LIMITER CONTAMINATION ET INFECTION
LIMITER CONTAMINATION ET INFECTION classe : 3ème durée : 50 min la situation-problème. En 1900 l'espérance de vie moyenne était de 45 ans pour les femmes
Best Practices for Environmental Cleaning in Healthcare Facilities
The following experts provided technical expertise on infection prevention and control (IPC) in resource-limited settings: Nizam Damani.
Infection with Salmonella
Salmonellosis is one of the most common foodborne infections in the United States Salmonellosis is generally self-limited and usually does not require ...
Guidance for the Selection and Use of Personal Protective
when and what PPE should be used to prevent exposure to infectious diseases. but aprons occasionally are used where limited contamination is anticipated ...
Guidelines for Environmental Infection Control in Health-Care
handwashing/hand hygiene; standard precautions; and infection-control measures used to prevent instrument or equipment contamination during patient care.
Aerosol-Generating Procedures and Patients with Suspected or
Farvardin 23 1401 AP These aerosol-generating procedures. (AGP) may put health care workers at an increased risk for exposure to SARS-CoV-2 and infection. Limited ...
Mask use in the context of COVID-19 - Interim guidance 1 December
Azar 11 1399 AP WHO Guidelines on infection prevention and control of ... contamination in the vicinity of people infected with SARS-. CoV-2 and the fact ...
Considerations for quarantine of individuals in the context of
Esfand 29 1398 AP or national policy for the quarantine of individuals and for ... to prevent the spread of infection or contamination.
Surgical Site Infection Event (SSI)
Dey 11 1400 AP The most recent CDC and Healthcare Infection Control Practices ... limited to: colon perforation
War surgery : working with limited resources in armed conflict and
13.1 Contamination and infection. 255. 13.2 Major bacterial contaminants in war wounds. 256. 13.3 Major clinical infections of war wounds.
LIMITER CONTAMINATION ET INFECTION - ac-reunionfr
LIMITER CONTAMINATION ET INFECTION classe : 3ème durée : 50 min la situation-problème En 1900 l’espérance de vie moyenne était de 45 ans pour les femmes 44 ans pour les hommes Actuellement elle est de 83 ans pour les femmes 75 ans pour les hommes
Lutte anti-infectieuse lors de la prise en charge des cas
pour limiter la contamination et se tenir éloignés d’un mètre les uns des autres dans une salle d’attente réservée et bien ventilée ; • vérifier que des mesures ont été prises pour limiter le temps d’attente des cas suspects de COVID -19 en vue du dépistage ; • après le dépistage et la mise en isolement trier les
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Accessable version: https://www.cdc.gov/infectioncontrol/guidelines/environmental/index.htmlGuidelines for Environmental
Infection Control in Health-Care
Facilities
Recommendations of CDC and the Healthcare Infection ControlPractices Advisory Committee (HICPAC)
U.S. Department of Health and Human Services
Centers for Disease Control and Prevention (CDC)
Atlanta, GA 30329
2003Updated: July 2019
Ebola Virus Disease Update [August 2014]: The recommendations in this guideline for Ebola has been superseded by these CDC documents:Infection Prevention and Control Recommendations for Hospitalized Patients with Known or Suspected Ebola Virus Disease in U.S. Hospitals (https://www.cdc.gov/vhf/ebola/healthcare-
us/hospitals/infection-control.html) Interim Guidance for Environmental Infection Control in Hospitals for Ebola VirusSee CDC"s
Ebola Virus Disease website (https://www.cdc.gov/vhf/ebola/index.html) for current information on how Ebola virus is transmitted. New Categorization Scheme for Recommendations [November 2018] In November 2018, HICPAC voted to approve an updated recommendation scheme. The category Recommendation means that we are confident that the benefits of the recommended approach clearly exceed the harms (or, in the case of a negative recommendation, that the harms clearly exceed the benefits). In general, Recommendations should be supported by high- to mode rate-quality evidence. In some circumstances, however, Recommendations may be made based on lesser evidence or even expert opinion when high-quality evidence is impossible to obtain and the anticipated benefits strongly outweigh the harms or when then Recommendation is required by federal law. For more information, see November 2018 HICPAC Meeting Minutes [PDF - 126 pages] (http://www.cdc.gov/hicpac/pdf/2018-Nov-HICPAC-Meeting-508.pdf). C. difficile Update [April 2019]: Recommendations E.VI.G. and E.VI.H. and the supporting text were updated to reflect changes in Federal regulatory approvals: LIST K: EPA"s Registered Antimicrobial Products Effective against Clostridium difficile Spores against-clostridium).Interim Measles Infection Control [July 2019]
See Interim Infection Prevention and Control Recommendations for Measles in Healthcare Settings Guidelines for Environmental Infection Control in Health-Care Facilities (2003)Last update: July 2019 2 of 241
Suggested Citations:
Available from the CDC Internet Site:
The full-text version of the guidelines appears as a web-based document at the CDC's Division ofHealthcare Quality Promotion
'sInfection Control
websiteThe full-text version of the guidelines should be cited when reference is made primarily to material in
Parts I and IV. The print version of the guidelines appears as: Sehulster LM, Chinn RYW, Arduino MJ, Carpenter J, Donlan R, Ashford D, Besser R, FieldsB, McNeil
MM, Whitney C, Wong S, Juranek D, Cleveland J. Guidelines for environmental infection control in health-care facilities. Recommendations from CDC and the Healthcare Infection Control Practices Advisory Committee (HICPAC). Chicago IL; American So ciety for Healthcare Engineering/AmericanHospital Association; 2004.
Part II of these guidelines appeared in the CDC's "Morbidity and Mortality Weekly Report:"Centers for Disease Control and Prevention. Guidelines for environmental infection control in health-care
facilities: recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee (HICPAC). MMWR 2003; 52 (No. RR-10): 1-48. Updates to the Part II recommendations also appeared in the MMWR in 2003 as "Errata: Vol. 52 (No. RR-10)" (MMWR Vol. 52 [42]: 1025-6) on October 24, 2003 and as a "Notice to Readers" scheduled toappear in February 2004. The full-text version of these guidelines (this document) incorporates these
updates. Guidelines for Environmental Infection Control in Health-Care Facilities (2003)Last update: July 2019 3 of 241
Centers for Disease Control and Prevention
Healthcare Infection Control Practices Advisory
Committee (HICPAC)
Guidelines for Environmental Infection Control in
Health-Care Facilities
Abstract
Background:
Although the environment serves as a reservoir for a variety of microorganisms, it is rarely implicated in
disease transmission except in the immunocompromised population. Inadvertent exposures to environmental opportunistic pathogens (e.g.,Aspergillus
spp. and Legionella spp.) or airborne pathogens (e.g.,Mycobacterium tuberculosis
and varicella -zoster virus) may result in infections with significantmorbidity and/or mortality. Lack of adherence to established standards and guidance (e.g., water quality
in dialysis, proper ventilation for specialized care areas such as operating rooms, and proper use of
disinfectants) can result in adverse patient outcomes in health-care facilities.Objective:
The objective is to develop an environmental infection-contro l guideline that reviews and reaffirms strategies for the prevention of environmentally-mediated infections, particularly among health-care workers and immunocompromised patients. The recommendations are evidence -based whenever possible.Search Strategies:
The contributors to this guideline reviewed predominantly English-language articles identified fromMEDLINE literature searches, bibliographies from published articles, and infection-control textbooks.
Criteria for Selecting Citations and Studies for This Review: Articles dealing with outbreaks of infection due to environmental opportunistic microorganisms andepidemiological- or laboratory experimental studies were reviewed. Current editions of guidelines and
standards from organizations (i.e., American Institute of Architects [AIA], Association for the Advancement of Medical Instrumentation [AAMI], and American Society of Heating, Refrigeration, andAir-Conditioning Engineers [ASHRAE]) were consulted. Relevant regulations from federal agencies (i.e.,
U.S. Food and Drug Administration [FDA]; U.S. Department of Labor, Occupational Safety and Health Administration [OSHA]; U.S. Environmental Protection Agency [EPA]; and U.S. Department of Justice) were reviewed. Some topics did not have well -designed, prospective studies nor reports of outbreak investigations. Expert opinions and experience were consulted in these instances.Types of Studies:
Reports of outbreak investigations, epidemiological assessment of outbreak investigations with control
strategies, and in vitro environmental studies were assessed. Many of the recommendations are derived
from empiric engineering concepts and reflect industry standards. A few of the infection-control measures
proposed cannot be rigorously studied for ethical or logistical reasons. Guidelines for Environmental Infection Control in Health-Care Facilities (2003)Last update: July 2019 4 of 241
Outcome Measures:
Infections caused by the microorganisms described in this guideline are rare events, and the effect of
these recommendations on infection rates in a facility may not be readily measurable. Therefore, the following steps to measure performance are suggested to evaluate these recommendations: 1. Document whether infection-control personnel are actively involved in all phases of a healthcare facility's demolition, construction, and renovation. Activities should include performing a risk assessment of the necessa ry types of construction barriers, and daily monitoring and documenting of the presence of negative airflow within the construction zone or renovation area. 2.Monitor and document daily the negative airflow in airborne infection isolation rooms (AII) and positive airflow in protective environment rooms (PE), especially when patients are in these rooms.
3. Perform assays at least once a month by using standard quantitative methods for endotoxin in water used to reprocess hemodialyzers, and for heterotrophic, mesophilic bacteria in water used to prepare dialysate and for hemodialyzer reprocessing. 4. Evaluate possible environmental sources (e.g., water, laboratory solutions, or reagents) of specimen contamination when nontuberculous mycobacteria (NTM) of unlikely clinical importance are isolated from clinical cultures. If environmental contamination is found, eliminate the probable mechanisms. 5.Document policies to identify and respond to water damage. Such policies should result in either repair and drying of wet structural materials within 72 hours, or removal of the wet material if drying
is unlikely within 72 hours.Main Results:
Infection-control strategies and engineering controls, when consistently implemented, are effective in
preventing opportunistic, environmentally-related infections in immunocompromised populations.Adherence to proper use of disinfectants, proper maintenance of medical equipment that uses water (e.g.,
automated endoscope reprocessors and hydrotherapy equipment), water-quality standards forhemodialysis, and proper ventilation standards for specialized care environments (i.e., airborne infection
isolation [AII], protective environment [PE], and operating rooms [ORs]), and prompt management of water intrusion into facility structural elements will minimize health-care associated infection risks andreduce the frequency of pseudo-outbreaks. Routine environmental sampling is not advised except in the
few situations where sampling is directed by epidemiologic principles and results can be applied directly
to infection control decisions, and for water quality determinations in hemodialysis.Reviewers' Conclusions:
Continued compliance with existing environmental infection control measures will decrease the risk of
health-care associated infections among patients, especially the immunocompromised, and health-care workers. Guidelines for Environmental Infection Control in Health-Care Facilities (2003)Last update: July 2019 5 of 241
Centers for Disease Control and Prevention Healthcare Infection Control Practices AdvisoryCommittee (HICPAC)
Guidelines for Environmental Infection Control in Health-Care FacilitiesTable of Contents
List of Abbreviations Used in This Publication ............................................................................................ 9
Executive Summary .................................................................................................................................... 15
Part I. Background Information: Environmental Infection Control in Health-Care Facilities .................... 17
A. Introduction ........................................................................................................................................ 17
B. Key Terms Used in this Guideline ..................................................................................................... 19
C. Air ...................................................................................................................................................... 20
1. Modes of Transmission of Airborne Diseases ................................................................................ 20
2. Airborne Infectious Diseases in Health-Care Facilities .................................................................. 21
3. Heating, Ventilation, and Air Conditioning Systems in Health-Care Facilities ............................. 27
4. Construction, Renovation, Remediation, Repair, and Demolition .................................................. 35
5. Environmental Infection-Control Measures for Special Health-Care Settings ............................... 48
6. Other Aerosol Hazards in Health-Care Facilities ............................................................................ 54
D. Water .................................................................................................................................................. 54
1. Modes of Transmission of Waterborne Diseases ............................................................................ 54
2. Waterborne Infectious Diseases in Health-Care Facilities .............................................................. 55
3. Water Systems in Health-Care Facilities ........................................................................................ 60
4. Strategies for Controlling Waterborne Microbial Contamination................................................... 68
5. Cooling Towers and Evaporative Condensers ................................................................................ 72
6. Dialysis Water Quality and Dialysate ............................................................................................. 74
7. Ice Machines and Ice
....................................................................................................................... 80
8. Hydrotherapy Tanks and Pools ....................................................................................................... 82
9. Miscellaneous Medical/Dental Equipment Connected to Main Water Systems
............................. 84E. Environmental Services ...................................................................................................................... 86
1. Principles of Cleaning and Disinfecting Environmental Surfaces .................................................. 86
2. General Cleaning Strategies for Patient-Care Areas ....................................................................... 88
3. Cleaning Strategies for Spills
of Blood and Body Substances ....................................................... 914. Carpeting and Cloth Furnishings .................................................................................................... 93
5. Flowers and Plants in Patient-Care Areas ....................................................................................... 94
6. Pest Control ..................................................................................................................................... 95
7. Special Pathogen Concerns ............................................................................................................. 97
F. Environmental Sampling .................................................................................................................. 103
1. General Principles: Microbiologic Sampling of the Environment ................................................ 103
2. Air Sampling ..................................................................................................................................... 104
Guidelines for Environmental Infection Control in Health-Care Facilities (2003)Last update: July 2019 6 of 241
3. Water Sampling ............................................................................................................................ 109
4. Environmental Surface Sampling ................................................................................................. 110
G. Laundry and Bedding ....................................................................................................................... 113
1. General Information ...................................................................................................................... 113
2. Epidemiology and General Aspects of Infection Control ............................................................. 113
3. Collecting, Transporting, and Sorting Contaminated Textiles and Fabrics .................................. 114
4. Parameters of the Laundry Process ............................................................................................... 115
5. Special Laundry Situations ........................................................................................................... 117
6. Surgical Gowns, Drapes, and Disposable Fabrics ........................................................................ 118
7. Antimicrobial-Impregnated Articles and Consumer Items Bearing Antimicrobial Labeling ....... 118
8. Standard Mattresses, Pillows, and Air-Fluidized Beds ................................................................. 118
H. Animals in Health-Care Facilities .................................................................................................... 120
1. General Information ...................................................................................................................... 120
2. Animal-Assisted Activities, Animal-Assisted Therapy, and Resident Animals ........................... 121
3. Service Animals ............................................................................................................................ 123
4. Animals as Patients in Human Health-Care Facilities .................................................................. 125
5. Research Animals in Health-Care Facilities ................................................................................. 126
I. Regulated Medical Waste .................................................................................................................. 127
1. Epidemiology ................................................................................................................................ 127
2. Categories of Medical Waste ........................................................................................................ 128
3. Management of Regulated Medical Waste in Health-Care Facilities ........................................... 128
4. Treatment of Regulated Medical Waste ........................................................................................ 128
5. Discharging Blood, Fluids to Sanitary Sewers or Septic Tanks ................................................... 131
6. Medical Waste and CJD ................................................................................................................ 131
Part II. Recommendations for Environmental Infection Control inHealth-Care Facilities ...................... 132
A. Rationale for Recommendations ...................................................................................................... 132
B. Rating Categories ............................................................................................................................. 132
C. RecommendationsAir ................................................................................................................... 133
I. Air-Handling Systems in Health-Care Facilities..................................................................... 133
II. Construction, Renovation, Remediation, Repair, and Demolition .......................................... 135
III. Infection-Control and Ventilation Requirements for PE Rooms ............................................ 137
IV. Infection-Control and Ventilation Requirements for All Rooms ............................................ 138
V. Infection-Control and Ventilation Requirements for Operating Rooms ................................. 139
VI. Other Potential Infectious Aerosol Hazards in Health-Care Facilities ................................... 140
D.Recommendations
Water .............................................................................................................. 140
I. Controlling the Spread of Waterborne Microoganisms .......................................................... 140
VII. Routine Prevention of Waterborne Microbial Contamination Within the Distribution System................................................................................................................................................ 141
VIII. Remediation Strategies for Distribution System Repair or Emergencies ............................... 141
Guidelines for Environmental Infection Control in Health-Care Facilities (2003)Last update: July 2019 7 of 241
IX. Additional Engineering Measures as Indicated by Epidemiologic Investigation for ControllingWaterborne, Health-care associated Legionnaires Disease..................................................... 142
X. General Infection-Control Strategies for Preventing Legionnaires Disease ........................... 143
XI. Preventing Legionnaires Disease in Protective Environments and Transplant Units ............. 144
XIII. Dialysis Water Quality and Dialysate ..................................................................................... 145
XIV. Ice Machines and Ice............................................................................................................... 145
XV. Hydrotherapy Tanks and Pools ............................................................................................... 146
XVI. Miscellaneous Medical Equipment Connected to Water Systems .......................................... 146
E.RecommendationsEnvironmental Services .................................................................................. 147
I. Cleaning and Disinfecting Strategies for Environmental Surfaces in Patient-Care Areas ...... 147II. Cleaning Spills of Blood and Body Substances ...................................................................... 149
F.RecommendationsEnvironmental Sampling ................................................................................. 152
I. General Information ................................................................................................................ 152
II. Air, Water, and Environmental-Surface Sampling ................................................................. 152
G.RecommendationsLaundry and Bedding ..................................................................................... 153
I. Employer Responsibilities ...................................................................................................... 153
II. Laundry Facilities and Equipment .......................................................................................... 153
III. Routine Handling of Contaminated Laundry .......................................................................... 153
IV. Laundry Process ...................................................................................................................... 153
V. Microbiologic Sampling of Textiles ....................................................................................... 154
VI. Special Laundry Situations ..................................................................................................... 154
VII. Mattresses and Pillows ............................................................................................................ 154
VIII. Air-Fluidized Beds .................................................................................................................. 154
H. Recommendations
Animals in Health-Care Facilities .................................................................. 154
I. General Infection-Control Measures for Animal Encounters ................................................. 154
II. Animal-Assisted Activities, Animal-Assisted Therapy, and Resident Animal Programs ...... 155III. Protective Measures for Immunocompromised Patients ......................................................... 155
IV. Service Animals ...................................................................................................................... 155
V. Animals as Patients in Human Health-Care Facilities ............................................................ 156
VI. Research Animals in Health-Care Facilities ........................................................................... 156
I. RecommendationsRegulated Medical Waste ................................................................................ 157
I. Categories of Regulated Medical Waste ................................................................................. 157
II. Disposal Plan for Regulated Medical Wastes ......................................................................... 157
III. Handling, Transporting, and Storing Regulated Medical Wastes ........................................... 157
IV. Treatment and Disposal of Regulated Medical Wastes .......................................................... 158
V. Special Precautions for Wastes Generated During Care of Patients with Rare Diseases ....... 158Part III. References ................................................................................................................................... 158
Part IV. Appendices .................................................................................................................................. 215
Appendix A. Glossary of Terms ........................................................................................................... 215
Guidelines for Environmental Infection Control in Health-Care Facilities (2003)Last update: July 2019 8 of 241
Appendix B. Air .................................................................................................................................... 223
1. Airborne
Contaminant Removal ................................................................................................... 223
2. Air Sampling for Aerosols Containing Legionellae ...................................................................... 224
3. Calculation of Air Sampling Results ............................................................................................ 224
4. Ventilation Specifications for Health-Care Facilities ................................................................... 225
Appendix C. Water ............................................................................................................................... 233
1. Biofilms......................................................................................................................................... 233
2. Water and Dialysate Sampling Strategies in Dialysis ................................................................... 234
3. Water Sampling Strategies and Culture Techniques for Detecting Legionellae ........................... 235
4. Procedure for Cleaning Cooling Towers and Related Equipment ................................................ 237
5. Maintenance Procedures Used to Decrease Survival and Multiplications of Legionella spp. in
Potable-Water Distribution Systems ........................................................................
............... 238Appendix
D. Insects and Microorganisms
............................................................................................ 239Appendix E. Information Resources ..................................................................................................... 240
Air andWater ..................................................................................................................................... 240
Environmental Sampling................................................................................................................... 240
Animals in Health-Care Facilities ..................................................................................................... 240
Regulated Medical Waste ................................................................................................................. 240
General Resources ............................................................................................................................ 240
Appendix F. Areas of Future Research ................................................................................................. 241
Air..... ............................................................................................................................................... 241
Water...... ......................................................................................................................................... 241
Environmental Services .................................................................................................................... 241
Laundry and Bedding ........................................................................................................................ 241
Animals in Health-Care Facilities ..................................................................................................... 241
Regulated Medical Waste ................................................................................................................. 241
Guidelines for Environmental Infection Control in Health-Care Facilities (2003)Last update: July 2019 9 of 241
List of Abbreviations Used in This Publication
Abbreviation Meaning
AAA animal-assisted activity
AAMI Association for the Advancement of Medical InstrumentationAAT animal-assisted therapy
ACGIH American Council of Governmental Industrial HygienistsACH air changes per hour
ADA Americans with Disabilities Act
AER automated endoscope reprocessor
AFB acid-fast bacilli
AHA American Hospital Association
AHJ authorities having jurisdiction
AIA American Institute of Architects
AII airborne infection isolation
AmB amphotericin B
ANC absolute neutrophil count
ANSI American National Standards Institute
AORN Association of periOperative Registered NursesASHE American Society for Healthcare Engineering
ASHRAE American Society of Heating, Refirgeration, and Air-Conditioning EngineersBCG Bacille Calmette-Guérin
BCYE buffered charcoal yeast extract medium
BHI brain-heart infusion
BMBL CDC/NIH publication "Biosafety in Microbiological and Biomedical Laboratories"BOD biological oxygen demand
BSE bovine spongiform encephalopathy
BSL biosafety level
C Centigrade
CAPD continuous ambulatory peritoneal dialysis
CCPD continual cycling peritoneal dialysis
CMAD count median aerodynamic diameter
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