JCAHO Update for Infection Control: Infection control and the environment of care

Key points to Joint Commission readiness

In a special report on infection control and the environment of care, a Joint Commission publication cited the following suggestions as key points and checklists regarding infection control and the environment of care.1

  • General housekeeping is adequate for dust and odor control.
  • Only facility-approved disinfectants are present on each unit, and they are labeled and used appropriately.
  • Refrigerators are cleaned, temperatures are monitored, and a detection system for power failure is in place.
  • Face shields, goggles, and personal protective equipment are provided to employees and used during procedures and in cleaning when appropriate.
  • Sharps containers are emptied when three-fourths full, and filled sharps containers are secured at all times until properly disposed of by an organization. Linen bags are free of holes/tears and are emptied when two-thirds full.
  • Dirty surgical and other patient care instruments transported though the facility are in a closed cart or bio bag.
  • When required, all high-level disinfection/ sterilization logs are appropriately maintained.

Infection control and equipment, supplies

  • Make sure that instructions for preparing equipment and supplies for contact with care recipients are appropriate and staff members are adhering to these instructions.
  • Provide comprehensive and intensive training for all staff members assigned to reprocessing equipment and supplies.
  • Separate broken pieces of equipment or instruments in the warehouse or storage area.
  • Perform appropriate cleaning, disinfecting, and sterilizing procedures for equipment and supplies.
  • Conduct performance testing with biological indicators (or equivalent) to show effectiveness of sterilization processes.
  • Establish a central sterilizing system to maintain consistency.
  • Quarantine instruments used in neurosurgery, including brain biopsies with unknown diagnoses or uncertain diagnoses, until a confirmation can be determined or use disposable instruments, if possible.
  • Destroy reusable instruments that come into contact with highly infectious tissues that are not proven to respond to regular sterilization techniques.

Infection control and utility systems

  • In addition to combating the bacteria and viruses that flourish on general surfaces and equipment, your facility could be at risk of infection transmitted by water (such as Legionella) or air (such as tuberculosis, aspergillus fungal spores, chickenpox, and measles). One goal of your utility systems management program (EC.1.7) is to reduce the potential for organization-acquired illness.
  • Open communication between plant managers and infection control professionals can decrease risk of pathogens in water and air-handling systems.
  • Utility managers must make sure that equipment that recirculates water continuously is properly designed, accurately installed, and adequately maintained. If this is done, pathogenic biological agents will be controlled and not allowed to harm those with impaired autoimmune systems.
  • Correctly designing, installing, and maintaining air-handling and ventilation systems are also critical to control the spread of infection, specifically pressure relationships, air exchange rates, and filtration efficiencies.
  • The concerns are paramount in areas where staff care for individuals who may have suppressed autoimmune systems, including operating special procedure, delivery, protective isolation, and sterile supply rooms and laboratories.

Infection control and construction

  • The creation and spread of contaminants and other environmental problems resulting from construction and renovation projects are a major concern in health care facilities.
  • When planning projects that involve demolition, you must assess the risks that the project will compromise care in occupied areas of your organization (EC.3.2.1). The risk criteria should address the potential impact on air quality and infection control, among other things.
  • The scope and depth of the particular project drive the degree of the preconstruction risk assessment.
  • For example, replacing a sink in an occupied room might require you to remove individuals from the room and take care that airborne particles are not pulled into the ventilation system. On the other hand, constructing a new wing requires assessing risks and implementing safeguards for fire safety, air quality, infection control, and other criteria in a much more comprehensive and systematic manner.
  • Regardless of the scope and nature of the assessment, your organization must develop and implement controls to reduce risk and minimize the impact.

Reference

1. Joint Commission Resources. The facility manager’s role in infection control: Doing your part to reduce organization-required infections. Environment of Care News: The official Joint Commission Environment of Care News Source. May 2003; Vol 6, Issue 5.