INFECTION CONTROL FOR FACILITIES MANAGERS: THE COMPLETE GUIDE

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: 

Federal Hospital Compliance Laws

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 with someone to oversee.
• 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

State Hospital Compliance Laws

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 states requiring public reporting, those reports 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 Hospital, 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. 

Get the ICRA Guidelines 

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. 

Learn more about the tools used for infection control in hospitals with our free whitepaper

In addition to ventilation, the infection control process around healthcare facility water has taken on even more importance in recent years. The increased visibility is largely due to the increased instance of Legionnaires Disease (the result of the bacterium Legionella). More than 6000 cases were reported in 2016, and occurrences of this potentially deadly disease have been on the rise since 2000. 

Responses to one 2017 survey found that more than 80% of facilities test their water for Legionella only on a sporadic basis. Rather than wait for a public outbreak, such as was the case with a Disneyland outbreak in 2017, facilities managers need to keep the water supply top of mind when it comes to infection control. Regular testing and analysis, not only for Legionella, is critical.

The best way to ensure infection control in this area is to establish a water management plan of which all stakeholders are aware. Water management and maintenance is particularly important in facilities that house patients with compromised immune systems such as nursing homes and hospitals. 

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 partnerships 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.