Current Practice:

Recommendations (Items in bold would be new practices)

Cleaning:

1)  Wet mop and HEPA vacuum

2)  Use approved quaternary ammonium

3)  Wipe all surfaces

a)     Clean all rooms when patient discharged and if long-term patient every two weeks.

b)     Use recommended standards.

3)   Patient and the patients belongings should be removed from the room while cleaning.

4)   The patients belongings need to be cleaned with the same standards which are used for other room equipment.

5)   Required for all high risk units.

6)   All units.

a)     Should include all vents/grills, window seals

b)     No dust should accumulate.

c)     Mop heads and water should be changed between rooms

Environmental Services and Nursing (support associates)

Case finding:

1)Standard definition

2)Surveillance strategies

1)      Develop an active surveillance program.  Apply case finding techniques to pediatrics and solid organ transplant patients

2)     Active surveillance based on case definition will occur among oncology/transplant patients.

c)     Microbiologic-based surveillance will occur among solid-organ transplant recipients and extremely premature infants.  All autopsies of pediatric patients will be reviewed.  Any autopsies that report findings suggestive of invasive fungal infections will be investigated.

HEIC

HEIC, Physicians and physician extenders (Pediatric Oncology, NICU, Solid Organ transplant physicians)

Current Practice:

Recommendations (Items in bold would be new practices)

Unit policies and procedures

1)    Personnel must follow unit policies and procedures.

2)    Traffic patterns may need to be reviewed and traffic may need to be redirected. 

Nursing

Nursing, HEIC, Facilities, Safety

Maintanence:

  1)General

  2)Construction

  3)HEPA filtration

1)     Clean exhaust grills weekly-all high risk rooms rooms

2)     HVAC devices are inspected, grills are cleaned, pre-filters replaced per existing Facility Department protocols on demand basis.

3)     All rooms are inspected annually for evidence of water damage.  Repairs will be made if areas are found.  Zone maintenance must occur annually.

4)     Clean exhaust grills on demand-all rooms NICU and CMSC units which house at risk solid organ transplant patients.

5)     Particle counts and pressure testing will be performed on a demand basis.

1)     Contractors/subcontractors must follow JHH construction policies and JHH Facilities Department procedures

2)    Project managers will verify that construction   complies with the construction procedures and policies (see Construction Policy).

1)     Rooms with fixed HEPA filtration are inspected weekly, devices are cleaned, pre-filters are changed and air devices are disinfected weekly.

2)     Additional mobile HEPA filter air cleaners are used in other open areas.  These must be maintained per protocols maintained in the Office of Health Safety and Environment.

Facilities Department

Nursing and Clinicians

Safety

HEIC

Safety

Facilities Department

Safety

Current Practice:

Recommendations

Outbreak/Cluster Management:

1)     Clusters and outbreaks will be investigated per the JHH Outbreak management policy.

2)     Thresholds for interventions will vary depending on the individual situation.  Baseline rates of invasive fungal disease must be established.

3)     A single nosocomial aspergillus case will trigger:

a)     an epidemiologic investigation.

b)     additional sets of environmental cultures     in the affected patient room and adjacent areas.

c)     if cultures in step 3b grow a significant Aspergillus sp. additional areas may be cultured.

d)     pressure relationships between rooms and the hall will be  evaluated.

e)     additional particle counts and air samples (for counts and speciation).

4)     Two cases of nosocomial Aspergillus/invasive fungal disease infection on one floor/unit or two cases of Aspergillus/invasive fungal infection on different floors/units due to the same A. species will trigger:

a)     an epidemiologic investigation.

b)     additional sets of environmental cultures     in the affected patient room and adjacent areas.

c)     if cultures in step 3b grow a significant Aspergillus sp. additional areas may be cultured.

d)     pressure relationships between rooms and the hall will be  evaluated.

e)     additional particle counts and air samples (for counts and speciation) an epidemiologic investigation.

f)       additional sets of environmental cultures in the affected patient room and adjacent areas.

g)     if cultures in step ii grow a significant Aspergillus sp. additional areas may be cultured.

h)     pressure relationships between rooms and the hall will be  evaluated.

HEIC

Outbreak management team members

Facilities Department

HSE

MIcrobiology Laboratory

OHSE

Clinicians

Current Practice:

Recommendations (Items in bold would be new practices)

Outbreak/Cluster

Management (continued)

i)       additional particle counts and air samples (for counts and speciation).

j)       additional cleaning would be required.

k)       unit facilities would be inspected for potential sources of infection, necessary repairs would be made.

l)       additional HEPA filters would be placed in rooms, units as needed.

m)    if a source is not identified and patients are deemed to be at continued risk of developing an invasive fungal infection additional steps would be considered including a) delaying elective admissions, b) closing part of or entire units, c) transfer of patients to another hospital unit or to another hospital.

5)   Two or more cases of nosocomial Aspergillus/ invasive fungal disease infection (see definition of case)  on one floor/unit or two or more cases of Aspergillus/invasive fungal infection on different floors/units due to the same A. species will trigger: (a-m) listed above under 4 except that the additional steps and interventions would be introduced more quickly if deemed necessary by the outbreak management team, the Hospital Epidemiologist and the Chief of the implicated service/unit.