Infection Control in a Trauma Room

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.