CDC at work on new environmental guidelines

First new guidance in 15 years expected in 2000

The Centers for Disease Control and Preven tion’s principal advisory committee on infection control issues expects to issue new guidelines on infection control in the health care environment in the coming year, Hospital Infection Control has learned. In what will be the first comprehensive CDC update on the issue in 15 years, the environmental infection control guideline is being crafted by the CDC Health care Infection Control Practices Advisory Committee (HICPAC).

While the guideline appeared to be very much a work in progress during discussions at a November meeting of the committee, principal sections will deal with the infection risks of air (i.e., aspergillus) and water (i.e., legionella). In addition, the document will address a host of related issues such as construction projects, air and water sampling, regulated medical waste, and environmental contamination via spills and sewage problems. Early drafts of the document have cited the mounting importance of the health care environment due to such factors as increasing severity of illness in patients, more invasive and life-saving devices, and use of immune-suppressive therapy for transplants.

"We hope to get it published in the year 2000," says Raymond Chin, MD, the HICPAC member who is steering the document through committee discussions and revisions. "I think that most institutions that deal with high-risk patients have something in place. But a lot of institutions look at guidelines as a validation of what they are doing to provide administrators with the background information."

Document will save ICPs some work

Indeed, the availability of the document will give ICPs a good reference point and ease decision making, notes Pat Metcalf, RN, CIC, infection control director at Children’s Hospital in Dallas. "It’ll really save a lot of work because now we’re going to be able to go right to this guideline and say, this is what HICPAC recommended, this is how highly they recommended it, and these are the references that they used.’ It’s going to make life for an infection control person easier."

In addition, a hospital environmental consultant is urging HICPAC to specifically include health care engineers in the target audience to help bolster their budgets. "I think they really need to have something focused right on the engineers because those are the guys whose budgets are most under scrutiny," says Andrew Streifel, MPH, REHS, hospital environment specialist at the University of Minnesota in Minneapolis. "When it comes to preventive maintenance and keeping fan coils, for example, draining properly so that they don’t build up and leak on the ceiling tile, you need people to do that. But, frankly, the hospital cuts them because they’re out of sight and out of mind."

As the CDC guidelines are under development, ICPs can consult the current literature for guidance, including a recent book chapter on the issue co-written by Streifel.¹ His basic environmental recommendations for health care include these key points:

• Air: Air generally should move from cleaner to dirtier locations. Operating rooms and bone marrow transplantation facilities should be considered at the cleanest end of the spectrum. Unne cessary traffic should be effectively excluded from any critical care area. Air-handling systems should be designed flexibly to allow higher-volume air circulation in critical areas. Duct and fan systems should be subject to routine maintenance and cleaning practices, including regular filter changes. Proto cols should be developed to ensure maintenance does not release accumulated build up of lint or other debris that could aerosol ize opportunistic fungal spores.

• Water: Important features of preventive maintenance of water reservoirs include control of temperature, periodic superheating, maintenance of chlorine residuals, routine cleaning of storage tanks and other reservoirs, and avoidance of dead-ends and stagnation. In special systems, such as renal dialysis units, ultraviolet light and/or bacterial filters may be appropriate to ensure consistent control.

• Housekeeping: Protocols should take into account the need for continuous surveillance of potential buildup of moisture conditions and subsequent fungal proliferation. Dust-suppression practices should be emphasized, and cleaning of vents and air conditioners should be routine. Any use of vacuum cleaners should incorporate exhaust filters.

Reference

1. Vesley D, Streifel AJ. "Environmental Services." In: Mayhall, ed. Hospital Epidemiology and Infection Control. 2nd ed. Philadelphia: Lippincott, Williams & Wilkins; 1999, pp. 1,047-1,053.