If an environmental source of airborne fungi is not identified, review infection control measures, including engineering controls, to identify potential areas for correction or improvement. Employers must launder workers’ personal protective garments or uniforms that are contaminated with blood or other potentially infectious materials. You may need to download version 2.0 now from the Chrome Web Store. Air-Handling Systems in Health-Care Facilities, C.II. After the last surgical procedure of the day or night, wet vacuum or mop operating room floors with a single-use mop and an EPA-registered hospital disinfectant. in water systems. Where supplemental engineering controls for air cleaning are indicated from a risk assessment of the AII area, install UVGI units in the exhaust air ducts of the HVAC system to supplement HEPA filtration or install UVGI fixtures on or near the ceiling to irradiate upper room air. Using active surveillance, monitor for airborne fungal infections in immunocompromised patients. Category IB”, 2008: “Do not perform disinfectant fogging in patient-care areas. (AIA: 5.1). (AIA: Table 7.2), Maintain airflow patterns and monitor these on a daily basis by using permanently installed visual means of detecting airflow in new or renovated construction, or using other visual methods (e.g., flutter strips, or smoke tubes) in existing PE units. Avoid providing access to nonhuman primates and reptiles as service animals. Avoid the use of upholstered furniture and furnishings in high-risk patient-care areas and in areas with increased potential for body substance contamination (e.g., pediatrics units). (OSHA: 29 CFR 1910.1030 § d.4.ii.A; EPA: 7 USC § 136 et seq.). Direct pedestrian traffic from construction zones away from patient-care areas to minimize the dispersion of dust. (AIA: 5.1). Incorporate certain specifications into the planning, and construction or renovation of AII units. Depending on state regulations on potable water temperature in public buildings, hospitals housing patients at risk for health-care associated legionellosis should either maintain heated water with a minimum return temperature of ≥124°F [≥51°C] and cold water at <68°F [<20°C]), or chlorinate heated water to achieve 1–2 mg/L (1–2 ppm) of free residual chlorine at the tap. Follow manufacturers’ instructions for cleaning and maintaining noncritical medical equipment. Suggested for implementation and supported by suggestive clinical or epidemiologic studies, or a theoretical rationale. Place smallpox patients in negative pressure rooms at the onset of their illness, preferably using a room with an anteroom if available. (OSHA: 29 CFR 1910.1030 § d.2.vii and § d.2.vii.A), Store regulated medical wastes awaiting treatment in a properly ventilated area that is inaccessible to vertebrate pests; use waste containers that prevent the development of noxious odors. Use a very thorough flushing of the water system instead of chlorination if a highly chlorine-resistant microorganism (e.g., Cryptosporidium spp.) Promptly clean and treat scratches, bites, or other wounds that break the skin. The Environmental Health Operational Guidelines (EHOG) manual was developed as a tool to aid Bureau of Environmental Health Services and Local Public Health Agency staff in the routine decision making processes associated with the various environmental public health programs … Launder pillow covers and washable pillows in the hot-water cycle between patients or when they become contaminated with body substances. Handle contaminated textiles and fabrics with minimum agitation to avoid contamination of air, surfaces, and persons. Avoid placing decorative fountains and fish tanks in patient-care areas; ensure disinfection and fountain maintenance if decorative fountains are used in the public areas of the health­ care facility. (States; AHJ), Treat regulated medical wastes by using a method (e.g., steam sterilization, incineration, interment, or an alternative treatment technology) approved by the appropriate authority having jurisdiction (AHJ) (e.g., states, Indian Health Service [IHS], Veterans Affairs [VA]) before disposal in a sanitary landfill. (AIA: 7.2.D3), Do not use a room with a through-the-wall ventilation unit as an AII room unless it can be demonstrated that all required AII engineering controls required are met. The Department of Environmental Health (DEH) enhances San Diegans' quality of life by protecting public health and safeguarding environmental quality, educating the public to increase environmental awareness, and implementing and enforcing local, state, and federal environmental … Use AII rooms for patients with or suspected of having an airborne infection who also require cough-inducing procedures, or use an enclosed booth that is engineered to provide. No recommendation is offered regarding whether more stringent requirements for water quality should be imposed in hemofiltration and hemodiafiltration. (States). Recommendations E.VI.G. Establish and maintain surveillance for airborne environmental disease (e.g., aspergillosis) as appropriate during construction, renovation, repair, and demolition activities to ensure the health and safety of immunocompromised patients. Use AIA guidelines as minimum standards where state or local regulations are not in place for design and construction of ventilation systems in new or renovated health-care facilities. Environmental-surface culturing can be used to verify the efficacy of hospital policies and procedures before and after cleaning and disinfecting rooms that house patients with VRE. Conduct a case-by-case assessment to determine if animal-assisted activities or animal- assisted therapy programs are appropriate for immunocompromised patients. Strongly recommended for implementation and strongly supported by well-designed experimental, clinical, or epidemiologic studies. Flowers and Plants in Patient-Care Areas, F.II. ENVIRONMENTAL HEALTH GUIDELINE. If the patient has to be extubated in the operating room, allow adequate time for ACH to clean 99% of airborne particles from the air (Appendix B, Table B.1) because extubation is a cough-producing procedure. Remediation Strategies for Distribution System Repair or Emergencies, D.IV. Use a smooth-surface ice scoop to dispense ice. Clean and disinfect inflatable tubs unless they are single-use equipment. Use an anteroom to ensure appropriate air balance relationships and provide independent exhaust of contaminated air to the outside, or place a HEPA filter in the exhaust duct if the return air must be recirculated. These recommendations do not apply to newer technologies involving fogging for room decontamination (e.g., ozone mists, vaporized hydrogen peroxide) that have become available since the 2003 and 2008 recommendations were made. Use a 1:100 dilution (500–615 ppm available chlorine) to decontaminate nonporous surfaces after cleaning a spill of either blood or body fluids in patient-care settings. Use portable, industrial-grade HEPA filters temporarily for supplemental air cleaning during intubation and extubation for infectious TB patients who require surgery. Implement culture strategies and potable water and fixture treatment measures in addition to those previously outlined (Water: V). When animals are treated in human health-care facilities, avoid treating animals in operating rooms or other patient-care areas where invasive procedures are performed (e.g., cardiac catheterization laboratories, or invasive nuclear medicine areas). (DHHS: BMBL), Conduct routine employee training on worker safety issues relevant to the animal research facility (e.g., working safely with animals and animal handling). Maintain continuous negative air pressure (2.5 Pa [0.01-inch water gauge]) in relation to the air pressure in the corridor; monitor air pressure periodically, preferably daily, with audible manometers or smoke tubes at the door (for existing AII rooms) or with a permanently installed visual monitoring mechanism. Follow the manufacturer’s instructions for cleaning. Adhere to current AAMI standards for quality assurance performance of devices and equipment used to treat, store, and distribute water in hemodialysis centers (both acute and maintenance [chronic] settings) and for the preparation of concentrates and dialysate. Natural ventilation for infection control in health … Do not use UV lights to prevent surgical-site infections. CDC is not responsible for Section 508 compliance (accessibility) on other federal or private website. (DHHS: BMBL), Biosafety level 4 laboratories must inactivate microbiological wastes in the laboratory by using an approved inactivation method (e.g., autoclaving) before transport to and disposal in a sanitary landfill. After each patient, discharge water and air for a minimum of 20–30 seconds from any dental device connected to the dental water system that enters the patient’s mouth (e.g., handpieces, ultrasonic scalers, and air/water syringe). (ASHRAE: 12:2000). Note: ADHS is open Monday through Friday from 8 a.m. to 5 p.m., except state holidays. Seal windows in work zones if practical; use window chutes for disposal of large pieces of debris as needed, but ensure that the negative pressure differential for the area is maintained. This issue will be revisited as additional evidence becomes available. Change the mop head at the beginning of the day and also as required by facility policy, or after cleaning up large spills of blood or other body substances. * Indicates a change to the numbering system. Edit: An * indicates recommendations that were renumbered for clarity. Recommendations from AIA guidelines cite the appropriate sections of the standard). If hands are not visibly soiled or contaminated with proteinaceous material, include an alcohol-based hand rub in the hand hygiene process. In patient-care areas, for major repairs that include removal of ceiling tiles and disruption of the space above the false ceiling, use plastic sheets or prefabricated plastic units to contain dust; use a negative pressure system within this enclosure to remove dust; and either pass air through an industrial grade, portable HEPA filter capable of filtration rates ranging from 300–800 ft3/min., or exhaust air directly to the outside. Maintain a high index of suspicion for health-care–associated Legionnaires disease, and perform laboratory diagnostic tests for legionellosis on suspected cases, especially in patients at risk who do not require a PE for care (e.g., patients receiving systemic steroids; patients aged ≥65 years; or patients with chronic underlying disease [e.g., diabetes mellitus, congestive heart failure, or chronic obstructive lung disease]). * on the wall near the ceiling or suspended from the ceiling as an upper air unit; * in the air-return duct of an AII room; or. (ASHRAE: 12:2000), Maintain towers according to manufacturers’ recommendations, and keep detailed maintenance and infection control records, including environmental test results from legionellosis outbreak investigations. Maintain the integrity of mattress and pillow covers. Environmental Health Program. (OSHA: 29 CFR 1910.1030 § d.4.ii.A, interpretation), If a spill occurs on carpet tiles, replace any tiles contaminated by blood and body fluids or body substances. Specifically, the 2003 and 2008 Guidelines state: These recommendations refer to the spraying or fogging of chemicals (e.g., formaldehyde, phenol-based agents, or quaternary ammonium compounds) as a way to decontaminate environmental surfaces or disinfect the air in patient rooms. Use sterilized textiles, surgical drapes, and gowns for situations requiring sterility in patient care. If plant or flower care by patient-care staff is unavoidable, instruct the staff to wear gloves when handling the plants and flowers and perform hand hygiene after glove removal. Requirements for Carts and Street Vendors Temporary Food License Factsheet Food Service Facilities in Child Care Centers and Family Day Cares Code of Maryland Regulations (COMAR 10.15.03) Baltimore City Health … Establish a facility policy for regular cleaning of fish tanks, rodent cages, bird cages, and any other animal dwellings and assign this cleaning task to a nonpatient-care staff member; avoid splashing tank water or contaminating environmental surfaces with animal bedding. Clean and disinfect mattress covers using EPA-registered disinfectants, if available, that are compatible with the cover materials to prevent the development of tears, cracks, or holes in the cover. (AIA: 1.5.A1), Establish a multidisciplinary team that includes infection-control staff to coordinate demolition, construction, and renovation projects and consider proactive preventive measures at the inception; produce and maintain summary statements of the team’s activities. and E.VI.H. Machines that dispense ice are preferred to those that require ice to be removed from bins or chests with a scoop. Flowers and potted plants need not be restricted from areas for immunocompetent patients. Follow precautionary procedures for TB patients who also require emergency surgery. When implementing strategies for preventing Legionnaires disease among severely immunosuppressed patients housed in facilities with HSCT or solid-organ transplant programs, incorporate these specific surveillance and epidemiologic measures in addition to the steps previously outlined (Water: V and Appendix C). If the facility does not treat severely immunocompromised patients, conduct an epidemiologic investigation, including retrospective review of microbiologic, serologic, and postmortem data to look for previously unidentified cases of health­ care–associated Legionnaires disease, and begin intensive prospective surveillance for additional cases. Clean and disinfect the polyester filter sheet thoroughly, especially between patients, using an EPA-registered product, if available. (AIA: 7.2.D3), * air supply and exhaust rate sufficient to maintain a 2.5 Pa [0.01-inch water gauge] negative pressure difference with respect to all surrounding spaces with an exhaust rate of ≥50 ft3/min. (Municipal order; ASHRAE 12:2000). When using phenolic disinfectants in neonatal units, prepare solutions to correct concentrations in accordance with manufacturers’ instructions, or use premixed formulations. You will be subject to the destination website's privacy policy when you follow the link. (DHHS: BMBL), Biosafety level 3 laboratories must inactivate microbiological wastes in the laboratory by using an approved inactivation method (e.g., autoclaving) or incinerate them at the facility before transport to and disposal in a sanitary landfill.101 (DHHS: BMBL). Minimize contact with animal saliva, dander, urine, and feces. PEHSUs are a network of medical experts that offer guidance to health care professionals and the public on prevention, diagnosis, management, and treatment of environmental conditions that affect reproductive and children’s health. Report the cases to the state and local health departments where required. * short-term evaluation of the impact of infection-control measures or changes in infection- control protocols. Extubate and allow the patient to recover in an AII room. Use an EPA-registered anti-fungal biocide (e.g., copper-8-quinolinolate) for decontaminating structural materials. 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