Environment Engineering Control

And

Infection Control

CONTENTS PAGE NO.

1. INTRODUCTION 2
2. PURPOSE 2

3. SCOPE 2
4. TARGET AUDIENCE 2

5. RESPONSIBILITY 2
6. POLICY 2

7. VENTILATION SYSTEM & AIR QUALITY 3

7.1 Introduction 3
7.2 Purpose 3
7.3 Local management responsibilities 3
7.4 Maintenance and repairs 3
7.5 Positive pressure 3
7.6 Negative pressure 4
7.7 In Door Air Quality

8. BIOLOGICAL HOOD IN LABORATORY 4

9. THERMOSTATS ON REFRIGERATION UNIT 5

10. WATER HEATER USED TO STERILIZE DISHES 5

11. WATER QUALITY 5

12. ICE MACHINES AND ICE 6

13. CARPETING AND CLOTH FURNISHINGS 6

14. FLOWERS AND PLANTS IN PATIENT-CARE AREAS 7

15. DEFINITIONS AND ABBREVIATIONS 7

16. RECOMMENDATION – ENVIRONMENTAL SAMPLING 7

17. REFERENCES 8
 1. INTRODUCTION:
Environment Engineering Control
The Environmental health is the interaction between the environment and the health of populations of
people. While environmental health is distinct from environmental protection there are overlaps in many
areas. Environmental health has been defined as "those aspects of human health determined by physical,
biological, and social factors in the environment."

Environmental health and Engineering Controls includes the following:

• Housekeeping services (See Housekeeping Policy)
• Microbiologic sampling procedures (refer to Microbiological sampling Policy) for
environmental controls, including performance controls of cleaning & disinfection machines,
sterilizers, laundry, kitchen, water and other fluids, hand hygiene
• Ventilation & air quality, Air-condition (HVAC) systems, clean air rooms, negative pressure
rooms, and biological hood in laboratory
• Water quality
• Needle stick injuries: Refer to infection control manual regarding needle stick injury
• Construction and renovation policy
• Thermostats on Refrigeration Unit
• Waste management
• Water Heater Used to Sterilize Dishes
• Operation Theatre

2. PURPOSE:
The purpose of this policy is to ensure and provide general guidelines and information about
Environment Engineering Control in HCF from prevention and control of infection point of view.

3. SCOPE
To provide a comprehensive integrated picture about Environment Engineering Control to all HCF staff

4. TARGET AUDIENCE
This policy applies to all involved services in the HCF and all clinical staff should familiarize
themselves with the policy.

5. RESPONSIBILITY
It is the responsibility of each staff member of the concerned unit/ward to deal and to ensure that policy,
procedures, and guidelines of the Environment Engineering Control are implemented and followed
meticulously.

6. POLICY:
The key to minimize the spread of infection is to decrease opportunities for cross contamination,
especially in all involved services of Environment Engineering Control in the HCF.

7. VENTILATION SYSTEM & AIR QUALITY:

7.1 Introduction
This document sets out safety responsibilities and advice associated with ventilation systems within
the HCF which managers are required to incorporate into their directorate/department health and
safety arrangements.

This policy to be used in conjunction with HAAD Policy for Healthcare Facilities Occupational and
Indoor Air Quality. Ref. No. PHP/PHR/OEH/01.
7.2 Purpose
To protect the health and safety of healthcare workers and other staff, patients and their families,
visitors to and contractors of public and private healthcare facilities with respect to conditions,
substances and/or pathogens that are present in air and that are to be limited, or required to be at
certain levels.

7.3 Local management responsibilities

The below mentioned appendix identifies local management responsibilities to the;
User - This is the local manager responsible for unit, e.g. the head of department, operating theatre
manager, head of laboratories etc. and has the responsibilities set out in the below attached table.
Plant Operator - This person will be designated by the user and will operate the equipment in a safe
and correct manner in accordance with training they have received and any appropriate
manufacturers instructions.

7.4 Maintenance and repairs

On no account shall a member of staff attempt the repair or maintenance of any piece of ventilation
equipment. Any problems should be reported as a matter of urgency; via call logging during normal
office hours and site engineer outside these times.

Technical equipment for occupational and indoor air quality measurements must be of internationally
acceptable standard, technically well maintained and must be calibrated as per the manufacturer’s
specifications.

TITLE NAME DUTIES

Verify new system design complies with
standards.
Authorized Person Technical Manager
Validate, audit and advise on installations and
their application.
Test Person To carry out testing on system performance as
Approved Contractor
directed by authorized person.
To ensure planned maintenance schedules are
carried out and maintenance staff is capable of
Maintenance Assistant Operational
carrying out duties.
person Manager (Engineering)
Maintain logbooks on individual ventilation
systems.
Advise on monitoring infection control and
microbiological performance of systems.
To carry out or authorize the carrying out by an
Microbiologist/
Infection Control accredited laboratory, the microbiological tests
Histopathologist
as required.
Liaise with authorized person on system
design.
Plant Operator To operate equipment.
Ensure operators are familiar with system
Person with Unit
User operation, controls, functions, faults and safety
responsibility
procedures.

Reference: http://www.gatesheadpct.nhs.uk/trust_reports/

7.5 Positive air pressure

Positive pressure is a pressure within a system that is greater than the environment that surrounds
that system. Consequently if there is any leak from the positively pressured system it will ingress
into the surrounding environment.
 However, use is made of positive pressure to ensure there is no ingress of the environment into a
supposed closed system. A typical example of the use of positive pressure is the location of a habitat
in an area where there may exist flammable gasses such as found on an oil platform.
Hospitals may have positive pressure rooms such as in Main OR, or for patients with compromised
immune systems. Air will flow out of the room instead of in, so that any airborne germs that may
infect the patient are kept away.

7.6 Negative air pressure

Controlling air pressure in patient's rooms is essential to comply with standards from the Centers for
Disease Control (CDC); Negative Air Pressure room is made to Prevent Cross-Contamination. A
negative pressure room includes a ventilation system designed so that air flows from the corridors, or
any adjacent area, into the negative pressure room, ensuring that contaminated air cannot escape
from the negative pressure room to other parts of the facility.
Washing area of CSSD, Isolation Room and Laboratory are an example of areas that requiring a
negative air pressure with 100% fresh air and 10 air changes per hour, no air is re-circulated.
Isolation rooms should be monitored daily when in use to ensure the negative pressure maintained.
Negative pressure in a room can be altered by changing the ventilation system operation or by the
opening and closing of the room's doors, corridor doors or windows. When an operating
configuration has been established, it is essential that all doors and windows remain properly closed
in the negative pressure room and other areas (e.g., doors in corridors that affect air pressure) except
when people need to enter or leave the room or area.
Reference: http://www.camfilfarr.com/cou_camfil/industries/care/negative_pressure.cfm

7.7 In Door Air Quality

The healthcare facility management is responsible, using a hazard analysis and risk assessment
approach, to decide upon suitable indications, locations and frequency for regular and adhoc
occupational and indoor air quality measurements. Regular occupational and indoor air quality
measurements is conducted in the HCF as often as necessary or indicated by risk assessment, but at
least once yearly as per HAAD Policy for Healthcare facilities – Occupational and Indoor Air
Quality.
For more information refer to point: 16

Keeping records of results of occupational and indoor air quality measurements, technical reports
and measures for at least three full years and make available to HAAD upon request.

Note: Internationally accepted standards, guidelines and recommendations for healthcare facility air
quality management [e.g. CDC Guidelines for Environmental Infection Control in Health
Care Facilities, MMWR June 6, 2003/52(RR10); 1 42] should be adopted wherever necessary
or reasonable, if the matter is not regulated by this policy and standard.

8. BIOLOGICAL HOOD IN LABORATORY:

8.1 Introduction
The HCF is committed to providing faculty and staff who work in laboratories with engineering
controls that minimize their exposure to hazardous materials.
The Laboratory fume hoods are the most important component used to protect laboratory workers
from exposure to hazardous chemicals and agents used in the laboratory. A hood is also an excellent
physical barrier against chemical splashes and explosions.

The design of laboratory hood and ventilation systems must consider their physical environment and
integration into the building’s supply and exhaust systems. System components include the hood,
supply air exhaust requirements, general room ventilation and Variable Air Volume (VAV) controls.
 8.2 Inspection and Preventive Maintenance
As with all mechanical systems, inspections and regular preventive maintenance are critical to ensure
that the laboratory exhaust systems operate without unscheduled interruptions in service. Facilities
Services personnel keep records of all inspections and corrective actions for each laboratory
building. Depending on the item, inspections are done quarterly, semiannually or annually.
Laboratory occupants must receive advanced notification of fan stoppage.

8.3 Annual Testing

Each hood shall be retested and recertified annually. Testing shall occur with HVAC systems
operating at 100%. Qualified and trained personnel shall conduct testing. At a minimum, the
following test procedures will be followed:
1. Visual inspection for hood damage, modifications or congestion.
2. Hood static pressure readings will be checked against the hood’s original baseline readings.
3. Face velocity measurements at the designated working sash position. (To pass, the average
velocity must not be below 90% or above 150% of criteria.
The face velocity criterion is100 fpm at 18 inches sash height.)
4. Hood alarm test, if applicable.

Hoods that pass the annual testing will have labels affixed stating the following:
• Test Date
• Initials of inspector
• Face velocity readings at the standard operating sash opening (usually 18 inches unless otherwise
specified)

8.4 Responsibility: Facilities Services.

9. THERMOSTATS ON REFRIGERATION UNIT:

Refer to Pharmacy Policy regarding refrigerator and thermostat

10. WATER HEATER USED TO STERILIZE DISHES:

The two basic strategies for washing and sterilizing dishes involve high-temperature and low
temperature approaches. Low-temperature dishwashers use the hot water supplied by the kitchen’s
existing water heater – typically this hot water is supplied at 140°F. These dishwashers use a chemical
sanitizing agent in the final rinse and in some cases, a drying agent. High temperature dishwashers use a
booster heater to raise the rinse water temperature to 180°F, hot enough to sterilize the dishes and assist
in the drying process.

9.1 Run the dishwasher only with full loads. The dishwasher uses the same amount of water whether it’s
half-full or completely full
9.2 Turn the dishwasher off at the start of the dry cycle. Open the door and let the dishes air-dry.
9.3 Install pipe insulation on your hot water pipes leading from the sink to the dishwasher.

For information refer to the manufacturer’s manual instructions.

11. WATER QUALITY

Drinking water and water that comes into contact with people should be safe to use. Water also needs to
be available in sufficient quantity so that it promotes good health and hygiene.
We use water in many ways and HCF is involved in developing various standards for water quality for
these different purposes:
Use water that meets nationally recognized standards for drinking water

Drinking water quality - we are involved in drinking water quality monitoring programs to ensure the
availability and adequate supply of water for drinking (outsources Supply).
 Household water quality - we provide treated water for the use of toilet flushing, clothes washing,
general household cleaning and fire fighting.

12. ICE MACHINES AND ICE

Ice machine and ice that comes into contact with people should be safe to use.
1. Do not handle ice directly by hand, and wash hands before obtaining ice.
1. Use a smooth-surface ice scoop to dispense ice
A. Keep the ice scoop on a chain short enough that the scoop cannot touch the floor or keep the
scoop on a clean, hard surface when not in use
B. Do not store the ice scoop in the ice bin.
2. Do not store pharmaceuticals or medical solutions on ice intended for consumption; use sterile ice to
keep medical solutions cold, or use equipment specifically manufactured for this purpose
3. Machines that dispense ice are preferred to those that require ice to be removed from bins or chests
with a scoop
4. Limit access to ice-storage chests, and keep container doors closed except when removing ice
5. Clean, disinfect, and maintain ice-storage chests on a regular basis.
A. Follow the manufacturer's instructions for cleaning.
B. Use an EPA-registered disinfectant suitable for use on ice machines, dispensers, or storage chests
in accordance with label instructions.
C. If instructions and EPA-registered disinfectants suitable for use on ice machines are not available,
use a general cleaning/disinfecting regimen
D. Flush and clean ice machines and dispensers if they have not been disconnected before anticipated
lengthy water disruptions.
6. Install proper air gaps where the condensate lines meet the waste lines.
7. Conduct microbiologic sampling of ice, ice chests, and ice-making machines and dispensers where
indicated during an epidemiologic investigation

13. CARPETING AND CLOTH FURNISHINGS

1. Vacuum carpeting in public areas of health-care facilities and in general patient-care areas regularly
with well-maintained equipment designed to minimize dust dispersion
2. Periodically perform a thorough, deep cleaning of carpeting as determined by facility policy by using
a method that minimizes the production of aerosols and leaves little or no residue
3. Avoid use of carpeting in high-traffic zones in patient-care areas or where spills are likely (e.g., burn
therapy units, operating rooms, laboratories, or intensive care units)
4. Follow appropriate procedures for managing spills on carpeting.
5. Thoroughly dry wet carpeting to prevent the growth of fungi; replace carpeting that remains wet after
72 hours
6. No recommendation is offered regarding the routine use of fungicidal or bactericidal treatments for
carpeting in public areas of a health-care facility or in general patient-care areas.
7. Do not use carpeting in hallways and patient rooms in areas housing immunosuppressed patients
8. Avoid using upholstered furniture and furnishings in high-risk patient-care areas and in areas with
increased potential for body substance contamination (e.g., pediatrics units)
9. No recommendation is offered regarding whether upholstered furniture and furnishings should be
avoided in general patient-care areas.

14. FLOWERS AND PLANTS IN PATIENT-CARE AREAS

1. Flowers and potted plants need not be restricted from areas for immunocompetent patients
2. Designate care and maintenance of flowers and potted plants to staff not directly involved with
patient care
3. If plant or flower care by patient-care staff is unavoidable, instruct the staff to wear gloves when
handling plants and flowers and perform hand hygiene after glove removal
4. Do not allow fresh or dried flowers, or potted plants, in patient-care areas for immunosuppressed
patients
16. RECOMMENDATION – ENVIRONMENTAL SAMPLING
A. General Information
1. Do not conduct random, undirected, microbiologic sampling of air, water, and environmental
surfaces in health-care facilities
2. When indicated, conduct microbiologic sampling as part of an epidemiologic investigation or
during assessment of hazardous environmental conditions to detect contamination or verify
abatement of a hazard
3. Limit microbiologic sampling for quality assurance purposes to: 1) biologic monitoring of
sterilization processes; 2) monthly cultures of water and dialysate in hemodialysis units; and 3)
short-term evaluation of the impact of infection-control measures or changes in infection-control
protocols
B. Air, Water, and Environmental Surface Sampling
1. When conducting any form of environmental sampling, identify existing comparative
standards and fully document departures from standard methods.
2. Select a high-volume air sampling device if anticipated levels of microbial airborne
contamination are expected to be low.
3. Do not use settle plates to quantify the concentration of airborne fungal spores.
4. When sampling water, choose growth media and incubation conditions that will facilitate
recovery of waterborne organisms.
5. When using a sample/rinse method for sampling an environmental surface, develop and
document a procedure for manipulating the swab, gauze, or sponge in a reproducible manner so
that results are comparable.
6. When environmental samples and patient specimens are available for comparison, perform
the laboratory analysis on the recovered microorganisms down to the species level at a minimum,
and beyond the species level if possible

17. DEFINITIONS AND ABBREVIATIONS:

• CDC: Centers for Disease Control
• CSSD: Central Sterilization Supplies Department
• Medical waste: Medical waste is defined as materials capable of causing harm (diseases or injury) to
human or environment if inappropriately disposed
• Sharps: Needles, infusion sets, scalpels, knives, saws, blades, broken glass, and nails.

18. REFERENCE:
• Infection Control Manual
• CDC Guidelines for Environmental Infection Control in Health‐Care Facilities, MMWR June 6,
2003/52(RR10);
• http://www.gatesheadpct.nhs.uk/trust_reports/