This paper discusses the pre-production deployment of the IC Sentinel® environmental facilities monitoring system at La Rabida Children’s Hospital in Chicago, IL. At La Rabida, the IC Sentinel® system was used to provide a continuous assessment of critical risks from planned construction areas, as well as used to monitor the overall patient environment during normal operations throughout the facility.
AIRBORNE INFECTIOUS DISEASE
According to a Center for Disease Control and Prevention (CDC) research article, it is estimated that in 2002 there were 1.7 million Hospital Acquired Infections (HAIs) in the U.S. This resulted in an estimated nearly 99,000 deaths, costing up to $45 billion that year. It is estimated that the cost to treat each HAI is now $40,000 to $60,000, with the costs of treatment falling on the hospital or facility where the infection occurred. Airborne Infectious Diseases are believed to be a contributor HAIs, and a comprehensive environmental plan to address HAIs must include controlling the source and transmission of airborne infectious disease.
It is widely believed that dust, mold, and fungal spores are a leading contributor to Airborne Infectious Disease, and consequently, HAIs. Mold can be found virtually everywhere in a hospital, including in and above ceilings, block walls, drywall, bathrooms; and perhaps most seriously, air ducts, and air handling diffusers and grills. Humidity control and environmental cleaning can help to reduce the spread of mold.
Construction, renovation, and maintenance activities can disperse dust and mold spores. The HVAC system can actually be a source of Airborne Infectious Disease, if the HVAC system allows contaminated air from construction zones to circulate into patient areas. This can be caused by vents not properly closed or sealed, incorrect air pressure in patient areas, inadequate air exchange rates, and HEPA filters not properly maintained.
A comprehensive environmental plan, including Infection Control Risk Assessment (ICRA) procedures and Infection Control Risk Mitigation Recommendations (ICRMRs), during construction activities can help to mitigate the spread of Airborne Infectious Diseases. Construction areas are to be isolated from surrounding areas with barriers and negative air pressure, and HEPA air filters engaged to remove particles. Construction and renovations areas should be continuously monitored for particulate count, differential air pressure, and air exchanges.
Within Hospitals, Protective Environment (PEs) rooms are designed to protect those patients most vulnerable to Airborne Infectious diseases. PEs include operating rooms, rooms for premature infants, bone marrow transplant patients, and other immunocompromised patients. They are designed to have clean, filtered air, with positive air pressure (relative to surrounding areas) to mitigate the ingress of particulates, nuclei, spores, and other pathogens.
Similarly, Airborne Infection Isolation (AIIs) rooms are designed to protect hospital staff, other patients, and the general public from potentially infectious patients. AIIs are designed to have negative air pressure relative to surrounded areas, and the air from the AII is exhausted in a controlled manner. Both PEs and AIIs should be continuously monitored for particulate count, differential air pressure, and air exchanges.
According to the CDC Environmental Control Guidelines, 2003, and the Facilities Guidelines Institute (FGI), healthcare facilities personnel should monitor PEs and AIIS; construction, renovation, and maintenance activities; and perhaps entire facilities, to develop short and long-term, continuous metrics of environmental factors which may contribute to airborne infectious disease. Personnel responsible for facilities monitoring may include:
• Facilities and Environmental Services personnel
• Infection Control professionals
• Patient Satisfaction personnel
• Construction and renovation personnel
IC Sentinel® INDOOR AIR QUALITY AND ENVIRONMENTAL MONITOR
The IC Sentinel® monitoring system continually collects and data logs key environmental metrics, including:
• Airborne particulates
• Differential air pressure
• Air quality
• Light and sound levels
The system is fully automated, and operates over the facility IP based IT network.
IC Sentinel® units can be deployed in fixed locations throughout a facility, such as operating rooms, ICUs, PE and AII rooms. The units can also be deployed as needed to monitor construction areas, and can verify negative pressures are maintained inside a construction site, as well as barrier effectiveness by monitoring particulate count adjacent to a construction site.
IC Sentinel® can be used as part of an integrated program to baseline and then improve environmental quality, including monitoring for the sources and pathways for airborne infectious diseases, compliance with ICRA procedures, effectiveness of PEs, AIIS, and barriers, and certain patient satisfaction criteria.
LA RABIDA CHILDRENS HOSPITAL, CHICAGO, IL
La Rabida, Chicago, Ill. is a 50 bed children’s hospital, with newborn through 18 year old patients. They have a large patient population with immune deficiencies. The facility is an older three story structure which is undergoing major renovation, with the potential to impact all operational areas throughout the facility.
At La Rabida, IC Sentinel® units were deployed to track airborne particulate levels and impact from construction. Units were installed on the first and second floors, and continuously monitored the laboratory, pharmacy, and respiratory rehabilitation areas. In addition, sound levels were measured and profiled in areas adjacent to construction zones. Any time a particulate threshold level was exceeded, the IC Sentinel® system generated an alert. These alerts allowed for immediate investigation into the cause, and associated remediation. With on-going monitoring, La Rabida staff and contractors could perform their duties with the confidence that undesirable changes in air quality or differential air pressure would create an immediate notification.
This clinical trial was performed in mid-2013. The system is still in place operating at La Rabida. In conclusion, an integrated real-time environmental monitoring system can:
• Provide full-time 24/7 monitoring of key environmental metrics
• Generate immediate alerts when a metric exceeds prescribed limits
• Provide the ability to analyze both short term and long term trends
• Be part of an overall proactive approach to identify the source and modes of transmission for airborne infectious disease
• Generate a basis to evaluate and improve patient satisfaction