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Transcript
• Wendy Davis
• Dip Carbon Management, Swinburne University, Melbourne
• MBA (executive), Harvard Business School, Boston
• M Ad Ed (adult workplace education), UTS, Sydney
• B App Sci (medical microbiologist), RMIT, Melbourne
Facilities – protecting your assets and
minimising hospital/facility acquired infection
Learning outcomes – Health Facilities
At the end of this session you will be able to…
Systematically identify areas of
High infection control requirements
High and medium horizontal impact risk
& understand why
this is critical
Learning outcomes – Health Facilities
At the end of this session you will be able to…
Design interiors to
Withstand the daily inundation of collisions
Minimise the opportunity for hospital/facility
acquired infections
& understand why
this is critical and how
they are related
Learning outcomes – Health Facilities
At the end of this session you will be able to…
Apply a cost benefit approach to design materials
Discuss the impact financial and other of
hospital acquired infection
Justify reduced operational costs vs capex
& understand why
this is critical
Importance of high infection control
requirements.
Hospital - acquired = nosocomial INFECTIONS
• Pertaining to or originating in a hospital
The most common complication affecting patients in hospital
• Unnecessary pain and suffering for patients and families
• Prolong hospital stays
• Costly to the health system
www.health.gov.au/internet/main/publishing.nsf/Content/Glossary#n
Accessed Dec 2015
Challenges
• Normal bacteria - ‘hospital’ strains of
bacteria that are resistant to antibiotics
“ensure consistent cleaning and
disinfection of surfaces in close proximity to the
patient and those likely to be touched by the patient, staff and visitors”
www.nhmrc.gov.au/_files_nhmrc/publications/attachments/cd33_infection_control_healthcare_140616.pdf. Accessed Dec
2015
You might have heard of these…
• MRSA, Golden Staph, MRSE (MR = methicillin resistant)
• VRE
• Clostridium difficile
• MRO (M = multi)
• SARS,
• Ebola
• Aspergillus
• Gastro. causing viruses – Norovirus
• Evolving influenza virus
Hospital acquired
infections
200,000 reported in
Australia in 2010 (very
under reported)
People die
Chain of infection
Susceptible person
Mode of
transmission
Source of infectious
agent
Risk of infection
accessed 2 Mar 2016
(http://www.nhmrc.gov.au/book/australian-guidelines-prevention-and-control-infection-healthcare-2010/b4-1-1-classifying-proce
Highlight in yellow,
areas of high infection risk
– see handout
Minimise the opportunity for hospital
acquired infections
• Best protection against infection
is intact skin
• Similarly best way to protect against
bacteria/viruses in the environment
is to minimise the opportunity for reservoirs
• Minimise cracks/damage/joins/pooling of water
Design interiors to
Minimise high and medium horizontal
impact risk
Withstand collisions, scrapes, and scratches
Design interiors to
• Withstand collisions, scrapes and
scratches.
High impact high traffic areas
CORNER
• Plan 2.3 Corner protection - remember we want to maintain the
integrity of the “barrier”(just like skin).
• So doors to operating theatre particularly those within the isolated
theatre space
• High visibility, and high use..patients in wheel chairs/wheeling drips
etc..
• This will be pretty easy to see when you walk around the existing
facility – just look for the bumps and scratches. Find the high profile
- high infection risk – high visibility to public. Obviously it would be
easier to just do all…but cost effectiveness is important.
Nord Parisien Private Hospital - Sarcelles (95)
flu-like human metapneumovirus (hMPV)
• Families blame hospital for four deaths at Herberton, North Queensland
• January 30, 2016 1:00amPeter MichaelThe Courier-Mail
• FAMILIES believe the botched handling of a sick patient is to blame for a deadly
virus outbreak that “swept like wildfire” through an aged-care facility in far north
Queensland.
• Four patients died and eight more were infected as the flu-like illness took a
lethal stranglehold at the public hospital in Herberton, 90 minutes southwest of
Cairns.
• Doctors, nurses, patients and family of victims spoken to by The Courier-Mail
expect a top-level probe will reveal how “Patient Zero”, the index case, was not
put into an isolation ward nearly three weeks ago.
• In a fatal mistake, it is understood a sick patient was transferred from another
hospital and placed into a general ward with “very elderly, frail, and vulnerable
patients in poorly ventilated rooms”, sources said.
Friday, Mar 4th 2016
Gastric flu outbreak spreads in Britain
Britain is in the grip of a gastric flu outbreak which has spread
from hospitals in Scotland to the south coast, health chiefs said
today.
Levels of the virus, which has already affected 12 hospitals in
Scotland, are higher than those recorded in the past, said the
Public Health Laboratory Service.
The number of people struck down with the viral infection on
hospital wards was today expected to rise amid reports of the
bug in Manchester, Hertfordshire, Sussex, Dorset and Cornwall.
There was also a similar case in Birmingham earlier this month.
So far, Glasgow's Victoria Infirmary has been worst hit with 283
patients and staff hit by the illness.
It has forced emergency admissions to the hospital to be
diverted to the city's Southern General Hospital until further
notice.
How long do bacteria/viruses/fungi live outside of
humans?
MRSA can survive for days to weeks on hard surfaces
C.difficile has survived for 5 months
Norovirus can survive for weeks or months
Aspergillus
http://www.nhs.uk/chq/Pages/how-longdo-bacteria-and-viruses-live-outside-the-body.aspx
Health care examples
• Airborne fungal spores eg. Aspergillus sp– indoor and outdoor
sources in high-risk patients.
• Bird droppings, soil, contaminated fire proofing material, damp timber and
plaster (particularly particle board)
• Building and maintenance activities disturb these reservoirs and
can send millions of spores throughout the health care facility
Example
• Construction related Nosocomial infections for Hospitalized patients:
Decreasing the Risk of Aspergillus, Legionella and Other Infections
cites 25 outbreaks of nosocomial Aspergillus sp infections over 20
year period, 106 deaths.
• These deaths were either suspected or confirmed as being caused by
construction activity
Canada Communicable Disease Report July 2001 http://publications.gc.ca/pub?id=9.559516&sl=0
National Health and Medical Research Council –
accessed on line Feb 2015
2010
How is this playing out in health - USA
• Oct 2008 Medicare decline
payments for 8 conditions that
could be avoided if “the hospital
followed preventative procedure
or common sense precautions”.
• 3 of these are Hospital Acquired
Infections
Infection prevention
• This responsibility applies to
everybody working and visiting a
healthcare facility, including
administrators, staff, patients
and carers.
• Successful approaches for
preventing and reducing harms
arising from HAIs involve
applying
• a risk-management framework to
manage ‘human’ and ‘system’
factors associated with the
transmission of infectious agents.
2009 figures
2009
• 2 million bed days per year in Australia lost to Hospital Acquired
Infection
So what?
Direct effects
during hospital stay
Increase length of stay
Diagnosis and treatment cost
increase
After discharge from hospital
Health – care services used more
intensively
Pharmaceuticals required to
treat infection
Indirect effects
Patient/carers miss out on normal
productive activities
Reputation of hospital damaged
Risk of litigation
Apply a cost benefit model to the selection of
design materials
• Cost of poor aesthetics - priceless?/missed opp/’bad press’
• Cost of wall repair? /Disruption of normal usage?/ how many hospital
administrators does it take to repair a wall…involvement of engineer,
tradesperson, nursing unit manager, operations manager, ward staff,
environmental services staff, patients, visitors, clinicians…
• How frequently do they paint? Should they paint? What’s the cost?
• Cost to the community of increased chance of hospital acquired
infection
Impact of overall infection rates of 1% on bed
availability (days)
(2004-2005) Graves, Nicholas and Halton, Kate A. and Paterson, Davis and Whitby, Michael
(2009) The economic rationale for infection control in Australian hospitals. Healthcare Infection, 14 (3). pp. 81-88.
What if we could decrease by 1%?
• 1% increase means loss of > 150,000 bed days nationally (2004-2005)
• 1% decrease means increase of 150,000 bed days nationally AT LEAST
• Total Loss of approx. 2 million bed days
nationally (2009)
• What is it in 2016?
LH PHOTO LESS THEN 12 MONTHS OLD
Chipping and caps see circle
LHS poor RHS correct
QUIZ
• Multiple choice. 7 Questions.