Another area of an FM's core competencies that is directly related to infection control effectiveness is waste management and disposal. Its importance was underscored by the recent Ebola scare.
One of the more critical lessons Gumeringer says he learned from the Ebola situation is to make sure waste-handling procedures and hauling contracts are in order and with the proper permitting. "We didn't understand the sheer complexity of how you bag and sanitize waste and how you get it in drums," he says. What's more, because the waste is a special classification of infectious hazardous waste, a special permit must obtained from the Department of Transportation in order to haul it to an incineration site. So Gumeringer says he had to work with his waste disposal contractors to obtain the permit.
Texas Children's didn't have an Ebola case, so the permit is essentially a fail-safe for the future, but talking with waste hauling and disposal contractors to be sure they can handle infectious medical waste is a step Gumeringer recommends for all healthcare facility managers. "You should make that phone call to the regulated medical waste hauler and ask what their position is in regards to infectious medical waste," he says. Gumeringer also says they realized there was a lack of space for storing these infectious materials before they're removed, so they're actually building a special containment unit for the waste.
At Geisinger, Neuner says the organization processes its own waste, so he checked with the Pennsylvania Department of Environmental Protection just to be sure the organization's current process was stringent enough. It was. The waste becomes sterile, so it could be shipped directly out after it's processed.
Both Gumeringer and Neuner stress the importance of working closely with the organization's infection control department, not only in terms of creating policies and procedures for processing waste, but also for regular day-to-day activities, as well as special cases, like possible Ebola patients. They will be the first ones working with people on the patient-care side, says Gumeringer. And so, "The worst time to learn who they are is during a crisis," he says. "The FM must understand this is part of a critical partnership. You must be very comfortable working with each other."
The Ebola scare was a major wake-up for many healthcare facility managers in regards to their infection control policies and procedures.
At Texas Children's Hospital in Houston, Bert Gumeringer, assistant vice president for facility operations, says his team ran simulations and drills — with actors portraying a "patient under investigation" — about how to process an Ebola patient in terms of routing that person through the hospital. They also updated policies and procedures regarding donning and doffing of personal protective equipment (PPE), including ensuring enough space for donning and doffing, and having a staff member observe donning and doffing to ensure it's done properly.
"I can truly say that from Day 1 to what we do now is night and day," says Gumeringer. "We're much better prepared now, and should Ebola patients be present here at Texas Children's, we'll be better prepared to handle them safely and make sure the staff is safe as well."
Providing adequate space for donning and doffing of PPE is a lesson Alan Neuner, vice president of facility operations for Geisinger Health System, says he learned as well. He says they've reconfigured their isolation unit four times as they've refined their practices to provide the space necessary for the healthcare workers treating highly infectious patients. "Changes are occurring almost weekly as we continue to practice and refine our plan," he says.
Additionally, the entire area is isolated from the existing nursing floor with infection control barriers until a "purpose-built unit can be designed and constructed," he says.
"Quite honestly, I don't know how that hospital in Texas (Presbyterian Hospital of Dallas) did so well," Neuner says. "When I look at the learning curve we've been on with CDC and the Department of Health, it's amazing how much we've learned to be better prepared."
— Greg Zimmerman
Infection Control Is High Priority for Healthcare Facility Managers
Risk Assessment, Rules, Cleaning Practices Play Crucial Role
Ebola Scare Underscores Importance of Waste Management, Disposal