Environment of Care
Summary
Though most health-care acquired infections (HAIs) are transmitted by personal contact due to poor hand hygiene, disease also can occur from pathogens in the environment of care. When this happens, outcomes are typically severe, causing serious illness or death.
The “environment of care” is defined by the Joint Commission:
A health care organization’s environment of care encompasses the physical environment in which patient care, treatment and services take place. This physical environment includes the building or space and its arrangement and features; the equipment used to operate the building and support patient care; and the activities involved in maintaining a safe and functional environment for patients, visitors and staff.--Infection Prevention and Control Issues in the Environment of Care, 2nd edition.
Joint Commission on Accreditation of Healthcare Organizations, 2009.
Effectively managing the environment of care—which includes ventilation systems, water systems and cleaning processes—gives hospitals opportunities to break the chain of infection. As described by the CDC, the chain of infection includes five links:
(1) pathogen(2) reservoir (where pathogen lives and grows)
(3) portal of exit
(4) mode of transmission
(5) portal of entry and susceptible host, or uninfected person.
Breaking just one link in the chain stops the spread of infection.
Environmental Sustainability and Health Care
Focusing on the environment of care to prevent infection presents another opportunity for hospitals: addressing environmental sustainability. Sustainability “expresses the value of contributing to the overall health and well-being of our communities through environmental stewardship,” as described in the AHA Executive Primer on Hospital Environmental Sustainability.
Hospitals are energy-resource-intensive facilities. They operate 24 hours, 7 days a week, with staff ready to meet routine and unexpected health care needs. Keeping all of a hospital’s systems operating and being energy efficient create challenges. Caring for patients’ medical needs also produces distinctive forms of waste, including hazardous materials.
According to Dale Woodin, director, American Society for Healthcare Engineering (ASHE), sustainability is already inferred in each health care organization’s mission, strategic plan and commitment to the community. Many health leaders are recognizing these links and placing more emphasis on creating a culture of sustainability at their organizations.
If sustainability is highlighted as fundamental to the organization’s mission, key operational directors and managers can step forward to develop the content for sustainability. For hospitals and health care organizations, this may include striving to maintain and restore health for patients and communities, implementing environmentally sustainable and safe practices, and reducing the health care “environmental footprint”—the environmental impact from the use of energy and materials—so resources can go back into direct patient care.
In addition, when planning new construction and renovation projects, hospitals can consult with the architects and engineers during the initial planning process and every step along the way to ensure installing the most efficient and innovative systems for air, water, cleaning and other utilities.
For more information about environment sustainability in health care organizations, visit the AHA’s www.hospitalsustainability.org.
Business Case
With effective practices and products, a hospital can create a safe and more healthful environment, reduce its environmental footprint and, at the same time, improve operational and financial performance. For example, reducing and preventing HAIs reduces health care costs. Implementing an effective waste management program can save a hospital hundreds of thousands of dollars a year. Using sustainable cleaning practices and nontoxic products can prevent environmental hazards that conventional cleaning might cause. Such practices also improve productivity and reduce costs.
Building design and construction present a huge opportunity to design energy efficiency for new hospitals and major additions and to incorporate infection control risk assessment. A hospital or health system can achieve tremendous operational savings each year if energy efficiency is a key priority during the project's design phase and implemented during construction. “Building in” infection control can facilitate cleaning and disinfecting. For example, room design might include choosing solid surfaces around sinks and cleanable nonporous materials for chairs and sofas. And designers can take measures to improve indoor air quality.
Health Care Reform/Regulatory/Policy Considerations
The Joint Commission's requirements for infection prevention and control include the environment of care. These EC standards include requirements for planning, implementing, evaluating improvements and minimizing risk in the following areas:
- Safety and security
- Use of hazardous materials and waste
- Fire safety
- Use of medical equipment
- Inspection and testing of utilities
- Renovation, demolition and/or construction projects³
For policy considerations related to environmental sustainability, refer to individual topics in the AHA Executive Primer on Hospital Environmental Sustainability.
