Download Infection Control Strategies for Sanitary and Efficient Healthcare

Infection Control Strategies for Sanitary and
Efficient Healthcare Facilities
Course # ICSF01
Provider # K-154
1 LU/HSW hour
AIA Best Practices
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© 2010, American Standard Brands
Learning Objectives
• Describe at least two reasons why infection control measures need
to be improved in healthcare facilities.
• Describe at least one room in a hospital and explain why it
contributes to spread of infection, and what can be to do reverse
spread of infection.
• Describe at least three design strategies that can improve infection
control prevention in healthcare facilities.
• Describe how healthcare facilities can be both environmentally
conscious and sanitary.
Learning Objectives
• Describe at least two reasons why infection control measures
need to be improved in healthcare facilities.
• Describe at least one room in a hospital and explain why it
contributes to spread of infection, and what can be to do reverse
spread of infection.
• Describe at least three design strategies that can improve infection
control prevention in healthcare facilities.
• Describe how healthcare facilities can be both environmentally
conscious and sanitary.
Our Aging Population
• The U.S. population is changing how we use healthcare facilities.
– Older generations are using healthcare facilities more
– Younger generations are using healthcare facilities less
• Existing facilities need to change to meet our current needs.
– Larger facilities with updated technologies
– Cleaner facilities to reduce spread of infection
– Conservative facilities that are resource efficient
Our Aging Population
Changes in Healthcare
Changes in Healthcare
• Hospitals are not just for accidents and illnesses anymore. An
increasing number of people are also going voluntarily for lifeimproving procedures.
– Joint replacements, heart/coronary procedures, plastic surgeries
This chart compares the
frequency of knee
This
chart compares
replacements
in adults the
45
frequency
and older inofthe U.S from
hospitalization
2000 to 2006. for
coronary arthrosclerosis
from 1990 to 2006.
Changes in Healthcare
• Hospital stays are longer for elderly patients after major surgeries.
This increases their risk of infection.
This chart compares the
percent of discharges and
days of care by age in the
U.S. in 2006.
Projected Growth
• Our change in need and use of healthcare facilities is creating a
need for renovation of existing facilities and construction of new
facilities.
• New construction will be slightly down or flat, but is still at an all-time
high.
– Hospital construction will drive the volume
– Special care facility construction will provide future growth opportunities
– By 2012 healthcare facility construction is expected to rise significantly
Learning Objectives
• Describe at least two reasons why infection control measures need
to be improved in healthcare facilities.
• Describe at least one room in a hospital and explain why it
contributes to spread of infection, and what can be to do
reverse spread of infection.
• Describe at least three design strategies that can improve infection
control prevention in healthcare facilities.
• Describe how healthcare facilities can be both environmentally
conscious and sanitary.
Room Designs
• Nosocomial infections, or healthcareassociated illnesses are often related to
insufficient hand washing and splashing of
water from sinks and drains onto adjacent
surfaces.
Healthcare
Associated
Illnesses (HAIs):
1.7 million people
incur an infection
during a hospital
visit annually
Nearly 100,000
deaths occur
annually from HAIs
Room Designs
• A typical patient room places the
bed very near the sink, preparation
and waste disposal areas.
• When two beds are separated by a
curtain, one bed is often close to
one of these areas.
Toronto Study
• Toronto, Ontario December, 2004 – March, 2006
– 36 patients in intensive care or transplant units incurred an HAI
– 17 patients died from these infections
• Pseudomonas aeruginosa
– Fourth most common pathogen – 10% of HAIs
– Only infects immuno-suppressed tissues
– 50% mortality rate
Toronto Study
• Infection control specialists tried to identify the location of the
bacteria; two control measures were taken to eliminate bacteria
spread from contact.
– Workers wore gloves, masks and gowns
– Patient rooms received enhanced cleaning (twice)
– Neither precaution had a lasting impact on the bacteria
Photo Source
Photo Source
Photo Source
Toronto Study
• Surfaces were cultured to identify where bacteria colonies were
present. Hand Hygiene sinks in patient rooms had the highest
number of positive cultures.
– Black lighting identified that water splashed as far as 3 feet away from
the sink
Photo Source
Toronto Study
• Sinks were renovated to help minimize
splashing
– Traps were replaced
– New faucets did not flow directly into
the drain
– Water pressure was decreased
– Splash guard placed around the sink
to minimize splashing
– Patient care materials moved farther
away from the sink.
Example of a sink with splash guards.
Bacteria on Surfaces
•
•
Staph infections are the most common infections in healthcare facilities.
One study found that MRSA or MSSA was present on 24% of all door
hardware
•
MRSA (methicillin resistant Staphylococcus aureus)
– Responsible for 63 percent of hospital-acquired staph infections
– Can live for:
• More than 12 days on a laminated countertop
• 11 days on a plastic patient chart
• 9 days on a cloth curtain
•
MSSA (methicillin susceptible Staphylococcus aureus)
– Can be fought with most antibiotics
Bacteria on Surfaces
• VRE (vancomycin-resistant enteroccus)
– An example of a bacteria that has become resistant to antibiotics
• Antibiotics are wonderful, but bacteria adapt faster than we can
create new variations of antibiotics. This is part of the reason why
we see drug-resistant bacteria causing HAIs.
Photo Source
Hand washing
• Hand washing is imperative for fighting infection control. There are
really only four things that can kill bacteria:
–
–
–
–
Prolonged exposure to UV light
Low nutrient levels
Antibiotics
Humidity levels below 10 percent
The Cost of Infection
• HAIs lead to nearly $5 billion to the national annual healthcare bill.
• Medicare and many private insurers are no longer reimbursing
facilities for the increased cost of “preventable infections.”
– This is added incentive to include infection control in your design
considerations.
Room designs
• A typical inpatientroom design often
places the bed in close
proximity to the hand
hygiene sink and the
preparation area.
• This is the typical room
design for the rooms in
the Toronto study.
Learning Objectives
• Describe at least two reasons why infection control measures need
to be improved in healthcare facilities.
• Describe at least one room in a hospital and explain why it
contributes to spread of infection, and what can be to do reverse
spread of infection.
• Describe at least three design strategies that can improve
infection control prevention in healthcare facilities.
• Describe how healthcare facilities can be both environmentally
conscious and sanitary.
Designing to Minimize Infection
• Room design and sink specification can significantly help in reducing
nosocomial infections.
• Infection control and
prevention considers
both human and
physical design
factors.
Designing to Minimize Infection
• Infection control and prevention professionals should be included in
the design and planning of a facility.
• Infection control specialists will be able to describe the chain-oftransmission of infectious agents and make recommendations to
eliminate or reduce potential hazards.
Inpatient Room Design
• New Construction
– Maximum number of beds shall be one,
unless a necessity of a two-bed
arrangement is required.
• Renovations
– Maximum room occupancy should not
exceed four, and should not be increased if
occupancy is currently one or two.
FGI Guidelines
recognize the
following
specialties:
• General Hospitals
• Small Primary
Care Hospitals
• Critical Access
Hospitals
• Psychiatric
Hospitals
• Rehabilitation
Hospitals
Inpatient Room Design
• FGI Guidelines’ Space Requirements:
– 120 square feet of clear floor space for
single-bed rooms
– 100 square feet of clear floor space per bed
in multiple-bed rooms must be provided.
• Privacy shall be provided in multiple-bed
rooms.
CHICA – Canada is
a multi-disciplinary,
voluntary
association of
Infection Control
Professionals (ICPs)
dedicated to the
health of Canadians
by promoting
excellence in the
practice of infection
control and
prevention.
Hand-Washing Stations
• FGI Guidelines’ Hand-washing stations:
– Sinks should be non-porous materials with
deep basins and be at least 144 square
inches.
– Water pressure shall be regulated
– Storage below sinks is prohibited
• Antibacterial gel dispensers may also be
included in patient rooms and at nursing
stations and may be permitted if adding a
sink is to feasible.
Hand-Washing Stations
• FGI Guidelines’ Hand-washing stations:
– Recommendations for reducing splashing:
• Faucet should angle water away from the drain, rather than directly
into the drain
• Water pressure should reduce forceful discharge at maximum flow
• Sink size and dept should follow ANSI Standards for sink design
• You may also have to accommodate ADA requirements for
clearance under the sink in patient and public restrooms.
Hand-Washing Stations
Designing to Minimize Infection
• Sink
– Material: vitreous china, stainless steel or other non-porous, chemicalresistant material
– Finish: white, or other colors
– Mounting: wall hung, carrier arms concealed
– Bowl: (inside size) minimum 10 in. x 14 in. front-to-back, by 9 in. deep
– Rim: shall be sloped to direct water into bowl and prevent placement of
objects in sink
– Sink shall not have an overflow drain
– Other desirable features
• Splash guards
• Smooth corners
• Antimicrobial finish
• Hands-free faucet
Designing to Minimize Infection
Wall Mounted
Sloping Rims
Hands-free Control
Gooseneck Faucet
Indirect Drain
Smooth Corners
Designing to Minimize Infection
• Faucet
–
–
–
–
Material: brass
Finish: chrome plated
Water flow: 2.2 gpm or less, preference for reduced flows
Spout:
•
•
•
•
rigid gooseneck preferred; others that are multi-functional can be considered
Locate spout near sink flood level
Water delivery shall be between front of sink and drain (not into drain)
Shall not have aerator/modulator or spray modifier
– Control:
• Hands-free operation required, electronic or foot-pedals
• Electronic controls are hand-motion activated, not booty-motion activated;
shall be line-powered and consider manual flow and temperature override
control
• Foot pedals should be wall-mounted with separate hot and cold pedals
Designing to Minimize Infection
• Gooseneck faucets are preferred in
healthcare facilities
• Hands-free sensor-operated faucets
help reduce HAI’s.
Designing to Minimize Infection
• Drain
–
–
–
–
Material: brass. Drain fitting gaskets to be plastic or neoprene
Finish: chrome plated
Size: 1-1/2 inch trap; 1-1/4 inch considered
Drain fitting shall not accept a plug or stopper
Designing to Minimize Infection
• Complete assembly
– Exposed elements shall be suitable for frequent exposure to
institutional-grade cleaners and disinfectors
– Elements shall periodically handle 180-degree F water temperature
without deterioration, cracking or other failure.
Designing to Minimize Infection
• Antimicrobial surfaces provide a passive method for infection
control. Silver-based antimicrobial surfaces only release
antimicrobial properties when microbes are present.
– Silver antimicrobials are less toxic than table salt
– Antimicrobial coatings will not leach from the fixture – they are
permanent
Designing to Minimize Infection
Standard Surface
• 52 days of flushing
• 74,000 cycles
• Iron stains & biofilm
Anti-microbial Surface
• 65 days of flushing
• 91,000 cycles
• No iron stains or biofilm
Surgical Prep Area Design
• The Scrubbing room typically has two steel scrub sinks with handsfree faucets. The workroom typically has a clinical sink, bedpan
washer and separate wall-mounted faucet.
Surgical Prep Area Design
• Scrub sinks
– Must be hands-free with foot,
knee or ultrasonic controls.
• Clinical sinks
– Can be hands-free or have single-lever or
wrist blade controls, provided handles are
at least 6 inches long.
Nursing Station Design
• Requirements for nursing stations:
– Space for counters
– Space for storage
– Convenient access to handwashing stations
• CHICA requires that a handwashing station be no more than
20 feet from a nursing station.
Examination/Treatment Room
• Single or multi-bed examination or treatment rooms may be
required. Space requirements depend on the number of beds.
–
–
–
–
An examination light
A hand-washing station
Storage facilities for supplies
A desk, computer or shelf space for writing or electronic documentation
Public Area Design
• Support areas for families, patients and visitors
–
–
–
–
Privacy
Area for communications
Patient-family information stations
Access to beverages and nourishment
– ADA Compliancy is something you should consider for public areas.
Future of Design
•
BIM is the design tool of the future.
Future of Design
Future of Design
• An example of a 3-D
rendering of a public
restroom in a healthcare
facility.
Learning Objectives
• Describe at least two reasons why infection control measures need
to be improved in healthcare facilities.
• Describe at least one room in a hospital and explain why it
contributes to spread of infection, and what can be to do reverse
spread of infection.
• Describe at least three design strategies that can improve infection
control prevention in healthcare facilities.
• Describe how healthcare facilities can be both environmentally
conscious and sanitary.
Water Usage in Healthcare
• Healthcare facilities are often exempt from water usage regulations.
On average, facilities with between 130 and 550 beds use 125,000
gallons of water daily.
http://www.energystar.gov/index.cfm?c=healthcare.ashe_sept_oct_2005
LEED for Healthcare
• LEED for Healthcare
– WE Prerequisite 1: Water Use Reduction
– WE Prerequisite 2:Minimize Potable Water Use for Medical Equipment
Cooling
– WE Credit 1: Water Efficient Landscaping: No Potable Water Use or No
Irrigation
– WE Credit 2: Water Use Reduction: Measurement & Verification
– WE Credit 3: Water Use Reduction: 30 – 40 Percent Reduction
– WE Credit 4: Water Use Reduction: Building Equipment
– WE Credit 4.2: Water Use Reduction: Cooling Towers
– WE Credit 4.3: Water Use Reduction: Food Waste Systems
LEED for Healthcare
• WE Prerequisite 1: Water Use Reduction
– Building Water Use Strategies (20%):
• Toilets – dual flush, or 1.6gpm or less
• Urinals – 1gpm or less, or waterless urinals
• Lavatory faucets – 2.2 gpm in patient rooms,
0.5 gpm in public-use areas
• Metered faucets: 0.25 gpc
• Shower heads: 2.5 gpm or less, at 80 psi.
– Process Water Use Strategies (20%):
•
•
•
•
•
Commercial clothes washers – less than 80 lbs – 9 gallon/CF/cycle
Commercial dishwashers – between 0.99 gallons/rack to 1.98 gallons/rack.
Ice machines – less than 25 gallons per 100 lbs of ice
food steamers – 8 gallons/hour/pan
combination ovens – 8 gph
LEED for Healthcare
• WE Credit 3: Water Use Reduction: 30 – 40%
Reduction, 1 – 3 points
– Building Water Use Strategies:
• Water closets – 1.6 gpf, or less
• Urinals – 1 gpf, or less
• Lavatory faucets – 2.2 gpm at 60 psi for private use,
0.5 gpm at 60 psi for public use
• Showers – 2.5 gpm or less at 80 psi
• Kitchen sink faucets and Pre-rinse spray valves –
1.6 gpm or less
– Process Water Use Strategies:
• Use efficient clothes washers, dish washers, ice
machines, combination ovens, food steamers and other
equipment.
LEED for Healthcare
• LEED for Healthcare
– WE Prerequisite 1: Water Use Reduction
– WE Prerequisite 2:Minimize Potable Water Use for Medical Equipment
Cooling
– WE Credit 1: Water Efficient Landscaping: No Potable Water Use or
No Irrigation
– WE Credit 2: Water Use Reduction: Measurement & Verification
– WE Credit 3: Water Use Reduction: 30 – 40 Percent Reduction
– WE Credit 4: Water Use Reduction: Building Equipment
– WE Credit 4.2: Water Use Reduction: Cooling Towers
– WE Credit 4.3: Water Use Reduction: Food Waste Systems
Green Guide for Healthcare
• Water Efficiency
– Prerequisite 1: Potable Water Use for Medical Equipment Cooling
– Credit 1: Water Efficiency Landscaping: No Potable Water use or No
Irrigation
– Credit 2.1: Potable Water Use Reduction: Measurement & Verification
– Credit 2.2: Potable Water Use Reduction: Domestic Water
– Credit 2.3: Potable Water Use Reduction: Domestic Water
– Credit 2.4: Potable Water Use Reduction: Process Water & Building
System Equipment
– Credit 2.5: Potable Water Use Reduction: Process Water & Building
System Equipment
Green Guide for Healthcare
• WE 2.2 Potable Water Use Reduction: Domestic Water
– Equip all urinals and hand wash sinks with sensor operators.
• Toilets, bed pan washers, compounding sinks, housekeeping sinks
and sinks in impatient bedrooms cannot contribute
Green Guides for Healthcare
• WE 2.3: Potable Water Use Reduction: Domestic Water
– Use low-flow fixtures or control fixtures to achieve these water
flows:
•
•
•
•
Lavatories – 1.5 gpm or less
Urinals – 1 gpf or less
Toilets – 1.6 gpf or dual flush or less
Showers – 1.8 gpm or less
Green Guide for Healthcare
• WE Credits 2.2 and 2.3: Potable Water Use Reduction: Domestic
Water
– Provide a separate glass-fill device in inpatient rooms to prevent
activation of the hand-wash sensor
– Specify self-closing or electronic sensor faucets
– Specify high efficiency fixtures or dry fixtures
– Consider reusing storm water or greywater for non-potable applications
Summary
• The way we use healthcare facilities is changing, leaving room for
substantial remodels and new construction in the future.
• Room design, sink design and sink placement can impact the health
and safety of patients, physicians, staff and visitors.
• Sink design and placement is important to consider in patient rooms,
nursing stations, scrub rooms and other patient-care rooms. BIM
allows you to see what your design will look like in 3-D before
construction is complete. This will aid in flexibility.
• Healthcare facilities can use low-flow fixtures and faucets to meet
LEED, GGHC and FGI guidelines for energy-efficient, clean
facilities.
Thank You
This concludes the learning portion of this course. Please contact
American Standard directly with any questions related to the
information presented.
Questions?
Jeff Gilmore
[email protected]
614-315-7153
American Standard Brands
www.americanstandard-us.com