Follow manufacturers’ instructions for bed maintenance and decontamination. (AIA: 5.1). (AAMI: ANSI/AAMI RD 62:2001), In conjunction with microbiological testing, perform endotoxin testing on product water used to reprocess dialyzers for multiple use. Use routine cleaning protocols for housekeeping surfaces after therapy sessions. Postal Service: CO23.8), Develop a plan for the collection, handling, predisposal treatment, and terminal disposal of regulated medical wastes. Keep operating room doors closed except for the passage of equipment, personnel, and patients, and limit entry to essential personnel. Employers must launder workers’ personal protective garments or uniforms that are contaminated with blood or other potentially infectious materials. These recommendations do not apply to newer technologies involving fogging for room decontamination (e.g., ozone mists, vaporized hydrogen peroxide) that have become available since the 2003 and 2008 recommendations were made. Explore engineering or educational options (e.g., install preset thermostatic mixing valves in point-of-use fixtures or post warning signs at each outlet) to minimize the risk of scalding for patients, visitors, and staff. Collect environmental samples from potential sources of airborne fungal spores, preferably using a high-volume air sampler rather than settle plates. Intubate the patient in either the AII room or the operating room; if intubating the patient in the operating room, do not allow the doors to open until 99% of the airborne contaminants are removed (Appendix B, Table B.1). In patient-care areas, for major repairs that include removal of ceiling tiles and disruption of the space above the false ceiling, use plastic sheets or prefabricated plastic units to contain dust; use a negative pressure system within this enclosure to remove dust; and either pass air through an industrial grade, portable HEPA filter capable of filtration rates ranging from 300–800 ft3/min., or exhaust air directly to the outside. (OSHA: 29 CFR 1910.1030 § d.2.vii and § d.2.vii.A), Store regulated medical wastes awaiting treatment in a properly ventilated area that is inaccessible to vertebrate pests; use waste containers that prevent the development of noxious odors. When sampling water, choose growth media and incubation conditions that will facilitate the recovery of waterborne organisms. (AAMI: ANSI/AAMI RD62:2001), When storage tanks are used in dialysis systems, they should be routinely drained, disinfected with an EPA-registered product, and fitted with an ultrafilter or pyrogenic filter (membrane filter with a pore size sufficient to remove small particles and molecules ≥1 kilodalton) installed in the water line distal to the storage tank. Establish employee occupational health programs specific to the animal research facility, and coordinate management of postexposure procedures specific for zoonoses with occupational health clinics in the health-care facility. Recommendations E.VI.G. Designate care and maintenance of flowers and potted plants to staff not directly involved with patient care. Routine Prevention of Waterborne Microbial Contamination Within the Distribution System, D.III. Keep emergency doors and exits from PE rooms closed except during an emergency; equip emergency doors and exits with alarms. (AIA: 7.2.D3), Do not use a room with a through-the-wall ventilation unit as an AII room unless it can be demonstrated that all required AII engineering controls required are met. Do not use mats with tacky surfaces at the entrance to operating rooms or infection-control suites. * Locate duct humidifiers upstream from the final filters. Natural ventilation for infection control in health … Follow appropriate procedures for use of areas with through-the-wall ventilation units. (States; ASHRAE: 12:2000). Clean and disinfect using EPA-registered products or sterilize equipment that has been in contact with animals, or use disposable equipment. Controlling the Spread of Waterborne Microoganisms, D.II. (Municipal order), After the advisory is lifted, run faucets and drinking fountains at full flow for ≥5 minutes, or use high-temperature water flushing or chlorination. is suspected as the water contaminant. Use a very thorough flushing of the water system instead of chlorination if a highly chlorine-resistant microorganism (e.g., Cryptosporidium spp.) Review pressure differential monitoring documentation to verify that pressure differentials in the construction zone and in PE rooms were appropriate for their settings. Flush and restart equipment and fixtures according to manufacturers’ instructions. Select portable HEPA filters that can recirculate all or nearly all of the room air and provide the equivalent of ≥12 ACH. The Environmental Health Operational Guidelines (EHOG) manual was developed as a tool to aid Bureau of Environmental Health Services and Local Public Health Agency staff in the routine decision making processes associated with the various environmental public health programs … Do not use large-volume room air humidifiers that create aerosols (e.g., by Venturi principle, ultrasound, or spinning disk) unless they are subjected to high-level disinfection and filled only with sterile water. (FDA: 21 CFR 801.5, 807.87.e). Use either soap and water or alcohol-based hand rubs when hands are not visibly soiled. When indicated, conduct microbiologic sampling as part of an epidemiologic investigation or during assessment of hazardous environmental conditions to detect contamination and verify abatement of a hazard. Ensure proper operation of the air-handling system in the affected area after erection of barriers and before the room or area is set to negative pressure. (EPA: 7 USC § 136 et seq.). Disposal Plan for Regulated Medical Wastes, I.III. Create and maintain negative air pressure in work zones adjacent to patient-care areas and ensure that required engineering controls are maintained. Avoid damaging the underground water distribution system (i.e., buried pipes) to prevent soil and dust contamination of the water. Provide patients with sterile water for tooth brushing, drinking, and for flushing nasogastric tubing during legionellosis outbreaks. (States; AHJ). (AIA: Table 7.2), Filter all recirculated and fresh air through the appropriate filters, providing 90% efficiency (dust-spot testing) at a minimum. (EPA: 7 USC § 136 et seq. (AIA: 7.2.C, 7.2.D), When UVGI is used as a supplemental engineering control, install fixtures, Seal windows in buildings with centralized HVAC systems and especially with PE areas. Wash hands with soap and water, especially if hands are visibly soiled. If a spill involves large amounts of blood or body fluids, or if a blood or culture spill occurs in the laboratory, use a 1:10 dilution (5,000–6,150 ppm available chlorine) for the first application of germicide before cleaning. Requirements for Carts and Street Vendors Temporary Food License Factsheet Food Service Facilities in Child Care Centers and Family Day Cares Code of Maryland Regulations (COMAR 10.15.03) Baltimore City Health … Monitor barriers and ensure the integrity of the construction barriers; repair gaps or breaks in barrier joints. Use barrier protective coverings as appropriate for noncritical equipment surfaces that are. Air-Handling Systems in Health-Care Facilities, C.II. Select EPA-registered disinfectants, if available, and use them in accordance with the manufacturer’s instructions. (OSHA; 29 CFR 1910.134,139). Environmental-surface culturing can be used to verify the efficacy of hospital policies and procedures before and after cleaning and disinfecting rooms that house patients with VRE. Monitor negative air flow inside rigid barriers. * make appropriate arrangements to address the patient’s needs in the absence of the service animal. (AIA: 7.2.C3), Conduct an infection-control risk assessment (ICRA) and provide an adequate number of AII and PE rooms (if required) or other areas to meet the needs of the patient population. (OSHA: 29 CFR 1910.1030 §d.4.iv), Use leak-resistant containment for textiles and fabrics contaminated with blood or body substances. Advise patients to avoid contact with animal feces and body fluids such as saliva, urine, or solid litter box material. Provide adequate, usable, and appropriate training, education, and informational material ... See “Guidelines for Environmental … limiting exposures to hazardous physical, chemical, and biological agents in air, water, soil, food, and other environmental media or settings that may adversely affect human health. Choose chemicals suitable for low-temperature washing at proper use concentration if low- temperature (<160°F [<71°C]) laundry cycles are used. (AIA: 7.2.D3). * covering debris and securing this covering before removing debris from the work zone. Flush the water system to clear sediment from pipes to minimize waterborne microorganism proliferation. Place laboratory specimens (e.g., fixed sputum smears) in covered containers for overnight storage. Install screens on all windows that open to the outside; keep screens in good repair.107. Minimize the length of time that immunocompromised patients in PE are outside their rooms for diagnostic procedures and other activities. Develop and maintain cleaning and disinfection procedures to control environmental contamination with agents of Creutzfeldt-Jakob disease (CJD), for which no EPA-registered product exists. If laundry chutes are used, ensure that they are properly designed, maintained, and used in a manner to minimize dispersion of aerosols from contaminated laundry. (AIA: 5.1, 5.2.B, C), Coordinate HVAC system maintenance with infection-control staff to allow for relocation of immunocompromised patients if necessary. Evaluate for possible environmental sources (e.g., potable water) of specimen contamination when waterborne microorganisms (e.g., NTM) of unlikely clinical importance are isolated from clinical cultures (e.g., specimens collected aseptically from sterile sites or, if post-procedural, colonization occurs after use of tap water in patient care). Save and subtype isolates of Legionella spp. This program is responsible for the implementation and enforcement of state regulations as delegated by the Maryland Department of the Environment and the Department of Health … (OSHA: 29 CFR 1910.1030 § d.4.ii.A, interpretation), If a spill occurs on carpet tiles, replace any tiles contaminated by blood and body fluids or body substances. Incinerate medical wastes (e.g., central nervous system tissues or contaminated disposable materials) from brain autopsy or biopsy procedures of diagnosed or suspected CJD patients. If cooling towers or evaporative condensers are implicated in health-care–associated legionellosis, decontaminate the cooling-tower system. Maintain the integrity of mattress and pillow covers. Clean noncritical medical equipment surfaces with a detergent/disinfectant. The Bureau of Environmental Health is comprised of two programs: Environmental Inspection Services and Animal Services. Recommendations from regulations adopted at state levels are also noted. (States; AHJ), Treat regulated medical wastes by using a method (e.g., steam sterilization, incineration, interment, or an alternative treatment technology) approved by the appropriate authority having jurisdiction (AHJ) (e.g., states, Indian Health Service [IHS], Veterans Affairs [VA]) before disposal in a sanitary landfill. Maintain a high level of surveillance for waterborne disease among patients after a boil water advisory is lifted. Keep mattresses dry; discard them if they become and remain wet or stained, particularly in burn units. Avoid dusting methods that disperse dust (e.g., feather-dusting). * uncertainty exists regarding the presence or absence of multi-drug resistant organisms on such surfaces. Clean wood furniture and materials (if still in good repair); allow them to dry thoroughly before restoring varnish or other surface coatings. infection. * Implement dust control measures on surfaces and by diverting pedestrian traffic away from work zones. Cleaning and Disinfecting Strategies for Environmental Surfaces in Patient-Care Areas, E.II. If either an environmental source of airborne fungi or an engineering problem with filtration or pressure differentials is identified, promptly perform corrective measures to eliminate the source and route of entry. Ensure that animals are handled by persons trained in providing activities or therapies safely, and who know the animals’ health status and behavior traits. This guide should be read in conjunction with the guideline for case finding, diagnosis, management and public health … Environmental Health Program. Use standard cleaning and disinfection protocols to control environmental contamination with antibiotic-resistant gram-positive cocci (e.g., methicillin-resistant Staphylococcus aureus, vancomycin intermediate-resistant Staphylococcus aureus, or vancomycin-resistant Enterococcus [VRE]). AND HEALTH GUIDELINES Contact Department of Public Health, Environmental and Social Determinants of Health World Health Organization Avenue Appia 20 1211 Geneva 27 ... Health, Environmental and Social Determinants of Health… Implement infection-control measures relevant to construction, renovation, maintenance, demolition, and repair. (OSHA 29 CFR 1910.1030 §d.3.i, ii), Discard used PPE by using routine disposal procedures or decontaminate reusable PPE as appropriate. Develop pest-control strategies, with emphasis on kitchens, cafeterias, laundries, central sterile supply areas, operating rooms, loading docks, construction activities, and other areas prone to infestations. (OSHA: 29 CFR 1910.1030 § d.4.ii.A), Use protective gloves and other PPE appropriate for this task. Environmental Standards personnel have performed environmental, health, and safety audits nationally and internationally at the request of industry, law firms, and engineering … Upon completion of the project, clean the work zone according to facility procedures, and install barrier curtains to contain dust and debris before removal of rigid barriers. Maintain a 2–5 ppm chlorine residual in the water of whirlpools and whirlpool spas. * Seal windows and reduce wherever possible other sources of outside air intrusion (e.g., open doors in stairwells and corridors), especially in PE areas. Restrict severely immunocompromised patients from taking showers. (OSHA: 29 CFR 1910.1030 § d.4.ii.A; EPA: 7 USC § 136 et seq.). Depending on state regulations on potable water temperature in public buildings, hospitals housing patients at risk for health-care associated legionellosis should either maintain heated water with a minimum return temperature of ≥124°F [≥51°C] and cold water at <68°F [<20°C]), or chlorinate heated water to achieve 1–2 mg/L (1–2 ppm) of free residual chlorine at the tap. Thoroughly dry wet carpeting to prevent the growth of fungi; replace carpeting that remains wet after 72 hours. (AIA: 1.5, 5.1, 5.2). Rinse disinfectant-treated surfaces, especially those treated with phenolics, with water. If hot-water laundry cycles are used, wash with detergent in water ≥160°F (≥71°C) for ≥25 minutes. * Determine if immunocompromised patients may be at risk for exposure to fungal spores from dust generated during the project. 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. Install central or point-of-use HEPA filters for supply (incoming) air. No recommendation is offered regarding the removal of faucet aerators in areas for immunocompetent patients. Position the units appropriately so that all room air passes through the filter; obtain engineering consultation to determine the appropriate placement of the unit. Alternatively, chlorinate the water and then flush it through the system. Strongly recommended for implementation and strongly supported by well-designed experimental, clinical, or epidemiologic studies. (AIA: 7.31.D9). Linking to a non-federal website does not constitute an endorsement by CDC or any of its employees of the sponsors or the information and products presented on the website. (DHHS: BMBL), Biosafety level 3 laboratories must inactivate microbiological wastes in the laboratory by using an approved inactivation method (e.g., autoclaving) or incinerate them at the facility before transport to and disposal in a sanitary landfill.101 (DHHS: BMBL). If there is no evidence of ongoing transmission, continue routine maintenance in the area to prevent health-care–acquired fungal disease. (AIA: 5.1). (EPA: 7 United States Code [USC] § 136 et seq), Do not use high-level disinfectants/liquid chemical sterilants for disinfection of either noncritical instrument/devices or any environmental surfaces; such use is counter to label instructions for these toxic chemicals. Either defer decontamination pending identification of the source of Legionella spp., or proceed with decontamination of the hospital’s water distribution system, with special attention to areas involved in the outbreak. • Protective Measures for Immunocompromised Patients, H.V. No recommendation is offered. Follow proper procedures for effective use of mops, cloths, and solutions. When contact precautions are indicated for patient care, use disposable patient-care items (e.g., blood pressure cuffs) whenever possible to minimize cross-contamination with multiple-resistant microorganisms. * Locate exhaust outlets >25 ft. from air-intake systems. Using active surveillance, monitor for airborne fungal infections in immunocompromised patients. Manage properly contained wastes from areas providing care to VHF patients in accordance with recommendations for other isolation areas (Regulated Medical Waste: III B). Cleaning Spills of Blood and Body Substances, E.IV. Do not conduct routine microbiological sampling of clean textiles. Advise patients to avoid direct or indirect contact with reptiles. To receive email updates about this page, enter your email address: Guidelines for Environmental Infection Control in Health-Care Facilities (2003), C.I. Update: This recommendation has been superseded by recommendation E.VI.G. Use portable, industrial-grade HEPA filter units capable of filtration rates in the range of 300–800 ft3/min. Spot-clean blood or body substance spills promptly. Maintain back-up ventilation equipment (e.g., portable units for fans or filters) for emergency provision of ventilation requirements for AII rooms and take immediate steps to restore the fixed ventilation system function. (AIA: Table 7.2), Maintain ≥15 ACH, of which ≥3 ACH should be fresh air. Use animals obtained from quality stock, or quarantine incoming animals to detect zoonotic diseases. Eliminate contaminated water or fluid environmental reservoirs (e.g., in equipment or solutions) wherever possible. (OSHA: 29 CFR 1910.1030 § d.3.i, ii), If the spill contains large amounts of blood or body fluids, clean the visible matter with disposable absorbent material, and discard the contaminated materials in appropriate, labeled containment. Keep adequate records of all infection-control measures and environmental test results for potable water systems. Hospitals, Interim Guidance for Environmental Infection Control in Hospitals for Ebola Virus, LIST K: EPA’s Registered Antimicrobial Products Effective against Clostridium difficile Spores, Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), Division of Healthcare Quality Promotion (DHQP), Environmental Infection Control Guidelines, U.S. Department of Health & Human Services. * a space or anteroom for changing clothing and storing equipment. (OSHA: 29 CFR 1910.1030 §d.4.ii.A), Follow proper procedures for site decontamination of spills of blood or blood-containing body fluids. * Assay for heterotrophic, mesophilic bacteria (e.g.. * Do not use nutrient-rich media (e.g., blood agar or chocolate agar). Air, Water, and Environmental-Surface Sampling, G.III. (AIA: 5.1). 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