Oct 17 2017

Support Your Local Infection Control Practitioner

Category: Infection Control,Questions and AnswersBKeyes @ 12:00 am

A ‘Conversation’ Regarding Environmental Services Closets

Q #1: Are housekeeping closets considered clean or dirty rooms and what type of supplies can you store in them? EVS is being advised by Infection Prevention that these are considered dirty and we cannot stores supplies, such as toilet paper, paper towels, trash bags, etc. Thanks in advance for any information you can provide.

A #1: I would agree with your IC people. Their opinion over-rides anything else. They’re the ‘boss’ when it comes to infection control issues, and if they say the room is ‘dirty’ then you cannot store clean supplies in there.

Q #2: Okay then going by that “policy” that means the EVS carts are also dirty, since they are of course stored in the EVS closets, and that then means the cleaners cannot carry supplies on the carts, which is what they are designed for?  I have been cleaning hospitals for 30 years and no offense but this does not make any sense at all.

A#2: Hey… it’s your IC people’s policy… not mine.

Ask them how they want you to deal with this. There is a difference with the cleaning supplies that are stored on the EVS carts, compared with the stacks of paper towels and toilet paper stored in these rooms. The general public does not come into contact with the EVS carts and the supplies on the carts, but they do come into contact with the paper towels and toilet paper. I can see the difference.

I would argue with the IC people that the cleaning supplies on the EVS carts are indeed ‘dirty’ but they can still be used to clean rooms, because the contents inside the cleaning supply bottles are clean. The paper towels and the toilet paper should be kept in a clean environment, but I would argue that the trash bags are dirty as soon as they are used, so there is no reason to store them in a clean environment.

All is well…. Just talk it out with the IC people. They are there to safeguard the health of your staff and patients. Work with them, not against them.

Jan 29 2016

Infection Control in a Trauma Room

Category: Infection Control,Questions and AnswersBKeyes @ 12:00 am

Q: I know it is inappropriate to place a flushing hopper sink in a trauma room between the hand washing sink and clean storage cabinets but I can’t find the standards to back me up. The hospital did not involve Infection Control during this planning phase and I need assistance.

A: My first look is to the Guidelines for Design and Construction of Health Care Facilities, written by the Facilities Guidelines Institute (FGI), 2010 edition. Section 2.1-2.6.10 says soiled workrooms or soiled holding rooms shall be separate from and have no direct connection with clean workrooms or clean supply rooms. It is obvious that a flushing hopper sink and a separate hand washing station are part of a “Soiled Workroom” as defined in 2.1-, and as such is required to be located in a soiled utility room and separated from clean supplies.

Table 7-1 “Design Parameters” in the same book requires soiled workrooms to have a negative air pressure in the room compared to its surrounding area, and clean workrooms are required to have a positive air pressure in the room compared to its surrounding area. That is physically impossible if the soiled and the clean are in the same room.  Also, a soiled workroom must have 2 ½ times the amount of air changes per hour than the clean workrooms.

It does not make sense to have a trauma room in a room that is defined as a soiled workroom. A room with a hopper sink is by definition a soiled workroom. According to Table 7-1, the air pressure in a soiled workroom must be negative, but the air pressure in a trauma room is required to be positive. Again, how can that be if the two rooms are together? The answer is, it can’t. The two rooms have to be separate.

Take this information to the project manager and explain the logic that differentiates their design. If they do not listen and do not change the design, then escalate this issue to a higher authority (your M.D. in charge of Infection Control; or the COO; or the CEO) and explain to them that CMS, Joint Commission, and any other accreditation organization will enforce the FGI guidelines for new construction and the arrangement you describe will be cited and the hospital will be required to resolve this at a later date. Better to resolve it now, while it is still being designed/built, than doing so a couple of years from now.