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					                             Infection Control Guidelines




Rev           Date            Purpose of Issue/Description of                         Planned Review
                              Change                                                  Date
PLHB
IC 029        March           Initial Issue- Infection Control                               March 2010
              2007            Guidelines




   Responsible Officer                              Approved by                                  Date

                                        Infection Control                             February 2007-
Infection Control                       Committee
Team                                                                                  March 2007
                                        Clinical Governance
                                        Committee




PLHB Ref: PLHB IC 029. Infection Control Guidelines, Approved: Clinical Governance Committee, March 2007. Review:
March 2010. Author: IC Team. Page 1 of 20
Infection Control Planning Information
This is intended as general guidance, and is also intended to be
used with the Infection Control checklist for the planning of
refurbishment/reconfiguration projects (appendix 1). When more
detailed guidance is required please contact the Infection Control
Department. There are an increasing number of official guidance
documents on the built environment; as a result this information
will be regularly updated to reflect current guidance.

Alcohol hand gel/foam dispensers should be provided at each
point of care delivery, including assisted toilets/bathrooms, unless
risk assessment indicates a potential danger to patients.

Antimicrobials an increasing number of products containing
antimicrobials are being produced for the health care sector. Some
are necessary such as anti-fungal in bath sealants etc. However,
claims are made that curtains, tiles, clothing etc containing anti
bacterial products contribute to the reduction of hospital acquired
infection. There does not seem to be any scientific evidence to
support these claims, and since there may be a possibility of
resistance developing to these products, the Infection Control Team
(ICT) does not support their use.

Baths/Bathrooms should have a wash sink suitable for patient
and be able to be used for staff handwashing e.g. with dual control
taps (sensor taps should be considered in a new
build/refurbishment). The design of assisted bathe should not
compromise cleaning and infection control principles. No raw wood
or cork mats should be used. Hair dressers basins for hair washing
are sometimes proposed; they have flexible hoses and spray heads
which may present a Legionella risk because of infrequent use. They
are also usually fitted with a tap which is unsuitable for hand
washing. The use of hair dressers basins is not permitted, other
arrangements for hair washing such e.g. shower is more suitable.

Bed Bays should have the smallest possible number of beds,
preferably no more than four. Bays should have doors for privacy
and to facilitate “cohort” nursing in outbreaks of infection. The
minimum of one hand wash sink (HWS see Hand wash sinks) which
is easily accessible and a dedicated en-suite shower room per bay.

Bed Pan Washers/Macerators
All wards including mental health units should have some form of
waste disposal unit. Where re-usable bed pans are used, ward areas
require adequate and suitable bed pan washer- disinfectors that
comply with NHS Estates Health Technical Memorandum 2030
(washer-disinfectors). Where disposable systems are used a


                              Page 2 of 20
macerator that meets above guidelines should be provided, there
should also be facilities to wash/disinfect bed pan holders

Bed spacing there is no consistency in Health Building Notes
(HBNs) on the advised distance between bed centres, spacing varies
from 2.5m to 3.6m there is good ergonomic evidence that 3.6m is
the preferred dimension. This is the recommended spacing in Health
Facilities Note (HFN) 30, and is therefore the recommendation of
the ICT that bed spacing should be 3.6m.

Bidets may present infection control problems, depending on
design and patient group. They are most frequently found in
maternity units. If used, they should not have flushing rims or spray
attachments, and should have a smooth easily cleanable bowl. As it
is not possible for bidets to be cleaned by ward domestics between
each use, it is important that patients for whom they are intended
are physically able to clean the bidet themselves if they wish to use
it, and that appropriate cleaning materials are made readily
available.

Carpets should NOT be used in ALL clinical areas. This includes
areas where spillage is anticipated. There is good evidence that they
are difficult to clean and disinfect adequately, and can quickly
become aesthetically unacceptable. There is a growing body of
evidence to suggest that contaminated carpets are associated with
outbreaks of infection. Carpets should not be used in areas where
food is stored, handled, or eaten. If planners or users insist on
carpets they must ensure carpets are regularly cleaned and sign the
infection control disclaimer (see appendix 2).

Catering/beverage facilities suitable to the type of meal
beverages provision, speciality, and number of patients should be
provided. Out patients departments providing beverages to patients
must have suitable facilities, which may include hot beverage/
canned drink dispensers. In order to ensure that these facilities
conform to legislation including the Food Safety Act 1990, Trust
Codes of Practice, and HBN 10–Catering Department, the following
along with the ICT should comment on plans the Food Safety
Manager and the local Environmental Health Officer.

Clean utility rooms should be suitably sited. They should be
designed with adequate and appropriate storage, with sufficient
work surfaces and HWS placed in such a way as to avoid splashing
of clean items/surfaces. The room and contents should be designed
to facilitate cleaning.




                             Page 3 of 20
Cleaning facilities/cleaners rooms enough suitably sited, sized
and equipped cleaning rooms should be provided with enough
storage facilities sufficient to separate clean and dirty items, these
should include facilities to hang mops and brushes, PPE, store
vacuum cleaners, a deep sink, a slop hopper, and a separate
appropriately sited HWS. Staff should be allowed to comment on
design and layout of the area.

Ceilings smooth hard impervious surfaces are recommended in
theatres and isolation rooms. Caution should be used when
considering the use of ceilings to produce visually appealing areas,
as they can be difficult and time consuming to access for cleaning.
False ceiling may be associated with accumulation of dust and fungi
and can harbour pest, guidance should be sought from Health
Technical Memorandum (HTM) 60.

Changing facilities (see staff changing facilities)
These should be provided where patients are expected to disrobe
for a clinical/surgical procedure e.g. day surgery unit/out patients, X
Ray department. The number of facilities depends upon the
estimated patient use. Part of the design should include lockable
storage cupboard to ensure safety of patient’s belongings. All
finishes should be easily cleanable and in line with Infection Control
guidelines.

Clinical Waste Bins should be made of a material that can
withstand constant use, easily cleaned, have a solid body, foot
operated; with a lid that cannot be opened by hand (lids sustain the
heaviest bacterial contamination). Bins with removable bodies are
ideal for allowing regular cleaning.

Cupboards these should be made of materials that are smooth non
porous and impervious to water. They should also be free of
fissures, open joints and crevices all surfaces should be able to
withstand regular cleaning with detergent and chemical
disinfectants. Handles should be smooth and easy to clean. There is
a penchant for purchasing domestic cupboards these are not
designed to withstand the wear and tear of the healthcare
environment and this practice must be discontinued.

Curtains and blinds (windows and beds) can become easily
contaminated and require regular laundering. All curtains purchased
need to be able to withstand washing processes at disinfection
temperatures (710 C for three minutes or 650C for ten minutes). It
is advisable before purchasing curtains samples should be sent to
the laundrette for testing to ensure the materials can withstand
these temperatures. Curtains with antimicrobials/silver etc built into


                              Page 4 of 20
the fabric require washing and until there is conclusive evidence to
suggest that they do prevent cross infection the ICT will not
recommend their use.
Blinds are notoriously difficult to keep clean especially vertical
blinds. If blinds are to be used they have to be washable and
detachable.
All blinds and curtains must be on a pre planned washing schedule.
Disposable curtains have their advantages especially in isolation
facilities and during an outbreak however the cost may outweigh
any gains and careful consideration must be taken when considering
these as an option. The ICT recommends disposable curtains for
isolation rooms and recovery areas.

Day ward/rooms/patient waiting areas there is often conflict
between planners and ICT’S regarding the aesthetics of these areas.
In many of these areas there is a potential for the spilling of blood
and body fluids. It is essential that floors, furnishings and the
environment in these areas can be easily cleaned and can withstand
the regular use of detergents and disinfectants.

Decant facilities during refurbishment/works facilities may have to
be moved, the area where services are to be provided must have
adequate facilities to ensure infection control is maintained. The
area must also be adequately cleaned both prior to transfer and on
vacation.

Decontamination current NHS Estates guidance is to avoid local
reprocessing of any re-usable medical devices. Where possible all
re-usable medical devices are to be reprocessed in an accredited
Hospital Sterile Services Decontamination Unit (HSDU). If the
decontamination of re-usable medical devices locally is unavoidable
it is essential that the design principles of decontamination in HBN
13 – Sterile Services Departments, HTM 2030 – Washer-Disinfectors
HTM 2010 Sterilization, HTM 2031 Clean Steam for Sterilization and
MHRA DB 2002(06) Guidance on the Purchase, Operation, and
Maintenance of Bench top sterlizers are followed. For new or re-
provided reprocessing facilities this must include physical separation
of clean and dirty areas.

Decontamination of patient equipment enough space should be
set aside for the decontamination of patient equipment either in the
dirty utility room or space permitting a purpose built facility. If the
latter is the case then arrangements should be made to separate
clean and dirty see guidelines set out in HBN 13 Sterile Services
Department.




                              Page 5 of 20
Dental Departments for specific guidance on general and specific
functional design requirements see HBN 12-Oral surgery,
Orthodontics and Restorative surgery Supplement 2, HBN O6- Vol 2
Diagnostic imagery PAC and specialist imagery and HTM 2022-
Supplement 1 upgrade Dental compressed air and vacuum systems

Dirty Utility rooms should be suitably sited for their function.
Their content will vary according to the speciality, but must include
a sluice hopper, deep sink, and HWS. If commodes are used, there
must be sufficient space for their storage and cleaning. There
should also be sufficient storage facilities for re-usable or single use
bed pans/urinals etc. No other clean or sterile items should be
stored in the dirty utility room.

Dispensers for soap, alcohol, paper, and PPE should be made from
a material that is easily cleanable. Soap and alcohol dispensers
should be non-touch or have an easily accessible push-in, corrosion-
resistant self-cleaning valve. Soap dispensers should not be
refillable but be of a disposable single cartridge design.

Disposal room each ward or hospital should have a lockable
disposal room the purpose of this is the temporary storage point for
all items of supplies and equipment which have to be removed for
cleaning, reprocessing or disposal e.g. linen, SSD items, waste
disposal and sharps.

Doors all bays and single rooms require doors if they are to be
used for cohort barrier nursing or isolation nursing. They should be
smooth (louvers and patterns harbour dust and are difficult to
clean), with smooth handles to afford for easy cleaning. The
materials used should not be affected by detergents and chemical
disinfectants, and will dry quickly (for further guidance see NHS
Estates HTM 58).

Endoscope reprocessing current advice from NHS Estates is to
avoid local reprocessing of any instruments, and capacity for central
reprocessing of all suitable instruments, including autoclavable rigid
scopes, should be built into appropriate schemes. If local flexible
scope reprocessing is unavoidable, it is essential that the design
principles of decontamination in HBN 13 Sterile Services
Departments, and HTM 2030 Washer-Disinfectors, are followed. For
new or re-provided reprocessing facilities this must include a
physical separation of dirty and clean areas.

Equipment cleaning sufficient space must be allowed for the
cleaning of equipment such as drip stands, trolleys, and commodes.
For new builds/up grades consideration should be given to an area


                               Page 6 of 20
designated for the cleaning of ward/hospital equipment in such
cases the principles of HBN 13 should be considered.

Floors should be covered with an impervious, hard wearing smooth
easily cleaned material, able to withstand regular cleaning with
detergents and chemical disinfectants; any joints should be welded
or sealed to prevent damage due to water, as lifting can cause a
reservoir for infections agents. There should be coving between the
floor and wall to prevent accumulation of dirt and dust in corners
and crevices. Wood, unsealed joints and tiles must be avoided as
they may produce reservoirs for infectious agents.

Furnishing, fixtures, and fittings should be chosen to be easily
cleanable, i.e. with smooth, impervious finishes. Hinges on
cupboards should be recessed. Upholstery in clinical areas including
waiting areas should be wipe able and not fabric. Modular furniture
or other difficult to move items including fridges in patients rooms
should either be wall mounted or on raised platforms to facilitate
floor cleaning. Radiators should be easily cleanable and wall
mounted to enable cleaning underneath, and associated pipe work
should be boxed in.

Hand hygiene facilities (clinical sinks) hand hygiene facilities
must be readily available in all clinical areas. There must be
sufficient sinks to encourage and assist staff and patients to wash
their hands.
Hand wash sinks should be easily visible and accessible and should
not be obscured by curtains, doors, or equipment.
Design of hand wash sinks must include the following
      have no overflow
      have no plug and be incapable of taking a plug
      have taps that are aligned so as not to run directly into the
       drain aperture and cause aerosol dispersion
      have curved sides to discourage splashing
      be large enough to enable a good hand wash technique
      be sealed to the wall or be far enough away from the wall to
       enable effective cleaning of all services
      have waterproof splash back
      have suitable non-hand-touch taps (see taps)
      have mixer taps to deliver water at a suitable temperature for
       hand washing
      non-touch taps are to be mains operated and not battery
       operated
      non-touch taps should be programmable to flush
       automatically in periods low usage for Legionella control.
      spray taps must not be used



                             Page 7 of 20
     sinks should be of hard, easily cleanable, non-scratch-able
      material (usually porcelain)
     sinks must not be made of polycarbonate or other moulded
      plastic materials
     sinks must have sufficient space around them to
      accommodate soap, alcohol, hand cream, paper towel
      dispensers and clinical waste bins.
     avoid swan neck tap outlets as they do not empty after use
     avoid the use of strainers and anti-splash fittings at outlets as
      they become contaminated with bacteria


            Number of hand wash      sinks (HSW) per bed
Clinical areas                       Number of sinks per bed
ITU/HDU                              1hand wash sink (HWS) per bed
Acute, elderly and long term care    1 HWS per 4 beds
Isolation/single room with en-       2 HWS one in patient room &
suite toilet/shower                  one in en-suite
Isolation/single room no en-suite    one HWS in patient room
2 bed bays with en-suite             2 HWS one in patient room &
                                     one in en-suite
2 bed bays without en-suite          one HWS in patient room
Mental health/learning               1 HWS per 4-6 beds
disabilities
Outpatient settings                  1 HWS per consulting
                                     /examination room (wall
                                     mounted alcohol hand gel/ foam
                                     should be made available in the
                                     consulting room
Decontamination facilities           2 clinical sinks one for washing
                                     dirty instruments and one for
                                     rinsing and 1 HWS
Primary care                         1 HWS per consulting
                                     /examination room
Sluice                               1 HWS
Domestic room                        1 HWS
Mortuary room                        1 HWS per 4 trolleys
Hospital Mortuary facilities         1 HWS
including fridges & chapel of rest
Ward Kitchens                      1 HWS
Staff rest rooms                   1 HWS
For guidance on hand wash facilities in kitchens areas see HTM 64




                              Page 8 of 20
Hand drying using paper disposable paper towels is the best
method of drying hands.

Hot air hand dryers should not be used in hospitals especially in
clinical areas, as warm air currents dry hands slowly and can only
be used by one individual at a time. This encourages the drying of
hands on clothes.

Ice Machines should be plumbed in and should be of a type that
dispenses ice by a no touch nozzle. Commercial ice machines are
not suitable for making ice for patient consumption. Ice machines
should be cleaned regularly and on a pre planned programme of
maintenance to ensure they are working correctly.

Internal drainage system must use the minimum amount of pipe
work, retain water, and be airtight at joints and connectors and
must be sufficiently ventilated to retain the integrity of water seals.
Provision for inspection, rodding, and maintenance should be
located to minimise disruption of possible contamination and man
hole should not be sited in clinical areas. For further guidance see
BS EN 12056 and CIBSE Guide G

Isolation Rooms the ICT recommends only enhanced single en-
suite rooms should be provided in new and upgrade schemes. The
cost implications are appreciated, but to distinguish between
“standard” and “enhanced” rooms is potentially confusing, and will
result in some sub standard re-provision of isolation rooms.
The following recommendations are based on guidelines set down in
HBN 4:

Standard en-suite rooms for non airborne infections

     Clinical hand wash sink with non touch, fixed temperature
       mixer tap, adjacent to door
     Wall-mounted soap, alcohol and paper towel hand dispensers
     bin for the disposal of non-clinical items
     bin for disposal of clinical waste
     suitable extract to the en-suite bathroom
     transfer grille in en-suite door
     en-suite WC to be non touch flush
     en-suite HWS to have single tap, temperature control and
       non-touch
     windows should be open able, with fixed opening for safety
       and should be lockable
     observation window in corridor with integral privacy blinds
       controllable by patients and staff



                              Page 9 of 20
      all windows, including observation windows, low enough to
       provide view for patients in beds

For isolation of airborne infections
   En-suite single room with ventilated lobby, to allow clean air to
     enter the patient’s room from the lobby, protecting the patient
     from air from the corridor. And potentially contaminated air
     from the bedroom is prevented from escaping into the corridor
     by the lobby. This arrangement allows the room to be used by
     both infectious patients and those at risk of infection. ”switch
     able” positive/negative pressure isolation rooms are not now
     recommended
  Modifications for the bedroom and bathroom of an isolation suite
  are as for an enhanced single room, plus
   A clinical waste bin for PPE in the bedroom
   A pressure stabilizer above the bedroom door

The lobby should have
   Clinical HWS with non-touch, fixed temperature mixer tap
   Wall-mounted soap, alcohol and paper towel hand dispensers
   Wall mounted storage dispensers for PPE
   Clinical waste bin for used PPE
   Bin for non clinical items
   Storage for room cleaning equipment
   A suitable air supply

For the suite as a whole

   A sealed solid sealing
   Windows to the exterior to be locked shut and sealed
   Heating and cooling provided via ventilation system


Laundry Facilities DOH guidance is that all hospital laundry is to
be washed in large industrial washers and tumble dryers due to
possibility of contamination with blood or body fluids and laundry
may have been used on infected patients. Hospital laundry must be
disinfected during the washing process to prevent the risk of
infection to both patients and staff; this cannot be achieved in
commercial machines.
In areas where laundry facilities still exist they must have facility to
segregate clean from dirty and enough storage space provided to
ensure no laundry is stored/placed directly on the floor.
The washing machines and dryers must be industrial and placed of
the floor to ensure cleaning can take place.
The ICT does not recommend the use of washing machines and
dryers in the LHB.


                              Page 10 of 20
Lighting location and design of luminaries should afford easy
changing of lamps and frequent cleaning. They should be designed
so that there are no ledges, ridges etc where dust can gather easily
and be dispersed when light is moved or knocked, all lights are to
be on a pre-planned programme of maintenance and cleaning.

Linen services/ storage enough space should be allocated for in-
use linen billies and bags awaiting disposal. Linen cupboards should
be large enough to avoid linen storage on open trolleys and suitably
sited for clean deliveries and the service shelves should be
impervious and cleanable, not raw wood.

Medical gas vacuum systems vacuum and suction equipment is a
potential cross-infection risk. The delivery system is similar to that
of gases, i.e. piped or via mobile equipment. The vacuum pipe
system must be able to be isolated in case of incidents where pipe
work becomes contaminated with blood and body fluids. For further
guidance refer to HTM 02-01: Medical gas pipeline systems-part A:
Design, installation, validation, and verification
HTM 02-01: Medical gas pipeline systems-part B: Operational
Management

Mortuaries for further guidance see HBN 20 Facilities for mortuary
and post-mortem room services 3rd edition

Nappy changing facilities the area for nappy changing should
have a surface that is easily cleaned, not raw wood. There should
be facilities for the disposal of dirty nappies preferably a solid bin
with a pedal and a lid that cannot be opened by hand. And a HWS
along with wall mounted soap and hand towel dispenser. Since
domestics cannot clean after individual use appropriate cleaning
material should be made available for users. These areas should be
cleaned at regular intervals through out the day.

Operating Theatres see HBN 26 Operating Department for further
guidance.

Patient call bell systems these include entertainment and
communication, phone, TV, and radio. These should be made of
materials that are easy to clean or disposable parts such as ear
piece pads which should be changed after each patient. These
should be on a pre-planned maintenance schedule.

Play areas should be easy to clean and have adequate toy storage
facilities. Soft play areas play mats, and equipment should be
cleaned on a daily basis, fabric and porous toys are to be avoided as


                             Page 11 of 20
they cannot be easily decontaminated. Toys should be washed at
the end of the day.

Pipe work should be sited carefully (pipe work sited along a wall
can become a dust trap and difficult to clean) and contained in a
smooth surfaced box that is easy to clean; pipes and cables running
through walls above false ceilings should be sealed where possible.

Pools/birthing/hydrotherapy require a great deal of
maintenance and monitoring to ensure there safety including
continuous disinfection systems for static water (hydrotherapy
pools). Consideration should be given to following appropriate
choice of site, running cost including microbiological testing of
water, single use liners for maternity pools, regular disinfection.
Further guidance can be found in Hygiene for hydrotherapy pools
Public Health Laboratory Service (PHLS) 1999

Public perception/aesthetics in its guidance NHS Estates has
attempted to incorporate the views of patients in design guidance,
some initiatives may be in line with infection control thinking while
others such as planting, soft furnishing, and carpets in areas such
as mental health facilities may present a challenge to Infection
Control Teams. A good rule of thumb for planners should be the
cost of maintenance, usage, and the availability of cleaning
systems.

Radiators should be smooth, accessible, and cleanable. Radiators
enclosed in protective coverings should be on a pre planned
maintenance schedule of cleaning.

Sanitary waste disposal there should be facilities for the disposal
of sanitary waste both in female staff/visitor toilets and in unisex
toilets. If an outside company is used then the boxes should be
emptied at regular planned intervals. If this is an in house service
the bins used must be yellow clinical waste bins with solid sides, a
lid that can only be opened using the pedal and this bin should be
emptied a minimum of once a day, more depending on usage.

Showers have their advantages over baths, and are often preferred
by patients, they take up less space which enables a higher
proportion of en-suite facilities; however they have also been
implicated in outbreaks of legionellosis. Showers that are not used
on a regular basis must be placed on a pre planned flushing
schedule. The following is to be considered when installing a
shower.

   Pre-formed shower trays are not suitable for disability access


                             Page 12 of 20
   Trays with grills are both an infection risk as well as a manual
     handling risk.
   Strainers are an infection risk, blocks regularly, and should be
     avoided
   A sloping floor with inset drain should be used in patient areas
   Design of area should be as such that people do not
    have to walk on wet floors
   It is preferable to have a screen between the shower and toilet;
     this should be sealed at floor level to prevent cross infection.
   A shower screen is difficult to clean but is preferable to shower
     curtains.
   If shower curtains are used they should be single-use disposable
     or washable, if the choice is the latter then curtains should be
     washed /changed at agreed intervals.
   They should be long enough to prevent excess splashing but not
     touch the floor.

SINGLE ROOMS SEE ISOLATION ROOMS

Soft furnishings for example seating used within all clinical and
associated areas should be covered in a material that is
impermeable. Fabric that becomes soiled and stained cannot be
adequately cleaned and so may require replacement, design should
ensure that surfaces are seam free, can be accessed easily for
cleaning, will not be physically affected by disinfectants and will dry
quickly.

Staff changing facilities to discourage the wearing of uniforms
out of work, staff changing facilities should be provided. Space
constraints often mean that there is a central facility. Toilets, hand
wash facilities, showers, and outdoor clothes storage should be
provided. Finishes should be designed with cleaning in mind
Theatres, and other areas were surgical procedures are performed
should have dedicated and suitably sited changing facilities.

Storage sufficient and suitable storage for equipment (including
large items e.g. patient hoist), linen, and waste should be allowed
for.

Taps newer HBNS are specifying the installation of electronically –
operated taps and HWBs for infection control and water saving
reasons. When used electronic taps must be mains operated rather
than battery operated ands should be programmable to flush
automatically in periods of low usage for Legionella control.
Conventional taps in clinical areas must be well-designed non-hand
touch types and must not have manually adjusted thermostats.



                              Page 13 of 20
Toilets should preferably be separated from bathrooms/showers,
but space constraints usually do not allow this. There must be easy
access to hand washing facilities. Toilet pans should be rimless,
wash down type to enable easy cleaning, made of a tough material
preferably ceramic and be of the “back to wall” or “wall-hung” type.
I f padded backrests are required (e.g. disabled toilets) these
should be seamless and easy to clean.

Toilet paper holders should cover the paper, made of a tough
easily cleaned material, and should be within easy reach.

Treatment rooms the function of treatment rooms will vary with
speciality. It is important to design in the appropriate infection
control facilities and finishes including a HWS, appropriate
cupboards for storage (no items are to be stored on the floor) and
to avoid the treatment room becoming a “dumping ground” for
unsuitable items of equipment.

Ventilation HTM 2025 – Ventilation in Healthcare premises is
currently being rewritten. Ventilation in general areas is often
governed by strict energy consumption requirements and the need
to provide cooling in modern buildings with high tech, heat
producing equipment. Consumerism demands access to fresh air
wherever possible for patients, because of all these issues, new
heating/cooling/ ventilation systems are being proposed. Ventilation
in critical areas such as operating theatres, angiography suites,
Endoscopy suite, intensive care units, and isolation facilities which
require specialised air change, direction, and quality requirements
as specified in the relevant HTM/HBN specialist technical advice is
usually required to achieve the standards specified by Infection
Control.

Visitor’s toilets these are heavily used and should provide enough
space and have a high grade of finishes to maintain a good standard
of hygiene and to ensure proper cleaning. Consideration should be
given to providing at least one toilet for children only with the
appropriate height furniture and fixtures to make use of the toilet
more user friendly. There should be an adequate number of HWS
provided to deal with the anticipated population along with liquid
soap and paper towel dispensers. There should be provision of
sanitary disposal facilities for sanitary waste in both women and
mixed sex toilets

Waste Handling storage these should be considered as an
integral part of any rebuild/new build. Lockable disposal storage
rooms /cupboards sited at the entrance of ward or departments,
with access from both ward and corridor is preferable to cluttering


                             Page 14 of 20
up dirty utility rooms, (which are often to small) or unsightly yellow
trucks placed at ward entrances for the disposal of waste. Each
hospital should have a designated secure area for the holding of
waste truck prior to collection.

Water hot and cold water supplies must conform to HTM 04-01
Parts A: Design, installation and testing and B: Operational
Management –The control of Legionella, hygiene ”safe hot water,
cold water and drinking water systems. During works it is important
to ensure that there is no contamination of the water supply, and
steps taken to ensure water quality is not compromised.
Appropriate estates personnel must comment on the plans. If
chilled drinking water is required for patients (except
immunocompromised patients) it may be provided by plumbed in
water dispensers, bottled water dispensers should not be used. The
dispensers should be easy to clean and the nozzles cleaned
regularly. Patients who are immunocompromised should have water
from a terminally filtered drinking tap or ice machine.

Windows should be chosen to provide shade and preserve patient’s
privacy and dignity. Suitable cleaning regimes must be existing for
whatever system is chosen. For high risk areas interstitial blinds
(between the panes of double glazing) are preferred for cleanliness.
In other areas curtains usually provide easiest to clean solution. See
curtain and blinds for more information.




                             Page 15 of 20
Appendix 1

Checklist for informing control prevention and infection team on the
planning reconfiguration/new builds

The following is a generic guide to all Matrons/Directorate Heads/
Ward Managers/Works Departments regarding the change in
use/refurbishment/new build.


Inform Infection Control if any of the following is to be undertaken

Work requiring change in use of room/ ward/department
Removal of tiles, pipe work, flooring, carpets
New build
Demolition of any wall (partial/complete)
Demolition of partitions/windows/ceilings
Installation of machinery/equipment
Noisy work adjacent to patient areas
Dusty work adjacent to patient areas
Work to Hot and cold water services
Work on air-conditioning/ventilation




                             Page 16 of 20
Appendix 11


Disclaimer (to be signed by individual on behalf of department)



Directorate Head/Matron/Manager ……………………………………………………
(Print name) on behalf of Directorate/Department…………………………..
………………………………………

The above have decided to go ahead with this project (state name
of project)…………………………………………………………………………………………
…………………………………………………………………………………………………………

Despite the recommendations made by the Prevention and Control
of Infection Department regarding the following:

Please state advice given




On behalf of ……………………………………………………………………… (Name of
Department/ Directorate) we agree to take responsibility for any
consequences occurring due to failure to act on the
recommendations/advice of the Prevention and Control of infection
Department.



Signature



Date: ___/___/____




                            Page 17 of 20
Appendix 111

                  Notification of Capital Project

To Infection Control Team/Microbiologist/H&S Advisor/Fire
Advisor/Risk Management/Estates/Hotel Services/IT/Telecomms


Scheme title

Location

Job no

Project Manager

Date

Current stage     concept brief design tender onsite

Approx. start

Approx. value

Brief description of works




The work involves               limited amount      extensive

Work in or near a clinical area               
Noisy work adjacent to patient area           
Dusty work adjacent to patient areas          
Work to H&C water services                    
Air-conditioning/ventilation                  
Asbestos removal                              
Imaging/lasers                                
New data and telephone outlets                
Other                                         
_____________________________________________________

Architect

M&E designer



                              Page 18 of 20
References
Acts and Regulations
 Construction (design and Management) Amendment Regulations
  2000. S1 2000 No 2380, the stationery Office.
 Control of Substance Hazardous to Health (COSHH) Regulations
  2002 http://www.hmso.gov.uk
 Water supply (Water Fittings) Regulations amendment 2000
  http://www.hmso.gov.uk
 Water supply (Water Quality) Regulations 2000
http://www.hmso.gov.uk
 Workplace (Health, Safety, and Welfare) Regulations 1999
http://www.hmso.gov.uk

NHS Estates Guidance (all guidance can be found on website below)
 Health Building Notes
 HBN 4: In patient accommodation –options for choice,
  supplement 1: isolation Facilities in acute settings
 HBN 10 Catering department
 HBN 12 Out-patient department
 HBN 13 Sterile Services department
 HBN 15 Accommodation for pathology services
 HBN 20 Facilities for mortuary and post-mortem room services 3rd
  edition
 HBN 25 Laundry
 http://howis.wales.nhs.uk/sites3/page.cfm?pid=7440&orgid=254
 http://www.dh.gov.uk/PolicyAndGuidance/OrganisationPolicy/Est
  atesAndFacilitiesManagement/fs/en

Health Facilities Notes (HFN)
 HFN 30 Infection Control in the Built Environment
 http://howis.wales.nhs.uk/sites3/page.cfm?pid=7440&orgid=254
 Health Technical Memoranda
 HTM 04-01: The control of Legionella, hygiene, “safe” hot water,
  cold water and drinking water systems Part A: Design, installation
  and testing
 HTM 04-01: The control of Legionella, hygiene, “safe” hot water,
  cold water and drinking water systems Part B: Operational
  Management
 HTM 02-01: Medical gas pipeline systems-part A: Design,
  installation, validation, and verification
 HTM 02-01: Medical gas pipeline systems-part B: Operational
  Management
 HTM 2025 Ventilation in Healthcare premises
 HTM 2027: Hot and cold water supply, storage, and mains
  services
 HTM 2030 Washer-disinfectors
 HTM 2010 Sterilization


                            Page 19 of 20
   HTM 2031 Clean Steam for Sterilization
   HTM 64 Sanitary assemblies
   HTM 60 Building components: Ceilings 2nd edition
   HTM 61 Building components: Flooring 3 rd edition
   http://www.dh.gov.uk/PublicationsAndStatistics/Publications/Publ
    icationsPolicyAndGuidance/PublicationsPolicyAndGuidanceArticle/f
    s/en?CONTENT_ID=4119663&chk=iuuoxk

Medicines Healthcare Regulatory Agency (MDA)
 MHRA DB 2002(06) Guidance on the Purchase, Operation, and
  Maintenance of Bench top sterlizers
 http://www.mhra.gov.uk/home/idcplg?IdcService=SS_GET_PAGE
  &nodeId=258




                             Page 20 of 20

				
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