Epid 680 Field Trip Report

EPID680 Field Trip: Tour of C.S. Mott Children's Hospital of the University of Michigan Jessica Hernandez-Holzman Tour Guide Name: Jen Sweeney, Infection Preventionist 03/29/18 This essay is submitted to meet partially Competency # 4 of the Hospital and Molecular Epidemiology Track of Epidemiology MPH Program, University of Michigan, School of Public Health

Facilities and materials used for HAI prevention Hospital Acquired Infection (HAI) prevention is one of the most important issues to be conscious of in a healthcare facility. There are various facilities and materials an epidemiologist would use to aide HAI prevention such as disinfectants and other cleansing products, various computer systems (Emerse, Theradoc, MiChart reviews), and rules and regulations implemented by The Joint Commission to name a few. Technology has increased ease in surveillance to be able to regulate various HAI rates that would have been difficult if not impossible to do in a reasonable time frame to inhibit the spread. As requirements and regulations are constantly changing, epidemiologists must be up to date on the latest regulations so that the healthcare facility can stay within compliance. One of the most recent regulation changes for healthcare facilities is 100% compliance with hand hygiene. As this is one of the regulations that cannot be monitored by online health charts, healthcare facilities perform hand hygiene audits to surveil and regulate healthcare worker’s hygiene practices to ensure that they are within compliance. Strategic placement of personal protective equipment and signage for contact precautions/isolation rooms is also essential to ensure that when necessary, the proper equipment is available for healthcare workers to enter into patient rooms safely. Without these facilities and materials, HAI prevention would be hindered.

Areas with high risks for HAIs and major challenges to HAI prevention There are a few areas with high risk for HAIs that need extra attention to ensure the prevention of HAIs. Some of these high risk areas for HAI transmission are children play areas, soiled instruments room, waiting rooms, surgery rooms, and construction areas. Surgery rooms need to be one of the most sterile areas within a hospital to prevent HAIs. During an operation, patients are the most vulnerable to HAIs as their greatest defense mechanism, their skin, is open and can easily become infected. Some preventative measures that are taken to reduce the possibility of a HAI is to educate the patient on pre-operative activities, appropriate use of prophylactic antibiotics, use of appropriate surgical attire, positive pressure air flow, and decrease surgical room traffic. Some major challenges to HAI prevention are lack of patient compliance with pre-operative activities and minimizing the room traffic as it can disrupt the air flow. These challenges are what epidemiologists target the most to prevent HAIs. One preventative measure implemented was the increase in air change. The Mott Children’s Hospital regularly has air changes 3-4 times an hour, while in surgery rooms there are air changes 20-30 times an hour. While there will always be room for improvements to aide in prevention within the healthcare facility, surgical rooms will always be the most critical area to focus on due to patients increased vulnerability for contracting a HAI. Construction within healthcare facilities is another major area with high risks for HAIs. With constant improvements hospitals implement within their facilities, precautions are needed to ensure patient safety as well as to prevent common infections that can be associated with construction. Construction produces a lot of dust which is the main concern that needs to be contained. Dust from construction can cause invasive mold infections and can cause outbreaks among hospital patients. Mold can survive in various construction materials such as drywall and pressboard and once wet, can quickly grow mold and spores. When construction is being done and dust is produced, this is when those spores are released and can cause disease within

hospitalized patients. This is the reason why regulations are put into place to block off the construction zones to ensure patient safety and contain the dust produced.

Roles and tasks of hospital epidemiologist in HAI prevention Hospital epidemiologists have various roles and tasks pertaining to HAI prevention. One of the roles an epidemiologist holds is to ensure good relationships with healthcare workers on the floors. Trust and confidence needs to be made between healthcare workers and epidemiologists to ensure that when problems arise, healthcare workers feel comfortable to approach the hospital epidemiologist for help with how to move forward in any problem they may have. Hospital epidemiologists also have to perform audits on the floors to ensure that proper practices are performed. A positive relationship with healthcare workers will facilitate productive communication if there is a concern that needs to be addressed during the audits. One of the major tasks epidemiologist have is to conduct surveillance. Surveillance is important to monitor infections that are of most concern. Through surveillance, epidemiologist can also track and identify outbreaks in real time to stop and prevent the spread sooner.

Reflections During our field trip, touring C.S. Mott Children’s Hospital of the University of Michigan, I grew a more profound desire to become an epidemiologist within a hospital. Learning more about various rules and regulations that hospital epidemiologist have to know and understand is very interesting to me and I like that this is something that can provide a huge impact to patient care where an attainable difference can be achieved. Some of the most interesting parts of the tour that I learned was that there needs to be a counter divider for sinks to prevent splash on other parts of usable counter space, as water can splash as far as 3 feet away. I also learned that for rooms that don’t have a door, to aide in visualizing the room barrier, Mott Children’s Hospital taped the floor for these rooms with a red line to indicate the barrier for when to wash hands before and after leaving the room. We also talked about how much thought goes into various surfaces throughout the hospital and how some areas are considered to be more high risk than others. For example, in waiting areas, furniture can have some liquid resistant cloth and some areas may even have carpet, while patient rooms only have furniture that is wipeable and does not have carpet. Other surfaces that needed to be easily cleanable were the surfaces in the play areas the hospital has for kids. The changes made to hospitals to decrease HAIs is something that is necessary for the benefit of everyone that enter into a hospital. Understanding various modes of transmission and ways to diminish those routes is key to protect patients, family, friends, and healthcare workers.