IAQ in Healthcare Environments – Transition Healthcare Challenges

As the economy heads further down the slippery slope of what promises to be a deep recession, and our healthcare infrastructure continues to grow and age, it is a naturalĀ  Spectrum Email progression to see more and more IAQ professionals turn to what some believe is a recession resistant market. From ambulatory facilities to long term care, the buildings that make up our healthcare infrastructure are constantly in need of renovations and repair. This new and promising opportunity for IAQ pros offers many long term rewards but is not without new and complex challenges that must be addressed.

Every IEP realizes the importance of appropriate use of antimicrobials, containment barriers and personal protection. Though often times IEPs find the regulations and guidelines they encounter in healthcare facilities to be daunting to say the least. In traditional remediation environments the focus is to ultimately provide an environment free of dangerous pathogens or contaminants. While attention is give to the methodology, often times the end results dwarf the means of acquiring those results. With a host of accepted methods to address indoor air quality in businesses, homes and public spaces the contractor finds themselves able to select from a variety of methods to deal with each issue. In the end it is the air clearance that counts, not so much which method was used to obtain it.

While the end results are just as, if not more important in healthcare environments; far more attention must be paid to the processes used. As many occupants of a healthcare facility cannot be moved and are highly susceptible to infection, there are very specific guidelines in place that govern all maintenance, repair and renovation work in a healthcare facility. Organizations like CDC, APIC and JCAHO have placed standards that apply to all activities that may have an impact on a healthcare environment. This is done with good reason considering the number HAIs (Hospital Acquired Infections) reported annually due to airborne pathogens like Aspergillus, which is disturbed during common daily maintenance. Nosocomial infections caused from routine maintenance reach into the hundreds of thousands each year. These guidelines and regulations are enforced in a facility by ICPs or infection control professionals.

Hospitals continually adapt to new, more stringent CMS guidelines limiting what medical treatments are reimbursable through Medicare or Medicaid, this has caused hospital administration to look more closely at every aspect of infection control in their facility. Beginning in October of 2008, Medicare and Medicaid began limiting payments made to facilities for the treatment of preventable nosocomial infections or conditions. These new CMS guidelines are driven by Section 5001(c) of the Deficit Reduction Act, which could mean that as deficits climb the list of non-reimbursable conditions are likely to grow. Infections like Aspergillosis, which is caused by airborne A.Fumigatus, are common in healthcare facilities. Aspergillus is one airborne pathogen that is commonly disturbed and distributed throughout a facility after maintenance work or renovations. The argument could be made that Aspergillosis is a preventable condition by ensuring appropriate containment and disinfection of disturbed areas.

Infection control professionals in healthcare environments have become increasingly diligent in monitoring the actions of contractors that work in their facilities. It is ICP’s responsibility to ensure all components of the infection control risk assessment are adhered to. While these key people can complicate the lives of the contractors working in healthcare facilities they are also actively saving lives by doing so. ICP’s will monitor and log details about each project to ensure that all compliance issues are being addressed. Two primary issues that impact infection control and prevention in healthcare settings are disinfection of contaminated surfaces with broad spectrum EPA registered disinfectants and appropriate containment of airborne particulate and pathogens.

Choosing the best disinfectant is one way to ensure the best possible level of microbial control during any abatement project in a facility. Healthcare facilities present the IEP with a unique set of challenges in regards to pathogens beyond the standard fungal and bacterial flora. Many of these pathogens can be highly infectious as well as drug resistant making them far more dangerous to the many immunocompromised patients housed in a healthcare facility. When selecting a hospital grade disinfecting it is imperative to keep several things in mind.

Does your disinfectant have sufficient kill claims to address the microbes you might encounter?
While no disinfectant can list every possible organism, it is important to find a disinfectant with the most possible EPA registered kill claims. Look for efficacy data. Disinfectants that do not show efficacy & testing data often have few or irrelevant kill claims and are not sufficient for the challenges found in healthcare facilities. It is also a positive if your disinfectant has EPA approved efficacy in the presence of 98% soil load as opposed to 5% which is required by the EPA. This higher soil load represents real world conditions. Beyond fungicidal kill claims, other claims that you might require involve infectious pathogens like MRSA, E-coli, HIV, Salmonella and Avian Influenza. You may also want to look for a product that can be used on both porous and non-porous surfaces and has disinfectant and sanitizing claims.

Understand what the active ingredients are in your disinfectant
It is essential to know what type of disinfectant is appropriate. Most common disinfectants are formulated using Alcohol, Phenol, Chlorine or a Quaternary Amine Base. There are arguments for each type of disinfectant and it is important to know the facts about the products you are working with. Each has advantages, but some have dramatic disadvantages that might make you think twice about using them.

Quaternary Ammonium Chloride (Quats) –
Examples Shockwave Disinfectant/Sanitizer, IAQ 2000/2500
Quats are often considered easier to use and safer than other disinfectant bases because they are less corrosive, non-carcinogenic and maintain efficacy for extended periods of time. Not all quat based disinfectants are equal though. There are a variety of products with EPA registered kill claims ranging from just a few all the way to over 130. In a healthcare environment it is important to seek out the latter, as the spectrum of microbes likely encountered in a hospital will be much broader than in common remediation situations. Unlike many other disinfectants quats based disinfectants are excellent cleaners making them ideal for surfaces with a large amount of biomaterial like fungi, blood or human waste. As many MDROs like C-DIFF, MRSA and VRE are transmitted by contaminated bodily fluids and waste this is an important factor in the equation to finding the ideal disinfectant for healthcare environments. Quats are highly stable and maintain efficacy even in the presences of high soil load. This makes them ideal for mold remediation as well as blood or bodily fluid spills.

Many IEPs as well as ICPs prefer the use of a quats because they not only offer a broad spectrum of kill claims, but are easy to work with and more cost effective than other options. In addition most quats do not have the drawbacks associated with chlorine, alcohol or phenol based products on the market.

Alcohol
While not as user friendly as quats, alcohol based disinfectants are considered by many to be easier to use than chlorine or phenol based products. High concentration alcohol based disinfectants can however be dangerous in a healthcare environment because of its tendency to open pores and dry skin. This can create openings for microbes to enter the body if not properly protected.

Though high concentration alcohol based disinfectants are generally highly effective against lipophilic viruses they are less active against non-lipid viruses and ineffective against bacterial spores. Generally alcohol disinfectants are not used for equipment immersion due to diminishing efficacy as the alcohol volatilizes. Alcohol disinfectants cannot be used as cleaners thus making them less effective for practical use on many surfaces. Even though some Alcohol based disinfectants can offer a broad spectrum of kill claims, it can be difficult to maintain appropriate wet contact time due to the rapid evaporation rate.

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