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HB 260

Handbook
HB 2602003

Hospital acquired infections Engineering down the risk

This Handbook was prepared under the responsibility of Committee H-000, Health and Food Standards Sector Board. It was published on 20 March 2003.

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The following are represented on Committee H-000: Accident Compensation Corporation, New Zealand Alfred Hospital, Melbourne Australian Dental Association Australian Medical Association Australian Patient Safety Foundation Australian Quarantine & Inspection Service (Commonwealth) Canterbury Health, New Zealand Michael Legg & Associates Ministry of Health, New Zealand Ministry of Consumer Affairs, New Zealand Safe Food New South Wales Sisters of Charity Health Services Steritech St Vincents Private Hospital, Sydney System Innovation in Health University of Queensland University of Sydney Additional interests participating in the preparation of this Standard: Australian Infection Control Association Australian Institute of Environmental Health Australian Society for Infectious Diseases Australian Society of Microbiology Canberra Hospital Institute of Hospital Engineering Queensland Health Royal Australian Institute of Architects

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Standards are living documents which reflect progress in science, technology and systems. To maintain their currency, all Standards are periodically reviewed, and new editions are published. Between editions, amendments may be issued. Standards may also be withdrawn. It is important that readers assure themselves they are using a current Standard, which should include any amendments which may have been published since the Standard was purchased. Detailed information about Standards can be found by visiting the Standards Australia web site at www.standards.com.au and looking up the relevant Standard in the on-line catalogue. Alternatively, the printed Catalogue provides information current at 1 January each year, and the monthly magazine, The Australian Standard, has a full listing of revisions and amendments published each month. We also welcome suggestions for improvement in our Standards, and especially encourage readers to notify us immediately of any apparent inaccuracies or ambiguities. Contact us via email at mail@standards.com.au, or write to the Chief Executive, Standards Australia International Ltd, GPO Box 5420, Sydney, NSW 2001.

HB 2602003

Handbook
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Hospital acquired infections Engineering down the risk

First published as HB 2602003.

COPYRIGHT
Standards Australia International All rights are reserved. No part of this work may be reproduced or copied in any form or by any means, electronic or mechanical, including photocopying, without the written permission of the publisher. Published by Standards Australia International Ltd GPO Box 5420, Sydney, NSW 2001, Australia
ISBN 0 7337 5016 8

HB 2602003

PREFACE
This Handbook was prepared by a Working Group in the Health Division of Standards Australia. Account has been taken of the following publications: Design Considerations for Infection Control HOSPLAN, New South Wales Hospitals Planning Advisory Centre April 1989. Capital Works Guidelines: Planning, Infection Control, Sterilising, Capital Works Branch, Queensland Health 1999. Guidelines for the Classification and Design of Isolation Rooms in Health Care Facilities, Standing Committee on Infection Control, Department of Human Services, Victoria, 2000.
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Due acknowledgment is given to N.S.W. Health Department, Department of Human Services, Victoria, and Queensland Health for use of their documents in this Handbook. The following organizations comprised the Working Group: Australian Infection Control Association Australian Institute of Environmental Health Australian Society for Infectious Diseases Australian Society of Microbiology Canberra Hospital Institute of Hospital Engineering Queensland Health Royal Australian Institute of Architects Standards Australia acknowledges the valued contribution of the members of the Working Group in the preparation of this Handbook.

HB 2602003

CONTENTS

Page FOREWORD ..............................................................................................................................5 SECTION 1 SCOPE AND GENERAL 1.1 SCOPE .........................................................................................................................7 1.2 REFERENCED DOCUMENTS ...................................................................................7 1.3 DEFINITIONS AND TERMINOLOGY ......................................................................8
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SECTION 2 PATIENT ACCOMMODATION 2.1 GENERAL ...................................................................................................................9 2.2 TYPES OF ROOMS ....................................................................................................9 SECTION 3 GENERAL PRINCIPLES/REQUIREMENTS FOR DESIGN AND CONSTRUCTION OF HEALTH CARE FACILITIES 3.1 GENERAL .................................................................................................................11 3.2 DESIGN AND CONSTRUCTION.............................................................................11 SECTION 4 HANDWASHING FACILITIES 4.1 GENERAL .................................................................................................................16 4.2 HANDWASHING BASINS.......................................................................................16 SECTION 5 REQUIREMENTS FOR ROOMS SUITABLE FOR INFECTION CONTROL 5.1 GENERAL PRINCIPLES ..........................................................................................19 5.2 TYPES OF ROOMS ..................................................................................................20 5.3 SUGGESTED DESIGN OF ROOMS SUITABLE FOR INFECTION CONTROL....20 5.4 PRESSURE GRADIENTS.........................................................................................20 5.5 VENTILATION/EXHAUST SYSTEM......................................................................21 5.6 SUPPLY AIR AND EXHAUST DUCT DESIGN......................................................21 5.7 AIR DISTRIBUTION ................................................................................................21 5.8 AIR CHANGE RATES ..............................................................................................22 5.9 MONITORING OF ROOM PRESSURE ...................................................................22 5.10 METHODS OF VARYING ROOM PRESSURE.......................................................23 5.11 QUARANTINE ISOLATION ROOMS .....................................................................23 5.12 MINIMUM FRESH AIR REQUIREMENTS.............................................................23 5.13 MINIMIZING OF ROOM AIR LEAKSTYPE 5 (RESPIRATORY ISOLATION) ROOMS .................................................................23 5.14 ROUTINE PERFORMANCE MONITORING AND MAINTENANCE....................23 5.15 ENERGY CONSERVATION ....................................................................................24 5.16 PLANT BACK-UP SYSTEMS ..................................................................................24 5.17 INTERIOR OF ROOMS ............................................................................................24 5.18 ROOM RENOVATION OR CONVERSION.............................................................25 5.19 CHECKLIST FOR ROOMS SUITABLE FOR INFECTION CONTROL PURPOSES.............................................................................................25

HB 2602003

Page SECTION 6 REQUIREMENTS FOR SPECIALTY AREAS 6.1 GENERAL .................................................................................................................26 6.2 INTENSIVE CARE/CRITICAL CARE/CORONARY CARE UNITS.......................26 6.3 EMERGENCY MEDICINE DEPARTMENTS (ADULT/PAEDIATRIC) .................27 6.4 NEONATAL INTENSIVE CARE UNITS .................................................................28 6.5 PAEDIATRIC UNITS................................................................................................28 6.6 ACUTE CARE RESIDENTIAL AGED CARE UNITS .............................................29 6.7 HAEMATOLOGY/ONCOLOGY UNITS..................................................................29 6.8 MORTUARY.............................................................................................................29 6.9 MATERNITY UNITS................................................................................................30 6.10 OPERATING ROOMS ..............................................................................................31 6.11 BRONCHOSCOPY SUITES .....................................................................................32 6.12 AREAS USED FOR DIALYSIS ................................................................................33
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APPENDICES A CONFIGURATIONS FOR TYPES OF ROOMS FOR INFECTION CONTROL PURPOSES.............................................................................................34 B BIBLIOGRAPHY ......................................................................................................40

HB 2602003

FOREWORD
The emergence of methicillin resistant Staphylococcus aureus (MRSA), glycopeptide resistant enterococci (VRE), multi-resistant acinetobacter, and other multi-resistant pathogens, as well as the ongoing threat of tuberculosis, HIV/AIDS and viral hepatitis (B and C), have led to a heightened awareness of the importance of infection control to the provision of quality patient care. The aim of this Handbook is to provide information that will assist in the reduction of the risk of transmission of the above diseases and infections generally. The Handbook provides accurate and appropriate advice and support for those involved with the task of redesigning or building a health care facility with particular emphasis on patient care. The Handbook has been developed by a group of experts in infection control, hospital engineering and architecture, and provides essential data that should be considered in all aspects of the planning and design of health care facilities. These guidelines are not designed to be applicable to existing facilities, other than in the context of redesigning/rebuilding such facilities. Globally, antibiotic resistance is becoming a crisis for all infection control practitioners and is leading to a potential post-antibiotic era. This factor has seen health care facilities develop additional precautions and environmental policies adequate for the 21st century. Spread of infection requires three elements, as follows: (a) (b) (c) A source of infecting microorganisms. A susceptible host. A means of transmission of the microorganism.

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In the hospital setting, human sources include both the patient and the staff. The likelihood of cross infection is particularly increased, for example, where patients are immunocompromised, are more severely ill or are in close proximity with each other as in the following areas: (i) (ii) Intensive care unit (ICU). Coronary care unit (CCU).

(iii) High dependency / renal dialysis units / step down units. (iv) (v) (vi) Emergency medicine departments. Oncology. Paediatrics.

In the above areas in particular, consideration of adequate rooms for isolation purposes and the location and number of clinical handbasins that are visible and accessible are important in the planning phase. The ability of staff to readily wash their hands through the provision of an adequate number of well-placed hand basins will minimize the transmission of microorganisms. Design features to minimize contact between in and out-patients, visitor traffic routes being such as to minimize contact with in-patients, the transportation of clean supplies on routes that will not allow contact with contaminated materials, and the provision of protective apparel to health care workers when there is a risk of blood and body fluid exposure are also important considerations when building or refurbishing a health care facility. Areas not specifically addressed in this document but that require infection control input in the design phase include loading docks, kitchens, medical imaging, cleaning/cleanup rooms, sterilizing services, pathology, pharmacy, radiotherapy areas, ambulatory care areas (e.g. outpatients departments), biomedical and engineering.

HB 2602003

The design of hospitals over recent years has moved away from shared accommodation. For infection control purposes, there is a minimum requirement for standard isolation rooms as referred to in this document. A standard isolation room is a single room with an ensuite that is not shared. In many hospitals, this will be the usual room utilized for patient accommodation and frequently will not be designated as, or utilized for, isolation purposes. However, this is a room that can be used for the isolation of patients with infections transmissible by means other than the airborne route. It is designed to minimize the potential for such infections to be transmitted to other patients and staff. During the rebuilding or refurbishment of health care facilities, there is the potential for increased dispersal of spores of Aspergillus sp. Protocols should be considered for the minimization of this potential and the appropriate disposition of immuno-suppressed patients during this period. Planning for new construction or major renovation requires early and continuous consultation between architects, engineers, infection control practitioners and staff operating in the new facility. Without this consultation, the completed facility may not meet the needs of health care facility staff and/or occupational health and safety and infection control practitioners. This Handbook provides principles of design for infection control purposes. The technological and architectural methods of achieving these purposes, and individual facility protocols will vary over time and are not prescribed in this Handbook. Furthermore, this Handbook does not address all issues of hospital design but focuses on the issues related to infection control.

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HB 2602003

STANDARDS AUSTRALIA Australian Handbook Hospital acquired infectionsEngineering down the risk

SECT ION
1.1 SCOPE

SCOPE

AND

GENERA L

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This Handbook provides guidelines for persons, including engineers, architects, building contractors, project managers and health care workers, involved in the building design phase of new buildings for hospitals or of buildings undergoing refurbishment or renovations in hospitals, to minimize the risk of acquiring infections in hospitals. Facilities for acute medical, surgical, paediatric and obstetric patients are covered in this handbook, but not psychiatric and long-term aged facilities, nor rehabilitation day care facilities. 1.2 REFERENCED DOCUMENTS The following documents are referred to in this Handbook: AS 1324 Air filters for use in general ventilation and air-conditioning 1324.1 Part 1: Application, performance and construction 1668 1668.2 1807 1807.6 1807.10 4031 4260 The use of ventilation and air-conditioning in buildings Part 2: Ventilation design for indoor air containment control Cleanrooms, workstations, safety cabinets and pharmaceutical isolators Methods of test Part 6: Determination of integrity of terminally mounted HEPA filter installations Part 10: Determination of air pressure of cleanrooms and pharmaceutical isolators Non-resusable containers for the collection of sharp medical items used in health care areas High efficiency particulate air (HEPA) filtersClassification, construction and performance

AS/NZS 3500 National plumbing and drainage 3500.2.1 Part 2.1: Sanitary plumbing and drainagePerformance requirements 3666 3666.1 3666.2 3666.3 3816 Air-handling and water systems of buildingsMicrobial control Part 1: Design, installation and commissioning Part 2: Operation and maintenance Part 3: Performance-based maintenance of cooling water systems Management of clinical and related wastes

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HB 260-2003, Hospital acquired infections Engineering down the risk

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