Title: Strategies for Airborne Infection Control Under Challenging Environments and Patient Conditions
1Strategies for Airborne Infection Control Under
Challenging Environments and Patient Conditions
- ENGINEERING CONTROLS
- Wayne R. Thomann, Dr.P.H
- Duke University Medical Center
- 2008 APIC Conference
- June 17, 2008
- Denver Colorado
2ON-GOING AND EVOLVING CHALLENGES
- Protective Inpatient Environments
- New Expectations for Inpatient Units
- Organ transplants and oncology patients
- Processing Centers for Cellular Therapies
- Protective Outpatient Environments
- Treatment Centers
- Outpatient surgery
- Community Containment
3ASSESSMENT OF BIOAEROSOL REDUCTION METHODS IN
STEM CELL TRANSPLANT UNITS AT A UNIVERSITY
HOSPITAL
- T. S. Alderman, MS, W.R. Thomann, Dr.P.H., D.L.
Hunt, Dr.P.H. - Duke University Medical Center
4INTRODUCTION
- Fungal Spores Present a Risk of Opportunistic
Infections - Both exogenous and endogenous sources
- Control is Essential to the Safety of
Immunocompromised Patients - Aspergillus sp. represent greatest exogenous
risk
5ENGINEERING CONTROLS FOR A PROTECTIVE ENVIRONMENT
- Long Recognized Infection Control Tool
- New JCAHO Expectation
- Manage airborne infection risks
- CDC Environmental Infection Control Guidelines
6PATIENT UNITS INVESTIGATED
- Standard Intensive Care Unit
- Adult Stem Cell Transplant Unit
- Pediatric Stem Cell Transplant Unit
- All have Different Engineering Controls
- Viable Spore Sampling Methodologies
- Thermo Andersen cascade impaction sampler
- Mattson-Garvin slit-to-agar sampler
7ENGINEERING CONTROL MEASURES FOR STUDY UNITS
indicates that the control measure is
available static pressure indicator installed
within the patient room indicates an
interlocked airlock
8RESULTS - FUNGAL SPORES
- Nine Fungal Genera Isolated
- No Aspergillus sp. Isolated from Patient Rooms in
the Stem Cell Transplant Units - Significantly Lower Spore Counts in Patient Rooms
- Use of All Engineering Controls Resulted in
Significantly Lower Spore Counts
9COMPARISONS OF MEAN SPORE CONCENTRATIONS FOR
PATIENT ROOM SAMPLE LOCATIONS
10MEAN CONCENTRATIONS OF APERGILLUS SP. AND TOTAL
VIABLE SPORES
serves each of the three nursing units
11VIABLE SPORE CONCENTRATIONS AT UNIT ENTRANCES
12PRESSURE CHANGE READINGS TAKEN AT VARIOUS UNIT
DOORWAYS
13MEAN SPORE CONCENTRATIONS IN OCCUPIED VERSUS
UNOCCUPIED ROOMS
14EVOLVING INPATIENT EXPECTATIONS
- At Risk Patients Everywhere/Anywhere
- Our ICU Studies Documented the Risks
- A good, but not great, environment
- Demand to Enhance the Local Environment
- Dont strive for perfection
- Prioritize the improvements
15IMPROVING THE LOCAL INPATIENT ENVIRONMENT
- Room Pressurization
- Central system or local adjunct
- Central system has limitations
- Directional Air Flow
- From breathing zone to door
- Re-Filtration or Air Cleaning
- Address both endogenous and exogenous sources of
contamination
16ENGINEERING CONTROLS FOR REDUCING BIOBURDEN
- Airlock with Interlocking Doors
- Prevent simultaneous openings
- HEPA Re-filtration Units to Manage Endogenous
Sources of Fungal Spores - Directional Airflow from Patient Breathing Zone
to Room Entry - Directional Airflow at gt2.5 Pascals
- Isolate Nursing Units from Stairwell Contaminants
17ADDITIONAL APPLICATIONS OF BIOAEROSOL CONTAINMENT
CONTROL PRACTICES
- Human Tissue Processing Areas
- Tissue Culture Facilities
- Production Pharmacies
18HUMAN MATERIAL PROCESSING LABORATORY
- FDA Regulations 21 CFR parts 210, 211, 600, and
610 - Non-prescriptive so address the intent
- Assure patient safety (asepsis)
- Protect the critical area where sterile product
may be exposed to - Environmental contaminants
- Personnel/process shedding
19IMPACT OF CONTAINMENT ENGINEERING IN A GMP/GLP
LABORATORY
20IMPACT OF CONTAINMENT ENGINEERING IN A GMP/GLP
LABORATORY
21CONDITIONS IN THE ADJACENT UNPROTECTED
ENVIRONMENT
22COFIGURATION OF CRITICAL AREA
23VALIDATION MONITORING IN THE CRITICAL AREA
24PROTECTIVE OUTPATIENT ENVIRONMENTS
- Sicker patients and more complicated procedures
- Oncology treatment facilities and outpatient ORs
- Different standard of care?
- May be Business Occupancy
- Different HVAC systems and controls
25PROVIDING A PROTECTIVE OUTPATIENT ENVIRONMENT
- Pressurization, Directional Air Flow, and
Re-Filtration Remain Critical - Local Application of these Technologies
26COMMUNITY CONTAINMENT
- New Initiative within ASHRAE
- Pressurize for Shelter-In-Place
- Exhaust for Isolation
- Re-Filtration is a Key Component in the Effort
27CONCLUSIONS
- We Can Engineer a Protective Inpatient
Environment - We Must Adapt Our Knowledge to Our New Challenges
- Accept the constraints and limitation
- Be creative in addressing these new obligations
- Set the new standards of care
28CONCLUSIONS
- Use Filtration Units to Pressurize the Space
- Sterile air piped into the containment zone
- Connect to supply air duct or direct discharge
- Re-Filtration within the Space