Six Ways to Reduce HAIs Using the Health Care Physical Environment

Wednesday, December 5, 2018
Image: surgeons scrubbing hands

On any given day, 1 in 31 hospital patients has at least one health care-associated infection.

Patients and health care personnel alike enter heath care facilities expecting safe, high quality care and positive health outcomes. The way health care facilities are designed and constructed helps prevent the presence of health care-associated infections (HAIs), protecting patients and caregivers and promoting facility well-being.

The following design, construction, and operational changes can be made to the built environment to support infection prevention and control. The ASHE resource, Using the Health Care Physical Environment to Prevent and Control Infection: A Best Practice Guide to Help Health Care Organizations Create Safe, Healing Environments, created as part of a grant from the CDC, dives deeper into these six topics with case studies and other valuable information.

  1. Infection Control Risk Assessments
    By conducting an infection control risk assessment (ICRA), health care facilities can identify infection risks and potential solutions when designing, constructing, or renovating a space. Organizations should assemble an interdisciplinary team that includes experts in both medical and building sciences to perform the ICRA. A common approach includes five steps:
    1. Identify the hazards.
    2. Decide who might be harmed and how.
    3. Evaluate the risks and decide on the precautions.
    4. Record findings, propose action, and identify who will lead on what action.
    5. Review the assessment and update if necessary.
  2. Hand Hygiene Infrastructure
    Design features should reduce the complexity of hand hygiene and encourage appropriate behaviors. Infrastructure improvements should be considered, such as sinks designed exclusively for handwashing and not patient use, valve faucets that automatically turn on and off, and paper towels in place of warm-air blowers. Alcohol-based hand rub dispensers should be designed in a bright color and placed just outside of patient doorways and next to patient beds to maintain maximum visibility and encourage caregivers to perform hand hygiene regularly.
  3. Reprocessing
    Areas where sterilization or high-level disinfection is performed should be thoughtfully designed to ensure optimal cleanliness. Best practices include bright lighting to maximize visibility, a unidirectional flow from dirty to clean, extra space to accommodate sterilization equipment and personal protective equipment, and proper humidity and ventilation.
  4. Cleaning of Environmental Surfaces
    Traditional cleaning methods do not always sufficiently remove dangerous pathogens from environmental surfaces. Health facilities should assemble a multidisciplinary team to institute a room cleanliness and disinfection plan that includes chemical usage guidelines, cleaning tasks, staff training, and new technology evaluations.
  5. Water-Related Environmental Infection Control
    Facilities should take steps to reduce pathogens as a result of plumbing, specifically the Pseudomonas that grow in stagnant water. Facilities should form a water management team to conduct a risk assessment for all water systems and water-containing equipment, and continually monitor key metrics to ensure water safety.
  6. Flow of Patients, Personnel, Equipment, and Waste
    Designing a space that is properly configured and contains features that ensure the optimal flow to limit cross contamination will drastically reduce the risk of infection transmission. Best practices include separating patients with infectious diseases from other patients through isolation or barriers, controlling airborne contaminants with appropriate airflow and ventilation, properly separating clean and dirty functions, and providing space outside of clinical areas for unpacking shipping boxes and supplies.

A Secondary Benefit: Improving HCAHPS Scores
Along with improving patient and caregiver well-being, measures to reduce HAIs can dramatically improve Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey scores, specifically those related to cleanliness and patient safety. These scores are the voice of the patient, providing insight into the perception of care, and are becoming increasingly more important for facilities in regard to government reimbursement and overall reputation.

Infection prevention is a hot topic and a challenge that many health care facilities face. Attend the following 2019 PDC Summit sessions to learn more: