Guidelines for Environmental Infection Control in Health-Care

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Facilities

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Centers for Disease Control and Prevention

2003

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Table of Contents

Executive Summary 1

Part I. Background Information: Environmental Infection Control in Health-Care Facilities 3

A. Introduction.3

B. Key Terms Used in this Guideline 5

C. Air.6

1. Modes of Transmission of Airborne Diseases6

2. Airborne Infectious Diseases in Health-Care Facilities7

3. Heating, Ventilation, and Air Conditioning Systems in Health-Care Facilities .13

4. Construction, Renovation, Remediation, Repair, and Demolition .21

5. Environmental Infection-Control Measures for Special Health-Care Settings.34

6. Other Aerosol Hazards in Health-Care Facilities .40

D. Water40

1. Modes of Transmission of Waterborne Diseases .40

2. Waterborne Infectious Diseases in Health-Care Facilities .41

3. Water Systems in Health-Care Facilities46

4. Strategies for Controlling Waterborne Microbial Contamination 53

5. Cooling Towers and Evaporative Condensers57

6. Dialysis Water Quality and Dialysate.59

7. Ice Machines and Ice 65

8. Hydrotherapy Tanks and Pools.67

9. Miscellaneous Medical/Dental Equipment Connected to Main Water Systems 69

E. Environmental Services .71

1. Principles of Cleaning and Disinfecting Environmental Surfaces71

2. General Cleaning Strategies for Patient-Care Areas.74

3. Cleaning Strategies for Spills of Blood and Body Substances .77

4. Carpeting and Cloth Furnishings 78

5. Flowers and Plants in Patient-Care Areas 80

6. Pest Control .81

7. Special Pathogen Concerns.82

F. Environmental Sampling .88

1. General Principles: Microbiologic Sampling of the Environment .88

2. Air Sampling89

3. Water Sampling 94

4. Environmental Surface Sampling .95

G. Laundry and Bedding98

1. General Information .98

2. Epidemiology and General Aspects of Infection Control.98

3. Collecting, Transporting, and Sorting Contaminated Textiles and Fabrics99

4. Parameters of the Laundry Process 100

5. Special Laundry Situations. 102

6. Surgical Gowns, Drapes, and Disposable Fabrics 103

7. Antimicrobial-Impregnated Articles and Consumer Items Bearing Antimicrobial Labeling 103

8. Standard Mattresses, Pillows, and Air-Fluidized Beds 104

H. Animals in Health-Care Facilities 105

1. General Information . 105

2. Animal-Assisted Activities, Animal-Assisted Therapy, and Resident Animals 106

3. Service Animals . 108

4. Animals as Patients in Human Health-Care Facilities . 110

5. Research Animals in Health-Care Facilities 111

I. Regulated Medical Waste. 112

1. Epidemiology . 112

2. Categories of Medical Waste . 112

3. Management of Regulated Medical Waste in Health-Care Facilities 113

4. Treatment of Regulated Medical Waste. 113

5. Discharging Blood, Fluids to Sanitary Sewers or Septic Tanks. 116

6. Medical Waste and CJD. 116

Part II. Recommendations for Environmental Infection Control in Health-Care Facilities 117

A. Rationale for Recommendations 117

B. Rating Categories 117

C. Recommendations—Air 118

D. Recommendations—Water. 125

E. Recommendations—Environmental Services . 133

F. Recommendations—Environmental Sampling . 138

G. Recommendations—Laundry and Bedding 138

H. Recommendations—Animals in Health-Care Facilities. 141

I. Recommendations—Regulated Medical Waste 143

Part III. References145

Part IV. Appendices.201

Appendix A. Glossary of Terms 201

Appendix B. Air 210

1. Airborne Contaminant Removal 210

2. Air Sampling for Aerosols Containing Legionellae. 210

3. Calculation of Air Sampling Results 211

4. Ventilation Specifications for Health-Care Facilities. 212

Appendix C. Water. 220

1. Biofilms. 220

2. Water and Dialysate Sampling Strategies in Dialysis 222

3. Water Sampling Strategies and Culture Techniques for Detecting Legionellae 223

4. Procedure for Cleaning Cooling Towers and Related Equipment . 225

5. Maintenance Procedures Used to Decrease Survival and Multiplications of Legionella spp. in

Potable-Water Distribution Systems . 227

Appendix D. Insects and Microorganisms 228

Appendix E. Information Resources. 229

Appendix F. Areas of Future Research 230

Index—Parts I and IV 231