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Infection Prevention and Control's Role in the Design and Construction of a new Ambulatory Care Center. Lessons Learned
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Poster Abstracts / American Journal of Infection Control 47 (2019) S15−S50
point toward a surface-component contamination and tissue-air risk connection. This investigation was designed to seek new data regarding any FAW-bacteria correlation in an effort to both better understand possible, associated, FAW-use risks and contribute to infection-control protocols that more effectively assist in mitigating or diminishing consequential Healthcare Associated Infection (HAI) risk. METHODS: A total of 320 surface and air samples were collected and cultured from in and around 35 unique FAW devices actively in-use in operating room (OR) settings at three hospital facilities in an associated acute-care system. Surface samples were taken from multiple FAW device points: the internal hose surface, the proximal hose end and the distal hose end. Each retrieved sample was bagged, plated and incubated under sterile procedures. RESULTS: The results show that 24.4 percent (78 of 320) of all samples collected were at higher than maximum acceptable Colony Forming Unit (CFU) pathogens levels. Forty-two and half, 42.5, percent (136 of 320) of all samples were at higher than minimum acceptable CFU levels; 37.2 percent (119 of 320) were equipment samples; 5.3 percent (17 of 320) were air samples. Study results also identified a correlation of positive airborne samples for instances that had high-pathogen contamination in the warmer-temperature components, resulting in a possible increased patient infection risk and possible attributable SSI as primary concerns. CONCLUSIONS: FAW device-component contamination may be a risk in the OR. Cross-contamination of the environment remains a risk as well. A reduction in surface and airborne CFUs may positively reduce SSI and HAI infection risk.
Presentation Number ECR-65 The Hidden Truth in the Faucets: A QualityImprovement Project and Splash Study of Hospital Sinks Kristen VanderElzen MPH, CIC, Michigan Medicine; Harry Zhen BS; Emily Shuman MD; Amanda Valyko MPH, CIC, FAPIC BACKGROUND: Sinks are potential sources of Healthcare Associated Infections (HAI) and have been linked to outbreaks. However, transmission of microorganisms from sink to patient is not well understood. Sink contents may be splashed onto patient care items, contaminating them during faucet use. A splash study was performed to understand the splash potential of the different faucet and sink designs in a larger academic teaching hospital in the Midwest, and an audit of sink cleanliness was conducted. METHODS: Faucets/sinks in intensive care units (ICU) were assessed. Adenosine triphosphate (ATP) monitoring was used to assess cleanliness of the faucet spout and sink bowl/drain cover. Cultures were performed for some faucets/sinks. A splash study was performed using a commercially available fluorescent indicator. Photos were taken to record notable findings during the audit and the splash study. RESULTS: Twenty faucet/sinks in four ICU's were evaluated, and eight different designs were observed. Faucet spouts were more soiled with organic material than sink bowls/drain covers as indicated by higher ATP readings. Pink slime/biofilm was observed on several faucet spouts and aerators. Visible biofilm was associated with higher ATP readings. Aerators were found on sinks where they had been removed previously. Cultures grew Pseudomonas aeruginosa, mold and other environmental organisms. The splash study showed visible splashing on the operator’s body and over four feet from the sink.
CONCLUSIONS: Some sink designs enable splashing sink contents onto patient care items, healthcare worker hands and into patient care spaces. Faucets were much dirtier than expected and a faucet replacement program, eliminating aerators, is currently being developed.
Presentation Number ECR-66 Infection Prevention and Control's Role in the Design and Construction of a new Ambulatory Care Center. Lessons Learned Richard Vogel MS, CIC, FAPIC, New York Presbyterian BACKGROUND: An urban, teaching medical center started designing a new 740,000 sq. foot ambulatory care center in 2013 with the Center scheduled to open in April 2018. Infection Prevention and Control (IPC) was included in the Planning and Design team, attending numerous meetings over the next 3?years. METHODS: At project design meetings, IPC input was incorporated into all areas of the center including Infusion Services, Intervention Radiology, Endoscopy, Ambulatory Surgery, Central Sterile Processing, and Diagnostic Imaging. Input included, the number of Isolation Rooms, number and location of handwashing stations and hand sanitizers, construction materials and finishes, and work flow. IPC signoff of the final design was required for all areas of the Center. At the start of construction, because dust control measures were not needed, IPC was not included in the construction meetings. RESULTS: Towards the end of construction, IPC joined in multidisciplinary weekly walkthrough of the various areas in the Center. Modifications and changes had been made to the design plans without input from IPC. Some of changes the included: Medication room counter use which encroached on the handwashing sink, locations of hand sanitizers, hot water circulating temperature and the addition of a second visual pressure monitor which in some instances was in conflict with the electronic monitor. To fix some of the changes required modification of the already built space. However, others could not be changed and resulted in a space that, from an Infection Prevention and Control perspective was not optmal. CONCLUSIONS: Had IPC continued to attend project meeting during construction, many of the modifications that were made could have been prevented, or a better solution could have been designed. This experience has taught us that IPC should be part of all construction projects for the entire project.
Presentation Number ECR-67 Lessons Learned from Legionella in the water of an Ambulatory Care Center Kristen VanderElzen MPH, CIC, Michigan Medicine; Kevin Thompson MPH, CIC; Amanda Valyko MPH, CIC, FAPIC; Laraine Washer MD BACKGROUND: Water Management Programs are an important part of preventing Legionella infection in healthcare settings. As part of a proactive risk assessment, Legionella was cultured from the potable water of an ambulatory care center. Investigation and remediation efforts give important lessons for future programs. METHODS: Chlorine levels, temperatures, the plumbing system and Legionella cultures were assessed. Remediation efforts included: super-heating and flushing of the hot water system, replacement of all drinking fountains with models that do not utilize carbon filters,
APIC 46th Annual Educational Conference & International Meeting| Philadelphia, PA | June 12-14 2019
Poster Abstracts / American Journal of Infection Control 47 (2019) S15−S50
point toward a surface-component contamination and tissue-air risk connection. This investigation was designed to seek new data regarding any FAW-bacteria correlation in an effort to both better understand possible, associated, FAW-use risks and contribute to infection-control protocols that more effectively assist in mitigating or diminishing consequential Healthcare Associated Infection (HAI) risk. METHODS: A total of 320 surface and air samples were collected and cultured from in and around 35 unique FAW devices actively in-use in operating room (OR) settings at three hospital facilities in an associated acute-care system. Surface samples were taken from multiple FAW device points: the internal hose surface, the proximal hose end and the distal hose end. Each retrieved sample was bagged, plated and incubated under sterile procedures. RESULTS: The results show that 24.4 percent (78 of 320) of all samples collected were at higher than maximum acceptable Colony Forming Unit (CFU) pathogens levels. Forty-two and half, 42.5, percent (136 of 320) of all samples were at higher than minimum acceptable CFU levels; 37.2 percent (119 of 320) were equipment samples; 5.3 percent (17 of 320) were air samples. Study results also identified a correlation of positive airborne samples for instances that had high-pathogen contamination in the warmer-temperature components, resulting in a possible increased patient infection risk and possible attributable SSI as primary concerns. CONCLUSIONS: FAW device-component contamination may be a risk in the OR. Cross-contamination of the environment remains a risk as well. A reduction in surface and airborne CFUs may positively reduce SSI and HAI infection risk.
Presentation Number ECR-65 The Hidden Truth in the Faucets: A QualityImprovement Project and Splash Study of Hospital Sinks Kristen VanderElzen MPH, CIC, Michigan Medicine; Harry Zhen BS; Emily Shuman MD; Amanda Valyko MPH, CIC, FAPIC BACKGROUND: Sinks are potential sources of Healthcare Associated Infections (HAI) and have been linked to outbreaks. However, transmission of microorganisms from sink to patient is not well understood. Sink contents may be splashed onto patient care items, contaminating them during faucet use. A splash study was performed to understand the splash potential of the different faucet and sink designs in a larger academic teaching hospital in the Midwest, and an audit of sink cleanliness was conducted. METHODS: Faucets/sinks in intensive care units (ICU) were assessed. Adenosine triphosphate (ATP) monitoring was used to assess cleanliness of the faucet spout and sink bowl/drain cover. Cultures were performed for some faucets/sinks. A splash study was performed using a commercially available fluorescent indicator. Photos were taken to record notable findings during the audit and the splash study. RESULTS: Twenty faucet/sinks in four ICU's were evaluated, and eight different designs were observed. Faucet spouts were more soiled with organic material than sink bowls/drain covers as indicated by higher ATP readings. Pink slime/biofilm was observed on several faucet spouts and aerators. Visible biofilm was associated with higher ATP readings. Aerators were found on sinks where they had been removed previously. Cultures grew Pseudomonas aeruginosa, mold and other environmental organisms. The splash study showed visible splashing on the operator’s body and over four feet from the sink.
CONCLUSIONS: Some sink designs enable splashing sink contents onto patient care items, healthcare worker hands and into patient care spaces. Faucets were much dirtier than expected and a faucet replacement program, eliminating aerators, is currently being developed.
Presentation Number ECR-66 Infection Prevention and Control's Role in the Design and Construction of a new Ambulatory Care Center. Lessons Learned Richard Vogel MS, CIC, FAPIC, New York Presbyterian BACKGROUND: An urban, teaching medical center started designing a new 740,000 sq. foot ambulatory care center in 2013 with the Center scheduled to open in April 2018. Infection Prevention and Control (IPC) was included in the Planning and Design team, attending numerous meetings over the next 3?years. METHODS: At project design meetings, IPC input was incorporated into all areas of the center including Infusion Services, Intervention Radiology, Endoscopy, Ambulatory Surgery, Central Sterile Processing, and Diagnostic Imaging. Input included, the number of Isolation Rooms, number and location of handwashing stations and hand sanitizers, construction materials and finishes, and work flow. IPC signoff of the final design was required for all areas of the Center. At the start of construction, because dust control measures were not needed, IPC was not included in the construction meetings. RESULTS: Towards the end of construction, IPC joined in multidisciplinary weekly walkthrough of the various areas in the Center. Modifications and changes had been made to the design plans without input from IPC. Some of changes the included: Medication room counter use which encroached on the handwashing sink, locations of hand sanitizers, hot water circulating temperature and the addition of a second visual pressure monitor which in some instances was in conflict with the electronic monitor. To fix some of the changes required modification of the already built space. However, others could not be changed and resulted in a space that, from an Infection Prevention and Control perspective was not optmal. CONCLUSIONS: Had IPC continued to attend project meeting during construction, many of the modifications that were made could have been prevented, or a better solution could have been designed. This experience has taught us that IPC should be part of all construction projects for the entire project.
Presentation Number ECR-67 Lessons Learned from Legionella in the water of an Ambulatory Care Center Kristen VanderElzen MPH, CIC, Michigan Medicine; Kevin Thompson MPH, CIC; Amanda Valyko MPH, CIC, FAPIC; Laraine Washer MD BACKGROUND: Water Management Programs are an important part of preventing Legionella infection in healthcare settings. As part of a proactive risk assessment, Legionella was cultured from the potable water of an ambulatory care center. Investigation and remediation efforts give important lessons for future programs. METHODS: Chlorine levels, temperatures, the plumbing system and Legionella cultures were assessed. Remediation efforts included: super-heating and flushing of the hot water system, replacement of all drinking fountains with models that do not utilize carbon filters,
APIC 46th Annual Educational Conference & International Meeting| Philadelphia, PA | June 12-14 2019