If there is no evidence of ongoing transmission, continue routine maintenance in the area to prevent health-care–acquired fungal disease. (ASHRAE: 12:2000), If using chlorination, add enough chlorine, preferably overnight, to achieve a free chlorine residual of ≥2 mg/L (≥2 ppm) throughout the system. Controlling the Spread of Waterborne Microoganisms, D.II. Remove the animal permanently from these programs. Food and General Environmental Health Fees. 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. Provide fresh air as per ventilation standards for operating rooms; portable units do not meet the requirements for the number of fresh ACH. Provide adequate, usable, and appropriate training, education, and informational material ... See “Guidelines for Environmental … 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. (Occupational Safety and Health Administration [OSHA]; 29 Code of Federal Regulations [CFR] 1910.134,139). Maintain constant recirculation in hot-water distribution systems serving patient-care areas. Situate portable HEPA units with the advice of facility engineers to ensure that all room air is filtered. Monitor barriers and ensure the integrity of the construction barriers; repair gaps or breaks in barrier joints. * Relocate patients whose rooms are adjacent to work zones, depending upon their immune status, the scope of the project, the potential for generation of dust or water aerosols, and the methods used to control these aerosols. (AIA: 5.1, 5.2.B, C), Coordinate HVAC system maintenance with infection-control staff to allow for relocation of immunocompromised patients if necessary. Consult with dental water-line manufacturers to. Maintain a high index of suspicion for legionellosis in transplant patients even when environmental surveillance cultures do not yield legionellae. These newer technologies were assessed by CDC and HICPAC in the 2011 Guideline for the Prevention and Control of Norovirus Gastroenteritis Outbreaks in Healthcare Settings, which makes the recommendation: “More research is required to clarify the effectiveness and reliability of fogging, UV irradiation, and ozone mists to reduce norovirus environmental contamination. Guidelines for Operating Food Establishments. The renumbering does not constitute change to the intent of the recommendations. Use an EPA-registered disinfectant suitable for use on ice machines, dispensers, or storage chests in accordance with label instructions. Wash hands with soap and water, especially if hands are visibly soiled. (DHHS: BMBL), Biosafety level 4 laboratories must inactivate microbiological wastes in the laboratory by using an approved inactivation method (e.g., autoclaving) before transport to and disposal in a sanitary landfill. Monitor negative air flow inside rigid barriers. Report the cases to the state and local health departments where required. ENVIRONMENTAL HEALTH GUIDELINE. Handle contaminated textiles and fabrics with minimum agitation to avoid contamination of air, surfaces, and persons. (AIA: 7.31.D9). Do not perform disinfectant fogging in patient-care areas. Other Potential Infectious Aerosol Hazards in Health-Care Facilities, D.I. Flush and restart equipment and fixtures according to manufacturers’ instructions. (AIA: 5.1). Clarification Statement: CDC and HICPAC have recommendations in both 2003 Guidelines for Environmental Infection Control in Health-Care Facilities and the 2008 Guideline for Disinfection and Sterilization in Healthcare Facilities that state that the CDC does not support disinfectant fogging. (ASHRAE: 12:2000), Implement infection-control procedures for operational cooling towers. Thoroughly clean and disinfect environmental and medical equipment surfaces on a regular basis using EPA-registered disinfectants in accordance with manufacturers’ instructions. General Infection-Control Measures for Animal Encounters, H.II. Take measures to protect immunocompromised patients who would benefit from a PE room and who also have an airborne infectious disease (e.g., acute VZV infection or tuberculosis). Use portable, industrial-grade HEPA filter units capable of filtration rates in the range of 300–800 ft3/min. Interim Measles Infection Control Recommendations, New Categorization Scheme for Recommendations. This may be followed with an application of an EPA-registered hospital disinfectant with or without a tuberculocidal claim (depending on the nature of the surface and the degree of contamination), in accordance with disinfectant label instructions. Recommendations from regulations adopted at state levels are also noted. (AAMI: ANSI/AAMI ST65:2000). Air-Handling Systems in Health-Care Facilities, C.II. If a source is identified, promptly institute water system decontamination measures per recommendations (see Water IV). * Implement dust control measures on surfaces and by diverting pedestrian traffic away from work zones. You may need to download version 2.0 now from the Chrome Web Store. If there is epidemiologic evidence of ongoing transmission of fungal disease, conduct an environmental assessment to determine and eliminate the source. If you are on a personal connection, like at home, you can run an anti-virus scan on your device to make sure it is not infected with malware. When using phenolic disinfectants in neonatal units, prepare solutions to correct concentrations in accordance with manufacturers’ instructions, or use premixed formulations. Do not use water from the faucets in patient-care rooms to avoid creating infectious aerosols. Maintain hot water temperature at the return at the highest temperature allowable by state regulations or codes, preferably ≥124°F (≥51°C), and maintain cold water temperature at <68°F (<20°C). (States). If upholstered furniture in a patient’s room requires cleaning to remove visible soil or body substance contamination, move that item to a maintenance area where it can be adequately cleaned with a process appropriate for the type of upholstery and the nature of the soil. Centers for Disease Control and Prevention. Cooling Towers and Evaporative Condensers, D.VIII. (States; AHJ), If treatment options are not available at the site where the medical waste is generated, transport regulated medical wastes in closed, impervious containers to the on-site treatment location or to another facility for treatment as appropriate. Treat sick animals or remove them from the facility. • Periodic culturing for legionellae in potable water samples from HSCT or solid-organ transplant units can be performed as part of a comprehensive strategy to prevent Legionnaires disease in these units. (AIA: 7.2.D), Locate air supply and exhaust grilles so that clean, filtered air enters from one side of the room, flows across the patient’s bed, and exits from the opposite side of the room. * Seal windows and reduce wherever possible other sources of outside air intrusion (e.g., open doors in stairwells and corridors), especially in PE areas. Inform personnel involved in the handling and disposal of potentially infective waste of the possible health and safety hazards; ensure that they are trained in appropriate handling and disposal methods. Coordinate system startups with infection-control staff to protect patients in PE rooms from bursts of fungal spores. (AIA: 5.1; ASHRAE: 1­ 1996). ), Clean surfaces that have been contaminated with body substances; perform low- to intermediate-level disinfection on cleaned surfaces with an EPA-registered disinfectant in accordance with the manufacturer’s instructions. Clean and disinfect the polyester filter sheet thoroughly, especially between patients, using an EPA-registered product, if available. Select EPA-registered disinfectants, if available, and use them in accordance with the manufacturer’s instructions. Additional Engineering Measures as Indicated by Epidemiologic Investigation for Controlling Waterborne, Health-Care–Associated Legionnaires Disease, D.V. * covering debris and securing this covering before removing debris from the work zone. Clean and disinfect inflatable tubs unless they are single-use equipment. When discarding items contaminated with blood and body fluids from VHF patients, contain these regulated medical wastes with minimal agitation during handling. Advise patients to avoid contact with animal feces and body fluids such as saliva, urine, or solid litter box material. Contract for routine pest control service by a credentialed pest-control specialist who will tailor the application to the needs of a health-care facility. Using active surveillance, monitor for airborne fungal infections in immunocompromised patients. 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. PEHSUs are a network of medical experts that offer guidance to health care professionals and the public on prevention, diagnosis, management, and treatment of environmental conditions that affect reproductive and children’s health. Follow the manufacturer’s instructions for cleaning. Change the mop head at the beginning of the day and also as required by facility policy, or after cleaning up large spills of blood or other body substances. No recommendation is offered for performing orthopedic implant operations in rooms supplied with laminar airflow. (OSHA: 29 CFR 1910.1030 § d.4.iv), Identify bags or containers for contaminated textiles with labels, color coding, or other alternative means of communication as appropriate. Avoid large-surface cleaning methods that produce mists or aerosols or disperse dust in patient-care areas. Use microbiological sampling during outbreak investigations if epidemiologic evidence suggests a role for health-care textiles and clothing in disease transmission. Use appropriate hand hygiene, PPE (e.g., gloves), and isolation precautions during cleaning and disinfecting procedures. (AIA: 5.1). WHO guidelines on environmental health 2017. Maintain positive-pressure ventilation with respect to corridors and adjacent areas. Do not use carpeting in hallways and patient rooms in areas housing immunosuppressed patients (e.g., PE areas). Flush the water system to clear sediment from pipes to minimize waterborne microorganism proliferation. Avoid use of carpeting in high-traffic zones in patient-care areas or where spills are likely (e.g., burn therapy units, operating rooms, laboratories, and intensive care units). Specifically, the 2003 and 2008 Guidelines … Select a high-volume air sampling device if anticipated levels of microbial airborne contamination are expected to be low. Preventing Legionnaires Disease in Protective Environments and Transplant Units, D.VII. Follow proper procedures for managing spills on carpeting. If the facility does not treat severely immunocompromised patients, conduct an epidemiologic investigation, including retrospective review of microbiologic, serologic, and postmortem data to look for previously unidentified cases of health­ care–associated Legionnaires disease, and begin intensive prospective surveillance for additional cases. Decontaminate the water supply as outlined previously (Water: IV). If a case of health-care–acquired aspergillosis or other opportunistic environmental airborne fungal disease occurs during or immediately after construction, implement appropriate follow-up measures. Consult with the dental unit manufacturer on the need for periodic maintenance of anti-retraction mechanisms. Periodically review the facility’s microbiologic, histopathologic, and postmortem data to identify additional cases. Clean mops and cloths after use and allow to dry before reuse; or use single-use, disposable mop heads and cloths. Place smallpox patients in negative pressure rooms at the onset of their illness, preferably using a room with an anteroom if available. Practice hand hygiene to prevent the hand transfer of waterborne pathogens, and use barrier precautions (e.g., gloves) as defined by other guidelines. (No recommendation/unresolved issue)”. Use caution when considering the use of antimicrobial mattresses, textiles, and clothing as replacements for standard bedding and other fabric items; EPA has not approved public health claims asserting protection against human pathogens for treated articles. Spot-clean blood or body substance spills promptly. Cloudflare Ray ID: 6158e01f9a571772 No recommendation is offered regarding permitting pet visits to terminally ill immunosuppressed patients outside their PE units. Create and maintain negative air pressure in work zones adjacent to patient-care areas and ensure that required engineering controls are maintained. were updated to reflect changes in Federal regulatory approvals: LIST K: EPA’s Registered Antimicrobial Products Effective against Clostridium difficile Sporesexternal icon. Designate the following as major categories of medical waste that require special handling and disposal precautions: Consult federal, state, and local regulations to determine if other waste items are considered regulated medical wastes. Use proper sharps disposal strategies. (AIA: 5.1, 5.2), Perform those engineering and work-site related infection-control measures as needed for internal construction, repairs, and renovations: (AIA: 5.1, 5.2). Laboratories that isolate select agents from clinical specimens must comply with federal regulations for the receipt, transfer, management, and appropriate disposal of these agents. Choose chemicals suitable for low-temperature washing at proper use concentration if low- temperature (<160°F [<71°C]) laundry cycles are used. (OSHA: 29 CFR 1910.1030 § d.4.iii.B), Swab the area with a cloth or paper towels moderately wetted with disinfectant, and allow the surface to dry. Machines that dispense ice are preferred to those that require ice to be removed from bins or chests with a scoop. (States; ASHRAE: 12:2000). Monitor areas with special ventilation requirements (e.g., AII or PE) for ACH, filtration, and pressure differentials. If plant or flower care by patient-care staff is unavoidable, instruct the staff to wear gloves when handling the plants and flowers and perform hand hygiene after glove removal. 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