STUDY ON BRAND: UCB KIDS CASE STUDY BY SHIREEN MEERA VM, NIFT, 2013-2014
Myths and Realities: The Role of the Built Environment in ... · Crook,5,6Nicole Stoesser,5,6...
Transcript of Myths and Realities: The Role of the Built Environment in ... · Crook,5,6Nicole Stoesser,5,6...
SPONSORS
Myths and Realities: The Role of the Built Environment in
Infection PreventionPaula Wright, RN, BSN, CICProject Manager, Infection Control UnitMassachusetts General Hospital
Healthcare-Associated Infections: 5 Categories
Pathogens* may be spread from patient to patient via:• hands of healthcare workers• contaminated equipment or environmental
surfaces• equipment or surfaces act as “fomites”
• inanimate objects that can spread infection
*e.g. MRSA, VRE, MDRO gram-negativebacteria (e.g. CRE) or C. diff.
Contact Spread(Direct and Indirect)
Health Design Insights
1Categories of HAIs
A. Lerner et al. J. Clin. Microbiol. 2013;51:177-181
Locations of testing for environmental CRE (eCRE). 1, personal bedside table; 2 to 4, bed linen around the
pillow (2), crotch (3), and legs (4); 5, pulse oximeter; 6, personal bedside chair; 7, electrical outlet line; 8, manual
respirator bag; 9, infusion pump; 10, dedicated stethoscope; 11, ventilator; 12, suction machine; 13,
cardiovascular monitor screen; 14, enteral feeding pump.
Associated with invasive devices such as:
• indwelling urinary catheters
• central venous catheters-contaminated either at the time ofinsertion or during use
• ventilators- that bypass normalprotections for the lungs
Device-related infections
Health Design Insights
2Categories of HAIs
• surgical site infections
• bloodstreaminfections – postendoscopy
Procedure-related infections include:
Health Design Insights
3Categories of HAIs
Spread from patient to patient or from staff to patients via:
• aerosolized large droplets such as influenza or pertussis
• inhalation of small droplet nuclei such as chickenpox or TB
• close personal contact with an infected person
• consumption of contaminated food or water
• contact with contaminated surfaces, e.g. norovirus gastroenteritis
Communicable diseases
Health Design Insights
Categories of HAIs
4
• fungal spores (e.g. aspergillus in construction dust, or fungi from wet building materials)
• Legionella (e.g. from contaminated ice machine, cooling towers, shower heads)
• gram-negative bacteria (e.g. from biofilm in a sink drain)
• atypical mycobacterium (e.g. contaminated equipment, heater/coolers)
Infections that result from exposure to an environmental source such as:
Health Design Insights
Categories of HAIs
5
“Contaminated heart surgery devices may pose infection risk to thousands”
Interventions r/t the Built Environment:3 Categories
1. Prevent transmission by direct or indirect contact
2. Prevent transmission via the airborne route or via
airborne contaminants
3. Prevent transmission via water sources
Interventions to Prevent Transmission by Direct or Indirect Contact
1
Single patient rooms
Health Design Insights
Preventing Transmission by Contact
Overall, 87% of studies reported advantages associated with SPRs (some a combination of advantages and disadvantages or a
combination of advantages and neutral results). Outcomes with the best evidence of benefit include communication, infection
control, noise reduction/perceived sleep quality, and preference/perception.
E. Taylor et al. HERD.2018;11:85-100
Easily cleaned surfaces:
• smooth and non-porous
• tolerate cleaning
products and methods
• durable
• integral sinks - avoid
undermount
Health Design Insights
Preventing Transmission by Contact
Mechanisms for containment and disposal of waste
Health Design Insights
Preventing Transmission by Contact
Provisions for PPE storage and donning and doffing at the room
entrance
Health Design Insights
Preventing Transmission by Contact
Handwashing station at the room entrance
Health Design Insights
Interventions to Prevent HAIs
Accessible ABHR at the entrance and in the room
Health Design Insights
Preventing Transmission by Contact
Separation of clean and dirty - cont.
17
Preventing Transmission by Contact
Interventions to Prevent Transmission Via Airborne Route or R/T
Airborne Contaminants
2
Health Design Insights
Use of Airborne Infection Isolation Rooms (AII)
or local source controlmethods for airborne
diseases
Preventing Transmission by Air
Centers for Disease Control and Prevention. Guidelines for environmental infection control in health-care facilities: recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee (HICPAC ) 2003
20
Health Design Insights
Use of negative airflow to contain contaminants in
dirty spaces
Toilet Room
Soiled Utility EVS
Closet
BSC in lab
Preventing Transmission by Air
Preventing Transmission by Air & Contact
Health Design Insights
Use of Protected Environment Rooms for highly
immunocompromised
patients
Health Design Insights
Preventing Transmission by Air
Use of pressurization, ACH, air supply design and face velocity to minimize contamination of
the surgical wound
Health Design Insights
Preventing Transmission by Air
Health Design Insights
Use of
Protected Environment Rooms (PE)
for highly immunocompromised
patients
Preventing Transmission by Air
Centers for Disease Control and Prevention. Guidelines for environmental infection control in health-care facilities: recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee (HICPAC ) 2003
Interventions Aimed at Eliminating Water Sources for Infection
3
ASHRAE 188
Water Management Plan
Health Design Insights
Preventing Transmission by Water
Water systems designed to avoid dead leg
Health Design Insights Preventing Transmission by Water
Elimination of aerators
Treatment and location of cooling towers
ASHRAE 170-2017
25 feet from air intakes
Health Design InsightsPreventing Transmission by Water
Regular PM of ice machines
Keeping a clear splash zone around water sources (sinks) to protect sterile supplies- 4 feet
Health Design Insights
Correct sink design to prevent splash-FGI 2.1-8.4.3.2
Preventing Transmission by Water
Intensive Care Unit Wastewater Interventions to Prevent Transmission of Multispecies Klebsiella pneumoniae Carbapenemase–Producing Organisms Amy J. Mathers,1,2 Kasi Vegesana,3 Ian German Mesner,3 Katie E. Barry,1 Aaron Pannone,4 Josh Baumann,3 Derrick W. Crook,5,6Nicole Stoesser,5,6 Shireen Kotay,1 Joanne Carroll,2 and Costi D. Sifri1,7 Clin Infect Dis. 2018 Feb 2
Preventing Transmission by Water
(a) Layout of the zones of the sink counter, bowl, and extension surface designated to
monitor droplet dispersion and (b) layout of the TSA plates used for GFP-expressing E. coli
droplet dispersion on the surfaces surrounding the sink.
Shireen Kotay et al. Appl. Environ. Microbiol.
2017;83:e03327-16
Spread from the Sink to the Patient: In Situ Study Using Green Fluorescent Protein (GFP)-Expressing Escherichia coli To Model Bacterial Dispersion from Hand-Washing Sink-Trap Reservoirs
Locate sink away from patient bed
Health Design Insights
Hota Study-
“Once you have the biofilms in there, short of ripping the sinks and the piping out, it’s impossible to get rid of. And in fact, even if you do that, it frequently comes back,” ….Dr. Alex Kallen, CDC’s division of health care quality promotion.
Preventing Transmission by Water
Will technology save us from HAIs
or drive increases?
• Copper
• Silver
Antimicrobial Surfaces –The Truth about Metals
Health Design InsightsInfection Prevention Technologies
• Copper
• Silver
Antimicrobial Surfaces-Marketing
Health Design Insights Infection Prevention Technologies
“Temple VA to use copper-infused surfaces to help prevent infections”
“Antibacterial coatings will also reduce the risk of infected surfaces acting as a reservoir for transmission to food and
humans.”
Copper Development Assoc.
• Antimicrobials, e.g. Triclosan - resistance and length of efficacy concerns
“FDA issues final rule on safety and effectiveness of antibacterial soaps Rule removes triclosan andtriclocarban from over-the-counter antibacterial hand and body washes”
Kaiser Permanente Rejects Antimicrobials for Infection Control With no proof that antimicrobial-treated furniture and fabrics improve infection prevention, health care system bans 15 chemicals from use in interior products
• Surface modification – Sharklet – “Forget chemicals or pills in the fight against nasty bacterial infections. Entrepreneur Mark Spiecker is betting that the secret lies with sharks”. Surface fails over time.
• Antimicrobial paint - Paint Shield® first EPA-registered microbicidal paint that kills greater than 99.9% of Staph (Staphylococcus aureus),
MRSA (Methicillin-resistant Staphylococcus aureus), E. coli (Escherichia coli), VRE (Vancomycin-resistant Enterococcus faecalis) and Enterobacter aerogenes within two hours of exposure on painted surfaces.
It continues to kill 90% of these bacteria even after repeated contamination on painted surfaces. The effectiveness lasts for up to four years as long as the integrity of the surface is maintained.
Antimicrobial Surfaces – Just the Facts
Health Design Insights
Infection Prevention Technologies
Marketing HAI Prevention-Read the Fine Print
37
Health Design Insights
“When the Integrity of the Surface
is maintained”
“Reduces human
cleaning
errors”
Infection Prevention Technologies
• UV light • H2O2 vapor
Robots to the Rescue – Touchless Disinfection
Health Design Insights
Infection Prevention Technologies
• Work stations on wheels (COWs or WOWs)
• Voalte phones
• Tablets
• Touch screens
• Lanyard communication devices
Electronics and Handheld Devices – More Surfaces to Clean and “Fomites” to Worry About
39
Health Design Insights
Infection Prevention Technologies
Bottom Line – What’ important when planning Healthcare Spaces?
Pre-construction Safety Risk-Assessment
Health Design Insights
Planning HC Spaces
Hand hygiene – optimizing sink locations and design
Health Design Insights
Back to Basics – What Works
Smooth, cleanable, durable, moisture resistant surfaces
Health Design Insights
Back to Basics – What Works
44
Design to facilitate cleaning
Back to Basics – What WorksHealth Design Insights
What keeps Infection Preventionists up at night?
Health Design Insights
Non-compliance by HCW’s with HH, PPE, Equipment cleaning/disinfection
So much equipment in the room - time pressure for room turnover - difficult to clean
More and more touch surface technology- HCW constant interaction with technology - they can’t separate clean and dirty activities
Device complexity – difficulty cleaning and disinfecting (e.g. scopes )
Antibiotic Resistance and Highly Pathogenic Avian flu (pandemic risk)
Contact Paula Wright at:
• Email - [email protected]
• Phone - 508-341-1724
Questions?
46
Health Design Insights