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Overview of topics in CDC Guidelines

The Guidelines for Environmental Infection Control in Health Care Facilities is strongly suggested reading for all facility managers, operating engineers, infection control professionals, safety officers, and other hospital staff involved with establishing policies for environmental infection control and tasked with compliance with JCAHO and other relevant public health requirements. The following is a quick overview of key recommendations made in the Guidelines:

Air-Handling Systems

  • Use AIA guidelines as minimum standards where state or local regulations are not in place for design and construction of ventilation systems (do not apply retroactively for existing construction)
  • Monitor ventilation systems in accordance with engineers recommendations
  • Engineer humidity controls into HVAC systems and monitor controls to ensure adequate moisture removal
  • Prevent dust accumulation by periodically cleaning air-duct grills (when rooms are not occupied by patients)
  • Portable HEPA filter units may be used in patient care areas and construction areas (provided all internal and external surfaces are cleaned and filter performance is verified)
  • Seal windows in buildings with centralized HVAC systems, including protective environment (PE) areas.
  • Develop contingency plan for backup capacity in the event of general power failure with emphasis on restoration of appropriate air quality and ventilation conditions of airborne infectious isolation (AII) rooms, PE rooms, operating rooms, emergency departments, and intensive care units.
  • Do not shut down HVAC systems serving patient care areas except for maintenance, repair, testing, or construction.

Construction, Renovation, Remediation, Repair, And Demolition

  • Incorporate mandatory adherence agreements for infection control in construction contracts with penalties for non-compliance
  • Implement infection control measures for external and internal construction activities including erecting construction barriers to prevent dust from entering patient care areas, seal off and block return air vents, implement dust control measures on surfaces, and relocate patients whose rooms are adjacent to work zones (depending on their immune status, scope of work, etc)
  • Use airborne particle sampling as a tool to evaluate barrier integrity (note, no recommendation is offered regarding routine microbiological air sampling before or during construction or before or during patient occupancy)
  • Commission the HVAC system before occupancy and use with emphasis on ensuring proper ventilation for operating rooms, AII rooms, and PE areas.

Infection Control and Ventilation Requirements for AII rooms, PE areas, and Operating Rooms
A detailed set of performance standards including air pressure and flow relative to adjacent areas, air exchanges per hour, location of supply and exhaust grills, filtration requirements, recirculation of air, use of anterooms, and the recommendation to routinely keep operating room doors closed are all addressed via recommendations.

Water Systems

  • Controlling the Spread of Waterborne Micro-organisms includes a recommendation to avoid placing decorative fountains and fish tanks in patient care areas
  • Routine Prevention of Waterborne Microbial Contamination within the Distribution Systems includes recommendations to maintain hot water temperature at the return at the highest temperature allowable by state regulations or codes, preferably greater or equal to 124 o F and cold water below 68 o F.  If temperatures cannot be maintained above 120 o F, recommendations include periodically increasing the hot water temperature to greater or equal to 150 o F at point of use or using a chlorine flush through the system.  No recommendation is offered for treating water with chlorine dioxide, heavy-metal ions, monochloramines, ozone, or UV light
  • Procedures for collecting and processing environmental specimens for Legionella are provided although no recommendation is offered regarding routine culturing of water systems in health care facilities that do not have patient care areas (i.e. PE or transplant units) for persons at high risk for Legionella infection
  • Recommendations regarding cooling towers include installation of drift eliminators, use of an effective biocide on a regular basis, and maintenance of towers to manufactures’ recommendations.

Environmental Services
Recommendations include the following areas:

  • Cleaning and disinfecting surfaces in patient care areas
  • Cleaning spills of blood and body substances
  • Regulated medical wastes
  • Carpeting and cloth furnishings
  • Flowers and plants in patient care areas
  • Pest control, and
  • Special Pathogens