Physical Environment and Infrastructure Managing the physical environment is a key component to breaking the chain of infection and IPC works closely with partners to provide appropriate infrastructure, risk mitigation strategies, and clean care environments. There is collaboration at site-, zone-, and provincial-levels between IPC and Linen and Environmental Services; Facilities Maintenance and Engineering; Capital Management; and Contracting, Procurement and Supply Management. Infrastructure Reviews and Inventory Provincial Engineering Reviews of Medical Device Reprocessing Areas A provincial review of all AHS medical device reprocessing areas was initiated in 2010 to identify the equipment and infrastructure required to maintain essential operations and to be compliant with current design guidelines and regulatory standards. All AHS and Covenant Health medical device reprocessing areas have been assessed and prioritized. Correcting deficiencies in equipment and infrastructure decreases the risk of reprocessing failures, addresses patient and staff safety issues, and helps support surgical service volumes. The Provincial Sterile Instrument/Medical Device Reprocessing Upgrades Phase 1 Major Capital Project identified eight medical device reprocessing areas as a priority for remediation. Two of the eight areas, Cold Lake Healthcare Centre and Lac La Biche Healthcare Centre, are being implemented by AHS Project Management with funding from the Infrastructure Maintenance Program. The remainder of the Phase I sites are proceeding to design with Alberta Infrastructure taking the lead. In Budget 2018, the Government of Alberta announced full funding of two Phase 1 medical device reprocessing areas at the Peter Lougheed Centre and Red Deer Regional Health Centre. A Needs Assessment has been developed for Phase 2 Provincial Sterile Instrument/Medical Device Reprocessing Upgrades. This is a Major Capital Project that will include an additional 18 AHS and Covenant Health medical device reprocessing areas that have been ranked in order of priority for remediation by the Provincial Medical Device Reprocessing Quality Committee. The identification and remediation of medical device reprocessing infrastructure deficiencies that did not require major renovations or major capital project funding are being managed at a zone-level and referred to the Provincial Medical Device Reprocessing Quality Committee for discussion. Airborne Isolation Rooms An inventory of airborne isolation rooms in acute care facilities was established in 2014/15, expanded in 2015/16, and has been updated annually in subsequent years. Rooms included in the inventory are required to meet minimal functional criteria based on current standards, including air exchange rates, airflow, and the ability to monitor pressure differentials. Criteria were reviewed and updated in 2017/18. The inventory provides guidance to frontline staff when managing patients with suspect or confirmed communicable diseases that require airborne precautions such as measles, pulmonary tuberculosis, and varicella. Capital Management and IPC jointly developed a provincial protocol to address preventative maintenance requirements for airborne isolation rooms, which is in the process of being completed. 1
Construction-related Support Resources University District Development Design and Construction The Design and Construction Working Group is a conjoint initiative between Capital Management and IPC that supports compliance with IPC measures during facility design, construction, and maintenance activities. In 2017/18, the working group focused on five main areas: Determining implications of new products with antimicrobial claims such as furniture, non-medical equipment, and building materials; Providing guidance on criteria for evaluating hand hygiene sinks; Investigating additional risk mitigation options for exhausting air from construction sites, including use of plenum boxes; Reviewing the revised Canadian Standards Association (2017) standard on Infection Control During Construction, Renovation, and Maintenance of Health Care Facilities; and Continuing to investigate questions brought forward at the Design and Construction Forum. Updates on these topics will be included in the revised IPC Health Care Facility Design Guidelines and Preventive Measures for Construction, Renovation and Maintenance Activities in 2018/19. The Design and Construction Forum meets monthly to disseminate information and discuss topics in a multidisciplinary setting. Many issues are elevated to the working group for resolution or incorporation into future guideline revisions. For construction, renovation, and maintenance projects within facilities, many sites engage in multidisciplinary teams to discuss upcoming and current projects and to identify and resolve problems. 2
New Hospital Construction 3
Medical Equipment In 2017/18, IPC partnered with Capital Management to further expand the pilot work conducted in Calgary Zone that identified cost savings and potential patient safety benefits with use of a new mattress surface repair product. When used as part of a routine preventative maintenance program, this product can safely prolong the lifespan of bed and stretcher mattresses and improve patient safety by minimizing potential cross-contamination from non-intact mattress surfaces. Two facilities, Foothills Medical Centre and South Health Campus, underwent mattress integrity assessments which evaluated over 1,000 mattresses and stretchers. Damage rates as high as 23% for beds and 42% for stretchers were identified. Most of the damage was considered repairable using the mattress surface repair product. This program incurs a high cost upfront for the patches, but savings are realized with a reduced need for new mattress purchases. In Central Zone, Linen and Environmental Services is doing a pilot of their staffs participation in the identification and remediation of damaged mattresses, which will be reported on in 2018/19. Once the pilot in Central Zone is completed, implementation in Edmonton Zone will occur, based on learnings and results from the other locations. IPC Pre-purchase Assessment of Medical Devices Environmental Services The Linen and Environmental Services Provincial Standards Committee and working groups at zone- and site-levels are in place to support environmental cleaning practices. These multidisciplinary groups, which include Linen and Environmental Services and IPC, are responsible for developing and applying guidelines. Stakeholders actively collaborate to explore products and processes for clean and safe patient environments. 4
Cleaning Patient Care Environments IPC and Linen and Environmental Services continued to focus on collaborative efforts to improve cleaning standards and protocols, standardize cleaning products, and support best practices. Equipment cleaning initiatives are a priority for Linen and Environmental Services. The program for dedicated equipment cleaners is a major initiative to improve clarity and accountability for cleaning of shared patient equipment. This means there is a dedicated team of staff who are responsible for cleaning designated pieces of shared patient equipment following a standardized process. Already established in the Calgary Zone, the program rolled out in the Edmonton Zone acute care facilities in September 2016 and will be fully implemented in the five regional acute care facilities in North, Central, and South zones in 2018/19. The benefits of the dedicated equipment cleaner program include improved patient experience, staff satisfaction and an increased sense of support, improved cleanliness audit scores, and resource efficiencies. An equipment cleaning manual was updated and is being used at sites to support the equipment cleaning program. The cleaning manual is available on the internal AHS Linen and Environmental Service website. Efforts continue to be made to standardize low-level hard surface disinfectants at sites across the province. A multidisciplinary provincial working group developed specifications for products being ordered, as well as standardized cleaning and disinfection processes to facilitate correct product use. This working group includes representatives from: Contracting, Procurement and Supply Management; IPC; Linen and Environmental Services; and Workplace Health and Safety. Pilots were conducted at one site in each of the five zones to be followed by a gradual rollout across the province. In January 2018, the zone-by-zone transition started with Central Zone, progressing to South, Calgary, Edmonton, and North zones. The total timeline is unknown and is dependent on each zone s capacity and the availability of the vendors, who are assisting in providing training and visual aids, to support the change. Work on non-manual room disinfection technologies in clinical settings is ongoing with Contracting, Procurement and Supply Management; Facilities Maintenance and Engineering; Health Technology Assessment and Innovation; IPC; Linen and Environmental Services; and Workplace Health and Safety. In 2014, a working group developed a process to evaluate non-manual room disinfection technologies. The working group reviewed available non-manual room disinfection technologies and selected two for proof of concept testing. In 2015, the Canadian Agency for Drugs and Technologies in Health released a report on non-manual room disinfection technologies and concluded that there was some evidence that technologies based on hydrogen peroxide and ultraviolet light were effective but more evidence was needed. Based on the results from the proof of concept testing and the report, the working group recommended a pilot using Nocospray. The pilot of Nocospray started on June 1, 2016 in six patient care units at three sites in Calgary and Edmonton zones. The purpose of the pilot was to assess the clinical effectiveness, operational feasibility, and cost effectiveness of this technology. The pilot is ongoing and results are expected in 2018/19. The pilot will be evaluated in the context of emerging literature on the use of these technologies in other jurisdictions. This will inform future decisions about technology use for disinfecting patient care environments and shared patient equipment. In 2016/17, Linen and Environmental Services implemented an automated quality audit system at the 13 largest hospital sites. Use of the system at 45 smaller sites within Calgary, Central, and Edmonton zones will be completed in 2018/19. The remaining 48 sites will be brought on stream in the following fiscal year. The reporting capability and real-time results of the automated system support immediate site-level quality improvement. The system uses software and hand-held devices for unit-level reviews. Auditors are trained and certified by the software company. Reporting on key performance indicators within the program became available for site-, zone-, and provincial-levels in September 2017. 5
Provincial Water Quality Steering Committee A Provincial Water Quality Steering Committee was formed to focus on water efficiency, safety, and sustainability in all AHS facilities. The committee is led by Capital Management and Facilities Maintenance and Engineering with IPC as a member. The work plan for the committee includes development of a screening tool to identify hazards across a variety of healthcare settings, survey the current status of water quality and temperature maintenance and operations, create a compendium of resources for facility managers, and develop a framework that facility managers can use to build water quality plans specific to their site. Water Quality Issues at the Medicine Hat Regional Hospital 6