Page 204 - policy and procedure infection control

Policies and Procedures on Infection Control

13.7.5 Infection Control and Ventilation Requirements for Patients undergoing allogeneic
hematopoietic stem cell transplant
• Patients undergoing allogeneic hematopoietic stem cell transplant should remain in
a Protective Environment room except for required procedures that cannot be
performed in the room, and they should use respiratory protection such as an N95
respirator when leaving the PE
• Protective Environment room must be equipped with ventilation system to maintain
>12 ACH and positive room air pressure (>2.5 Pa [0.01-inch water gauge]) in relation
to the corridor
• Maintain airflow patterns and monitor these on a daily basis by using permanently
installed visual means of detecting airflow in new or renovated construction, or by
using other visual methods (e.g., flutter strips or smoke tubes) in existing PE units.
Document the monitoring results
• Minimize exposures of severely immunocompromised patients (e.g., solid-organ
transplant patients or allogeneic neutropenic patients) to activities that might cause
aerosolization of fungal spores. Avoid carpeting in patient rooms or hallways,
upholstered furniture and furnishings, and fresh or dried flowers or potted plants in
PE rooms or areas. When vacuum cleaning is needed, the vacuum should be equipped
with HEPA filters
• Horizontal surfaces should be wet-dusted daily with cloths moistened with MOH
approved hospital disinfectant and detergent. Methods that stir up dust should be
avoided.
• Engineering features should include central or point-of-use high-efficiency particulate
air (HEPA; 99.97% efficiency) filters that can remove particles 0.3 μm in diameter for
supply (incoming) air; well-sealed rooms; properly constructed windows, doors, and
intake and exhaust ports; smooth ceilings free of fissures, open joints, and crevices;
walls sealed above and below the ceiling

13.7.6 Investigation for source of nosocomial fungal infections outbreaks
• If no epidemiologic evidence exists of ongoing transmission of fungal disease, conduct
an environmental assessment to find and eliminate the source
• Collect environmental samples from potential sources of airborne fungal spores,
preferably by using a high-volume air sampler rather than settle plates
• If either an environmental source of airborne fungi or an engineering problem with
filtration or pressure differentials is identified, promptly perform corrective measures
to eliminate the source and route of entry
• If an environmental source of airborne fungi is not identified, review infection-control
measures, including engineering controls, to identify potential areas for correction or
improvement
• If possible, perform molecular sub-typing of Aspergillus spp. isolated from patients
and the environment to compare their strain identities.

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