The Healthcare Built Environment and the EIC Guideline : 20 Years of Guidance
By Kelly M . Pyrek
One expert who knows the healthcare built-environment intimately is Douglas Erickson , CEO of the Facility Guidelines Institute ( FGI ), an expert with 50-plus years of experience who also has worked with the American Hospital Association ( AHA ) and the American Society for Healthcare Engineering ( ASHE ), among others . He was a significant contributor to the Guidelines for Environmental Infection Control in Health-Care Facilities from the CDC / HICPAC , which was issued in 2003 and which celebrates its 20 th anniversary this year .
As a content expert on the environment of care , Erickson acknowledges the importance of air-related issues and ventilation in the healthcare setting . He says it ’ s an issue he ’ s been working on since the mid-1980s when he joined the AHA . “ We began by examining the effect that the environment had on the patient population ,” Erickson says . “ From my work on the various FGI guidelines , I knew what the old , minimum construction requirements from the federal agencies , the Department of Health and Human Services , were , and we knew there was a correlation between human health and the built environment . But we didn ’ t know how significant that correlation was between the environment and the patients in hospitals as well as the resident populations that we serve in nursing homes and assisted living facilities . So , experts Judene Bartley , Andy Streifel and I embarked upon a project back in the late 1980s to educate designers , architects , consulting engineers , owners , facility managers , directors of planning design and construction , infection preventionists , and environmental services personnel about the healthcare built environment . And the 2003 EIC guideline , which addresses the environment of care , was critical in tackling issues relating to not only construction and design , but operational issues and how they all come together to help prevent giving something to a patient or a resident that they did not intend to receive as a result of being in our care or being housed within our healthcare facilities .”
Erickson says he thinks progress was being made in advancing what was known at the time about the EOC ’ s role in the prevention of infections , medical errors and adverse events .
“ I think we were making some tremendous strides in marrying the concerns of infection preventionists and clinicians with those of design profession professionals , construction workers and contractors ,” he confirms . “ However , it was kind of catch-as-catch-can because there were different documents that were available through ASHRAE or through APIC , but none of them brought all of the elements together , and fine-tuned them to where it could speak not only to the clinicians who were actively once again trying to take care of patients , but also to those of us who were designing , constructing , and operating those facilities . That ’ s where the 2003 EIC guideline synthesized all EOC-directed knowledge at the time .”
Erickson lent to the 2003 EIC guideline his expertise on some water-related issues such as Legionella mitigation , control and prevention , he supplied key material on ventilation-related imperatives . Interestingly enough , the release of the EIC guideline came in 2003 when the first SARS epidemic developed , and is book-ended 20 years later with the official termination of the emergency status of the COVID-19 pandemic .
“ There has been research being conducted on the role that the air plays in viral transmission , with one major healthcare organization on the West Coast pushing to reduce the number of air changes per hour , because when you increase the number of air changes per hour , you ’ re also increasing the use of energy , and we know that hospitals and nursing homes are energy-intensive because they are 24 / 7 organizations ,” Erickson says . “ We also have a lot of equipment that we ’ re using on a minute-by-minute basis . And so , as you ’ re looking to get energy use under control , how to reduce energy utilization tends to be one of the things that we ’ re always looking at , including can we cut back on the number of air changes per hour ?”
He continues , “ If you ’ ve been in the business a long time , you ’ ll always hear that the solution to getting rid of contaminants is dilution ; in other words , to put as much air into a space as you possibly can , and then hopefully , through a dilution factor , we will eliminate airborne particulates . However , as we discovered during the COVID-19 pandemic , the very first thing out of the CDC was that the concern was about large droplet nuclei . Probably , it would settle out after 3 to 6 feet and not stay in the air for an extended time . And then , as the research continued to develop , we did find out that it was staying airborne
From my work on the various FGI guidelines , I knew what the old , minimum construction requirements from the federal agencies , the Department of Health and Human
Services , were , and we knew there was a correlation between human health and the built environment . But we didn ’ t know how significant that correlation was between the environment and the patients in hospitals as well as the resident populations that we serve in nursing homes and assisted living facilities .”
www . healthcarehygienemagazine . com • august 2023
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