Environment of Care (CAMCAH / Critical Access Hospitals)
Q. In reviewing the utility management standards, I see that one goal for these standards is to "reduce the potential for organizational acquired illness", but there is no prescriptive standards given as to how this is to be done. What references should I be using?
Utility System and Acquired Illness
Updated | November 24, 2008
A. This standard was written globally to take advantage of new technologies as they evolve. It is important to remember that this is a utility equipment standard, not an infection control standard. This addition under utilities was designed to engender communication between plant managers and infection control professionals. Collaboration between the plant managers and infection control professionals most likely will include the review and approval of engineering policies and procedures related to inspections and preventive maintenance, and the culturing guidelines to be used if there is a case of a suspected or known nosocomial infection.
Regarding water based systems, guidance for how this may be accomplished can be found in ASHRAE 12-2000 (See www.ashrae.org) or in the CDC Guidelines for Environmental Infection Control in Healthcare Facilities. (See www.cdc.gov.)
Regarding the correct design, installation and maintenance of air handling and ventilation systems, the areas of concern are 1) pressure relationships; 2) air exchange rates; and 3) filtration efficiencies. These concerns are paramount in areas of facilities where patients are treated or housed that may have auto immune systems that are suppressed. These areas include operating rooms, special procedure rooms, delivery rooms, protective isolation rooms, laboratories and sterile supply rooms. Guidance for this issue can be found in the AIA Guidelines for Design and Construction of Hospitals and Healthcare Facilities, tables 2 and 3. Given, however, that the AIA Guidelines provide model criteria primarily for new construction, existing facilities currently unable to meet these guidelines should ensure that they maintain original design criteria for these elements to the maximum extent possible. The AIA Guidelines or similar standards or guidelines should then be utilized as design criteria whenever areas are renovated or modernized to accommodate these functions.