A healthcare facility may have to deal with issues related to animate and inanimate entities of surrounding environments. These issues are important, not only for maintaining proper health and hygiene, but are also important from the Hospital Acquired Infection (HAI) point of view. HAI leads to a significant mortality rate and financial loss to the healthcare sector.
According to the World Health Organization (WHO), out of every 100 hospitalized patients at any given time, seven in developed countries and ten in developing countries will acquire at least one healthcare-associated infection. About 30% of the patients in intensive care units (ICU) are affected by at least one healthcare-associated infection in high income nations; however, it is 2-3 times higher in middle or low income countries.
Infections that are not present or incubating at the time of admission to a healthcare facility but appear during and/or after discharge in a patient or occupational infection amongst the caregiver are known as HAI or “Healthcare Associated Infection” in general terms. Technically, it is referred to as a “Nosocomial” infection. These infections may be categorized as clinical and/or environmental depending upon their source. Person to person transmission and use of contaminated materials such blood, serum, etc. are good examples of clinical infection. Whereas infection due to exposure of contaminated air, surface and water in and around facilities are good instances of environmentally imposed infection.
Environmental contaminants are highly influenced by heating, ventilation and air conditioning (HVAC) systems, construction activities, remodeling efforts, aging healthcare buildings, declining equipment, low-priority or deferred maintenance, improper building hygiene, water leakage/damage and natural disasters, etc. besides their source and growth factors. The main sources are comprised of biogenic and/or a-biogenic entities of ambient environments.
These entities are capable of initiating infection in susceptible hosts and substrates. Viruses (influenza, rheo, heptatitus, etc.), bacteria (Methicillin-resistant Staphylococcus aureus (MRSA), Vancomycin resistant enterococci (VRE), Legionella, Pseudomonas, etc.), mold/fungi (aspergilli, penicillia, cladosporia, histoplasmas, trichophytons, microsporums, yeasts, etc.), besides other biogenic contaminants (pollen grains, mites, protozoans, airborne cystic spores, etc.), are linked with a variety of infections. Nuisance dust, Volatile Organic Compounds (formaldehyde, ether, ethyl alcohol, benzene, xylene, etc.) and Microbiological Volatile Organic Compounds (endotoxins, eycotoxins, etc.) alongside environmental factors (such as temperature, light, humidity, etc.) are important sources of infection initiation in healthcare systems. Septicemia, pneumonia, respiratory infections, mycosis, multidrug-resistant organisms (MDROs), Legionnaires', tissue necrosis, hemorrhage, wound infections, folliculitis, endocarditis, meningitis, abscess, skin infection, eye infections, bone and joint infections, eczema, etc. are some important medical conditions that can be appear in individuals due to negligence in management of environmental conditions.
Extraordinary complexity in modern healthcare facilities makes it exceedingly difficult to manage the ambient environment without a coordinated, multidisciplinary action plan. The protection to healthcare personnel and their users against such infections can be minimized or eliminated by implementing good practices for environmental evaluation on a proactive and/or reactive basis around these places.
Some important and common steps in this management are associated with a periodical environmental monitoring. Sustainable, cost-effective intervention in combating infection associated with environmental factors are successfully undertaken by practicing periodical air quality checks, building hygiene assessments, air conveyance, HVAC systems monitoring for microbial proliferation and maintenance issues, adequacy of proper ventilation/lighting, verification and suitability of building envelopes and pressurization, periodical inspection of water distribution systems, moisture intrusion, evaluation of frequently touched surfaces, handling storage and use of medical apparatus/devices/materials/utilities, ensuring decontamination and sterility in medical procedure/process, proper disposal of bio-waste/biohazard, consideration of new development and remolding activities, studies on transmission modes of the infectious agents, surveillance on building as well as residents conditions, testing of biological, chemical and environmental samples collected for the purpose, epidemiologic investigation, efficacy and suitability of recovery and remediation measures, if needed.
The outcome of good practices for environmental infection control in healthcare facilities also enables assistance in the event of emergencies caused by infectious agents that may also include antimicrobial resistant organisms. An environmental auditing program is significant in preventing, sterilizing and disinfecting causal elements and its sources. Good practices for environmental infection control in healthcare facilities is an effective way to improve the quality of lives by avoiding unnecessary suffering and a potential financial savings often due to such affairs.
Author: Dr. Rajiv R Sahay, CIAQP, FIAS
EDLab at Pure Air Control Srvices Inc.
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