FEATURE The computer system provides other

valuable information critical to prevent- ing infections, Reiter says. “It will auto- matically send an alarm email if the humidity, temperature or pressure in a room goes out of its safe range. The system also informs us when we need to service one of our high-efficiency particulate air (HEPA) filters. These remove harmful pollutants from the air, so maintaining them is a priority.” Considering the potential dangers associated with even small HVAC- related issues, Altree advises ASCs to consider implementing a solution that continuously monitors and logs tem- perature, humidity and pressure. “Checking these qualities before you start procedures is important, but you need to know if any of them change unexpectedly throughout the day,” he says. “If you only check once a day, how would you know if someone left an OR door open long enough to reduce the room’s positive pressure to a level that invites contaminants to enter the room?” This is an example of a question ASCs are increasingly hearing from Medicare and other regulatory surveyors, he says. “They want facilities to have the capa- bility to show and log their performance 24 hours a day, seven days a week, even during weekends and holidays when the facility is closed.” To help ensure an HVAC system functions properly, Smith says, ASC management should schedule routine maintenance for all the equipment serv- ing the building. “Maintenance require- ments are typically provided in the operation and maintenance manual pro- vided by the contractor in a construc- tion project. Additionally, regular visual observation of the equipment and facil- ity—particularly in relatively hidden locations, such as above ceilings and utility closets—will help management know sooner when there is a problem.”

Turn Problems Into Fixes

ASCs should be prepared to respond promptly when they determine or

If an HVAC system is unable to handle the humidity, the high humidity can lead to increased infection risk in operating rooms and sterile storage areas.”

—Michael Altree, American Pharma Technologies

believe a problem exists with their HVAC system, Smith says. “Man- agement should have developed a risk analysis for the facility when it opened, which is required through standards such as the Facility Guide- lines Institute’s guidelines and the National Fire Protection Association’s NFPA 99. They generally provide the appropriate steps or contacts to make to address HVAC issues. The most important thing is to define the prob- lem and not ignore any issues.” Every problem represents a learn- ing and improvement opportunity, Altree says. “When something goes awry, ASCs would be wise to put in new processes that address the devia- tion.” For example, if a facility learns that its decontamination room experi- enced a loss of negative pressure over- night, which can encourage the spread of harmful airborne contaminants, man- agement should contact its HVAC com- pany to discuss what happened, deter- mine why it happened and what should

happen going forward to avoid it from occurring again, he suggests. Altree recalls a conversation with

an ASC manager about a report indi- cating the differential pressure in an OR dropping to zero for extended peri- ods. “This was occurring after normal hours of operation. We determined that the cleaning crew was propping open the OR door during the room’s entire cleaning. That presented a train- ing opportunity.” In addition, the ASC revised its standard operating proce- dures to include guidance for how long an OR door should remain open. Reiter says the service agreement

her ASC maintains with its HVAC computer system vendor includes a teaching element. “Our ASC can receive a certain number of hours of education and training each year, and we make sure to take advantage of it. When you are working with com- plex systems that play such a vital role in patient safety, you should not pass up any opportunity to learn and improve.”


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