INFECTION PREVENTION AND CONTROL
Infectious Agent
Susceptible Host
Melanie Jacobsen Cox
Melanie Jacobsen Cox joined HLM as head of Healthcare in early 2022, bringing extensive experience in the technical project delivery of healthcare architecture. She is ‘inspired by refining processes and efficiency, while building a network of best practice to enable healthcare providers to deliver improved care for patients through the thoughtful design of therapeutic and healing environments’. She is responsible for expanding and advocating ‘the extensive expertise’ of the HLM healthcare leadership team, strategically growing existing business relationships, and creating new opportunities nationally across all areas of the healthcare industry.
Everything is connected, and IPC risk assessment and resolution need to look beyond the obvious.
Portal of Entry
Mode of Transmission
n Non-clinical space considerations – support facilities – waste, cleaning, linen, storage.
n Clean to dirty patient flow: why is it important?
Session 3: Water safety in healthcare environments – Key risks and considerations n Waterborne pathogens and transmission, and at-risk patient cohorts.
n Introduction to biofilms / microbial risks within a complex water system.
n Project water safety plan and design roles within the Water Safety Group.
n Project governance and accountability.
Session 4: Preventing an incident / outbreak n Learning scenarios – risk assessment and mitigation.
Session 5: Ventilation in healthcare settings n Airborne pathogens, transmission, and at-risk patient cohorts.
n High-risk patient groups / settings. n Plant spaces: What are the IPC considerations? – design considerations from IPC perspectives.
n Specific considerations for planned construction/ renovation activity.
The hierarchy of controls against IPC risks needs to start with a focus on elimination.
effective Most
Session 6: HAI-SCRIBE (Healthcare Associated Infection – Systems for Controlling Risk in the Built Environment) n Risk assessments and IPC.
Hierachy of Controls Elimination
Substitution
Engineering controls
Administrative controls
PPE effective 62 Health Estate Journal November 2024 Least
All the sessions were recorded, so that participants could go back and re-watch deeply thought-provoking presentations and follow on discussions. Some of the issues and questions that the sessions raised included: n ‘We’re encouraged to reduce Net to Gross internal area percentages as much as possible – including reducing circulation spaces – compromising the separation of clean and dirty flows.’
n ‘Should we be raising infection prevention and control risks, and ventilation and water safety, as residual risks that require ongoing management by the end-user to minimise and mitigate prevalent and known risks?’
n ‘When we start a new project at an existing hospital – as designers, should we be asking to see the Trust’s / Health Board’s Water Safety Plan and Ventilation Safety Group notes?’
Following on, the sessions kickstarted internal revisions
to the way in which we work. Among the key outcomes were: n Colleagues reported an increased awareness around healthcare-associated infections, especially around the relative revelation that clinical basins were not necessarily a source of cleanliness, more a point of disposal, and could potentially introduce contamination to a space.
n A better understanding around external influences such as adjacencies to factories or industrial processes, which could have a detrimental effect on air quality supplied to a space, especially if there is not sufficient remediation in the air-handling unit, such as filters.
Physically remove the hazard
Replace the hazard
Isolate people from the hazard
Change the way people work
Protect the worker with Personal Protective Equipment
n Greater understanding of waterborne and airborne pathogens, along with the external, construction, and maintenance implications, and the need to consider IPC at the earliest stage.
n Greater insight into the complexities and importance of the commissioning and witnessing process, and how construction management can undermine satisfactory installations. This included discussions around MMC (Modern Methods of Construction), and prefabricated elements such as IPS panels and en suite bathroom pods, which can be constructed outside the controlled environment, and were then installed and commissioned as part of the overall system
n Wider understanding of our role within IPC design, and the need to provide robust specifications, but also better considerations around future maintenance – making this easy, and inclusion of future maintenance
Reservoir
Chain of Infection
Portal of Exit
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