A clean sweep: New CDC guidance on environment

Air, water, cleaning all addressed by HICPAC

The first new Centers for Disease Control and Prevention guidelines on infection control and the health care environment in more then 15 years comprise a sweeping look at an area of increasing concern.

While updating the basic measures for cleaning and environmental sampling, the impressive scope of the document covers the gamut of environmental concerns from bad air to insects. (See recommendation highlights, pp. 53-54.) ICPs have until April 20, 2001, to make any comments or suggestions on the guidelines, which were issued by the CDC’s Healthcare Infection Control Practices Advisory Committee (HICPAC).

With patient acuity on the rise and many hospitals trying to extend the life of aging facilities through renovations and expansions, the risk of infection posed by the health care environment has become an increasing concern for ICPs. (See two-part series in Hospital Infection Control, December 1999 and January 2000, under archives at www.HIConline.com.)

Wide variety of environmental approaches

Though environmental issues have become more of a concern, approaches to the issue appear to vary widely by health care setting.

"There is a certain level of controversy and things that we don’t know that well except for some outbreak investigations," says William Scheckler, MD, HICPAC member and professor of medicine at the University of Wisconsin Hospital and Clinics in Madison.

"There is certainly quite a wide variety of environmental contamination with different pathogens." he says.

"But that apparently has different meanings in different places. So the guideline was [an attempt] to at least use the available literature related to safety and cleaning issues," Scheckler points out.

The Guideline for Environmental Infection Control in Healthcare Facilities, 2001 updates and replace portions of the previously published CDC Guideline for Handwashing and Hospital Environmental Control and the environmental infection control portions of the CDC Guideline for Prevention of Nosocomial Pneumonia, 1994.¹ Background Information: Environmental Infection Control in Healthcare Facilities, serves as the background for the consensus recommendations of HICPAC that are contained in Part II, Recommendations for Environmental Infection Control in Healthcare Facilities.

Identifying key elements

The guideline also identifies key process management elements to assist facilities in monitoring compliance with the evidence-based Category IA or IB recommendations provided in Part II.

Those recommendations include:

• conducting a risk assessment prior to construction, renovation, demolition, or major repair projects;

• conducting ventilation assessments related to construction barrier installation; establishing and maintaining appropriate pressure differentials for special care areas (e.g., operating rooms, airborne infection isolation, protective environments);

• evaluating nontuberculous mycobacteria culture results for possible environmental sources;

• implementing infection control procedures to prevent environmental spread of antibiotic-resistant gram-positive cocci and assuring compliance.

(Editor’s note: The CDC environmental guideline has also been posted on your free subscriber web site
at www.HIConline.com.) under "Headline Watch."

Comments on the draft should be submitted to the Resource Center, Attention: EnviroGuide, Division of Healthcare Quality Promotion, CDC, Mailstop E-68, 1600 Clifton Road N.E., Atlanta, GA 30333. Fax: (404) 639-6459. E-mail: [email protected]. Internet URL: http://www.cdc.gov/ncidod/hip/enviro/guide.htm.)

Reference

1. Healthcare Infection Control Practices Advisory Committee (HICPAC). Draft Guideline for Environmental Infection Control in Healthcare Facilities. Atlanta: Centers
for Disease Control and Prevention; 2001. Web site: http://www.cdc.gov/ncidod/hip/enviro/env_guide_draft.pdf.