By 1999 , CDC and
HICPAC embarked on revising the environmental guidelines ,” Stover recalls .
“ The 2003 guideline provides strong background information on the state of the art of environmental risks . The guideline incorporates more specific scientific and practical infection prevention guidance , with the addition of recognized architectural and engineering organization recommendations and federal agency regulations incorporated into the guidelines .”
— Beth Stover the facility ’ s biomedical engineer should clean that device . It ’ s not the responsibility of EVS . So , these are issues that take time to resolve .”
In terms of the EIC guideline , Arduino says his contributions consisted of reviewing the use of water in the healthcare setting , starting from when the water comes into the building , how it is used in healthcare , and addressing any infections due to water usage in healthcare .
“ That includes water used to reprocess devices and instruments , or even water used to mix disinfectant solutions in EVS . You should always start with clean buckets , and you should always prepare fresh solutions so that you don ’ t cross-contaminate your solutions with microorganisms . We also looked at the quality of tap water that was being used in the healthcare facility ; if , for instance , contaminated water was being used in a device like an automated endoscope reprocessor ( AER ), that could contaminate the scopes and cause infections and disease . The other issue of concern were outbreaks related to Legionella , or outbreaks related to Pseudomonas related to tap water . Currently we have ASHRAE ’ s all-hazards approach to water , so that we ’ re now looking at all opportunistic pathogens related to water and plumbing , and water systems as a source for organisms that may cause a disease in susceptible populations .”
In terms of the significance of the EIC guideline , Arduino says , “ The document helped end users to understand the EPA ’ s product-approval process , as well as how to interpret the Spaulding Classification and where to use what products and when . It also helped them understand the difference between a one-step process and a two-step process , as well as where to use the different types of cleaning products . Even to this day , there is still some consternation when it comes to products . We ’ ve been working with the EPA on improving teaching points about how they classify and label products , trying to clarify the labeling to make it easier on the end users of these products . Prior to the release of the EIC guideline , I think the end user had more difficulty in selecting appropriate products to be used on surfaces . It ’ s important for end users to understand the different roles that the FDA and the EPA played related to disinfectants . So , the regulation of high-level disinfectants belonged to the FDA , those that are used on devices and environmental surfaces ; and the general disinfectants used in healthcare are regulated through the EPA . And then there are products which are not regulated by anyone , and those are the devices usually used for upper air and are increasingly being used now for whole-room disinfection , including UV robots . Those are always used as supplements to cleaning and disinfection because they are not stand-alone interventions .”
Arduino continues , “ We conducted extensive literature reviews to get the science together to examine where the failures in cleaning and disinfection are , how cleaning solutions get contaminated during the cleaning process , how to make your cleaning and disinfection processes more efficient .”
When asked what he is most proud of when reflecting on his contributions to the guideline , Arduino quips , “ Well , since I still play with water , the contributions that I ’ ve made to the water section and to the dialysis section remain the high bar . In the 20 years since the publication of the EIC guideline , our dialysis standards have tightened up , becoming more focused on endotoxins and other contamination by microbial materials .
Arduino says he is pleased to have been part of something as impactful as the EIC guideline , a process he notes as being long and complex . “ It was Lynne Sehulster ’ s main job , but I was only working on it part time , because I was also running the outbreak lab and conducting research . It was Joe Carpenter and myself creating the water section , and Barry Fields was tackling the Legionella component , and I believe we started in the late 1990s . It was a lot of serious effort for all the contributors and reviewers . Too bad Lynne can ’ t share a picture of her office at the CDC ; these were the days before PDFs , so she had stacks and stacks of hard copies of papers and reference documents everywhere . It was a truly amazing undertaking .”
Beth H . Stover
Serving as an expert reviewer of the EIC guideline , Beth H . Stover brought her considerable infection prevention background and leadership skills to bear on the guidance-creation process . She has served as advisor and consultant to the CDC ’ s Hospital Infection Program / DHQP for specific activities , at CDC ’ s request ; provided comments and technical assistance on communications messages , guidelines , and nosocomial infection definitions for several decades .
Stover explains that a historical perspective provides a foundation to address the state of environmental infection control and the importance of the EIC guideline : “ CDC recognized the severity of S . aureus and other hospital-associated infections , and the need for systematic surveillance , data analysis to identify problems , and application of investigative techniques , plus implementation of infection control interventions and prevention measures — marking recognition of infection prevention and control as a needed entity . CDC embarked on the Comprehensive Hospital Infections Project ( CHIP ) in 1965 . U . S . hospitals began implementing infection prevention and control programs and established the infection control position . Most appointed to this position were nurses . It was apparent that many hospitals had not established infection prevention and
20 june 2023 • www . healthcarehygienemagazine . com