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INFECTION CONTROL


Because of the importance of infection


control, ICRA is beginning to be adopted as a requirement for renovation work in Japan.


Survey of Aspergillus spores Prior to the demolition of the existing building in Takamatsu Red Cross Hospital in Japan, the hospital director specialising in respiratory medicine called for new measures against aspergillosis beyond conventional dust scattering prevention. So, we started by examining the whereabouts of infectious spores to develop new measures.


Samples were taken from various


places in the building, and colonies after culture were automatically analysed for gene sequences by a DNA analysis and matched against a database to identify fungal types. As a result, it was found that dust on the ceiling board was


Compressed air


Unspecified 23%


Is the dust leaking for some reason?


inhabited by many aspergillus spores.4 Following the results of the survey, it


Other sources 11%


Air-conditioning systems


17% The cause of Aspergillosis


Cases connected with construction and engineering work


49%


was deemed reasonable and effective to disinfect the ceiling cavities before dismantling the ceiling board. We decided to try a chemical spray using a two-fluid nozzle, previously used for sterilisation, and confirmed the disinfecting effect of hypochlorous acid solution. Aspergillus spores, a type of mould, were evaluated by changing the spraying


conditions and dosage with an aqueous solution of hypochlorous acid, and it was found that


eradication was possible. In each room in the hospital, a spray nozzle was inserted into the


ceiling cavity and it was disinfected by spraying the chemical. After the disinfection work was completed, dismantling work in the room started in sequence. The disinfected area was about 5000 square metres. As a result of collecting and culturing


the dust on the ceiling board before and after the chemical spraying, 98% or more eradication effect could be confirmed.5 We were able to receive high evaluation from the hospital director.


Disinfectant The two-fluid nozzle.


Table 1. Recommended infection control measure. Patient risk group


Low risk group


Medium risk group High risk group


Highest risk group


Type A I I I


II


Construction project type Type B II II II


Type C II II


III/IV


III/IV III/IV


Table 2. Description of required infection control precaution by class. Category Class I Class II Class III


During construction project Omitted Omitted


Complete all critical barriers (ie sheetrock, plywood, plastic), to seal area from non-work area or implement control cube method (cart with plastic covering and sealed connection to work site with plastic covering and sealed connection to work site with HEPA vacuum – for vacuuming prior to exit) before construction begins. Maintain negative air pressure within work site, utilising HEPA-equipped air filtration units Omitted other


Class IV Same as Class III IFHE DIGEST 2020 Disinfectant fog


Type D III/IV IV IV IV


Application of sterilisation technology to hospital renovation work To receive Joint Commission International Certification at Fujita Health University Hospital in Japan, it was decided to proceed with the renovation work based on the ICRA, which is positioned as one of the certification conditions. Therefore, the infection control department and the facility department of the hospital, and the construction company decided in advance to consider infection control measures related to the renovation work and to carry them out according to the checklist.


During the


renovation work at Fujita Health University Hospital, we disinfected the ceiling cavity of approximately 4800 square metres from November 2017 to September 2018


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