Preventing environmental infection at the Center Stage is important in a pandemic.

As the health care system shifts away from focusing solely on COVID-19 to embracing living with the disease and infection preventionists (IPs), they are also struggling with how to maintain a new era for infection prevention. Basic infection prevention principles that were put off for at least 2 years are now back in fashion. IPs are now being consulted by staff to make recommendations in areas where they may not have had as much oversight.

One subject IP may see environmental infection prevention as a good area for collaboration and feedback. The important role that the environment plays in infection prevention is becoming more apparent with each passing pandemic. These opportunities could be rediscovered as health care systems resume projects that were put on hold. IPs can offer valuable input in many environmental areas including ventilation, water safety, construction, and ventilation.

Construction Projects

In the health care environment, construction projects can increase the likelihood of mold and fungus being in the environment. Organisms like AspergillusThis organism can be found in areas where construction has been or is currently taking place if proper infection prevention techniques are not followed. This organism can be found in healthy individuals and may not cause any damage or be detected. This organism can cause severe respiratory illness in immunocompromised patients.

The Facility Guidelines Institute is an organization that provides guidance on the design, construction, planning, and maintenance of healthcare facilities.¹FGI requires the completion of an infection control risk assessment tool (ICRA) before any construction projects are started.

An ICRA organizes construction projects by classifying the work to be done and the risk involved in the event of a project not being completed correctly. Different expectations can be set for the way the project should proceed depending on how risk and type align.

The ICRA document must be completed by the project manager at the construction site, who will be responsible for ensuring compliance. Once the scope of work is complete, it should be sent out to other key stakeholders like those involved in safety and infection prevention. IPs should feel free to ask for a job site walkthrough if they have any questions about the scope of work.

Once the project has been started, especially if there is a high risk to nearby patient care areas, IPs should visit the site every week to ensure that the ICRA are being followed. Any concerns should immediately be addressed to the project manager.

Water Safety

Water management programs in health care facilities are key to preventing the spread of infection. Water is essential for many health care procedures, including the provision of oral care to patients and the reprocessing medical devices. Patients can be at risk if microbial growth is allowed in these areas. A water management plan is intended to prevent the growth of microbial organisms. Legionella,A genus containing bacteria that can be transmitted from one person to another if they inhale contaminated waters.

The CDC provides resources to better understand the current state of a facility’s water safety. The agency’s guide, Developing Water Management Programs to Reduce Water Safety, is available. LegionellaGrowth and Spread in Buildings²This article explains the steps involved in creating a water management program.

IPs who don’t know much about the water management plan for their facility should contact their facilities team to have a conversation and to collaborate in the creation of a plan. A diagram showing how water enters and exits the facility is one of the first priorities. This allows potential hazards like stagnant or fountain water to be identified. These risks can then be identified and mitigation strategies can be developed.

Ventilation

Proper ventilation can reduce the risk of infection, as was highlighted during the pandemic. Since COVID-19, the concept of ventilation as a way to reduce infection transmission risk has been part of health-care expectations.

FGI and The American Society of Heating, Refrigerating and Air Conditioning Engineers ASHRAE help to provide best practices expectations for health care facilities relating heating, ventilation, and/or air conditioning (HVAC).³Air circulation is vital to reducing the transmission of communicable disease through the air. Therefore, it is important that outdoor air is regularly exchanged at the minimum acceptable level (MAC).

High efficiency particulate air filters (HEPA) are an additional way to trap particulates in the air. It is important to determine if the filter has been classified HEPA and how often it should be replaced.

Air is circulated throughout facilities throughout the year. This means that indoor HVAC systems can be affected by changes in temperature and humidity. It is important that you regularly review the temperature/humidity standards set by ASHRAE/FGI for each area. This will help to reduce the possibility of microbial proliferation.

Conclusion

Construction projects, water safety and ventilation are all areas that can be susceptible to infection. This is why multidisciplinary oversight is necessary. It is essential that professionals from all areas of health and safety, facility management, infection prevention, and other disciplines work together to ensure that patient safety is maintained when there are changes made to a facility. Also, it is important to examine current workflows even when things are slow.

Refer to

1. Guidelines for the Design and Construction of Hospitals. Facility Guidelines Institute. 2018. Accessed February 10, 2022.https://fgiguidelines.org/guidelines/2018-fgi-guidelines/
2. To reduce water consumption, develop a water management plan LegionellaGrowth and spread in buildings: A practical guide to implementing industry standards. CDC. June 24, 2021. Accessed February 10, 2022.https://www.cdc.gov/legionella/downloads/toolkit.pdf
3. ASHRAE offers a course on the role HVAC systems play in infection control. News release. American Society of Heating, Refrigerating and Air-Conditioning Engineers. March 23, 2020. Accessed February 10, 2022. https://www.ashrae.org/about/news/2020/ashrae-offers-course-on-the-role-of-hvac-systems-on-infection-control