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Janet Haas PhD, rn, cic
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tarix | 15.11.2018 | ölçüsü | 6,98 Mb. | | #79834 |
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Janet Haas PhD, RN, CIC Rich Vogel MS, CIC Disclosures: Haas - Hand Hygiene Study funded by 3M Vogel - None VogVela
First, do no harm First, do no harm Meet needs of functional program Support delivery of care model Enhance the patient environment, staff effectiveness and stewardship of the environment
States may have individual requirements States may have individual requirements Facilities Guidelines Institute - Publish "Guidelines for Design and Construction of Health Care Facilities" (2010)
- New edition due in 2014
- “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.” EC.02.06.05 EP2
Multi-disciplinary team Multi-disciplinary team Design Construction Compliance Risk mitigation
Number, location and type of: Number, location and type of: - Airborne infection isolation and Protective environment rooms
- These cannot be switchable
- Hand washing sinks, sanitizer dispensers
- Eyewash stations and deluge showers
HVAC systems to meet functional needs -e.g. Procedure rooms, laboratories etc. Water systems to limit legionella
General Principles - Clean to Dirty General Principles - Clean to Dirty - Dirty areas (janitors closets, decontamination rooms, areas for bronchoscopy, laboratory with specimens) are negative pressure
- Procedure areas, pharmacy compounding, sterile supply areas are positive pressure
Best Reference is ANSI/ASHRAE/ASHE Standard 170-2008 Table 7-1
Negative Pressure = Air flows from corridor to (anteroom if present) to patient room Negative Pressure = Air flows from corridor to (anteroom if present) to patient room - 12 air changes/hour with 2 outside air changes/ hour
Exhaust air grills in ceiling over patient head or on wall at head of bed
Toilet and tub/shower and pt sink in the inpatient room as well as hand washing station for staff Toilet and tub/shower and pt sink in the inpatient room as well as hand washing station for staff Air must be exhausted directly outside without mixing with non-AIIR exhaust Continuous visual pressure monitor Area for gowning/storage directly inside or outside of entry In retrofitted settings, can HEPA filter exhaust air Can use for non-isolation patients, but pressure settings do not change
Positive Pressure = Cleanest (patient area) to less clean Positive Pressure = Cleanest (patient area) to less clean Supply air to PE room is HEPA filtered just before entering the room or suite of rooms - 12 Air changes/ hour including 2 outside air changes/ hour
Permanently installed visual mechanism to constantly monitor pressure status of the room Anteroom not required per Facilities Guidelines, but does mitigate against pressure changes
Reversible air flow NOT allowed. Reversible air flow NOT allowed. Air supply = PE room Exhaust air = AIIR requirements Airflow patterns may be from anteroom to both the pt room & corridor OR Airflow may be from pt room & corridor to anteroom Must have 2 visual monitors 1 between pt room and anteroom; 1 between anteroom and corridor
Design water systems to reduce risk Design water systems to reduce risk - Scale system for actual needs (don’t over build), leads to decreased circulation around water circuits
- Limit dead legs and areas of stagnation
Assess need for filtration in high risk areas - Legionella in the incoming water, high risk patients, amount of water use in the area
- COMMISSIONING PROCEDURES
Hands free Hands free Wrist blades, knee control, electronic eye Avoid aerators as these promote water dispersal Electronic eye: Save water, are popular with patients May be more prone to legionella contamination Must consider wiring to emergency power
Mixing Valves - control water temperature at the outlet by use of a thermostat
Cold water less likely to harbor legionella Cold water less likely to harbor legionella Need water and ice for patient care/comfort Assure cleaning and maintenance plan is in place Assure people are trained to change filters and clean/disinfect various components of machines Trouble spots are anywhere water sits for prolonged periods Prevent contamination of ice by providing place outside of ice for the scoop
Raise Sheetrock off floor during construction. Raise Sheetrock off floor during construction.
Everyday concern Everyday concern May contaminate environment Staff safety concern Red bag waste is costly to manage
Nurse call, documentation, patient education and diversion/recreation Computer cabling and device location Other controls - access hatches Environmental disinfection technology
Needs assessment to identify appropriate equipment for the service area. Needs assessment to identify appropriate equipment for the service area. Definition of space and structural and other design requirements to accommodate this equipment - Prevent hallway clutter
- Adequate outlets
- Assure safe patient handling
Provide supplies within work flow while minimizing risk of cross contamination Provide supplies within work flow while minimizing risk of cross contamination Just outside the patient room Outside to inside access
For patients and families For patients and families Match needs of functional program and care delivery model Assess length of stay/needs - Example: If you offer washer/dryer, then consider clothes storage space
- CLUTTER PREVENTION
Pleasant, inviting appearance (at least when new) Pleasant, inviting appearance (at least when new) Comfort and warmth underfoot Sound deadening properties No solid evidence that carpeting is linked to increased risk of HAI under normal circumstances Wet carpet is a risk for Aspergillus
Easily cleanable with hospital disinfectants Easily cleanable with hospital disinfectants Not prone to soiling with extensive use (e.g. vinyl upholstery vs. cloth) Skid-resistant No crevices for dust
Cleanable/rust resistant Cleanable/rust resistant Designed to reduce clutter Support patient mobility/independence Bed bug ‘resistant’ (limit crevices, assure no tears in upholstery)
Copper Surfaces - Passive continuous activity; need info on exact alloys and application method; long term efficacy
Curtains - become contaminated again shortly after cleaning (within 1 week)
- Antimicrobial curtains may delay contamination (to 2 weeks in recent study)
- May be more effective vs certain pathogens
- Consider alternatives (e.g. smartglass)
Attention to detail at all levels Attention to detail at all levels ICRA is not just a permit for dust control during construction Design is something you will live with for years Don’t forget the fixtures and finishes
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