Limit microbiologic sampling for quality assurance purposes to. You may need to download version 2.0 now from the Chrome Web Store. * Develop and implement a maintenance schedule for ACH, pressure differentials, and filtration efficiencies using facility-specific data as part of the multidisciplinary risk assessment. Conduct a case-by-case assessment to determine if animal-assisted activities or animal- assisted therapy programs are appropriate for immunocompromised patients. If there is evidence of continued health-care–associated transmission (i.e., an outbreak), conduct an environmental assessment to determine the source of Legionella spp. Strongly recommended for implementation and supported by certain experimental, clinical, or epidemiologic studies and a strong theoretical rationale. When using a pulse or one-time decontamination method, superheat the water by flushing each outlet for ≥5 minutes with water at 160°F–170°F (71°C–77°C) or hyperchlorinate the system by flushing all outlets for ≥5 minutes with water containing ≥2 mg/L (≥2 ppm) free residual chlorine using a chlorine-based product registered by the EPA for water treatment (e.g., sodium hypochlorite [chlorine bleach]). To rinse disinfected endoscopes and bronchoscopes, use water of the highest quality practical for the system’s engineering and design (e.g., sterile water or bacteriologically-filtered water [water filtered through 0.1–0.2-µm filters]). Provide fresh air as per ventilation standards for operating rooms; portable units do not meet the requirements for the number of fresh ACH. are not detectable in unit water, remove, clean, and disinfect shower heads and tap aerators monthly by using a chlorine-based, EPA-registered product. Use the multidisciplinary team approach to policy development, including public media relations in order to disclose and discuss these activities. If reusable medical or surgical instruments are used in an animal procedure, restrict future use of these instruments to animals only. Routine Prevention of Waterborne Microbial Contamination Within the Distribution System, D.III. Air, Water, and Environmental-Surface Sampling, G.III. (FDA: 21 CFR 801.5, 807.87.e). Strongly recommended for implementation and strongly supported by well-designed experimental, clinical, or epidemiologic studies. Manage the handling and disposal of regulated medical wastes generated in isolation areas by using the same methods as for regulated medical wastes from other patient-care areas. If the pH of the municipal water is in the basic range (e.g., when chloramine is used as the primary drinking water disinfectant in the community), consult the facility engineer regarding the possible need to adjust the pH of the water to a more acid level before disinfection, to enhance the biocidal activity of chlorine. The new WHO Guidelines on Sanitation and Health summarize the evidence on the effectiveness of a range of sanitation interventions and provide a comprehensive framework for health-protecting … Do not use phenolics or any other chemical germicide to disinfect bassinets or incubators during an infant’s stay. Collect environmental samples from potential sources of airborne fungal spores, preferably using a high-volume air sampler rather than settle plates. Clean and disinfect moisture-resistant mattress covers between patients using an EPA- registered product, if available. Ensure compliance by housekeeping staff with cleaning and disinfection procedures. If this is not practical, air from the room can be recirculated after passing through a HEPA filter. Please enable Cookies and reload the page. * Assay for heterotrophic, mesophilic bacteria (e.g.. * Do not use nutrient-rich media (e.g., blood agar or chocolate agar). Maintain backup ventilation equipment (e.g., portable units for fans or filters) for emergency provision of ventilation requirements for operating rooms, and take immediate steps to restore the fixed ventilation system function. Restore appropriate ACH, humidity, and pressure differential; clean or replace air filters; dispose of spent filters. Follow manufacturers’ instructions for bed maintenance and decontamination. B), If a patient must be separated from his or her service animal while in the health-care facility. 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). Recommendations E.VI.G. CDC is not responsible for Section 508 compliance (accessibility) on other federal or private website. (AIA: 1.5.A1; JCAHO: EC 1.4), Deploy infection-control procedures to protect occupants until power and systems functions are restored. Ensure proper operation of the air-handling system in the affected area after erection of barriers and before the room or area is set to negative pressure. (AIA: 5.1). (AIA: 7.15.E, 7.31.D23, 9.10, Table 7.2). If an environmental source of airborne fungi is not identified, review infection control measures, including engineering controls, to identify potential areas for correction or improvement. Protective Measures for Immunocompromised Patients, H.V. Implement environmental infection-control and ventilation measures for operating rooms. Animals as Patients in Human Health-Care Facilities, H.VI. (Joint Commission on Accreditation of Healthcare Organizations [JCAHO]: Environment of Care [EC] 1.4), Emphasize restoration of proper air quality and ventilation conditions in AII rooms, PE rooms, operating rooms, emergency departments, and intensive care units. Clean and disinfect using EPA-registered products or sterilize equipment that has been in contact with animals, or use disposable equipment. Use central wall suction units with in-line filters to evacuate minimal laser plumes. (EPA: 7 USC § 136 et seq. No recommendation is offered for performing orthopedic implant operations in rooms supplied with laminar airflow. Dialysis Water Quality and Dialysate, D.XI. Keep adequate records of all infection-control measures and environmental test results for potable water systems. (U.S. Department of Agriculture [USDA]: 7 USC 2131), Keep animal rooms at negative pressure relative to corridors. (OSHA 29 CFR 1910.1030 §d.3.viii). (AIA: 7.31.E.3). (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. (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. Use disposable barrier coverings as appropriate to minimize surface contamination. (DHHS: 42 CFR 73 § 73.6). When environmental samples and patient specimens are available for comparison, perform the laboratory analysis on the recovered microorganisms down to the species level at a minimum and beyond the species level if possible. Restrict access to animal facilities to essential personnel. 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. The edits do not constitute any change to the intent of the recommendations. Infection-control staff, with clinical laboratory consultation, must supervise all environmental culturing. 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. Whenever possible, avoid inactivating or shutting down the entire HVAC system at one time, especially in acute-care facilities. No recommendation is offered for treating water in the facility’s distribution system with chlorine dioxide, heavy-metal ions (e.g., copper or silver), monochloramine, ozone, or UV light. Decontaminate bulk blood and body fluids from VHF patients using approved inactivation methods (e.g., autoclaving or chemical treatment) before disposal. Recommendations from regulations adopted at state levels are also noted. were updated to reflect changes in Federal regulatory approvals: LIST K: EPA’s Registered Antimicrobial Products Effective against Clostridium difficile Sporesexternal icon. Do not use water from the faucets in patient-care rooms to avoid creating infectious aerosols. For large hydrotherapy pools, use pH and chlorine residual levels appropriate for an indoor pool as provided by local and state health agencies. Update: The recommendations in this guideline for Ebola has been superseded by these CDC documents: See CDC’s Ebola Virus Disease website for current information on how Ebola virus is transmitted. Special Precautions for Wastes Generated During Care of Patients with Rare Diseases, Centers for Disease Control and Prevention. When appropriate, use active voice to avoid ambiguity. Seal windows in work zones if practical; use window chutes for disposal of large pieces of debris as needed, but ensure that the negative pressure differential for the area is maintained. (AIA: 5.1, 5.2), Provide backup emergency power and air-handling and pressurization systems to maintain filtration, constant ACH, and pressure differentials in PE rooms, AII rooms, operating rooms, and other critical-care areas. Promptly clean and treat scratches, bites, or other wounds that break the skin. Do not store the ice scoop in the ice bin. (AIA: 7.2.C3), Install self-closing devices on all AII room exit doors. If there is epidemiologic evidence of ongoing transmission of fungal disease, conduct an environmental assessment to determine and eliminate the source. Disposal Plan for Regulated Medical Wastes, I.III. Advise patients to avoid contact with animal feces and body fluids such as saliva, urine, or solid litter box material. (AIA: 1.1.A, 5.4), Monitor ventilation systems in accordance with engineers’ and manufacturers’ recommendations to ensure preventive engineering, optimal performance for removal of particulates, and elimination of excess moisture.

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