Theatre,building and the air

[MelindaL Griffiths]

My Facility is currently planning to close a part of the Operating Theatre down to do some renovations. The hospital executive have asked me to devise an “air quality” program. Can anyone share their experience or steer me in the right direction.

Melinda Griffiths
CNC Infection Control
Alice Springs Hospital
08 89517737

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[Wishart, Michael]

Hi Melinda

I consulted in a facility that built and refurbished operating rooms
whilst the department was still running. What we did was a baseline air
quality assessment prior to the work commencing (used a contractor for
that, cost a fair bit) then did monthly settle plate counts in each
working operating room (using a slit sampler) for the duration of the
work. I would suggest before you embark on this you talk to your local
lab and find out what they have capability for (they may have issue
processing some of the special plates in some of the air sampler types).

The facility also did daily cleaning checks (mainly for dust) and
discussed any issues immediately with the builders.

Most of this sampling was more to give assurance to surgeons and
patients that the facility was monitoring the works, but I think it
helped the whole process work more smoothly.

Hope this helps.

Cheers
Michael

Michael Wishart | GPH – Infection Control Coordinator

GPH – Quality & Safety Unit (Infection Control) | Greenslopes Private
Hospital
Newdegate St, Greenslopes QLD 4120
t: 07 3394 7919 | pager 047 | f: 07 3394 7985
e: WishartM@ramsayhealth.com.au | w: http://www.ramsayhealth.com.au

Ramsay Health Care is an environmentally responsible corporation, please
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—–Original Message—–
Behalf Of MelindaL Griffiths

My Facility is currently planning to close a part of the Operating
Theatre down to do some renovations. The hospital executive have asked
me to devise an “air quality” program. Can anyone share their experience
or steer me in the right direction.

Melinda Griffiths
CNC Infection Control
Alice Springs Hospital
08 89517737

Messages posted to this list are solely the opinion of the authors, and
do not represent the opinion of AICA.
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[Marija Juraja]

Hi Melinda

We do a similar approach to what Michael has taken with regards to using settle plates to verify the air quality, except we did this post remodelling (cost factor). We also ensure the area being remodelled is completely sealed, staff working in the environment wear theatre blues and we used a portable double HEPA filter machine that ensures as much as possible, the air coming into the theatre environment is as clean as possible.

We also had our ICLN in theatre do daily cleaning checks and we had enhanced cleaning with a detergent/disinfectant combined solution to reduce the risk of any further environmental contamination. If any issues were identified we discussed this immediately with the theatre staff and the builders.

Our theatres were still running while the work was going on. Our post whole of theatre cleaning and settle plates returned a clean slate and reassured the staff that the environment was clean.

Hope this helps.

Marija
Mrs Marija Juraja
Clinical Service Coordinator (CICP)

Infection Prevention and Control Unit

—–Original Message—–

My Facility is currently planning to close a part of the Operating Theatre down to do some renovations. The hospital executive have asked me to devise an “air quality” program. Can anyone share their experience or steer me in the right direction.

Melinda Griffiths
CNC Infection Control
Alice Springs Hospital
08 89517737

Messages posted to this list are solely the opinion of the authors, and do not represent the opinion of AICA.
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[John Ferguson]

Hi Melinda

Our approach and its evidence base is described on HICSIG- see http://www.asid.net.au/hicsigwiki/index.php?titleOperating_theatre_commissioning_-_Microbiological
HICSIG would welcome feedback about the draft protocol.

Kind regards
John

—–Original Message—–

My Facility is currently planning to close a part of the Operating Theatre down to do some renovations. The hospital executive have asked me to devise an “air quality” program. Can anyone share their experience or steer me in the right direction.

Melinda Griffiths
CNC Infection Control
Alice Springs Hospital
08 89517737

Messages posted to this list are solely the opinion of the authors, and do not represent the opinion of AICA.
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[Glenys Harrington]

Melinda,

I’m assuming that operating theatres are going to remain operational during the renovations that the area being renovated can be completely sealed off from the rest of the complex?

The purpose of air sampling under these circumstances is to qualitatively detect breaks in environmental infection control measures.

In terms of air sampling I would do rank order air sampling.

The objective of rank order air sampling is to monitor the efficacy of dust control measures by measuring and comparing the count of fungi in the area before, during and after the works. This approach determines the rank order of air quality from dirty (i.e. the outdoor air) to clean (i.e. air filtered through high-efficiency filters [90%-95% filtration]) to cleanest (i.e. HEPA-filtered air – the operating theatres).

As an example rank order microbiological air sampling involves a standard number of samples taken on a routine, regular basis over a specified time in specific areas such as the following:

Outdoors (dirty).
An indoor area not under construction and away from construction site(clean).
The Operating Theatre/Operating Theatre Complex(cleanest).

The more data you have before works commence (i.e. baseline data) the better.

You will need to take care in terms of interpreting the air sample results as air sampling can be problematic for the following reasons:
Lack of standards linking fungal spore levels with infection rates.
Lack of standards/protocols for testing (sampling intervals, number/location).
Resource intensive (if you are to undertake this sampling for a long or protracted period the resource implications for an ICP or a team can be significant).
Substantial laboratory support required.
Unknown incubation period of Aspergillus infection.
Variability of sampling circumstances.

In addition there should be a risk assessment undertaken before works commence and the barriers should be checked on a routine regular basis for breaches. If breaches are identified works should cease until the breaches are rectified along with the theatres being notified that unfiltered air from an adjacent construction site may be entering the theatre complex.

References
1. Centres for Disease Control and prevention. Guideline for Environmental Infection Control in Health-Care Facilities: recommendations of CDC and healthcare Infection control Practices Advisory Committee (HICPAC). MMWR 2003; 52(no.RR-10): 1-48
2. Microbiological Commissioning and Monitoring of Operating Theatre Suites, A report of a working party of the Hospital Infection Society UK, Sept 2005

Regards

Glenys

Glenys Harrington
Consultant
Infection Control Consultancy (ICC)

PO Box 5202
Middle Park
Victoria, 3206
Australia

H: +61 3 96902216
M: +61 404 816 434
infexion@ozemail.com.au

ABN 47533508426

—–Original Message—–

My Facility is currently planning to close a part of the Operating Theatre down to do some renovations. The hospital executive have asked me to devise an “air quality” program. Can anyone share their experience or steer me in the right direction.

Melinda Griffiths
CNC Infection Control
Alice Springs Hospital
08 89517737

Messages posted to this list are solely the opinion of the authors, and do not represent the opinion of AICA.
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