Guidelines for Environmental Infection Control in Health ...

1 Please note: An erratum has been published for this issue. To view the erratum, please click here. Morbidity and Mortality Weekly Report Recommendations and Reports June 6, 2003 / Vol. 52 / No. RR-10. Guidelines for Environmental Infection Control in Health -Care Facilities Recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee (HICPAC). depar tment of Health and human ser department vices services Centers for Disease Control and Prevention MMWR. CONTENTS. The MMWR series of publications is published by the Introduction .. 1. Epidemiology Program Office, Centers for Disease Control and Prevention (CDC), Department of Parameters of the Report .. 1. Health and Human Services, Atlanta, GA 30333. Performance Measurements .. 3. Updates to Previous Recommendations .. 3. SUGGESTED CITATION Key Terms.

2 4. Centers for Disease Control and Prevention. Guidelines for Environmental Infection Control Abbreviations .. 4. in Health -care facilities: recommendations of CDC Recommendations for Environmental Infection and the Healthcare Infection Control Practices Control in Health -Care Facilities .. 5. Advisory Committee (HICPAC). MMWR 2003;52. (No. RR-10):[inclusive page numbers]. Rationale for Recommendations .. 5. Rating Categories .. 5. Centers for Disease Control and Prevention Recommendations Air .. 5. Julie L. Gerberding, , Recommendations Water .. 14. Director Recommendations Environmental Services .. 22. Recommendations Environmental Sampling .. 26. David W. Fleming, Deputy Director for Public Health Science Recommendations Laundry and Bedding .. 27. Recommendations Animals in Health -Care Facilities.

3 28. Dixie E. Snider, Jr., , Associate Director for Science Recommendations Regulated Medical Wastes .. 30. References .. 31. Epidemiology Program Office Stephen B. Thacker, , Director Office of Scientific and Health Communications John W. Ward, Director Editor, MMWR Series Suzanne M. Hewitt, Managing Editor, MMWR Series C. Kay Smith-Akin, Lead Technical Writer/Editor Douglas W. Weatherwax Project Editor Beverly J. Holland Lead Visual Information Specialist Malbea A. Heilman Visual Information Specialist Quang M. Doan Erica R. Shaver Information Technology Specialists Disclosure of Relationship Raymond Chinn is a private-practice physician and salaried employee On the Cover: Left, airborne-particle sampling is used to of Sharp Memorial Hospital in San Diego, California. Dr. Chinn received evaluate construction barriers; right, the efforts of housekeeping no research funds from commercial sources either directly, or indirectly staff are key to Environmental Infection Control in Health -care through awards made to the hospital, before or during the development of facilities.

4 Photos used with permission. this guideline. Vol. 52 / RR-10 Recommendations and Reports 1. Guidelines for Environmental Infection Control in Health -Care Facilities Recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee (HICPAC). Prepared by Lynne Sehulster, Raymond Chinn, 1. Division of Healthcare Quality Promotion National Center for Infectious Diseases 2. HICPAC member Sharp Memorial Hospital San Diego, California Summary The Health -care facility environment is rarely implicated in disease transmission, except among patients who are immunocompromised. Nonetheless, inadvertent exposures to Environmental pathogens ( , Aspergillus spp. and Legionella spp.) or airborne pathogens ( , Mycobacterium tuberculosis and varicella-zoster virus) can result in adverse patient outcomes and cause illness among Health -care workers.

5 Environmental Infection - Control strategies and engineering controls can effectively prevent these infections. The incidence of Health -care associated infections and pseudo-outbreaks can be minimized by 1) appro- priate use of cleaners and disinfectants; 2) appropriate maintenance of medical equipment ( , automated endoscope reprocessors or hydrotherapy equipment); 3) adherence to water-quality standards for hemodialysis, and to ventilation standards for special- ized care environments ( , airborne Infection isolation rooms, protective environments, or operating rooms); and 4) prompt management of water intrusion into the facility. Routine Environmental sampling is not usually advised, except for water quality determinations in hemodialysis settings and other situations where sampling is directed by epidemiologic principles, and results can be applied directly to Infection - Control decisions.

6 This report reviews previous Guidelines and strategies for preventing environment-associated infections in Health -care facilities and offers recommendations. These include 1) evidence-based recommendations supported by studies; 2) requirements of federal agencies ( , Food and Drug Administration, Environmental Protection Agency, Department of Labor, Occupational Safety and Health Administration, and Department of Justice); 3) Guidelines and standards from building and equipment professional organizations ( , American Institute of Architects, Association for the Advancement of Medical Instrumentation, and American Society of Heating, Refrigeration, and Air-Conditioning Engineers); 4) recommendations derived from scientific theory or rationale; and 5) experienced opinions based upon Infection - Control and engineering practices.

7 The report also suggests a series of performance measurements as a means to evaluate Infection - Control efforts. Introduction revises multiple sections ( , cleaning and disinfection of Environmental surfaces, Environmental sampling, laun- Parameters of the Report dry and bedding, and regulated medical waste) from pre- This report, which contains the complete list of recommen- vious editions of CDC's Guideline for Handwashing and dations with pertinent references, is Part II of Guidelines for Hospital Environmental Control ;. Environmental Infection Control in Health -Care Facilities. The incorporates discussions of air and water Environmental full four-part Guidelines will be available on CDC's Division concerns from CDC's Guideline for Prevention of Nosoco- of Healthcare Quality Promotion (DHQP) website.

8 Relative mial Pneumonia;. to previous CDC Guidelines , this report consolidates relevant Environmental Infection - Control measures from other CDC Guidelines ; and includes two topics not addressed in previous CDC guide- The material in this report originated in the National Center for lines Infection - Control concerns related to animals in Infectious Diseases, James M. Hughes, , Director; and the Division Health -care facilities and water quality in hemodialysis of Healthcare Quality Promotion, Steven L. Solomon, , Acting settings. Director. 2 MMWR June 6, 2003. In the full Guidelines , Part I, Background Information: procedures to prevent airborne contamination in operat- Environmental Infection Control in Health -Care Facilities, ing rooms when infectious tuberculosis (TB) patients provides a comprehensive review of the relevant scientific lit- require surgery.

9 Erature. Attention is given to engineering and Infection - guidance regarding appropriate indications for routine Control concerns during construction, demolition, renovation, culturing of water as part of a comprehensive Control pro- and repair of Health -care facilities. Use of an Infection - Control gram for legionellae;. risk assessment is strongly supported before the start of these guidance for recovering from water-system disruptions, or any other activities expected to generate dust or water aero- water leaks, and natural disasters ( , flooding);. sols. Also reviewed in Part I are Infection - Control measures Infection - Control concepts for equipment using water from used to recover from catastrophic events ( , flooding, sew- main lines ( , water systems for hemodialysis, ice age spills, loss of electricity and ventilation, or disruption of machines, hydrotherapy equipment, dental unit water water supply) and the limited effects of Environmental sur- lines, and automated endoscope reprocessors).

10 Faces, laundry, plants, animals, medical wastes, cloth furnish- Environmental surface cleaning and disinfection strategies ings, and carpeting on disease transmission in Health -care with respect to antibiotic-resistant microorganisms;. facilities. Part III and Part IV of the full Guidelines provide Infection - Control procedures for Health -care laundry;. references (for the complete guideline) and appendices, respec- use of animals in Health care for activities and therapy;. tively. managing the presence of service animals in Health -care Part II (this report) contains recommendations for environ- facilities;. mental Infection Control in Health -care facilities, describing Infection - Control strategies for when animals receive treat- Control measures for preventing infections associated with air, ment in human Health -care facilities; and water, or other elements of the environment.