Transcript Title of Presentation Arial 50pt Bold

Environment of Care
Establishing a Protective Environment
October 25, 2013
Larry Rubin, CPE, CHFM, CHSP, CEM
Senior Director, Facilities Management
Introduction
• CMS/TJC Compliance for
Pressure Differential Rooms
-
Operating Rooms
Isolation Rooms
Sterile Processing
Monitoring
In a Hospital…………….
“Which way does the wind blow?”
Always clean, not dirty!
What’s the Risk?
According to the CDC every year
hospital acquired infections;
• Sicken 9.8 billion
• Kill over 99,000
• Almost 5000 deaths per
year from construction
related hazards
• Adds more than $28
billion to health care
costs
What’s the Risk?
“The Centers for
Medicare &
Medicaid Services
are no longer
reimbursing for the
extra costs
of treating patients
for some hospitalacquired infections
that reasonably
could have been
prevented.
Private insurers are
sure to follow.”
Establishing a Protective Environment
What does The Joint Commission say?
–EC.02.05.01 EP6
In areas designed to
control airborne
contaminants (such as
biological agents, gases,
fumes, dust) the
ventilation system
provides appropriate
pressure relationships
air exchange rates, and
filtration efficiencies
Establishing a Protective Environment
What does The Joint Commission say?
–EC.02.05.01 EP6
Note- Areas designed for control of airborne contaminants
include spaces such as:
• Operating rooms
• Special procedure rooms
• Delivery rooms for patients diagnosed with or
suspected of having airborne communicable diseases
(such as- pulmonary or laryngeal tuberculosis)
• Patients in “protective environment” rooms (such asthose receiving bones marrow transplants)
• Laboratories
• Pharmacies & Sterile supply rooms
What Pressurization is Required by FGI-2010?
Room Type
Air Changes per
Hour (ACH)
Pressure
Class B and C ORs
20
Positive
Delivery Rooms
20
Positive
NICU
6
Positive
Trauma
15
Positive
Medical/anesthesia gas storage
8
Negative
Procedure Room
15
Positive
Protective Environmental room
12
Positive
AII room
12
Negative
Laboratory
Varies
Negative
Pharmacy
4
Positive
Endoscope Cleaning
10
Negative
Soiled or Decontamination Room
6
Negative
What’s the Risk?
Negative Pressure Differential
How NEGATIVE is NEGATIVE
TB
ISOLATION
ROOM
DIRTY
CORRIDOR
-0.01
CLEAN
CDC- “TB isolation rooms
should be checked daily for
negative pressure while being
used for TB isolation. The
minimum pressure difference
necessary to achieve and
maintain negative pressure
that will result in airflow
into a room is very small
(0.01 inch of water) and
pressure-sensing devices
should incorporate an audible
warning with a time delay.”
Negative Pressure
FGI Guidelines
• Differential pressure shall be a minimum of
0.01” water gauge (2.5 Pa)
• Table 7-1 note n : The verification of airflow
direction can include a simple visual method
such as;
• Smoke trail
• Ball-in-tube
• Flutterstrip
Measuring Pressure
Smoke Trail
Measuring Pressure
Flutter Strip
Measuring Pressure
Ball in Tube
Measuring Pressure
Ball in Tube
Measuring Pressure
Portable Monitor
Operating Rooms
Establishing a Protective Environment
–EC.02.05.01
OR Rooms
The ventilation
system provide
appropriate
pressure
relationships, air
exchange rates
and filtration
efficiencies (and
relative humidity
between 20% and
60%).
Establishing a Protective Environment
References- OR
• There is no period for the OR testing implied
• Many hospitals just set up their building automation systems
(BAS) to trend the systems. They also set up alarms in the BAS
if the parameters go out of bounds.
• The OR staff should be trained to recognize conditions that are
not consistent with the normal environmental parameters.
• Even though there is not a "D" by the EP, Surveyors still ask for
documentation during a survey, but cannot write the finding
unless there is no program at all
• The hospital should have a policy that is approved by Facilities
Management and Infection Control and has been fully
implemented.
Leo Gehring, CHFM, CHC, FASHE (25 OCT 11)
Gehring Health Facility Resources
References- OR
• Because there is no specific frequency we survey to the
organization policy
• Generally twice a year (may be reduced to annual based on
trending)
• If the organization has a Building Automation System (BAS)
that monitors (and alarms when out of range) they might test
annually (calibration of the BAS). It really depends on the
organization policy
George Mills, MBA, FASHE, CEM, CHFM, CHSP (25 OCT 11)
Senior Engineer
Standards Interpretation Group
The Joint Commission
Sterile Processing
Establishing a Protective Environment
DISINFECT
CLEAN
STORAGE
DECON
Establishing a Protective Environment
Any Hospital, USA
Establishing a Protective Environment
FGI
Monitoring
Measuring Pressure
Iso-Tek Space Monitor
What is that key switch for?
Does it effect the operation or
readout of the monitor?
-0.01
Measuring Pressure
Iso-Tek Space Monitor
• Differential Pressure shall be a
minimum of 0.01” water gauge
• If alarms are installed,
allowances shall be made to
prevent nuisance alarms of
monitoring devices
• The health of people may
depend on the proper
installation, setup, and
maintenance of this device
-0.01
Measuring Pressure
Iso-Tek Space Monitor
-0.01
EC.02.05.01 EP 6
•
Ventilation system is unable to provide
appropriate pressure relationships, air-exchange
rates and filtration efficiencies
- Specific areas lack
• negative or positive pressures in
relationship to adjacent areas
• i.e. Endoscopy Processing Room should be
negative to the egress corridor
• the correct number of air changes per hour
• Improper filtration
• MERV = minimum efficiency reporting
value
SCREENING
•
Tissue test: only to be used as a pre-screening tool to
evaluate if further investigation needs to occur
- To perform the flutter test take a tissue and let it hang
just off the floor near the bottom edge of a door
- If the tissue indicates incorrect air flow, stabilize the
area by closing doors and windows, wait a few minutes
and retest
- If the organization presents a Testing & Balancing report
the following questions should be asked
• when was the balancing done (seasonal issues)
• are any specific requirements (such as keeping a
door closed) needed to achieve satisfactory results
SURVEY PROCESS
•
EC.02.05.01 EP 6 will generate a CLD
- If the organization can repair the process that
led to non-compliance the LSCS may review
- Following LSCS review, the LSCS may contact
the Central Office to discuss the possibility of
reducing the CLD to SLD, with no change to
the finding
- Resolution should include the area affected by
the equipment identified as non-compliant, not
just the identified room/area
- I.e. ensure zone is balanced
- Is there an ongoing process to assess
References- OR
• Guidelines for Design and Construction of Health Care
Facilities, 2010 Edition, administered by the Federal
Guidelines Institute (FGI) and published by ASHE
• The Joint Commission, Environment of Care standard
EC.02.05.01, EP 6
• CDC "Guidelines for Preventing the Transmission of
Mycobacterium Tuberculosis in Health-Care Facilities,
1994" on October 28, 1994
Pressure Differential Rooms
Wrap-up
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Operating Rooms
Isolation Rooms
Sterile Processing
Monitoring
Questions,
Comments?