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 United States healthcare facilities each year.
There is no question that healthcare facilities managers must maintain a vigilant watch 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.
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 informational resource will address those key categories where you can zero in on the most important aspects of infection control that will give 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.
Infection control and prevention
A recent Columbia University School of Nursing study found that the presence of an educated and board certified director and participation in a
According to Irena Kenneley,
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.
A free resource of public health training sessions, including Continuing Education units. Courses are available in infection control topics such as
The newly introduced Certified Surgical Cleaning Technician is designed to:
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.
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:
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.
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.
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
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.
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.
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.
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
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.