Future Focused: Managing long-term costs of infection control

In the wake of recent concerns over the spread of highly infectious diseases, hospitals and healthcare organizations are searching for ways to better prepare facilities for potential pandemics and widespread viral outbreaks.

Institutions must ensure facilities are code and regulatory compliant system-wide at all times, not just in times of outbreak. According to the Joint Commission, last year healthcare facilities in the U.S. were regularly cited for unsafe patient care conditions, including ventilation, temperature and humidity issues.

Integrated building systems, maintenance programs and technologies can enhance a hospital’s ability to control infection. Unfortunately, these features are often diminished — or cut out entirely — in order to save money. A misinformed approach to value-engineering healthcare projects can lead to solutions that may seem cost effective in the short-term, but actually increase costs over the long term. Healthcare organizations may be unaware of the long-term costs of omitting these features, not to mention the potential impact the absence of these features could have on the health of patients, visitors and staff.

Looking ahead to maximize infection-control measures

In the early stages of a healthcare project, owners and representatives should always keep the future facility’s day-to-day operations in mind when value-engineering changes to the design. During design review and value-engineering sessions, it’s imperative that decision-makers refrain from cutting certain features of the mechanical and electrical systems that will enhance infection control once the facility is up and running. Furthermore, opening a facility with minimum MEP systems can lead to long-term operational challenges and unanticipated costs.

As time passes, healthcare facilities need to change or add systems to operation in order to stay current with regulatory and code compliance. Incorporating additional capacity into a facility’s design allows for future expansion to its building systems. For example, the original design of Project X specified 20 percent extra capacity in the electrical system for future expansion.

The additional electrical panels and associated materials, however, were deemed unnecessary and were cut from the project. Then, three months from completion, a sterilizer and some additional equipment were added to the system. Because the extra capacity was cut from the project, walls had to be opened and additional conduit and a new run of power had to be added. In the end, changing the design ended up costing three times what it would have cost to keep the extra capacity in place.

Owners should be actively present during decision-making sessions at every phase of a project. Proposed savings to mechanical and electrical systems should be thoroughly vetted with all stakeholders to understand the potential impacts on future operations and related costs. One person will not be able to address all aspects of future operations for a given project and an uninformed decision can drastically impact patient care.

Closely monitor performance to control infection

Once a building is operational, facility managers must monitor hospital environments on a regular basis and keep building systems code compliant. They must also ensure preventive maintenance programs are up-to-date and are being executed per plan. Using a commissioning plan and report protocol to ensure all building systems are running at optimal performance is critical. Implementing this approach can highlight systems not functioning properly, so that timely corrective actions can be taken.

All air changes, pressure relationships, filtration and other HVAC features must function as designed. Improper pressure relationships can lead to the spread of infection, contamination, or other environmental situations detrimental to patient care. For example, filters in a facility’s air handling system may seem insignificant, but play a vital role in keeping patient care areas code compliant. Facility managers should know where all filters reside system-wide. Neglecting filter sites could not only require future maintenance and equipment replacement costs, but could also result in breakdowns in infection control in patient care areas.

Additionally, certain challenges can be avoided if proper commissioning documentation for routine systems maintenance and operation is being followed. During the commissioning process, settings for one system’s manufacturer-recommended settings might be changed in order to accommodate another system. If a facility manager is relying solely on the manufacturer’s operation and maintenance data for these systems and ignoring settings set forth in the commissioning process, then the building will have issues.

Using integrated technologies to track and contain infection

Certain integrated technologies can be critical to a hospital’s comprehensive defense plan. Technologies that include real-time locating systems, building management system controls and environmental disinfection systems are valuable tools in controlling infection. If implemented properly, these technologies can help control increased operating costs by creating “situational awareness” in patient environments. This awareness can help staff respond to patient needs more quickly and efficiently, allow the optimization of HVAC system operations, pinpoint system failures for faster response and mitigation, help reduce the concentration of microorganisms and help reduce energy usage.

RTLS technologies allow for rules and algorithms to be set for all scenarios so staff is alerted when a process or procedure has been compromised. These technologies create situational awareness by enabling staff to monitor the location of tagged assets — both people and devices — in the hospital in real-time to ensure these assets are located within predetermined safe areas. They can alert staff to potential compliance breaches, such as instances where hand-washing protocols have not been followed or when an infected patient has left a safe location. RTLS also allows equipment such as an IV pump to be tagged, tracked and locked so it cannot be reassigned to another patient until it has been properly cleaned. Building systems controls, such as elevators, can be bypassed using RTLS so infected patients are delivered to destinations before stopping for hall calls.

Digital waste stream tracking is another effective tool for infection control. Rooms with patients diagnosed as infection risks can be monitored via radio frequency identification or bar-coding systems for waste removal. They can track who removes trash from the room, when the trash is removed and where trash travels on its way to final disposal. Real-time alerts are triggered when infection control protocols are violated.

Digital room signs integrated into the hospital data systems can be automated to display various caution messages and warnings based on patient diagnoses and events. Other information can also be displayed such as fall risks, privacy requests, in-room exam notifications, risk level indications, warning messages and isolation precautions.

Implementing additional layers of infection-prevention technologies, such as ultraviolet light room disinfection and HVAC ultraviolet germicidal irradiation, along with emerging new technologies, can also play a role in a comprehensive approach to infection control.

In order to prevent the spread of disease, and maintain public health, healthcare organizations should consider taking the above actions to prepare facilities for better infection control. Integrating building systems with cutting-edge technologies and monitoring hospital environments through preventive-maintenance programs are effective strategies to track and contain disease. Taking these actions can also ensure that costs, as well as infection, are controlled over the long term.

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Posted February 10, 2015

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