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Rules Governing the Sanitation of Hospitals, Nursing Homes, Rest Homes and Other Institutions 2002 A

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Title: Rules Governing the Sanitation of Hospitals, Nursing Homes, Rest Homes and Other Institutions 2002 A


1
Rules Governing the Sanitation of Hospitals,
Nursing Homes, Rest Homes and Other
Institutions2002 Amendments Jim Hayes
2
Current Status (Sept 12, 2002)
  • Delayed by pending House Bill 1777
  • HB 1777 was approved by the House of
    Representatives on August 20, 2002 and referred
    to the Senate
  • Senate Health Care Committee Substitute adopted
    September 20, 2002

3
House Bill 1777
  • Delay effective date until March 1, 2003
  • Field test new grading system Oct 1 - Feb 1
  • DEH to train staff of facilities
  • DEH to review rules for duplication
  • DEH to report results to CHS and ERC
  • CHS to have fast track for amending rule changes
    to eliminate unanticipated costs

4
Institutions Subject to The Rules
  • House or feed 13 or more patients or residents
  • Obtain a license or certificate from the NC Dept
    of Health and Human Services
  • These rules do not apply to adult day services

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Approval of Plans
  • Approved by the licensing agency
  • Approved by the local health department
  • Construction must comply with the .1300
    sanitation rules

7
Inspections
  • Institutions are inspected once every 6 months
    and will receive a sanitation grade separate from
    the food service area
  • Food services will be inspected quarterly and
    receive sanitation grades based on the same
    standards as restaurants

8
Reinspections
  • Administrator may request a reinspection to raise
    the posted sanitation grade
  • An unannounced reinspection of an institution
    must be made within 30 days of the request
  • An unannounced reinspection of the food service
    area must be made within 15 days

9
Approved Institutions
  • Sanitation grades are posted separately in the
    resident care and food service areas
  • Grade A 90 percent or better
  • Grade B 80 to 89.5 percent
  • Grade C 70 to 79.5 percent

10
Disapproved Institutions
  • Institution or food service sanitation scores
    below 70 percent are disapproved
  • Conditions dangerous to the health of residents
  • Licensing agency is notified within 24 hours

11
Inspection Form
  • DENR 1213 Inspection of Hospitals, Nursing and
    Rest Homes and Other Institution
  • 48 items each count 1 to 4 of score
  • Non-compliant items can be deducted half credit
    or full credit

12
Items 1 and 2 Floors
  • Smooth, non-absorbent, easy to clean
  • in intensive care units, bathrooms, showers,
    hydrotherapy areas, operating rooms, soiled
    utility rooms, and laundry areas
  • in areas subjected to flooding-type cleaning
  • Carpeting shall be maintained clean, odor free,
    dry and in good repair

13
4 Lighting
  • Sufficient Illumination
  • 10 foot candles 30 inches above the floor in all
    areas
  • Food service areas shall meet 15A NCAC 18A .2600

14
5 Ventilation
  • Clean and good repair
  • Ambient air temperature 65º F. to 85º F.

15
6 Moisture Control
  • Moisture shall be controlled such that there is
    no evidence of microbial growth on interior
    surfaces and objects

16
7 Smoke Exposure
  • Indoor smoking restricted to dedicated smoking
    rooms
  • Smoking rooms shall be ventilated to prevent
    smoke from moving into other occupied portions of
    the building
  • No obligation to establish smoking rooms

17
8 Handwashing Facilities
  • Accessible
  • Where personnel can be exposed to bodily
    excretions or secretions
  • Sterile supply processing areas
  • Medication rooms
  • Laundry areas
  • Nutrition stations
  • Soiled and Clean utility rooms
  • Food preparation areas

18
11 Lavatories
  • Hot and cold running water
  • Mixing faucet or tempered warm water
  • Soap
  • Sanitary towels or approved hand-drying device
  • Handwashing lavatories used only for handwashing

19
11 Lavatories Provided for Use of Patients or
Residents
  • Use only for
  • Handwashing
  • Personal Hygiene
  • Rinsing Feeding Tubes
  • Obtaining Water
  • Shall not be used for disposal of bodily fluids
    or cleaning soiled linens

20
13 Water Heaters
  • Shall Provide Hot Water Within the Temperature
    Range Of 100º F. to 116º F. at all lavatories and
    bathing facilities

21
14 Shared Bathing Equipment
  • Skin contact bathing equipment cleaned and
    disinfected after each patients use
  • Clean with Detergent
  • Disinfect with EPA registered hospital
    disinfectant
  • Follow manufacturers instructions for
    disinfecting equipment with pumps

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14 Disinfectant
  • EPA Registered Hospital Disinfectant
  • Accessible To Bathing Areas
  • Disinfectants Mixed On Site
  • Concentration Assured By
  • Metering Pump
  • Measuring Device Or
  • Chemical Test Kit

27
16 Water Supply Interruption
  • Notify local health department if water supply is
    interrupted for more than 4 hours
  • Have backup water supply plan to provide 25
    gallons per day per patient or resident for up to
    3 days
  • Label or hood water sources if water is
    determined to be unsafe for drinking

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19 Handling of Ice
  • Protect against contamination
  • Ice machines, buckets, other containers, scoops
  • Cleaned on a regular schedule and kept free of
    scum, rust, mold or other contamination
  • Maintained and located where protected from the
    elements and use by unauthorized personnel
  • Stored Ice accessible to patients or the public
    provided through dispensing equipment

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22-23 Solid Waste
  • Stored in leak-proof, covered containers or in a
    vermin-proof room
  • Adequate for storage of all solid waste
  • Kept clean, facilities for cleaning
  • Disposed of frequently
  • Medical waste handled and disposed of in
    according to 15A NCAC 13B .1200

33
Types of Medical Wastes
  • Non-regulated medical waste
  • Sharps - needles, syringes with needles,
    capillary tubes, slides and cover slips, scalpel
    blades
  • Regulated Medical Waste - blood and body fluids
    in containers gt 20 ml, microbiological waste,
    pathological waste

34
23 Requirements for Sharps
  • Sharps placed in container which is rigid,
    leak-proof when in upright position and puncture
    resistant
  • Not compacted prior to disposal

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23 Requirements for Regulated Medical Waste
  • Stored in an area accessible only to authorized
    personnel
  • Treated prior to disposal by incineration or
    sterilization or
  • Packaged in impervious, leak-proof, impact
    resistant bag in a rigid container, labeled and
    picked up by a medical waste hauler within seven
    days

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27 Animal Maintenance
  • Animal areas cleaned to minimize accumulation of
  • Animal Waste
  • Pet Dander
  • Allergens
  • Veterinary records kept on premises

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30 Medication Carts
  • Cleaned when visibly soiled
  • Food utensils handled in a sanitary manner
  • Unused cups covered or inverted
  • Sharps containers secured

46
Can you see anything wrong here?
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31 Miscellaneous
  • Reused Feeding Syringes
  • Labeled with patients name date opened
  • Rinsed after each use stored in a clean
    container
  • Disposed of within 24 hours of first use
  • Tube Feeding Bags
  • Changed According to Manufacturer Instructions
  • Reused Oral Suction Catheters
  • Flushed After Each Use Stored in a Clean
    Container
  • Disposed of Within 24 Hours of First Use

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32 Furnishings
  • Furniture, bed springs, mattresses, sleeping
    mats, curtains, shades, venetian blinds, or other
    furnishings kept clean and in good repair
  • Mattresses shall have non-absorbent cleanable
    covers

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33 Linen
  • Clean Bed Linen
  • Provided for each individual
  • Changed when soiled
  • Soiled Linen
  • Placed in covered container at point of use
  • Handled and stored separately from clean linen
  • Soiled laundry carts labeled

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34 Linen
  • Hot water - at least 160º F
  • Wash with a detergent
  • Low Temperature Less than 160º F.
  • Use chemical laundry disinfectants
  • Clean Linen Storage
  • Stored to prevent contamination
  • Laundry Area and Equipment Kept Clean

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35 Patient Contact Items
  • Kept clean and in good repair
  • Soiled items stored separately from clean items
  • Room or area provided for cleaning
  • Contaminated items cleaned disinfected after
    each use
  • Shared toys subject to mouthing cleaned and
    disinfected with 70 alcohol or 100 ppm chlorine
    after each days use
  • Soiled non-washable items gas sterilized or
    disposed of

58
37 Rehabilitation Activity Kitchens
  • Can use domestic utensils and equipment
  • Can be used to prepare meals for groups of 12 or
    less people
  • Can be used as a serving area for meals catered
    from the main kitchen for groups of 13 or more
    people for planned events from which the public
    is excluded

59
38 Activity Kitchens and Nutrition Stations
  • Provisions shall be made for cleaning and
    sanitizing equipment and utensils
  • Return to central kitchen for cleaning or
  • Provide at least a two-compartment sink with
    counter space at each end
  • Any area where food is portioned, served or
    handled shall be equipped with a separate
    handwash lavatory

60
39 Food Service (for 13 or more)
  • Shall comply with Rules Governing Restaurants and
    other Foodhandling Establishments (15A NCAC 18A
    .2600)
  • Facilities serving food to the public or catering
    food to events outside the facility population
    are already covered under the restaurant rules

61
40 Food Supplies
  • Free from spoilage, adulteration misbranding
  • Safe for human consumption
  • Food from home
  • Stored separately from institution food supply
  • Labeled with persons name and date
  • Kept only as long as it is clean free from
    spoilage

62
42 Food Protection
  • Protected from contamination while being stored,
    prepared transported, displayed and served
  • Maintained at safe temperatures (45º F or below,
    or 140º F or above
  • Potentially hazardous foods served shall be
    consumed or discarded within 2 hours
  • Medications shall be stored in a manner which
    will not contaminate food

63
45 Food Protection
  • No live animals in food prep or storage area
  • Animals are allowed in dining areas
  • In tanks, terrariums or enclosed aviaries
  • Patrol dogs support animals
  • Pets are allowed in dining areas of group
    residences except during meals if
  • Kept out of food storage prep areas
  • Condiments, equipment utensils are protected
  • Surfaces are cleaned before meals

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47 Employees
  • Wear visibly clean outer clothing
  • No tobacco use while preparing or handling food
  • Wash or decontaminate hands
  • Before beginning work
  • After using the toilet
  • Before after patient contact
  • After contact with a source of microorganisms
  • After removing gloves

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47 Employee Handwashing
  • When hands are visibly soiled
  • Vigorously lather for at least 10 seconds and
    rinse
  • Dry with disposable towel or drying device
  • When hands are not visibly soiled it is
    acceptable to use alcohol-based hand antiseptics
  • When water is not available, hand antisepsis can
    be achieved by using detergent containing
    toweletts alcohol-based hand rubs

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