Uninstall icra

D18, D15 Do not use such areas as PE rooms. D3 Do not use a room with a through-the-wall ventilation unit as an AII room unless it can be demonstrated that all required AII engineering controls required are met. D3 Keep emergency doors and exits from PE rooms closed except during an emergency; equip emergency doors and exits with alarms. Category II Develop a contingency plan for backup capacity in the event of a general power failure. B, C Coordinate HVAC system maintenance with infection-control staff to allow for relocation of immunocompromised patients if necessary.

Category II Whenever possible, avoid inactivating or shutting down the entire HVAC system at one time, especially in acute-care facilities. Construction, Renovation, Remediation, Repair, and Demolition.

Avoid damaging the underground water distribution system i. Minimize exposures of severely immunocompromised patients e. Document the monitoring results. D6 Install self-closing devices on all room exit doors in protective environments. D4 Do not use laminar air flow systems in newly constructed PE rooms. D1, A7. D If an anteroom is not available, place the patient in AII and use portable, industrial-grade HEPA filters to enhance filtration of spores in the room.

Incorporate certain specifications into the planning, and construction or renovation of AII units. Document the results of monitoring. C7, Table 7. C3 Install self-closing devices on all AII room exit doors. If this is not practical, air from the room can be recirculated after passing through a HEPA filter.

D23, 9. Place smallpox patients in negative pressure rooms at the onset of their illness, preferably using a room with an anteroom if available. Implement environmental infection-control and ventilation measures for operating rooms. Maintain positive-pressure ventilation with respect to corridors and adjacent areas. D4 Do not use UV lights to prevent surgical-site infections. Category II Provide fresh air as per ventilation standards for operating rooms; portable units do not meet the requirements for the number of fresh ACH.

Category II No recommendation is offered for performing orthopedic implant operations in rooms supplied with laminar airflow. In settings where surgical lasers are used, wear appropriate personal protective equipment, including N95 or N respirators, to minimize exposure to laser plumes. Controlling the Spread of Waterborne Microoganisms. Practice hand hygiene to prevent the hand transfer of waterborne pathogens, and use barrier precautions e.

Category II Evaluate for possible environmental sources e. Whenever possible, disconnect the ice machine before planned water disruptions.

Category II Prepare a contingency plan to estimate water demands for the entire facility in advance of significant water disruptions i. Category II Corrective decontamination of the hot water system might be necessary after a disruption in service or a cross-connection with sewer lines has occurred. Decontaminate the system when the fewest occupants are present in the building e.

Use a very thorough flushing of the water system instead of chlorination if a highly chlorine-resistant microorganism e. Category II Change the pretreatment filter and disinfect the dialysis water system with an EPA-registered product to prevent colonization of the reverse osmosis membrane and downstream microbial contamination.

Category II If the facility has a water-holding reservoir or water-storage tank, consult the facility engineer or local health department to determine whether this equipment needs to be drained, disinfected with an EPA-registered product, and refilled. Category II Implement facility management procedures to manage a sewage system failure or flooding e. Relocate patients and clean or sterilize supplies from affected areas. Category II Contact the manufacturer of the automated endoscope reprocessor AER for specific instructions on the use of this equipment during a water advisory.

Category II Remediate the facility after sewage intrusion, flooding, or other water-related emergencies. Close off affected areas during cleanup procedures. Category II Ensure that the sewage system is fully functional before beginning remediation so contaminated solids and standing water can be removed.

Category II If hard-surface equipment, floors, and walls remain in good repair, ensure that these are dry within 72 hours; clean with detergent according to standard cleaning procedures.

Category II Clean wood furniture and materials if still in good repair ; allow them to dry thoroughly before restoring varnish or other surface coatings.

Category II Regardless of the original source of water damage e. Conduct an infection-control risk assessment of the facility to determine if patients at risk or severely immunocompromised patients are present. Category IC States If the facility does not treat severely immunocompromised patients, conduct an epidemiologic investigation, including retrospective review of microbiologic, serologic, and postmortem data to look for previously unidentified cases of healthcare—associated Legionnaires disease, and begin intensive prospective surveillance for additional cases.

Either defer decontamination pending identification of the source of Legionella spp. Category II No recommendation is offered regarding routine culturing of water systems in health-care facilities that do not have patient-care areas i.

Unresolved issue Keep adequate records of all infection-control measures and environmental test results for potable water systems. When implementing strategies for preventing Legionnaires disease among severely immunosuppressed patients housed in facilities with HSCT or solid-organ transplant programs, incorporate these specific surveillance and epidemiologic measures in addition to the steps previously outlined Water: V and Appendix C.

Maintain a high index of suspicion for legionellosis in transplant patients even when environmental surveillance cultures do not yield legionellae. Unresolved issue In areas with patients at risk, when Legionella spp. Decontaminate the water supply as outlined previously Water: IV. Cooling Towers and Evaporative Condensers. When planning construction of new health-care facilities, locate cooling towers so that the drift is directed away from the air-intake system, and design the towers to minimize the volume of aerosol drift.

Dialysis Water Quality and Dialysate. Adhere to current AAMI standards for quality assurance performance of devices and equipment used to treat, store, and distribute water in hemodialysis centers both acute and maintenance [chronic] settings and for the preparation of concentrates and dialysate.

Unresolved issue Conduct microbiological testing specific to water in dialysis settings. In conjunction with microbiological testing, perform endotoxin testing on product water used to reprocess dialyzers for multiple use. Monthly disinfection is recommended. Ice Machines and Ice. Do not handle ice directly by hand, and wash hands before obtaining ice.

Category II Use a smooth-surface ice scoop to dispense ice. Category II Do not store pharmaceuticals or medical solutions on ice intended for consumption; use sterile ice to keep medical solutions cold, or use equipment specifically manufactured for this purpose. Category II Use an EPA-registered disinfectant suitable for use on ice machines, dispensers, or storage chests in accordance with label instructions.

Category II Install proper air gaps where the condensate lines meet the waste lines. Category II Conduct microbiologic sampling of ice, ice chests, and ice-making machines and dispensers where indicated during an epidemiologic investigation.

Hydrotherapy Tanks and Pools. Drain and clean hydrotherapy equipment e. Category II In the absence of an EPA-registered product for water treatment, add sodium hypochlorite to the water: Maintain a ppm chlorine residual in the water of small hydrotherapy tanks, Hubbard tanks, and tubs. Category II Clean and disinfect inflatable tubs unless they are single-use equipment. Category II No recommendation is offered regarding the use of antiseptic chemicals e.

Unresolved issue Conduct a risk assessment of patients prior to their use of large hydrotherapy pools, deferring patients with draining wounds or fecal incontinence from pool use until their condition resolves. Category II For large hydrotherapy pools, use pH and chlorine residual levels appropriate for an indoor pool as provided by local and state health agencies.

Category IC States No recommendation is offered regarding the use in health care of whirlpools or spa equipment manufactured for home or recreational use. Unresolved issue. Take precautions to prevent waterborne contamination of dental unit water lines and instruments. Environmental Services. This may be followed with an application of an EPA-registered hospital disinfectant with or without a tuberculocidal claim depending on the nature of the surface and the degree of contamination , in accordance with disinfectant label instructions.

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