One of the things that infection preventionists have been advocating for is being able to be involved early in the process and being consulted by our partners in project management and facility design , our architect partners – they have so many voices telling them what to do and what to prioritize that it ’ s sometimes difficult to get a seat at the table .”
And regarding water , Zimring , et al . ( 2013 ) observe , “ Common approaches for controlling waterborne pathogens include maintaining optimal water temperatures and chlorination levels and eliminating ‘ dead ends ’ in plumbing systems to inhibit the growth of Legionella and other pathogens … Certain sink and faucet designs have been implicated in outbreaks of waterborne pathogens . Faucets should not be located directly above the drain to prevent splashing . Elements in some electronic faucets may also be predisposed to bacterial growth and contribute to the spread of microorganisms . Decorative fountains are controversial ; the few reports linking outbreaks to these water features have been highly publicized . Common features of outbreaks traced to decorative fountains include design flaws and inadequate maintenance .”
In their review , Zimring , et al . ( 2013 ) outline four conclusions :
➊ Poor design and suboptimal maintenance of the built environment can increase the risk of transmission of pathogens and can lead to outbreaks .
➋ Even with contemporary design and maintenance , the built environment contributes to some transmission events within hospitals .
➌ Novel and best-practice technologies , materials , and design strategies may directly decrease the risk of transmission of pathogens by decreasing the burden of microorganisms in the environment .
➍ Optimal design may indirectly decrease the development of HAIs by influencing human behaviors to decrease person-to-person transmission .
Within the environment of care , the built environment can impact on HAI prevention and control , experts say .
“ The usual suspects come to mind , like the cleanliness of surfaces , the filtration of air and the direction of that air and the cleanliness of water ,” Dickey confirms . “ There are other challenges related to the built environment and how we as care providers function within it . As an example , one facility had a cluster of mold infections and when personnel examined the potential origins of those infections , there were gaps in the caulking around the windows and the patient-care unit had become depressurized , pulling in air from the outside . Simultaneously with the time-frame for infection , there also had been construction activity outside of the facility . So , it often comes down to something as basic as verifying during commissioning that a room is well sealed . Depending on the patient population inside and the activity or weather conditions outside , something that innocuous can contribute to infection . Unfortunately , sometimes these environmental clusters of infection , or sometimes even just one infection , don ’ t provide enough clues to help identify the culprit . Many times , you may not know for certain what may be contributing to environmentally-associated outbreak . But sometimes , there might be some indicators , like a space that should be negatively pressured but fails in some way , or a space that ’ s supposed to be neutral or positively pressurized but becomes depressurized , and now we ’ re seeing cases of something being transmitted . You must consider the possibility that during the commissioning process of a renovated or new space , was something related to water , air or surfaces missed , or is something different now that we ’ ve put the space into use ? Sometimes you can pick up clues sideways to help point to what the issue might be .”
The range of potential challenges is wide ; the culprit could be a lack of following all regulatory and statutory requirements and recommendations regarding ventilation , filtration and air cleaning , for example . Facility engineers oversee maintaining outdoor airflow rates guidance for ventilation as specified by applicable codes and standards , as well as following recommendations on filters and air cleaners that achieve MERV 13 or better levels of performance , plus the use of any air-cleaning devices . They also see to the process of air distribution within the facility , including the mixing of space air . Their purview includes HVAC system operation , including maintaining temperature and humidity design set points , maintaining equivalent clean air supply required for design occupancy , overseeing air exchanges and limit re-entry of contaminated air , and verifying that HVAC systems are functioning as designed .
While the facility ’ s infection preventionist has quite a full plate , it is essential for the IP to have a basic understanding of the built environment in healthcare and a working knowledge of the issues that impact the health and safety of patients and personnel .
“ IPs can be advocates to improve safety during the design or renovation of the built environment ,” Dickey says . “ Utilizing data unique to the organization and knowledge of risks associated with the built environment , IPs can perform a risk assessment to inform design considerations tailored for each space in a project . Understanding that time is often limited to build a case during the early stages of design , IPs must be prepared to make that a well-reasoned five-minute elevator speech to the highest level that they can within hospital leadership . If they could review draft plans early enough to identify potential errors or omissions that may contribute to infection , it provides an opportunity to course correct . Unfortunately , what IPs experience is engagement in the process when projects are too far down the line , and it ’ s decided that it ’ s too late or too costly to make a change . One of the things that infection preventionists have been advocating for is being able to be involved early in the process and being consulted by our partners in project management and facility design , our architect partners – we understand they have many voices telling
18 august 2023 • www . healthcarehygienemagazine . com