Construction, renovation, and other environmental disturbances within the healthcare environment provide an increased risk for respiratory healthcare-associated infections (HAIs). Routine monitoring of the environment during construction, such as air handling pressure and ceiling maintenance can be helpful in preventing exposures to infection sources.
The infection prevention (IP) staff at Greenville Health System conducted a prospective cohort study for six months within a population of 19 neuro-trauma intensive care (NTICU) patients following exposure to ceiling debris.1 The objective of monitoring this patient population for respiratory HAI following an exposure to deteriorating ceiling tiles was to enhance prerequisite environmental practices prior to construction.
Real-time surveillance technology was used to alert IP staff of all readmissions or culture testing among all NTICU patients over a two-day period and these events from were cataloged, analyzed temporally, and reviewed for association to the environmental exposure. In addition, the impacted ceiling panels were swabbed and cultured to determine possible infection sources. Settling agar plates were used to assess air particulates and results were compared.
During the study follow-up period, prospective surveillance identified 13 (68%) of the patients had a subsequent hospital encounter. Of these patients, three were readmitted as inpatients. One patient had two positive respiratory specimens obtained and no fungal growth was noted. The cultured ceiling tile swab revealed polymicrobial growth, including fungal spores unrelated to the patient-specific culture results. The settling plates from each unit both uncovered similar air particulate compositions.
The study found no HAIs in the exposed population as a result of the environmental disturbance. Construction personnel implemented a visual inspection of the duct system prior to airflow changes. To reduce future HAI risk from construction, air handling practices were modified to continually monitor pressure within the duct system.
Located in South Carolina, Greenville Health System (GHS) is a public not-for-profit academic healthcare delivery system committed to medical excellence through clinical care, education and research. The health system is comprised of multiple hospital campuses, more than 1,260 beds, 11 specialty hospitals, a 746-bed tertiary-care center and 180 physician practices.
- “Electronic-Assisted Surveillance Following a Construction-Related Event to Improve Patient Safety.” Poster presented at APIC 2016, Charlotte, NC. Durham, P. Weissenbach, M. Steed, C.