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The engineer's secrets for prevention of hospital acquired infections
The document outlines the role of engineering in preventing Hospital Acquired Infections (HAIs) through effective hospital design and construction. It emphasizes the importance of interdisciplinary Infection Control Risk Assessments (ICRA) and best practices for maintaining clean and safe hospital environments. Key topics include optimal airflow in operating rooms, effective hand hygiene infrastructure, and strategies for managing water-related infections.
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The engineer's secrets for prevention of hospital acquired infections
- 1. The Engineer’s (Engineering) Secretsfor Prevention of HAI Dr. Lallu Joseph Quality Manager, CMC Vellore Secretary General, CAHO
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- 4. Who is anEngineer? • An engineer is a person who uses scientific knowledge to design, construct, and maintain engines and machines or structures such as buildings, roads, railways, and bridges.
- 5. Hospital Engineering Services HospitalEngineering Services is the life line for a smooth functioning hospital Hospital Engineering Services Mechanical Engineering Electrical Engineering Biomedical Engineering Civil Engineering Environmenta l Engineering Fire and other support services Air Conditioning
- 7. Planning a Hospital •New Construction - Complex process • Challenges – optimum flow to reduce HAI is one of the goals. • Other goals – safety, patient satisfaction, sustainability and flexibility, surge capacity • Coupled with obligation to complete on time (within budget)
- 8. Infection Control Risk Assessments(ICRA) • First step and the most important step: Infection Control Risk Assessment (ICRA) when designing, renovating or constructing a health care facility. • ICRA team - doctors, architects, engineers, facility management, quality managers, environmental specialists, infection control officers, epidemiologists, interior designers, nurses.
- 9. ICRA approach Step 1:Identify the hazards - Hazard Vulnerability Assessment (HVA) Step 2: Decide who might be harmed and how. Step 3: Evaluate the risks and decide on the precautions. Step 4: Record findings, propose action and identify who will lead on what action. Step 5: Review the assessment and update if necessary.
- 10. Best practices relatedto ICRA Ensure the ICRA team is interdisciplinary. Get infection prevention involved early in the design process. Involve the ICRA team to address minimum standards identified in several guidance sources, including the Center for Disease Control (CDC). Use the ICRA precautions matrix to determine precautions needed during construction activity. Include construction-related requirements of the ICRA into contract documents.
- 11. New Construction/ Renovation •Identifying, isolating and containing – ER • Protecting clean spaces, supplies from dust and moisture • Separating clean and dirty function to prevent cross contamination
- 12. IDENTIFYING, ISOLATING ANDCONTAINING
- 13. Emergency Room • Hospitalmanages high volume, communicable diseases: – Consider airborne isolation rooms (negative pressure near triage), unidirectional flow. – Ensure space for storage of PPE and area for don and doff. – Creating flexible spaces where airflow can be made negative pressure. – Consider dedicated entrances, quarantine for managing epidemic situations. – Separate HVAC system, not connected to other areas. – Separate waiting hall for patients with febrile, cough or rash.
- 14. PROTECTING CLEAN SPACES,SUPPLIES FROM DUST AND MOISTURE
- 15. Central Sterile Supplies Department(CSSD) • Positive pressure, controlled temperature and RH • Intended to protect from dust and maintain integrity of sterile packaging which can be affected by extremes of temperature and humidity. • Decision depends on shelf life. • Storage in ward, procedure areas – away from splash zone of sink (4 ft), not in moist area. • Work flow study and human factor engineering required.
- 16. Operating Rooms • Designedto protect patients from SSI due to bacteria or fungi introduced into the incision during procedure. • Sources of bacteria include patient and HCW. • Shed from exposed areas and caught in air currents. • Published standards are based on computational fluid dynamics – behaviour of particles around surgical wound.
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- 19. Indoor design conditions Temperature 21+/- 3 deg c Humidity 20%-60% Positive pressure levels – min 2.5 pascals (recommended 8 pa) Air velocity at the grille 25-35fpm Laminar flow panel size 8 ft by 6 ft Return air grille level 6 inches above floor level
- 20. Filtration in OR •Pre-filters inside the AHU filtering upto 90% down upto 10 microns • Bag filters inside the AHU filtering upto 99% down upto 5 microns • HEPA filters inside the laminar panel filtering upto 99.97% down upto 0.3 microns
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- 22. SEPARATING CLEAN ANDDIRTY FUNCTION TO PREVENT CROSS CONTAMINATION
- 23. • Space foraccumulation/ holding of regular and medical waste away from flow of staff/ patients. • Bulk waste storage carts clean and stored in an area separated from patient care • Delivery of clean material is separate from waste removal • Space for removal of supplies from external shipping boxes (particularly ORs) • Adequate storage for patient care equipment.
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- 25. Available Literature • Locationof sinks is more influential than number. • Study found each additional meter between the patient’s immediate surroundings and the nearest sink decreased the likelihood of handwashing by 10 percent. • Pathogens can be spread by water splashed from sinks, so water pressure should be optimized and flow should be offset from the drain. • Sinks designated for handwashing, and not for patient use, improved hygiene.
- 26. Deficiencies in Design •Poor visibility • Poor access • Undesirable height • Wide spatial separation of supplies that are used sequentially
- 27. Good design ofhand hygiene facilities During design make hand hygiene processes explicit point of concern. Handwashing sinks separate from patient-use sinks and not used for waste disposal. Handwashing sink placement near the point of care. Easily visible (within 180 deg field of vision), height of the rim 85 -110 cm from ground Adequate depth and size, to minimize splashing Material – porcelain, stainless steel or solid surface Choose paper towel dispensers and avoid warm air dryers to prevent dispersion of bacteria. Install alcohol-based hand rub dispensers at patient room doors and at every bed. Evaluate the location of soap and glove dispensers at the hand hygiene sink during design. Ensure adequate space for waste containers near hand hygiene sink.
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- 29. Infrastructure to preventinfections Flow through the space must be unidirectional from dirty to clean. Pipes, conduit or ductwork located above work areas should be enclosed to prevent dust accumulation, and ceilings should be made of materials that do not shed particulates. Sterilizers should be located in restricted areas to prevent accidental removal of unsterilized equipment. Hand-washing sinks should be readily available so staff can wash after handling items yet to be processed and before handling processed items.
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- 31. Water management to preventinfections Multidisciplinary water management team. Perform a risk assessment for all water systems and water-containing equipment. Include water within equipment, stagnant water plumbing during construction, and rarely used locations, such as eye-wash stations and emergency showers. Avoid in-hospital decorative water features (water walls, reflecting pools, fountains). Surveillance- chemical and biological Adequate chlorination
- 32. References • Using theHealth Care Physical Environment to Prevent and Control Infection, A Best Practice Guide to Help Health Care Organizations Create Safe, Healing Environments, A PROJECT BY: The Health Research & Educational Trust of the American Hospital Association American Society for Health Care Engineering, Association for Professionals in Infection Control and Epidemiology Society of Hospital Medicine University of Michigan. • Deyneko, A., Cordeiro, F., Berlin, L., Ben-David, D., Perna, S., & Longtin, Y. (2016). Impact of sink location on hand hygiene compliance after care of patients with Clostridium difficile infection: A cross-sectional study. BMC Infectious Diseases, 16(1), 203. • Hota, S., Hirji, Z., Stockton, K., Lemieux, C., Dedier, H., Wolfaardt, G., & Gardam, M. A. (2009). Outbreak of multidrug-resistant Pseudomonas aeruginosa colonization and infection secondary to imperfect intensive care unit room design. Infection Control & Hospital Epidemiology, 30(1), 25-33. • Doring, G., Jansen, S., Noll, H., Grupp, H., Frank, F., Botzenhart, K., … Wahn, U. (1996). Distribution and transmission of Pseudomonas aeruginosa and Burkholderia cepacia in a hospital ward. Pediatric Pulmonology, 21(2), 90-100.
- 33. References • Memarzadeh, F.,& Manning, A.P. (2002). Comparison of operating room ventilation systems in the protection of the surgical site (Discussion). ASHRAE Transactions, 108, 3. • Panahi, P., Stroh, M., Casper, D., Parvizi, J., & Austin, M. S. (2012). Operating room traffic is a major concern during total joint arthroplasty. Clinical Orthopaedics and Related Research, 470(10), 2690– 2694. • Boyce, J. M., & Pittet, D. (2002). Guideline for hand hygiene in health-care settings: Recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. Infection Control and Hospital Epidemiology: The Official Journal of the Society of Hospital Epidemiologists of America, 23(12 Suppl), S3-40. • Kaplan, L. M., & McGuckin, M. (1986). Increasing handwashing compliance with more accessible sinks. Infection Control, 7(8), 408-410Kendall, A., Landers, T., Kirk, J., & Young, E. (2012). Point-of- care hand hygiene: Preventing infection behind the curtain. American Journal of Infection Control, 40(4 Suppl 1), S3-10 • Anderson, J., Gosbee, L. L., Bessesen, M., & Williams, L. (2010). Using human factors engineering to improve the effectiveness of infection prevention and control. Critical Care Medicine, 38 (8 Suppl), S269-281.
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