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Using the Health Care Environment to Prevent and Control Infection

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Using the Health Care Environment to Prevent and Control Infection Using the Health 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 ACKNOWLEDGMENTS This publication was prepared for the Centers for Disease Control and Prevention as part of Contract Number 200 – 2015 – 88275. The project was conducted by the following organizations: • The Health Research & Educational Trust of the American Hospital Association • American Society for Health Care Engineering (ASHE), a professional membership group of the American Hospital Association • Association for Professionals in Infection Control and Epidemiology • Society of Hospital Medicine • University of Michigan As the lead developer for this document, ASHE would like to recognize the expertise and contributions of the following: • Project leader Linda Dickey, RN, MPH, CIC, FAPIC, Senior Director of Quality, Patient Safety & Infection Prevention, University of California Irvine Health • Ellen Taylor, PhD, AIA, MBA, EDAC, Vice President of Research, The Center for Health Design • Laurie Conway, RN, PhD, CIC, Infection Prevention and Control Nurse; Kingston, Frontenac, Lennox, & Addington Public Health • Frank Myers, MA, CIC, Infection Preventionist, University of California-San Diego • Dan Bennett, CHESP, T-CHEST, Director of Environmental Services, St. Joseph’s Hospitals, BayCare Health System • Amy Nichols, RN, MBA, CIC, FAPIC, Director, Hospital Epidemiology and Infection Control, University of California–San Francisco Health • Paula Wright, RN, BSN, CIC, Project Manager, Massachusetts General Hospital • The Association for the Health Care Environment (AHE), a professional membership group of the American Hospital Association ASHE Catalog #055196 1 Table of Contents Executive Summary ................................................................................................................... 6 Quick Guides ............................................................................................................................10 Quick Guide, Chapter 1: Infection Control Risk Assessments ................................................10 Quick Guide, Chapter 2: Hand Hygiene Infrastructure ...........................................................12 Quick Guide, Chapter 3: Reprocessing..................................................................................14 Quick Guide, Chapter 4: Cleaning of Environmental Surfaces ...............................................15 Quick Guide, Chapter 5: Water-Related Environmental Infection Control ..............................16 Quick Guide, Chapter 6: Flow of Patients, Personnel, Equipment and Waste........................18 CHAPTER 1: Infection Control Risk Assessments ....................................................................20 Introduction ...........................................................................................................................20 Health Care Facility Construction .......................................................................................20 Evidence-Based Design in Health Care .............................................................................21 Infection Control Risk Assessment for Health Care Facility Design ....................................21 The Business Case ............................................................................................................22 Brief Literature Review ..........................................................................................................22 A Conceptual Framework of the Role of the Built Environment and Healthcare-Associated Infections ...........................................................................................................................22 Best Practices and Recommendations ..................................................................................25 Hazards and Risks .............................................................................................................25 ICRA Development and Use ..............................................................................................26 Minimum Considerations During Design ............................................................................26 Methods to Assess Safety During Design ..........................................................................26 Minimum Considerations During Construction ...................................................................27 Opportunities for a Systems Approach ...............................................................................28 Communication .....................................................................................................................28 The Role of the Infection Preventionist ...............................................................................28 The ICRA Team .................................................................................................................28 Leadership .........................................................................................................................29 Case Studies .........................................................................................................................29 Health System A: A medium-sized regional system that includes academic medical centers ..........................................................................................................................................30 Health System B: A large statewide system that includes academic medical centers ........31 2 Aids for an ICRA ....................................................................................................................31 Tools .....................................................................................................................................32 CHAPTER 2: Hand Hygiene Infrastructure ................................................................................43 Introduction ...........................................................................................................................43 Brief Literature Review ..........................................................................................................44 Sinks ..................................................................................................................................44 Faucets ..............................................................................................................................45 Hand Dryers and Paper Towels .........................................................................................45 General Recommendations from the Facility Guidelines Institute .......................................46 Alcohol-Based Hand Rub ...................................................................................................47 Electronic Hand Hygiene Monitoring Systems ....................................................................51 Gloves ...............................................................................................................................51 Hand Lotion .......................................................................................................................51 Construction Design Process .............................................................................................52 Best Practices and Recommendations ..................................................................................54 Sinks ..................................................................................................................................54 Faucets ..............................................................................................................................54 Hand Towels and Dryers ....................................................................................................54 Product Dispensers ............................................................................................................54 Alcohol-Based Hand Rub ...................................................................................................55 Electronic Hand Hygiene Monitoring Systems ....................................................................55 Construction Design Process .............................................................................................56 Case Studies .........................................................................................................................57 Facility C: Adapting to a new work flow configuration .........................................................57 Facility D: Low hand hygiene compliance in perioperative areas ........................................58 Facility E: Constant construction ........................................................................................59 Facility F: Visualizing work flow during the design of a new hospital ..................................60 Tools .....................................................................................................................................61 CHAPTER 3: Reprocessing ......................................................................................................74 Introduction ...........................................................................................................................74
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