The Benefits of Collaboration: Infection Prevention and Industrial Hygiene
By Ed Rutkowski
An infection prevention professional and an industrial hygienist discussed their collaboration in a May 21 session that illustrated how organizations can benefit from the two professions working together. The speakers—Cherie Frame, MSN, RN, CIC, and Nick Rice, MSOH, CIH, CSP—are coworkers at Intermountain Health, a nonprofit health system that operates hospitals and clinics in Utah, Colorado, Montana, and southern Idaho.
Frame is senior director of infection prevention at Intermountain, while Rice is director of safety and industrial hygiene. Their presentation revolved around several case studies that revealed how the two professions’ perspectives can be combined to better protect the health of patients and workers.
Water Management
One topic involved the implementation of water management practices across the Intermountain enterprise, which required members of a multidisciplinary team to review facility construction plans. Frame said that the skills needed to understand these plans aren’t part of infection preventionists’ education. She encouraged industrial hygienists to be patient with their IP colleagues in these situations. “We’re just trying to figure this out as we go,” Frame said. “When you’re looking at [construction plans], you need to create a safe space for learning” by allowing infection prevention professionals to learn, grow, and become more proficient.
When Intermountain needed to implement safety measures in response to the presence of Legionella at a facility, Frame credited Rice and his staff for ensuring that ice machines were cleaned and disinfected. The team might have missed this detail if they hadn’t been working with IHs, Frame said.
Operating Room Ventilation
On another occasion, the infection prevention staff was investigating a rise in Pseudomonas infections among patients who visited a particular operating room. At the same time, Rice, who was not involved in the Pseudomonas investigation, discovered that the HVAC in the facility delivered air to the operating room through condensing cooling coils without any filtration, which could result in the aerosolization of microbes.
Rice contacted Frame to express his concerns, and Frame changed the Pseudomonas investigation to include water testing. While the testing identified no link between the problematic HVAC design and Pseudomonas, it illustrated how infection prevention can benefit from an IH’s understanding of microbial amplification inside an HVAC. Rice also explained to the building engineer and architect that their own professional association, ASHRAE, prohibited the design they had implemented.
Ultraviolet Disinfection
Rice and Frame also worked together to implement ultraviolet disinfection devices in Intermountain facilities. UV is a national best practice and an effective supplement for disinfection, Frame said, but the IH perspective identified the potential occupational hazards of UV light, including eye and skin hazards. One product under consideration used a wavelength less than 240 nanometers, which produced enough ozone to exceed the ACGIH Threshold Limit Value in a matter of seconds, Rice said.
An infrared detector at the base of the device was supposed to turn it off when it sensed movement. But testing revealed that the equipment in the operating room blinded the motion detector, which only had a range of 13 feet. Stringent administrative controls were required to ensure no one entered the room while the device was in use.
Measles Exposure
The final case study concerned exposure to measles. The virus that causes this highly contagious disease can survive in a room for hours after an infected person leaves, and the infectious dose is very low. The patient, an infant who was too young to receive the measles vaccine, had recently traveled to eastern Europe and presented to the emergency room with a fever and rash. After several days, testing confirmed that the infant had measles.
Contact tracing was necessary, so Intermountain needed to identify everyone who was potentially exposed. The IH team quickly examined the HVAC airflow, pressurization, and filtration. ASHRAE requires emergency department waiting rooms to be under negative pressure, but the IH team discovered that a pair of doors at one end of the emergency room had been left open. The doors connected to a hallway, which led to a cafeteria. “This whole space was essentially neutral,” Rice said. Even worse, nearby was an area reserved for immunocompromised patients.
Because of the IH team’s timely discovery, the infection prevention team was aware that the exposed population was potentially much larger than originally anticipated. Ultimately, 588 contacts were identified, including mothers and young children, but none developed measles. “We lucked out,” Frame said. She acknowledged that the information provided by the IH team was crucial to conducting a thorough investigation.
Alignment and Trust
As a result of their work together, Rice and Frame agreed that it’s crucial for infection prevention professionals and industrial hygienists to support each other. When the two professions aren’t aligned, Rice said, confusion can result. And trust between the professions is necessary for emergencies such as the recent COVID-19 pandemic. “When we speak in a unified manner, that can be really powerful,” Rice said. “Together, we’re better, we’re stronger, we’re safer.”
Ed Rutkowski is editor in chief of The Synergist.
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