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Infection Prevention and Control Issues in the Environment of Care, 3rd Edition

Infection Prevention and Control Issues in the Environment of Care, Revised 3rd Edition

Develop or improve an infection control program that will protect patients, staff, and visitors from the threat of HAIs in the environment of care

November 2015, Revised 2017. 178 pages.

  • An individual license is intended for single users only. This ebook cannot be shared, disseminated, downloaded, or posted for widespread or public use. 
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Product Description

Product Description

It’s a sobering fact: Millions of patients in health care organizations around the world develop infections during their stay. Each year, a significant number of them die because of those health care–acquired infections (HAIs). In addition to the human cost, there are financial repercussions: In the United States, treating patients who acquire HAIs costs an estimated $9.8 billion annually.
An organization’s physical environment is inextricably linked to its ability to prevent and control infection. A well-designed, thoughtfully managed environment is the foundation upon which most infection control activities are built. Every health care setting—not just hospitals—faces the challenge of keeping patients and staff free of infection, including HAIs. Those challenges differ by setting. Behavioral health care settings, for example, will not need to worry about negative-pressure isolation rooms, but they may need to address higher numbers of patients with infections such as tuberculosis or hepatitis C. Home care organizations will handle infection control differently because their staff members are providing care in patients’ homes, where the organization has little control over the environment.
Infection Prevention and Control Issues in the Environment of Care, Revised Third Edition, is designed to help infection preventionists, other infection control practitioners, and physical environment professionals collaborate on infection control issues to develop an infection control program that will protect patients, staff, and visitors from the threat of infection. This edition explores various infection control risks, in the United States and abroad, that can be minimized or eliminated through proper management of the physical environment. It has been completely revised with current domestic and international standards, as well as new case studies and tools, and reflects the 2012 Life Safety Code. 
Key Topics: 
  • The connection between infection control and the physical environment 
  • Protecting utility systems from IC risks, including air-handling, ventilation and water distribution systems 
  • The role of leadership in supporting collaboration between clinicians and environment of care professionals to make infection control an organizationwide effort
  • Staff issues associated with infection control in the environment, including hand hygiene and sharps management
  • Proper cleaning, disinfection, sterilization and maintenance of medical and surgical equipment and other items
  • Infection control needs in environmental services and laundry operations, including safely managing medical waste 
  • Special IC considerations to address before, during, and after construction 
  • Emergency management issues related to infections, including infectious disease outbreaks
Key Features:
  • Strategies for using performance improvement and measurement to track, share, and apply data on infection control
  • General and specific guidelines and strategies to organize, improve and benchmark your IC efforts 
  • Case studies that offer examples of plans or projects that have proven effective in a range of health care facilities 
  • Online resources and websites that will help you further examine key issues 
  • Examples of useful tools, pros and cons of various infection control approaches
  • Tracer scenarios 
Standards: Infection Prevention and Control (IC), Environment of Care (EC), Emergency Management (EM); international standards for Prevention and Control of Infections (PCI), Facility Management and Safety (FMS)
Setting: All settings
Key Audience: Infection preventionists, infection prevention and control program leaders, facility managers, environment of care staff, housekeeping 
Table of Contents

Table of Contents


Chapter 1
THE CONNECTION: Infection Control and the Physical Environment
Infection Control Standards and the Infection Control Program
  - GUIDELINES AND REQUIREMENTS: Overview: The Joint Commission Infection Prevention and Control (IC) Standards; Overview: JCI’s Prevention and Control of Infections (PCI) Standards
  - Planning for the Infection Control Program
  • Assigning responsibility
  • Performing risk assessment
  • Creating a plan
  - Implementation of the Infection Control Plan
  • Addressing prioritized process risks
  • Addressing risks of infectious disease
  • Addressing influenza risks
  • Addressing equipment and waste risks
  • Addressing communication and information
  - Evaluation and Improvement of the Infection Control Plan
  • Scheduling evaluations
  • Sharing findings from evaluations
Infection Control and Standards Related to the Physical Environment
  - GUIDELINES AND REQUIREMENTS: Overview: The Joint Commission Environment of Care (EC) Standards Addressing Infection Control; Overview: Joint Commission International (JCI) Facility Management and Safety (FMS) Standards Addressing Infection Control
  - Standards for Demolition, Renovation, and/or Construction
  - Standards for Medical Equipment and Utility Systems
  • The AEM option
  - Standards for Hazardous Materials and Waste
  - Standards for Emergency Power Sources
  - Standards for a Safe and Functional Environment
Infection Control and Patient Safety Goals
  - Patient Safety Goals and Evidence-Based Practices
  - Patient Safety Goals, CLABSI, and CAUTI
Collaboration Among Infection Control and Environmental Professionals
  - A Multidisciplinary Infection Control Team
  • The infection preventionist
  - Typical Collaborative Relationships
  - A Common Understanding: Infectious Organisms
  • Transmission routes
  • Environmental and engineering approaches
  - CASE STUDY: Overview: Infection Control Issues in Opioid Treatment Facilities
  - Environmental Tours for Infection Control
  - Elements of the Environmental Tour
  • Environmental tour policy
  • Environmental tour team
  • Environmental tour checklists
  • Environmental tour interviews
  - TOOL: Infection Control Checklist for Environmental Tours
Tracers for Infection Control
  - Tracers to Evaluate and Assist
  • Tracing functional areas
  • Tracing management processes
  - Infection Control System Tracer
  - TRACER: Sample Scenario: Infection Control System Tracer
Chapter 2
THE HUMAN ELEMENT: Staff and Infection Control Compliance
Collaboration Made Easier
  - Collaboration with Leadership Support
  - Collaboration Over Time and Across Teams
  • Sharing data and other information
Human Factors and Hand Hygiene
  - Human Factor Barriers to Hand-Hygiene Practice
  • Hand-hygiene barriers in developing countries
  - Insufficient Time Spent in Hand Hygiene
  • Alcohol-based hand rubs
  • Soap and water
  - GUIDELINES AND REQUIREMENTS: Comparison of US CDC and WHO Hand-Hygiene Guidelines
  - Delayed Feedback on Hand Hygiene
  - Overcoming the Human Factor Barriers to Hand Hygiene
  • Strategies to overcome psychological/behavioral barriers
  - Hand Hygiene Targeted Solutions Tool™
  - Environmental Input to Hand Hygiene Approaches
  - TOOL: Checklist for Environmental-Related Hand-Hygiene Elements
  • Hand-washing stations
  • Alcohol-based hand rub dispenser placement
  - GUIDELINES AND REQUIREMENTS: Life Safety Standards for Alcohol-Based Hand Rub Dispensers
Human Error and Sharps Management
  - Sharps Prevention Program
  • OSHA bloodborne pathogen standard
  - CASE STUDY: Performance Initiative for Sharps Injury Prevention
  - Logging and Reporting Sharps Injuries
  - TOOL: Sharps Injuries Log
  - Safety Training for Sharps
  - Sharps Disposal Containers
  - TOOL: Sharps Risk Assessment Questionnaire
  - GUIDELINES AND REQUIREMENTS: US NIOSH Performance Criteria for Sharps Disposal Containers
Human Nature and Staff Training and Competency
  - Multidisciplinary Team Approach
  - Basic Education on Infection Control
  • Annual training
  - Collaborative Orientation on Infection Control
  - Infection Control Training for Contract Staff
  • Using services from Joint Commission-accredited organizations
  • Making training the responsibility of the contractors
  - Infection Control Competency
  • Ongoing infection control competency monitoring
  • SPECIAL CONSIDERATIONS for staff training in non-acute care
Chapter 3
CONSTRUCTION PROJECTS: Infection Control Considerations
Infection Control Regulations for Construction Projects
  - FGI Guidelines
  - Other Infection Control and Construction Guidelines
  - GUIDELINES AND REQUIREMENTS: Sample of Key Changes in the 2014 FGI Guidelines
  - RESOURCES: Online Guidelines for Infection Control and Construction
Construction Project Collaboration
  - Executive Project Team
  • Other construction project teams
  - Expert Input
  - Scope of Infection Control Practitioner Involvement
Design Elements for Infection Control
  - Design Elements for Clinical and Ancillary Rooms
  • SPECIAL CONSIDERATIONS for specific patient populations and spaces
  - Design Elements Posing Challenges for Infection Control
  • Sink placement
  • Flooring and carpets
  • Furniture
  - Design Elements for Infection Control in Specific Areas
Sustainable Design and Infection Control
  - Maximizing Environmental and Infection Control Goals
  - RESOURCES: Online Information on Sustainable Design
Infection Control Before Construction
  - Risk Assessments
  • The preconstruction risk assessment
  • Infection control risk assessment
  - TOOL: Infection Control Risk Assessment (ICRA) Matrix
  • Disaster risk assessment
  - Project Responsibility and Accountability
  - Worker Education and Safety
  • Construction workers
  • Organization staff
  - Safe Airflow
  • Negative-pressure isolation rooms
  • SPECIAL CONSIDERATIONS for isolation rooms in nursing care centers
  - SPECIFICATIONS AND RECOMMENDATIONS: Engineered Specifications for Positive-and Negative-Pressure Rooms
  • Temporary barriers for safe airflow
  - Pre-Construction Checklists for Infection Control
  - TOOL: Infection Control Checklist for Construction Projects
Infection Control During Construction
  - Monitoring Construction Zone Materials
  • Materials going in and out
  • Tacky mats
  • Worker clothing
  - Air and Water Samples
  - Common Construction-Related Contaminants
  • Aspergillus and other fungal spores
  • The bacteria Legionella
  • Dust and fibers
  - CASE STUDY: Air Quality During Construction
Infection Control After Construction
  - Post-Construction Agreements
  • Clean-up agreements
  - Pre-Occupancy Walk-Through
Chapter 4
MEDICAL EQUIPMENT: Reprocessing for Infection Control
A Systematic Approach to Reprocessing
  - A Reprocessing Policy
  • Reprocessing guidelines
  • Contracted equipment or services
  - RESOURCES: Organizations to Consult in Developing a Reprocessing Policy
  - The Spaulding System
  • Three types of medical/surgical items
  - Cleaning Medical/Surgical Items
  • When and where to clean
  • How to clean
  - Disinfecting Medical/Surgical Items
  • Types of disinfectants
  • Levels of disinfection
  • Monitoring use of HLDs
  - SPECIFICATIONS AND RECOMMENDATIONS: Spectrum of Activity Achieved by the Main Disinfectants
  • SPECIAL CONSIDERATIONS for laboratories
  - CASE STUDY: Infection Control Risks and Point-of-Care Testing
  - Sterilizing Medical/Surgical Items
  • Pros and cons of sterilization methods
  • Heat-based sterilization
  • Immediate-use steam sterilization (IUSS)
  - SPECIFICATIONS AND RECOMMENDATIONS: Advantages and Disadvantages of Various Sterilization Methods
  - SPECIFICATIONS AND RECOMMENDATIONS: Level of Reprocessing Required for Medical/Surgical Items
Monitoring Reprocessing
  - Sterilizing: Mechanical Indicators
  - Sterilizing: Chemical Indicators
  - Sterlizing: Biological Indicators
  • Response to a positive biological indicator test
  - POLICIES AND PROCEDURES: Protocol for Investigating Exposure Risk Due to Disinfection or Sterilization Failure
  - Sterilizer Maintenance
  • Monitoring of maintenance
  - Monitoring for Policy Compliance
Central Processing
  - Location and Areas of Central Processing
  • Four main areas
  - Packaging and Inspecting
  • Packaging materials
  - Storage and Transport
  - Sterile Surgical Department
  - Central Processing Staff Education and Training
  - SPECIFICATIONS AND RECOMMENDATIONS: AAMI Recommendations for Reprocessing Staff Competency
Biomedical Engineering
  - Infection Risk in Biomedical Engineering
  - Biomedical Staff Education and Training
AEM and Reprocessing Equipment
  - AEM Restrictions
Collaboration in Reprocessing
Reprocessing Single-Use Devices
  - Regulations Regarding SUDs
  - SUDs for TSE Precautions
Reprocessing Endoscopes
  - Standards for Reprocessing Endoscopes
  - CASE STUDY: Verifying the Manual Cleaning Process of Flexible Endoscopes
  • Reprocessing duodenoscopes
  • SPECIAL CONSIDERATIONS for ambulatory/office-based surgery settings
  - Addressing Endoscope Reprocessing Challenges
  - TOOL: Sample Checklist for Reprocessing Endoscopes
Chapter 5
UTILITY SYSTEMS: Infection Control Concerns
Infection Control Regulations for Utility Systems
  - Utility Systems Policies
Infection Control and HVAC Systems
  - SPECIFICATIONS AND RECOMMENDATIONS: HVAC and UVGI to Control Spread of Tuberculosis Infection
  - HVAC Systems Variable: Pressure Relationships
  • Pressure relationships in special ventilation units
  • Regulations for pressure relationships
  - SPECIFICATIONS AND RECOMMENDATIONS: Areas with Special Ventilation Requirements
  - HVAC System Variable: Air Change Rates
  • Regulations for air change rates
  • Effectiveness of a VAV HVAC system
  - HVAC System Variable: Filtration
  • Filtration for fungi
Infection Control and HVAC System Maintenance
  - TOOL: Indoor Air-Quality Maintenance Checklist
  - HVAC Systems Maintenance Tasks
  • Controlling contamination from wildlife
  - AEM for Utility Systems
Other Options: New Technologies and Sustainable Approaches
  - Effective and Economical Future Options
  - Environmentally Sustainable Options
  • Simple green strategies
  • Adjustment and upgrading strategies
Infection Control and Water Distribution Systems
  - EXAMPLES AND ILLUSTRATIONS: Water-Linked Infection Outbreaks in Health Care Organizations
  - Preventing Waterborne Pathogens from Colonizing
  • Risk assessments for waterborne contaminants
  • Interventions for waterborne contaminant risks
  - EXAMPLES AND ILLUSTRATIONS: Interventions for Waterborne Pathogens in a Health Care Facility
  • Interventions for common waterborne contaminant locations
  • Tap water contaminants
  - Disinfecting Water
  - SPECIFICATIONS AND RECOMMENDATIONS: What Every Clinician Needs to Know About Legionnaire’s Disease
  - Surveillance for Legionnaire’s Disease Outbreaks
  • Response to a suspected outbreak
  • Response to a confirmed outbreak
  • Response to elimination of an outbreak
  - Prevention Methods for Legionnaire’s Disease Outbreaks
  • Cooling towers
  • Hot and cold water systems
  - Routine Sampling for Legionella
  - Tracing for Legionella
  - TRACER: Sample Scenario – Legionella Tracer
Chapter 6
Housekeeping and Infection Control
  - TOOL: Checklist for Housekeeping Infection Control
  - Basic Cleaning Methods and Materials
  • Mostly noncritical items
  • Some higher-risk surfaces
  - SPECIFICATIONS AND RECOMMENDATIONS: Ability of Surfaces to Harbor PSAE* Without Cleaning / Ability of Surfaces to Harbor VRE* Without Cleaning
  • Some higher-risk locations
  • General cleaning
  • General disinfection
  - Choosing the Right Cleaning Product
  - SPECIFICATIONS AND RECOMMENDATIONS: Ability of Surfaces to Harbor PSAE* Without Cleaning / Ability of Surfaces to Harbor VRE* Without Cleaning
  - Challenges of Cleaning Patient Rooms
  - CASE STUDY: Technology Solutions for Effective Cleaning
  - Protecting Housekeeping Staff
  • Creating a written schedule
  • Using personal protective equipment
  • Using the right gloves
  - Housekeeping Hot Spots
  • Carts
  • Hand-washing stations
  • Janitor’s closet
Laundry Operations and Infection Control
  • Wash water temperatures
  - Laundry Sorting and Transporting
  • Linen packs
  - Protecting Laundry Staff
  - Policies and Procedures for the Laundry Operations
  • Laundry guidelines to consult
  - GUIDELINES AND REQUIREMENTS: Healthcare Laundry Accreditation Council – Sample Standards
Regulated Medical Waste Disposal and Infection Control
  - Categories of Regulated Medical Waste
  - Treatment and Disposal of Regulated Medical Waste
  - ADVANTAGES AND DISADVANTAGES: Treatment Methods for Regulated Medical Wa
  • Disposal decisions
  - Fluid Waste Disposal
  • Fluid management system
  - Ebola-Contaminated Waste
  - SPECIFICATIONS AND RECOMMENDATIONS: Recommendations for Disposal of Ebola-Contaminated Waste
  - Ebola-Contaminated Waste
  • Precautions for caring for patients with Ebola virus disease
  • SPECIAL CONSIDERATIONS for laboratories
Chapter 7
EMERGENCY MANAGEMENT: Infection Control for Disasters
The EOP/EM Plan
  - The Four Phases of Emergency Management
  • Infection control input into the four phases
  • Surge Capacity
General elements of surge capacity
  • The Hazard Vulnerability Analysis
Assessing the likelihood of specific types of emergencies
  - TOOL: Hazard Vulnerability Analysis
  • Recommendations for Environmental Leaders
Infectious Patient Surges
  - Communication and Infectious Patients Surges
  • Communication about infectious patient surges
  • Communication in response to infectious patient surges
  • Communication about influenza outbreaks
  - TOOL: Organizational Assessment for Influenza Preparedness
  - Managing a Surge of Infectious Patients
  • Establishing an infectious patients surge planning team
  • Preventing the infection from entering the organization
  • Treating patients during an infectious patient surge
  • Addressing staff needs during an infectious patient surge
  - Managing Epidemics
Environmental Considerations for Infectious Disease Outbreaks
  - Isolation Rooms and Anterooms for Infectious Disease Outbreaks
  - Use of PPE for Infectious Disease Outbreaks
  - Training on PAPRs
  - Cleaning for Infectious Disease Outbreaks
  - CASE STUDY: Resuming Service After Blackwater Flooding
  - Infectious Waste from Infectious Disease Outbreaks
  - Victim Decontamination Program
  - Benefits of a victim decontamination program
  - Decontamination Incidents
  - Triage for Decontamination
  • Priorities for decontamination triage
  • OSHA decontamination requirements for triage
  - Decontamination and Equipment
  - Decontamination Facilities
  - Outdoor Decontamination Facilities
  • Portable units
  • Units connected to the facility
  - Climate
  - Privacy
  • Hazardous waste disposal
  - Indoor Decontamination Facilities
  • Work flow and patient flow
  • Supplies and equipment
  • Hazardous waste disposal
  - Additional Decontamination Facilities Issues
  • Chemical incidents
  • Adjustments for containment in the facility
  • Air respirators for PPE
  • Clean and dirty sides
  • Clothing
  - Decontamination Team


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