reservoir Portal of Entry Portal of Exit- Demolition plume Mode of Transmission The Chain of Infection: Mode of Transmission Agent Susceptible Host Reservoir Portal of Entry Portal of Exit Mode of Transmission- Air currents 8

9 The Chain of Infection: Portal of Entry Agent Susceptible Host Reservoir Portal of Entry-Lung Portal of Exit Mode of Transmission Twenty-one cases of Invasive Aspergillosis (IA) High-risk oncology unit Unit became negative Positive environmental samples matched patients Six patients died Thio, CL, et al. Refinements of Environmental Assessment During an Outbreak Investigation of Invasive Aspergillosis in a Leukemia and Bone Marrow Transplant Unit. Inf Control and Epidemiology, Vol 121, Jan 2000,

10 Some Historical Notes From On Agriculture by Marcus Terentius (published in 36 BC):...and because there are bred certain minute creatures which cannot be seen by the eyes, which float in the air and enter the body through the mouth and nose and there cause serious diseases. Miasmatic theory... diseases such as cholera and the black plague were caused by a miasma - a noxious form of "bad air. In 1858 Florence Nightingale wrote Notes on Hospitals advocating: Breaking up hospitals of any size into a number of separate detached units Developing ventilation systems 10

11 The Hill-Burton Hospital Survey and Construction Act 1947 Provided federal grants or guaranteed loans to improve the physical plant of the nation s hospital system. Developed standards for ventilation of spaces within hospitals Rooms lacking outside windows and being used by hospital personnel shall be provided with forced ventilation to change the air at least once every six minutes. Hospitals today... are built to accommodate different patient populations with different needs. Two examples: Protective Environment Rooms (PE) For patients who have weak immune systems Positive pressure rooms Airborne Infection Isolation Rooms (AIIR) for patients who have diseases that we don t want others to catch Negative pressure rooms 11

12 We create different environments... by changing how much supply and exhaust air we provide for each type of room Protective Environment (PE) rooms have more supply air than exhaust air Airborne Infection Isolation (AIIR) rooms have more exhaust air than supply air Construction and renovation areas are treated just like Airborne Infection Isolation Rooms Outside Air, Supply, Return & Exhaust 12

13 In this section we discuss.. Requirements and regulations around infection prevention in construction and renovation projects Why they are important Significant Regulations and Guidelines The Joint Commission National Fire Protection Association (NFPA) Guidelines for the Design and Construction HealthCare Facilities (mandated by some states) CDC Guidelines on Environmental Infection Control Association for Professionals in Infection Control and Epidemiology (APIC) The role of infection control during construction in healthcare facilities ASHRAE 170 Ventilation of Healthcare Facilities 13

14 Centers for Disease Control Guidelines for Environmental Infection Control in Health- Care Facilities, Construction, Renovation, Repair and Demolition Establish a multidisciplinary team Include infection control staff to coordinate activities Consider proactive measures at the inception Produce and maintain summary statements of the team s activities Educate the construction team and healthcare staff Immunocompromised patient care areas Airborne risks associated with construction projects Methods to control the dissemination of fungal spores. Centers for Disease Control Guidelines for Environmental Infection Control in Health- Care Facilities, Construction, Renovation, Repair and Demolition Construct barriers to prevent dust from construction areas from entering patient care areas Ensure that barriers are impermeable to fungal spores Use airborne-particle sampling as a tool to evaluate barrier integrity Monitor negative airflow Clean work zones and their entrances daily. 14

15 APIC The role of infection control during construction in healthcare facilities Recommends the creation of a Comprehensive Construction and Renovation Policy to ensure timely notification of early planning efforts Recommends the use of an Infection Control (IC) permit designed assessing risks and identify prevention strategies Infection Control participation in the planning stages is critical to ensure that relevant design components are addressed The Joint Commission Environment of Care Standards: EC 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. 15

16 ASHE/FGI Guidelines for Design and Construction of Hospital and Health Care Facilities, 2010 edition A comprehensive set of design guidelines for all types of healthcare facilities. From the 2010 FGI GUIDELINES ICRA - Infection Control Risk Assessment A determination of the potential risks of transmission of various air and waterborne biological contaminants in the facility Owner shall provide during the programming phase Recommendations on design Monitoring of the effectiveness of the program ICRMR Infection Control Risk Mitigation Recommendations Describes the specific methods by which transmission of air and waterborne biological contaminants will be avoided 16

17 Learning Objective Two Identify infection prevention strategies used during construction projects This section of the program Provides: An explanation of Infection Control Risk Assessment (ICRA) and Infection Control Risk Mitigation Recommendations (ICRMR) process: Major elements of an ICRA matrix Using an ICRA matrix ICRMR Monitoring and Documentation 17

18 How the ICRA Matrix works: Step 1 - Type of Project Activity Types Athrough h D Based upon anticipated disruption Step 2 - Patient Risk (for Infection Groups) Low, medium, high, highest Step 3 - Determine Class of IC Precautions Levels I through 4 ICRA Matrix PATIENT Risk Group LOW Risk Group MEDIUM Risk Group HIGH Risk Group HIGHEST Risk Group TYPE A TYPE B TYPE C TYPE D I II II III / IV I II III IV I II III / IV IV II III / IV III / IV IV Adapted from ICRA Matrix developed by J. Bartley ECSI, Beverly Hills, MI; used with permission 18

19 Type A activities Inspections and Non-invasive activities Type B Activities 19

20 Type C Activities Type D Activities 20

21 Risk Groups 1 & 2 Group 1 Example: Office areas Group 2 Example: Cafeteria Risk Type 3 21

22 Risk Group 4 External work: ICRMRs May Include Re-route pedestrian traffic Water dust plumes Contain excavation spoils Keep doors/windows closed in adjacent buildings 22

23 ICRMRs Typically Include Barrier Walls to separate Construction or renovation activities from other areas Hard walls Soft Walls Combination Walls Containment Cubes ICRMRs Typically Include Fan systems to create negative pressure within the work area as well as monitoring devices to demonstrate that the desired pressure is being met gauge 23

24 HEPA Vacuums Can be used to create negative pressure in small areas Best practice is to have a program to ensure HEPA vacuums are working correctly Learning Objective Three List two key ways two key ways Environmental Services directly supports patient safety during construction 24

25 Cleaning Responsibilities During Construction Contractor Keep construction zone tidy Control dust outside construction zone Keep materials dry & clean Owner Design input: Housekeeping closets, other? Help maintain cleanliness outside construction zone when in public or clinical areas Final clean of construction zone prior to move in Cleaning Protocols During Construction Know construction schedule-need to coordinate Frequent cleaning outside construction zone during heaviest demo Final clean of all surfaces; use hospital grade disinfectants 25

26 Questions? 26