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Guidelines For Environmental Infection Control In Health Care Facilities

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Ventilation Specifications For Health

Guideline 6: School Health Services

The following tables from the AIA Guidelines for Design and Construction of Hospitals and Health-Care Facilities, 2001 are reprinted with permission of the American Institute of Architects and the publisher .120

Note: This table is Table 7.2 in the AIA guidelines, 2001 edition. Superscripts used in this table refer to notes following the table.

Cleaning And Sanitation Practices In Food Preparation Areas

The manufacturers instructions regarding the use and maintenance of equipment as well as the use of chemicals for cleaning and sanitizing food contact surfaces should be followed. Food contact surfaces such as those of sinks, tables, equipment, utensils, thermometers, carts should be washed, rinsed and sanitized before each use, between uses and anytime contamination occurs.

Cleaning Best Practices At Patient Care Areas

Housekeeping in the health care setting should be performed on a routine and consistent basis to provide for a safe and sanitary environment. Maintaining a clean and safe health care environment is an important component of infection prevention and control. The frequency of cleaning and disinfecting individual items or surfaces in a particular area or department depends on:

  • a)

    Whether surfaces are high-touch or low-touch

  • b)

    The type of activity taking place in the area and the risk of infection associated with it

  • c)

    The vulnerability of patients housed in the area and

  • d)

    The probability of contamination based on the amount of body fluid contamination surfaces in the area might have or be expected to have

  • See example in Table .

    Table 2 Risk Stratification Matrix to determine the frequency of cleaning

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    Recommendations For Environmental Infection Control In Health

    Rationale for Recommendations

    As in previous CDC guidelines, each recommendation is categorized on the basis of existing scientific data, theoretic rationale, applicability, and possible economic effect. The recommendations are evidence-based wherever possible. However, certain recommendations are derived from empiric infection-control or engineering principles, theoretic rationale, or from experience gained from events that cannot be readily studied .

    The HICPAC system for categorizing recommendations has been modified to include a category for engineering standards and actions required by state or federal regulations. Guidelines and standards published by the AIA, American Society of Heating, Refrigeration, and Air-Conditioning Engineers , and the Association for the Advancement of Medical Instrumentation form the basis of certain recommendations. These standards reflect a consensus of expert opinions and extensive consultation with agencies of the U.S. Department of Health and Human Services. Compliance with these standards is usually voluntary. However, state and federal governments often adopt these standards as regulations. For example, the standards from AIA regarding construction and design of new or renovated health-care facilities, have been adopted by reference by > 40 states. Certain recommendations have two category ratings , indicating the recommendation is evidence-based as well as a standard or regulation.

    Rating Categories

    Category IA.

    Category IB.

    Table B3 Pressure Relationships And Ventilation Of Certain Areas Of Nursing Facilities1

    Background information in the Guideline for Disinfection ...
    Pressure relationships and ventilation of certain areas.

    Area designation


  • The ventilation rates in this table cover ventilation for comfort, as well as for asepsis and odor control in areas of nursing facilities that directly affect resident care and are determined based on nursing facilities being predominantly No Smoking facilities. Where smoking may be allowed, ventilation rates will need adjustment. Areas where specific ventilation rates are not given in the table shall be ventilated in accordance with ASHRAE Standard 62, Ventilation for Acceptable Indoor Air Quality, and ASHRAE Handbook HVAC Applications. OSHA standards and/or NIOSH criteria require special ventilation requirements for employee health and safety within nursing facilities.
  • To satisfy exhaust needs, replacement air from outside is necessary. Table B.3 does not attempt to describe specific amounts of outside air to be supplied to individual spaces except for certain areas such as those listed. Distribution of the outside air, added to the system to balance required exhaust, shall be as required by good engineering practice.
  • Air from areas with contamination and/or odor problems shall be exhausted to the outside and not recirculated to other areas. Note that individual circumstances may require special consideration for air exhaust to outside.
  • The ranges listed are the minimum and maximum limits where control is specifically needed. See A8.31.D in the AIA guideline for additional information.
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    Contributions Were Made By The Following Cdc Staff Members:

    Matthew Arduino, DrPH Joe Carpenter, PE Rodney Donlan, PhD Lynne Sehulster, PhDDivision of Healthcare Quality PromotionNational Center for Infectious Diseases

    David Ashford, DVM, Dsc, MPH Richard Besser, MD Barry Fields, PhD Michael M. McNeil, MBBS, MPH Cynthia Whitney, MD, MPH Stephanie Wong, DMV, MPHDivision of Bacterial and Mycotic DiseasesNational Center for Infectious Diseases

    Dennis Juranek, DVM, MSCNational Center for Infectious Diseases

    Jennifer Cleveland, DDS, MPH

    Recommendations Of Cdc And The Healthcare Infection Control Practices Advisory Committee

    Prepared by 1Division of Healthcare Quality Promotion National Center for Infectious Diseases 2HICPAC member Sharp Memorial Hospital San Diego, California

    The material in this report originated in the National Center for Infectious Diseases, James M. Hughes, M.D., Director and the Division of Healthcare Quality Promotion, Steven L. Solomon, M.D., Acting Director.

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    Infection Control During Construction And Renovation

    Construction and renovation activities in the hospital may be associated with transmission of pathogens such as filamentous fungi, including Aspergillus spp, Candida spp, Fusarium and also bacteria such as Legionella and Nocardia . The most commonly reported hospital construction-related infection is Aspergillus, which represent the greatest threat to neutropenic patients.

    Construction Clean is the level of cleaning performed by construction workers to remove gross soil, dust and dirt, construction materials and workplace hazards within the construction zone. This is done at the end of the day, or more frequently if needed, to avoid accumulation of dust. Hotel Clean and Hospital Clean begin where the construction site ends, i.e., outside the hoarding and are generally done by the staff of the health care setting.

    Prior to the construction and renovation activities, an Infection Control Risk Assessment must be completed. The risk assessment consists of the following 3 steps:-

  • I.

    Identify the type of construction project.

  • II.

    Identify those patient areas at risk.

  • III.

    Match the type of construction activity with the patient risk group.

  • Infection control precautions to be taken for respective class of risks are described in and

    Table B2 Ventilation Requirements For Areas Affecting Patient Care In Hospitals And Outpatient Facilities1

    New CDC guidelines for health care workers

    The format of this section was changed to improve readability and accessibility. The content is unchanged.


  • The ventilation rates in this table cover ventilation for comfort, as well as for asepsis and odor control in areas of acute care hospitals that directly affect patient care and are determined based on health-care facilities being predominantly No Smoking facilities. Where smoking may be allowed, ventilation rates will need adjustment. Areas where specific ventilation rates are not given in the table shall be ventilated in accordance with ASHRAE Standard 62, Ventilation for Acceptable Indoor Air Quality, and ASHRAE Handbook HVAC Applications. Specialized patient care areas, including organ transplant units, burn units, specialty procedure rooms, etc., shall have additional ventilation provisions for air quality control as may be appropriate. OSHA standards and/or NIOSH criteria require special ventilation requirements for employee health and safety within health-care facilities.
  • Design of the ventilation system shall provide air movement which is generally from clean to less clean areas. If any form of variable air volume or load shedding system is used for energy conservation, it must not compromise the corridor-to-room pressure balancing relationships or the minimum air changes required by the table.
  • When required, appropriate hoods and exhaust devices for the removal of noxious gases or chemical vapors shall be provided .
  • Appendix I:

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    Calculation Of Air Sampling Results

    Assuming that each colony on the agar plate is the growth from a single bacteria-carrying particle, the contamination of the air being sampled is determined from the number of colonies counted. The airborne microorganisms may be reported in terms of the number per cubic foot of air sampled. The following formulas can be applied to convert colony counts to organisms per cubic foot of air sampled.1218

    For solid agar impactor samplers:

    C / = N


    N = number of organisms collected per cubic foot of air sampledC = total plate countR = airflow rate in cubic feet per minuteP = duration of sampling period in minutes

    For liquid impingers:

    / = N


    C = total number of colonies from all aliquots platedV = final volume in mL of collecting mediaQ = total number of mL platedP, R, and N are defined as above

    Components Of Hotel Clean

    • Floors and baseboards are free of stains, visible dust, spills and streaks

    • Walls, ceilings and doors are free of visible dust, gross soil, streaks, spider webs and handprints

    • All horizontal surfaces are free of visible dust or streaks

    • Bathroom fixtures including toilets, sinks, tubs and showers are free of streaks, soil, stains and soap scum

    • Mirrors and windows are free of dust and streaks

    • Dispensers are free of dust, soiling and residue and replaced/replenished when empty

    • Appliances are free of dust, soiling and stains

    • Waste is disposed of appropriately

    • Items that are broken, torn, cracked or malfunctioning are replaced

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    Biochemical Oxygen Demand :

    A measure of the amount of oxygen removed from aquatic environments by aerobic microorganisms for their metabolic requirements. Measurement of BOD is used to determine the level of organic pollution of a stream or lake. The greater the BOD, the greater the degree of water pollution. The term is also referred to as Biological Oxygen Demand .

    Assessment Of Cleanliness And Quality


    There are several methods for assessing environmental cleanliness:

  • a.

    Conventional program of direct and indirect observation

  • b.

    Enhanced program of monitoring residual bioburden and environmental marking tools

  • Environmental marking measures the thoroughness of cleaning using a surrogate marking system. It involves the use of a colorless solution or Glo Germ powder or gel that is applied to objects and surfaces in the patients environment prior to cleaning, followed by detection of residual marker immediately after cleaning, usually involving fluorescence under ultraviolet light. Environmental marking may be used either on a daily basis to assess routine cleaning, or prior to discharge to assess terminal cleaning.

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    Environmental Cleaning After Flood

    Flood waters are characterized as either clear water, gray water, or black water . Clear water refers to water from tap or rain water, while gray water refer to water from sinks, showers, tubs, and washers. In contrast, black water refers to flood water contaminated with waste from humans and animals . The recommended post-flood cleaning and disinfection processes are contingent upon the type of flood water and the material to be cleaned. A Spaulding classification is generally recommended for cleaning and disinfection for all healthcare equipment . Special approaches for area decontamination may be needed related to use of ultraviolet light C and use of hydrogen peroxide vaporizers, in situations where fungal bioburden were higher than acceptable level .

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