What goes around still comes around ; in public health the same sorts of things repeat over and over . The root causes are still the same , and the interventions are still the same .” Twenty years later , the EIC guideline remains a time-tested document , with revisions being made over the last decade to reflect outbreaks and evolving best practices .”
increased numbers of high-risk vulnerable patient populations at risk for serious environment-associated opportunistic airborne and waterborne infections . These professionals recognized increased prevention and control attention , particularly , engineering maintenance and construction measures were needed to reduce airborne transmission risks to the vulnerable immunosuppressed populations . However , specific guidance was lacking .”
Stover says the CDC recognized the need for a comprehensive review of the environment ’ s association with infections , a comprehensive review of established industry standards , as well as guidance on effective methods to prevent and contain these infections .
“ 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 . When the 2003 environmental guideline was published , the document provided a readily available and accessible document for infection prevention and control professionals and hospital epidemiologists to use in gaining approval from hospital leadership , as well as engineering , maintenance , and construction ( internal and external ) directors .”
Standing the Test of Time
Gratifying to the content contributors and reviewers of the 2003 EIC guideline is how well it was received by the healthcare community .
“ I think it was very well received in its time ,” Matt Arduino says . “ And it remains relevant today . It ’ s still referenced widely for its expertise . It was referenced during both SARS , during Ebola . We had to make some tweaks in the guideline for Ebola , but it ’ s still relevant . There are recommendations in the guideline that that are relevant today that will still be relevant tomorrow because the science still holds true .”
Arduino emphasizes that infectious disease epidemiology is a stable undertaking , due to the foundational science and the evidence-based practices that have served the test of time .
“ What we know about transmission of infectious agents from the environment is something we ’ ve understood for decades ,” he says . “ I ’ ve been conducting outbreak investigations for 33 years , so I can say , ‘ I ’ ve seen that before ; the root cause is X , Y or Z . The Epidemic Intelligence Service ( EIS ) officers look at me and say , ‘ How do you know that ?’ and I tell them , ‘ We saw the same sort of thing 20 years ago . And if you look here , here , and here , you will identify the underlying cause . And here ’ s how you fix it .’ What goes around still comes around ; in public health the same sorts of things repeat over and over . The root causes are still the same , and the interventions are still the same .”
Twenty years later , the EIC guideline remains a time-tested document , with revisions being made over the last decade to reflect outbreaks and evolving best practices .
“ The comprehensive review of environmental risks for hospital-associated infections ( HAI ), combined with evidence-based ( to the extent possible ) recommendations presented in the 2003 Guidelines for Environmental Infection Control in Health-Care Facilities assured these guidelines the ability to withstand the test of time ,” remarks Beth Stover . “ The guidelines addressed environmental-associated infection risks in 2003 and beyond , and provided practical containment strategies that are current to this day . The recommendations introduced a categorization scheme based on data from scientific research and studies , knowledge gained during infectious disease investigations in healthcare facilities , those derived from engineering concepts and industry standards , existing federal regulations , and recommendations that cannot be rigorously evaluated but have strong theoretical rationale .”
Lynne Sehulster acknowledges the need for updated commentary to take the guideline into a future where new and more virulent pathogens lie in wait .
“ As solid as the guideline is , and it ’ s withstanding the test of time , there are new topics to address , so it might be nice to have new insights reflective of the more current medical literature . The fact that it has stood for 20 years , with almost minimal modifications to it , I see no reason why it can ’ t move forward with some updates but retaining the core content .”
www . healthcarehygienemagazine . com • june 2023
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