EPID680 Field Trip: Tour of C.S.

Mott Children's Hospital of the University of Michigan

Jessica Hernandez-Holzman
Tour Guide Name: Jen Sweeney, Infection Preventionist
03/29/18
This essay is submitted to meet partially Competency # 4 of the Hospital and Molecular
Epidemiology Track of Epidemiology MPH Program, University of Michigan, School of Public
Health
Facilities and materials used for HAI prevention

Hospital Acquired Infection (HAI) prevention is one of the most important issues to be conscious
of in a healthcare facility. There are various facilities and materials an epidemiologist would use
to aide HAI prevention such as disinfectants and other cleansing products, various computer
systems (Emerse, Theradoc, MiChart reviews), and rules and regulations implemented by The
Joint Commission to name a few. Technology has increased ease in surveillance to be able to
regulate various HAI rates that would have been difficult if not impossible to do in a reasonable
time frame to inhibit the spread. As requirements and regulations are constantly changing,
epidemiologists must be up to date on the latest regulations so that the healthcare facility can
stay within compliance. One of the most recent regulation changes for healthcare facilities is
100% compliance with hand hygiene. As this is one of the regulations that cannot be monitored
by online health charts, healthcare facilities perform hand hygiene audits to surveil and regulate
healthcare worker’s hygiene practices to ensure that they are within compliance. Strategic
placement of personal protective equipment and signage for contact precautions/isolation rooms
is also essential to ensure that when necessary, the proper equipment is available for
healthcare workers to enter into patient rooms safely. Without these facilities and materials, HAI
prevention would be hindered.

Areas with high risks for HAIs and major challenges to HAI prevention

There are a few areas with high risk for HAIs that need extra attention to ensure the prevention
of HAIs. Some of these high risk areas for HAI transmission are children play areas, soiled
instruments room, waiting rooms, surgery rooms, and construction areas. Surgery rooms need
to be one of the most sterile areas within a hospital to prevent HAIs. During an operation,
patients are the most vulnerable to HAIs as their greatest defense mechanism, their skin, is
open and can easily become infected. Some preventative measures that are taken to reduce
the possibility of a HAI is to educate the patient on pre-operative activities, appropriate use of
prophylactic antibiotics, use of appropriate surgical attire, positive pressure air flow, and
decrease surgical room traffic. Some major challenges to HAI prevention are lack of patient
compliance with pre-operative activities and minimizing the room traffic as it can disrupt the air
flow. These challenges are what epidemiologists target the most to prevent HAIs. One
preventative measure implemented was the increase in air change. The Mott Children’s Hospital
regularly has air changes 3-4 times an hour, while in surgery rooms there are air changes 20-30
times an hour. While there will always be room for improvements to aide in prevention within the
healthcare facility, surgical rooms will always be the most critical area to focus on due to
patients increased vulnerability for contracting a HAI.
Construction within healthcare facilities is another major area with high risks for HAIs. With
constant improvements hospitals implement within their facilities, precautions are needed to
ensure patient safety as well as to prevent common infections that can be associated with
construction. Construction produces a lot of dust which is the main concern that needs to be
contained. Dust from construction can cause invasive mold infections and can cause outbreaks
among hospital patients. Mold can survive in various construction materials such as drywall and
pressboard and once wet, can quickly grow mold and spores. When construction is being done
and dust is produced, this is when those spores are released and can cause disease within
hospitalized patients. This is the reason why regulations are put into place to block off the
construction zones to ensure patient safety and contain the dust produced.

Roles and tasks of hospital epidemiologist in HAI prevention

Hospital epidemiologists have various roles and tasks pertaining to HAI prevention. One of the
roles an epidemiologist holds is to ensure good relationships with healthcare workers on the
floors. Trust and confidence needs to be made between healthcare workers and epidemiologists
to ensure that when problems arise, healthcare workers feel comfortable to approach the
hospital epidemiologist for help with how to move forward in any problem they may have.
Hospital epidemiologists also have to perform audits on the floors to ensure that proper
practices are performed. A positive relationship with healthcare workers will facilitate productive
communication if there is a concern that needs to be addressed during the audits. One of the
major tasks epidemiologist have is to conduct surveillance. Surveillance is important to monitor
infections that are of most concern. Through surveillance, epidemiologist can also track and
identify outbreaks in real time to stop and prevent the spread sooner.

Reflections
During our field trip, touring C.S. Mott Children’s Hospital of the University of Michigan, I grew a
more profound desire to become an epidemiologist within a hospital. Learning more about
various rules and regulations that hospital epidemiologist have to know and understand is very
interesting to me and I like that this is something that can provide a huge impact to patient care
where an attainable difference can be achieved. Some of the most interesting parts of the tour
that I learned was that there needs to be a counter divider for sinks to prevent splash on other
parts of usable counter space, as water can splash as far as 3 feet away. I also learned that for
rooms that don’t have a door, to aide in visualizing the room barrier, Mott Children’s Hospital
taped the floor for these rooms with a red line to indicate the barrier for when to wash hands
before and after leaving the room. We also talked about how much thought goes into various
surfaces throughout the hospital and how some areas are considered to be more high risk than
others. For example, in waiting areas, furniture can have some liquid resistant cloth and some
areas may even have carpet, while patient rooms only have furniture that is wipeable and does
not have carpet. Other surfaces that needed to be easily cleanable were the surfaces in the play
areas the hospital has for kids. The changes made to hospitals to decrease HAIs is something
that is necessary for the benefit of everyone that enter into a hospital. Understanding various
modes of transmission and ways to diminish those routes is key to protect patients, family,
friends, and healthcare workers.