In regards to facility work, the best practices are performing infection control risk assessments (ICRAs) as well as developing strict, hard-and-fast rules for infection control. Also playing a crucial role is a facility's cleaning practices.
At Geisinger facilities, whenever staff drills into a wall for any reason, they must use a piece of equipment called a drill box — a sealed, airtight box that covers the spot on the wall to be drilled. The drill passes through the box, which creates an airtight seal, and ensures that dust or anything unknown on the other side of the wall isn't released into the air. "We can do this in any space then," says Neuner, "We can create a hole in the wall without exposing anyone." Still, Neuner says, no work is ever allowed to be done in an occupied patient room, even minor work like changing a ceiling tile.
At Texas Children's, assessing risk for infection control and taking the appropriate action means designating facility work in one of four categories — low, medium, high, highest. Low might be a simple ceiling tile replacement, whereas highest could be a full-scale wing renovation. Each level has air flow requirements and requirements for containment barriers, developed as a result of the industry-standard ICRA process. "This process really establishes the level of protection that needs to be put in place," says Gumeringer.
At The Christ Hospital, a 555-bed facility in Cincinnati, Ohio, Rick Perkinson, divisional director, facility management, uses a similar system. "We have a risk assessment policy wherein any time a ceiling tile is removed, a permit is required," he says. "The permit addresses the area where the work is to be done (different areas of the facility have different levels of risk), and the type and extent of the work."
For construction projects at Geisinger facilities, Neuner says, "an ICRA is performed with all involved parties to determine the best way to maintain patient and employee safety through the interruption." It's a multi-disciplinary, multi-department initiative, he says. "We look at the scope of the project, risks to surrounding populations, and what needs to be put in place to address risks," says Neuner. Another thing Neuner says his team does is to take air quality samples before any project starts. They then take checks during the project, as well. This helps them confirm that air barriers are working.
It's this simple: "Failure to adequately clean and sanitize space can lead to the spread of infections," says Gumeringer. The most important thing in regards to cleaning that can control infection is simple, as well: Because infections are spread through person-to-person contact, people need to wash their hands. "Still, today, the biggest culprit is lack of hand washing," says Neuner.
Of course, this includes facility staff, but facility staff can also help with making sure others sanitize as well by making sure hand-washing stations — an alcohol-based hand rub is most effective, says Gumeringer — are ubiquitous and well-maintained.
Beyond the simple, however, Gumeringer says, "Proper cleaning of surfaces, and proper laundering of blankets, towels, and sheets is very important." One specific infection-control-related cleaning strategy Gumeringer recommends is to use microfiber mop heads and sanitizer to mop patient rooms, and only use one per room. "A mop with a bucket just moves an infection to the next room," he says. Rooms are cleaned and thoroughly disinfected after each patient is discharged, he says — an upgraded level of cleaning compared with the daily cleaning.
At Geisinger Health, Neuner concurs with the criticality of proper cleaning. "We have invested heavily in state-of-the-art equipment to sterilize patient rooms upon discharge," he says. This includes UV disinfection equipment, because as Neuner says, when humans clean a surface, it's only about 70 percent effective. "But by using alternate technologies, we can be sure rooms are 100 percent disinfected."
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Risk Assessment, Rules, Cleaning Practices Play Crucial Role
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