The physical environment of hospitals and other health care facilities can contribute to efforts to reduce the risk of health care-associated infections (HAIs). From the placement of hand sanitizer to maximize use to managing water systems to minimize pathogens, the physical environment plays an important role in infection prevention and control. By understanding how aspects of the built environment relate to the transmission of infection, and by tapping into innovative ideas on these important topics, health care providers can optimize their buildings for improved infection prevention and control.

To help with these efforts, the AHA’s Health Research & Educational Trust (HRET) and American Society for Healthcare Engineering (ASHE) are working with the Centers for Disease Control and Prevention (CDC) on a three-year initiative to improve infection prevention efforts in U.S. hospitals. As part of the project, ASHE, HRET and CDC are developing a publication on using the health care physical environment to prevent and control infection. 

The publication will cover six key components of infection prevention and the physical environment: 

  • Infection control risk assessments: The infection control risk assessment process uses an interdisciplinary expert panel to examine potential infection risks and mitigating factors during design and construction of health care facilities. By taking a proactive, integrated approach, HAIs can be prevented. 
  • Hand hygiene infrastructure: The design and placement of sinks, faucets, hand-drying facilities, and hand sanitizer can help prevent infections. In addition, the physical environment can improve hand hygiene compliance by including features that force or prompt appropriate behaviors.  
  • Reprocessing: The sterilization and high-level disinfection of reusable medical instruments and equipment is critical to preventing infections. Ensuring that reprocessing locations are designed properly plays a role in infection prevention as well as employee safety.
  • Cleaning of environmental surfaces: ASHE worked with the AHA’s Association for the Healthcare Environment  on this chapter, which covers general environmental cleaning and low-level disinfection. Cleaning and disinfection surfaces in health care spaces is a critical component of preventing HAIs.
  • Water-related environmental infection control: Health care facility plumbing systems should be designed to prevent the growth of pathogens so that patients—especially the most vulnerable patients—do not develop HAIs. 
  • The flow of patients, personnel and equipment: By thinking strategically about the way patients, personnel and equipment move through hospitals, spaces can be designed to reduce the risk of infection transmission.  

The infection prevention initiative wraps up later this year, and the AHA and its affiliated organizations will alert members when the publication is available. 

For additional information related to infection prevention and the health care physical environment, ASHE offers a monograph—Water Management in Health Care Facilities: Complying with ASHRAE Standard 188—and an education program—Managing Infection Prevention During the Construction & Operation of Health Care Facilities. The education program also is offered as a hosted program that ASHE faculty can bring on-site to individual health care organizations.

PJ Andrus is the executive director of ASHE, which is a professional membership group of the AHA. With more than 12,000 members, ASHE is the largest association devoted to professionals who design, build, maintain, and operate hospitals and other health care facilities. ASHE members include health care facility managers, engineers, architects, designers, constructors, infection control specialists and others.

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