Infection Control for Facilities Managers: The Complete Guide
Mitigating the effects of infectious bacteria in healthcare settings is among the most important tasks that a facilities manager must pay attention to.
According to the Centers for Disease Control and Prevention, 1 in 20 patients has an infection acquired from a healthcare facility (HAIs or nosocomial infection) on any given day. There are about 1.7 million HAIs, that lead to 99,000 deaths, in U.S. healthcare facilities each year.
There is no question that facilities managers must maintain vigilance over their facilities to decrease the occurrence of these types of infections, but with the amount of information available it can be difficult to know where to focus your efforts. Too many facilities managers can fall into the trap of deferring important infection control elements to clinical staff, but as Linda Dickey, Director of Epidemiology & Infection Prevention at UC Irvine Health noted at the 2017 American Society for Healthcare Engineers (ASHE) Annual Conference and Technical Exhibition, “We need an intersection between those who are clinical and those who are not. And [we need to] look at how we can learn from one another and where those risks emerge. We have to have strong working relationships and partnership to keep patients safe.”
This post will address those key categories where you can zero in on the most important aspects of infection control that will show you -- and the patients at your facility -- the best possible outcomes. We have combed the best advice from infection control specialists, highly regarded facilities, and notable infection control journals to compile this reference.
Please read and share with anyone who is dedicated to creating safer, healthier healthcare facilities.
Background for Successful Infection Control Teams
Infection control and prevention takes buy-in from a wide range of staff. Facilities managers must work side by side with Infection Preventionists (IPs).
A recent Columbia University School of Nursing study found that the presence of an educated and board certified director and participation in a multi facility performance improvement project were associated with significantly lower Methicillin-resistant Staphylococcus aureus (MRSA) bloodstream infection (BSI) rates. If you do not currently have an infection control director with an academic background, or ideally who is board certified, this may be an important first step towards improving infection control outcomes.
According to Irena Kenneley, PhD, APRN-BC, CIC adjunct faculty member at American Sentinel University, the majority of IPs work in acute care settings, although an ambulatory and outpatient services, including long-term care, home health, and other practice settings are increasingly hiring these specialists as well. Because infection prevention programs are designed to protect patients in addition to healthcare personnel from Healthcare-Associated Infections (HAIs), it is essential that all healthcare facilities have some type of well-designed program in place.
Infection Control Training Resources
Infection control certification and training is a critical aspect of keeping patients safe. Without the foundational knowledge of what infection control for facilities managers is and the purpose that it serves, it becomes nearly impossible to build and maintain a protocol that accomplishes the cleanest, safest facility possible. Following are just a few ways that you can implement a more successful infection control training process.
The Association for Professionals in Infection Control and Prevention (APIC) has created an IP competency model. The model outlines the skills needed to advance the infection prevention field. Education and Certification are critical stages in the model. APIC training should be considered for any IP or facility manager looking to establish competency in infection control and prevention.
CDC Train: A free resource of public health training sessions, including Continuing Education units. Courses are available in infection control topics such as: Infection Prevention in Long-Term Care Settings
AHE Certified Surgical Cleaning Technician Program
The newly introduced Certified Surgical Cleaning Technician is designed to:
- Increase performance levels and job satisfaction, while decreasing staff turnover.
- Facilitate execution of evidence-based standards of practice.
- Enhance efforts to improve patient outcomes.
This type of training, while not specifically designed for facilities managers, is still helpful in that role. Managers can either require or request that the cleaning technicians they hire have some type of certification, or even offer time and resources to complete the training to current employees.
Compliance Issues for Facilities Managers in Infection Control
The most important aspect of any infection control protocol is that it protects patients. However, it also must comply with established infection control regulations, such as:
At the national level, the Centers for Medicare and Medicaid Services (CMS) have established the Condition of Participation (CoP) Interpretive Guidelines for Infection Control. Included in these guidelines are:
- Hospitals must be sanitary
- Have an active infection prevention and control program and someone overseeing it
- Surveillance must be systematic
- Infections must be “logged”
- Leadership must:
- Ensure problems identified by IP are addressed
- Take responsibility for corrective action plans when problems identified
But federal laws are not the only compliance issue. Hospitals must also comply with state level laws.
27 state laws require public reporting of hospital-acquired infection rates while others have pending laws or laws mandating private reporting to state regulatory agencies. In those states requiring public reporting, those reports can not only influence state-level funding for some facilities but can also sway patients who are able to choose which hospital they go to. Keeping HAI rates low is essential for a healthcare facility to thrive. CDC statistics state that a single HAI can cost $20,000 to $40,000 to treat.
Compliance is not a matter of taking an action and forgetting about it. Instead, regular assessment is critical. For example, at Texas Children's, Bert Gumeringer, assistant vice president for facility operations says his staff performs spot checks and has contracted with a company to do monthly checks on airflow.
As a facilities manager, the intersection of construction and infection control rests squarely in your purview, particularly the conducting of the Infection Control Risk Assessment (ICRA) for construction and renovation projects.
To properly conduct this type of assessment, facilities managers must work with multiple departments (like infection control, environmental health and safety, and the construction team) to conduct an ICRA and determine safety and pressure control procedures.
In establishing a safe and healthy construction or renovation site, the facilities team must be well aware of ventilation. As air travels into the rooms of immunocompromised patients or out of the rooms where a patient is being treated for a highly infectious disease, it can put many disparate populations at risk for infection.
Positive pressurization protects patients while negative pressurization protects caregivers and controls odors. Patients who are immunocompromised should have air directed out of the room while those who are potential source of infection should have air directed into the room, protecting other patients and staff.
Tools like anterooms and negative air machines are essential in maintaining proper ventilation. However, it is also important that ventilation is regularly assessed. Rooms that present an infection risk must be properly sealed so that contaminated air is only directed out by the ventilation system, and room pressure should be checked to ensure it is kept negative. Further, HEPA air filters must be changed regularly, according to manufacturer recommendations, so that only the most effective filters are in use at any time.
Communication is Critical
While the daily physical tasks of infection control -- from training to cleaning -- can easily take over, communication between teams is perhaps the most critical part of a successful infection control program and must not be overlooked.
Again at the 2017 ASHE Conference and Technical Exhibition, Linda Dickey, R.N., MPH, CIC, University of California Irvine Health told an audience:
“We need an intersection between those who are clinical and those who are not. And [we need to] look at how we can learn from one another and where those risks emerge. We have to have strong working relationships and partnership to keep patients safe.”
While establishing a well-educated and dedicated infection control team is essential, the reality is that infection control impacts everyone and therefore is the responsibility of everyone in the facility -- from surgeons to custodial staff to the patients themselves. Without clear and consistent communication it is too easy for this network of people to forget their responsibilities to one another. Instead, as a facility manager, it is your job to keep those lines of communication open with regular meetings, spot checks, training sessions, and camaraderie.
New Technology is Always on the Horizon
As a facilities manager, assessing technology will always be part of the job. When it comes to infection control, recent technological developments have made the spectrum of choices for healthcare facilities much broader.
Improved Disinfection Solutions
No matter how much infection control technology improves, physical cleaning of rooms and equipment will always be a requirement. As previously discussed, proper education and training are key to ensuring that surface cleaning is thorough and complete. However, advances in cleaning solutions themselves aim to minimize the possibility of human error in their use.
According to the Antimicrobial Resistance & Infection Control Journal, "New disinfectants that are currently available or under development include improved hydrogen peroxide liquid disinfectants, peracetic acid-hydrogen peroxide combination, electrolyzed water, cold atmospheric pressure plasma, and polymeric guanidine. Several improved hydrogen peroxide disinfectants have been shown to be effective one-step cleaner/disinfectant agents that significantly reduce bacterial levels on surfaces.
The idea behind these improved solutions is to minimize the impact of variance in the thoroughness of cleaning from person to person and ensure that patients are not put at risk due to lackadaisical cleaning. While it is not critical to replace all tried and true cleaning solutions for the latest developments, it is important to continually monitor staff and offer the right products to support their work wherever possible and practical.
No-Touch Disinfection Technologies
While UV disinfection is not entirely new, the last few years have seen an influx of new products in this arena in addition to conclusive evidence that hospital UV disinfection can be effective against such bacteria as Clostridum difficile and Staphyloccocus. No-touch UV lights can take less than 10 minutes to disinfect entire rooms, improving patient safety and exposing cleaning staff to fewer infections, which can lead to lost work hours. According to Becker's Hospital Review, hospitals are even "recruiting robots outfitted with the technology to act as roving infection control patrollers."
Learn more about UV disinfection in our presentation: 10 Facts About Far-UV Sterilray
The more willing facilities and facilities managers are to engage with these new technologies, the more facilities will be able to see upward trends in their ability to prevent infection from the outset.
Infection control is an ongoing process. Maintaining a facility that prioritizes the health and safety of both patients and staff should be paramount for the best facilities managers. Infection control and infection prevention are full-time concerns that touch every aspect of a healthcare facility. While your education in pathogens, air flow, disinfection, and infection prevention technology should be ongoing, let this reference piece guide you to the right sources and experts for developing and consistently improving your own infection control program.