Automatic doors are an excellent way to improve accessibility. So it’s no surprise that they’re a common sight in many healthcare settings. If you are recovering from an illness or healing from surgery, then the last thing you feel like doing is having to push open a heavy door. Hospital automatic doors make life much easier for patients and their families. As well as health care staff, by eliminating the need to open and close doors manually. They also help your building to become compliant with The Equality Act. Which requires all public buildings to be accessible to people with disabilities.

There are several different types of automatic doors used in hospitals and healthcare facilities. Including sliding doors, swing doors, revolving doors, and bi-parting doors. Some of these types can be combined to create a custom system that meets the specific needs of the premises. They can be controlled using a variety of methods but push buttons and motion sensors are most commonly found in healthcare settings. Each system has its own advantages, so it is important to choose one that will be the most effective for your building’s needs.

Types of Healthcare Facilities That Can Benefit from Automatic Doors

Automatic doors are a versatile solution to a wide range of accessibility problems. So many healthcare settings can benefit from their presence.

General Hospitals

Healthcare staff transporting patients from surgery to the recovery ward, or from one hospital department to another, will find automatic doors extremely helpful. Sliding or bi-parting doors are often used in these areas to make it easier to transport patients on a hospital bed, while swing and revolving doors can be used in lobbies.

Care Homes

Residents of care homes often have mobility issues that make it difficult for them to open traditional doors. Automatic doors can provide residents with the independence they need to move around the facility and help to prevent falls.

ICU Departments

Intensive care units are another area where automatic doors can be very beneficial. Sliding or bi-parting doors are often used to provide fast and easy access to vulnerable patients.

Birth Centres and Maternity Hospitals

New parents often have their hands full with a baby. So automatic doors can make life much easier for them when they are coming and going from the hospital. Most birth centres and maternity hospitals use push-button operated doors. As they are the most convenient for parents who are navigating exits while pushing a pram or holding a car seat.

GP Surgeries

Automatic doors can also be found in many GP surgery centres. They provide a convenient way for patients to enter and exit the building and help to prevent the spread of infection by minimising the number of surfaces that are touched.

Dental Clinics

Cross-contamination and hygiene control are a concern for many dental clinics. Automatic doors can play a key role in keeping patients safe by eliminating patient contact points. They also add a professional and modern touch to the reception area.

6 Reasons Why Healthcare Settings Should Have Automatic Doors

Automatic doors are an excellent way to improve the functionality and accessibility of any healthcare facility. Whether you are looking to improve the experience of patients. Staff or visitors, automatic doors are a versatile solution that can be tailored to the specific needs of each setting. Here are 6 of the main reasons why healthcare and hospital automatic doors are such an important addition:

1. Accessibility

Accessibility will always be a prime concern for any kind of healthcare setting. Wheelchairs are common throughout any hospital, clinic, or care facility, and automatic doors allow these patients to have greater independence and mobility. Additionally, many healthcare facilities will transport patients on trollies and stretchers, which can be difficult to manoeuvre through standard doors. Automatic doors make it much easier for staff to get patients in and out of a building. Helping them to receive the care they need more quickly and easily. This can be particularly crucial in any setting where timely care is essential. Such as in an emergency room or intensive care unit.

2. Infection Control

In the wake of the COVID-19 pandemic, contamination and infection control have become top priorities for healthcare facilities around the world. Hospital automatic doors can help to reduce the spread of infection by minimising contact points and eliminating the need for door handles. Studies have revealed that the novel coronavirus can survive on surfaces for anything from a few hours to a few days, depending on environmental conditions.

We already know that door handles harbour large numbers of bacteria. The more people who touch them, the greater the risk of contamination. And in healthcare settings such as a hospital. It’s not just COVID-19 that may pose a risk to patients – other harmful and highly resistant bacteria such as MRSA can spread this way too. By having automatic doors in place. Healthcare facilities can significantly reduce their chances of spreading harmful pathogens from patient to patient and help to keep everyone safe.

3. Safety and Security

In addition to helping prevent the spread of infectious diseases. Hospital automatic doors also play an important role in ensuring patient safety. These doors provide security against the admission of unauthorised personnel and can also help to prevent patients from wandering out of a facility if they become confused or disorientated. In the event of a fire or other emergency. Hospital automatic doors can help to facilitate a quick escape route, allowing patients and staff to get out of a building quickly and safely. Automatic doors are also difficult to break into, so they provide an additional layer of security against potential intruders. This is essential when protecting vulnerable patients.

4. Privacy and dignity

For many patients, particularly the elderly or vulnerable ones, maintaining privacy and dignity is a key consideration. Healthcare settings are inherently open and busy places, but hospital automatic doors can help to reduce the number of people who have access to a particular area and give staff more control over who can enter. This extra level of privacy can be crucial in ensuring that patients feel safe, comfortable, and able to focus on their recovery without any undue stress.

5. Convenience

Automatic doors can also offer a number of practical benefits to healthcare staff, by making their daily routines easier and more efficient. They make it quicker and easier for staff to move between different areas of a facility and can also help to reduce noise levels by eliminating the need for doors to be constantly opened and closed. In a busy healthcare environment, every little time saving can make a big difference, and hospital automatic doors offer a convenient solution that helps to streamline daily operations.

6. Traffic Control

In any busy healthcare facility, traffic control is a major consideration. Automatic doors can help to manage the flow of people in and out of an area, preventing bottlenecks and overcrowding in waiting rooms or other areas. They can also make it easier for patients to get to their appointments, by providing clear and unobstructed access. This can help to reduce waiting times and make the overall patient experience more efficient and convenient.

Finding the Right Automatic Door Specialist

Hospitals and healthcare facilities have automatic doors because they are a simple, effective way to improve accessibility for all. They help patients and their families to move around the building more easily, which can ease the stress of being in a hospital. Hospital automatic doors also help to meet the needs of people with disabilities, which is essential under The Equality Act. So, if you are looking for a way to make your healthcare facility more accessible, then automatic doors are the way forward.

However, it’s important to choose a professional who specialises in the installation of automatic doors in this setting. There are unique considerations when it comes to installing an automatic door in a healthcare facility. So it’s important to work with a company that has experience and expertise in this area. For example, your facility may benefit from a specialised trackless automatic door that can minimise the build-up of contaminants in the guide track. Access control is also an essential feature in many healthcare settings. So it’s important to choose a company that can install a door that can be integrated with existing security systems.

J Manny

At J Manny, we have extensive experience in the installation of automatic doors for hospitals and healthcare facilities. We work with a range of different door types. Including swing doors and sliding doors, and offer a full range of installation options to suit your specific needs. Our experienced team will be happy to work with you to find the right solution for your healthcare facility. We can also provide ongoing maintenance and servicing to keep your doors in perfect working order. If you would like to find out more about our services. Or if you need any advice on choosing the right automatic door for your healthcare facility, then please don’t hesitate to get in touch. We’d be happy to help!

Doors For Hospitals, Research Labs And Pharmaceutical Facilities

Pre-hung doors are an important choice for any construction or renovation project because they come already mounted on a frame, making installation easier and more efficient. These doors are a complete unit that is ready to be installed, saving time and effort during the building process. Pre-hung doors are also more secure and airtight than doors that are hung separately, which can improve energy efficiency and reduce drafts. These benefits make pre-hung doors a popular choice for hospitals, research labs, and pharmaceutical facilities.

Hospital doors play a crucial role in maintaining a sterile and safe environment for patients, staff, and visitors. These doors should be made of materials that are easy to clean and disinfect, such as stainless steel, and should have smooth, non-porous surfaces to prevent the accumulation of dirt and germs. Automatic doors with touchless sensors are becoming increasingly popular in hospitals as they minimize the risk of cross-contamination and help to reduce the spread of germs and bacteria.

Research labs and pharmaceutical facilities require doors that are able to provide a high level of security and containment. These doors should be able to resist tampering or forced entry and should be equipped with lock systems that can only be accessed by authorized personnel. Special seals or gaskets may also be necessary to prevent the escape of hazardous materials or contaminants. In addition, these doors should be able to withstand extreme temperatures and other environmental conditions that may be present in the facility.

When it comes to doors for hospitals, research labs, and pharmaceutical facilities, durability and reliability are key. These doors must be able to withstand heavy usage and be easy to maintain to ensure the safety and security of the building and its occupants. It is important to choose doors that meet the specific requirements and needs of the facility.

Please note: An erratum has been published for this article. To view the erratum, please click here.

Persons using assistive technology might not be able to fully access information in this file. For assistance, please send e-mail to: [email protected]. Type 508 Accommodation and the title of the report in the subject line of e-mail.

Guidelines for Environmental Infection Control in Health-Care Facilities

Recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee (HICPAC)

Prepared by
Lynne Sehulster, Ph.D.1
Raymond Y.W. Chinn, M.D.2
1Division of Healthcare Quality Promotion
National Center for Infectious Diseases
2HICPAC member
Sharp Memorial Hospital
San Diego, California

The material in this report originated in the National Center for Infectious Diseases, James M. Hughes, M.D., Director; and the Division of Healthcare Quality Promotion, Steven L. Solomon, M.D., Acting Director.

Summary

The health-care facility environment is rarely implicated in disease transmission, except among patients who are immunocompromised. Nonetheless, inadvertent exposures to environmental pathogens (e.g., Aspergillus spp. and Legionella spp.) or airborne pathogens (e.g., Mycobacterium tuberculosis and varicella-zoster virus) can result in adverse patient outcomes and cause illness among health-care workers. Environmental infection-control strategies and engineering controls can effectively prevent these infections. The incidence of health-care--associated infections and pseudo-outbreaks can be minimized by 1) appropriate use of cleaners and disinfectants; 2) appropriate maintenance of medical equipment (e.g., automated endoscope reprocessors or hydrotherapy equipment); 3) adherence to water-quality standards for hemodialysis, and to ventilation standards for specialized care environments (e.g., airborne infection isolation rooms, protective environments, or operating rooms); and 4) prompt management of water intrusion into the facility. Routine environmental sampling is not usually advised, except for water quality determinations in hemodialysis settings and other situations where sampling is directed by epidemiologic principles, and results can be applied directly to infection-control decisions.

This report reviews previous guidelines and strategies for preventing environment-associated infections in health-care facilities and offers recommendations. These include 1) evidence-based recommendations supported by studies; 2) requirements of federal agencies (e.g., Food and Drug Administration, U.S. Environmental Protection Agency, U.S. Department of Labor, Occupational Safety and Health Administration, and U.S. Department of Justice); 3) guidelines and standards from building and equipment professional organizations (e.g., American Institute of Architects, Association for the Advancement of Medical Instrumentation, and American Society of Heating, Refrigeration, and Air-Conditioning Engineers); 4) recommendations derived from scientific theory or rationale; and 5) experienced opinions based upon infection-control and engineering practices. The report also suggests a series of performance measurements as a means to evaluate infection-control efforts.

Introduction

This report, which contains the complete list of recommendations with pertinent references, is Part II of Guidelines for Environmental Infection Control in Health-Care Facilities. The full four-part guidelines will be available on CDC's Division of Healthcare Quality Promotion (DHQP) website. Relative to previous CDC guidelines, this report

• revises multiple sections (e.g., cleaning and disinfection of environmental surfaces, environmental sampling, laundry and bedding, and regulated medical waste) from previous editions of CDC's Guideline for Handwashing and Hospital Environmental Control;
• incorporates discussions of air and water environmental concerns from CDC's Guideline for Prevention of Nosocomial Pneumonia;
• consolidates relevant environmental infection-control measures from other CDC guidelines; and
• includes two topics not addressed in previous CDC guidelines --- infection-control concerns related to animals in health-care facilities and water quality in hemodialysis settings.

In the full guidelines, Part I, Background Information: Environmental Infection Control in Health-Care Facilities, provides a comprehensive review of the relevant scientific literature. Attention is given to engineering and infection-control concerns during construction, demolition, renovation, and repair of health-care facilities. Use of an infection-control risk assessment is strongly supported before the start of these or any other activities expected to generate dust or water aerosols. Also reviewed in Part I are infection-control measures used to recover from catastrophic events (e.g., flooding, sewage spills, loss of electricity and ventilation, or disruption of water supply) and the limited effects of environmental surfaces, laundry, plants, animals, medical wastes, cloth furnishings, and carpeting on disease transmission in health-care facilities. Part III and Part IV of the full guidelines provide references (for the complete guideline) and appendices, respectively.

Part II (this report) contains recommendations for environmental infection control in health-care facilities, describing control measures for preventing infections associated with air, water, or other elements of the environment. These recommendations represent the views of different divisions within CDC's National Center for Infectious Diseases and the Healthcare Infection Control Practices Advisory Committee (HICPAC), a 12-member group that advises CDC on concerns related to the surveillance, prevention, and control of health-care--associated infections, primarily in U.S. health-care facilities. In 1999, HICPAC's infection-control focus was expanded from acute-care hospitals to all venues where health care is provided (e.g., outpatient surgical centers, urgent care centers, clinics, outpatient dialysis centers, physicians' offices, and skilled nursing facilities). The topics addressed in this report are applicable to the majority of health-care facilities in the United States. This report is intended for use primarily by infection-control practitioners, epidemiologists, employee health and safety personnel, engineers, facility managers, information systems professionals, administrators, environmental service professionals, and architects. Key recommendations include

• infection-control impact of ventilation system and water system performance;
• establishment of a multidisciplinary team to conduct infection-control risk assessment;
• use of dust-control procedures and barriers during construction, repair, renovation, or demolition;
• environmental infection-control measures for special areas with patients at high risk;
• use of airborne-particle sampling to monitor the effectiveness of air filtration and dust-control measures;
• procedures to prevent airborne contamination in operating rooms when infectious tuberculosis (TB) patients require surgery;
• guidance regarding appropriate indications for routine culturing of water as part of a comprehensive control program for legionellae;
• guidance for recovering from water-system disruptions, water leaks, and natural disasters (e.g., flooding);
• infection-control concepts for equipment using water from main lines (e.g., water systems for hemodialysis, ice machines, hydrotherapy equipment, dental unit water lines, and automated endoscope reprocessors);
• environmental surface cleaning and disinfection strategies with respect to antibiotic-resistant microorganisms;
• infection-control procedures for health-care laundry;
• use of animals in health care for activities and therapy;
• managing the presence of service animals in health-care facilities;
• infection-control strategies for when animals receive treatment in human health-care facilities; and
• a call to reinstate the practice of inactivating amplified cultures and stocks of microorganisms onsite during medical waste treatment.

Topics outside the scope of this report include 1) noninfectious adverse events (e.g., sick building syndrome), 2) environmental concerns in the home, 3) home health care, 4) terrorism, and 5) health-care--associated foodborne illness.

Wherever possible, the recommendations in this report are based on data from well-designed scientific studies. However, certain of these studies were conducted by using narrowly defined patient populations or specific health-care settings (e.g., hospitals versus long-term care facilities), making generalization of findings potentially problematic. Construction standards for hospitals or other health-care facilities may not apply to residential home-care units. Similarly, infection-control measures indicated for immunosuppressed patient care are usually not necessary in those facilities where such patients are not present.

Other recommendations were derived from knowledge gained during infectious disease investigations in health-care facilities, where successful termination of the outbreak was often the result of multiple interventions, the majority of which cannot be independently and rigorously evaluated. This is especially true for construction situations involving air or water.

Other recommendations were derived from empiric engineering concepts and may reflect industry standards rather than evidence-based conclusions. Where recommendations refer to guidance from the American Institute of Architects (AIA), the statements reflect standards intended for new construction or renovation. Existing structures and engineered systems are expected to be in continued compliance with those standards in effect at the time of construction or renovation.

Also, in the absence of scientific confirmation, certain infection-control recommendations that cannot be rigorously evaluated are based on strong theoretic rationale and suggestive evidence. Finally, certain recommendations are derived from existing federal regulations.

Performance Measurements

Infections caused by the microorganisms described in this guideline are rare events, and the effect of these recommendations on infection rates in a facility may not be readily measurable. Therefore, the following steps to measure performance are suggested to evaluate these recommendations:

1. Document whether infection-control personnel are actively involved in all phases of a health-care facility's demolition, construction, and renovation. Activities should include performing a risk assessment of the necessary types of construction barriers, and daily monitoring and documenting of the presence of negative airflow within the construction zone or renovation area.
2. Monitor and document daily the negative airflow in AII rooms and positive airflow in PE rooms, especially when patients are in these rooms.
3. Perform assays at least once a month by using standard quantitative methods for endotoxin in water used to reprocess hemodialyzers, and for heterotrophic and mesophilic bacteria in water used to prepare dialysate and for hemodialyzer reprocessing.
4. Evaluate possible environmental sources (e.g., water, laboratory solutions, or reagents) of specimen contamination when nontuberculous mycobacteria (NTM) of unlikely clinical importance are isolated from clinical cultures. If environmental contamination is found, eliminate the probable mechanisms.
5. Document policies to identify and respond to water damage. Such policies should result in either repair and drying of wet structural or porous materials within 72 hours, or removal of the wet material if drying is unlikely within 72 hours.

Contributors to this report reviewed primarily English-language manuscripts identified from reference searches using the National Library of Medicine's MEDLINE, bibliographies of published articles, and infection-control textbooks. All the recommendations may not reflect the opinions of all reviewers. This report updates the following published guidelines and recommendations:

CDC. Guideline for handwashing and hospital environmental control. MMWR 1998;37(No. 24). Replaces sections on microbiologic sampling, laundry, infective waste, and housekeeping.

Tablan OC, Anderson LJ, Arden NH, et al., Hospital Infection Control Practices Advisory Committee. Guideline for prevention of nosocomial pneumonia. Infect Control Hosp Epidemiol 1994;15:587--627. Updates and expands environmental infection-control information for aspergillosis and Legionnaires disease; online version incorporates Appendices B, C, and D addressing environmental control and detection of Legionella spp.

CDC. Guidelines for preventing the transmission of mycobacterium tuberculosis in health-care facilities. MMWR 1994;43(No. RR13). Provides supplemental information on engineering controls.

CDC. Recommendations for preventing the spread of vancomycin resistance: recommendations of the Hospital Infection Control Practices Advisory Committee (HICPAC). MMWR 1995;44(No. RR12). Supplements environmental infection-control information from the section, Hospitals with Endemic VRE or Continued VRE Transmission.

Garner JS, Hospital Infection Control Practices Advisory Committee. Guideline for isolation precautions in hospitals. Infect Control Hosp Epidemiol 1996;17:53--80. Supplements and updates topics in Part II --- Recommendations for Isolation Precautions in Hospitals (linen and laundry, routine and terminal cleaning, airborne precautions).

Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR, Hospital Infection Control Practices Advisory Committee. Guideline for prevention of surgical site infection. Infect Control Hosp Epidemiol 1999;4:250--78. Updates operating room ventilation and surface cleaning/disinfection recommendations from the section, Intraoperative Issues: Operating Room Environment.

U.S. Public Health Service, Infectious Diseases Society of America, Prevention of Opportunistic Infections Working Group. USPHS/IDSA guidelines for the prevention of opportunistic infections in persons infected with human immunodeficiency virus. Infect Dis Obstet Gynecol 2002; 10:3--64. Supplements information regarding patient interaction with pets and animals in the home.

CDC, Infectious Diseases Society of America, American Society of Blood and Marrow Transplantation. Guidelines for preventing opportunistic infections among hematopoietic stem cell transplant recipients. Cytotherapy 2001;3:41--54. Supplements and updates the section, Hospital Infection Control.

Key Terms

Airborne infection isolation (AII) refers to the isolation of patients infected with organisms spread via airborne droplet nuclei <5 µm in diameter. This isolation area receives numerous air changes per hour (ACH) (>12 ACH for new construction as of 2001; >6 ACH for construction before 2001), and is under negative pressure, such that the direction of the air flow is from the outside adjacent space (e.g., the corridor) into the room. The air in an AII room is preferably exhausted to the outside, but may be recirculated provided that the return air is filtered through a high-efficiency particulate air (HEPA) filter. The use of personal respiratory protection is also indicated for persons entering these rooms when caring for TB or smallpox patients and for staff who lack immunity to airborne viral diseases (e.g., measles or varicella zoster virus [VZV] infection).

Protective environment (PE) is a specialized patient-care area, usually in a hospital, with a positive air flow relative to the corridor (i.e., air flows from the room to the outside adjacent space). The combination of HEPA filtration, high numbers of air changes per hour (>12 ACH), and minimal leakage of air into the room creates an environment that can safely accommodate patients who have undergone allogeneic hematopoietic stem cell transplant (HSCT).

Immunocompromised patients are those patients whose immune mechanisms are deficient because of immunologic disorders (e.g., human immunodeficiency virus [HIV] infection or congenital immune deficiency syndrome), chronic diseases (e.g., diabetes, cancer, emphysema, or cardiac failure), or immunosuppressive therapy (e.g., radiation, cytotoxic chemotherapy, anti-rejection medication, or steroids). Immunocompromised patients who are identified as high-risk patients have the greatest risk of infection caused by airborne or waterborne microorganisms. Patients in this subset include persons who are severely neutropenic for prolonged periods of time (i.e., an absolute neutrophil count [ANC] of <500 cells/mL), allogeneic HSCT patients, and those who have received the most intensive chemotherapy (e.g., childhood acute myelogenous leukemia patients).

Abbreviations

AAMI Association for the Advancement of Medical Instrumentation

ACH air changes per hour

AER automated endoscope reprocessor

AHJ authority having jurisdiction

AIA American Institute of Architects

AII airborne infection isolation

ANSI American National Standards Institute

ASHRAE American Society of Heating, Refrigeration, and Air-Conditioning Engineers

BMBL Biosafety in Microbiological and Biomedical Laboratories (CDC/National Institutes of Health)

CFR Code of Federal Regulations

CJD Creutzfeldt-Jakob disease

CPL compliance document (OSHA)

DFA direct fluorescence assay

DHHS U.S. Department of Health and Human Services

DOT U.S. Department of Transportation

EC environment of care

EPA U. S. Environmental Protection Agency

FDA U.S. Food and Drug Administration

HBV hepatitis B virus

HEPA high efficiency particulate air

HIV human immunodeficiency virus

HSCT hematopoietic stem cell transplant

HVAC heating, ventilation, air conditioning

ICRA infection-control risk assessment

JCAHO Joint Commission on Accreditation of Healthcare Organizations

NaOH sodium hydroxide

NTM nontuberculous mycobacteria

OSHA Occupational Safety and Health Administration

PE protective environment

PPE personal protective equipment

TB tuberculosis

USC United States Code

USDA U.S. Department of Agriculture

UV ultraviolet

UVGI ultraviolet germicidal irradiation

VHF viral hemorrhagic fever

VRE vancomycin-resistant Enterococcus

VRSA vancomycin-resistant Staphylococcus aureus

VZV varicella zoster virus

Recommendations for Environmental Infection Control in Health-Care Facilities

As in previous CDC guidelines, each recommendation is categorized on the basis of existing scientific data, theoretic rationale, applicability, and possible economic effect. The recommendations are evidence-based wherever possible. However, certain recommendations are derived from empiric infection-control or engineering principles, theoretic rationale, or from experience gained from events that cannot be readily studied (e.g., floods).

The HICPAC system for categorizing recommendations has been modified to include a category for engineering standards and actions required by state or federal regulations. Guidelines and standards published by the AIA, American Society of Heating, Refrigeration, and Air-Conditioning Engineers (ASHRAE), and the Association for the Advancement of Medical Instrumentation (AAMI) form the basis of certain recommendations. These standards reflect a consensus of expert opinions and extensive consultation with agencies of the U.S. Department of Health and Human Services. Compliance with these standards is usually voluntary. However, state and federal governments often adopt these standards as regulations. For example, the standards from AIA regarding construction and design of new or renovated health-care facilities, have been adopted by reference by >40 states. Certain recommendations have two category ratings (e.g., Categories IA and IC or Categories IB and IC), indicating the recommendation is evidence-based as well as a standard or regulation.

Rating Categories

Recommendations are rated according to the following categories:

Category IA. Strongly recommended for implementation and strongly supported by well-designed experimental, clinical, or epidemiologic studies.

Category IB. Strongly recommended for implementation and supported by certain experimental, clinical, or epidemiologic studies and a strong theoretic rationale.

Category IC. Required by state or federal regulation, or representing an established association standard. (Note: Abbreviations for governing agencies and regulatory citations are listed where appropriate. Recommendations from regulations adopted at state levels are also noted. Recommendations from AIA guidelines cite the appropriate sections of the standards.)

Category II. Suggested for implementation and supported by suggestive clinical or epidemiologic studies, or a theoretic rationale.

Unresolved issue. No recommendation is offered. No consensus or insufficient evidence exists regarding efficacy.

Recommendations --- Air

I. Air-Handling Systems in Health-Care Facilities

1. Use AIA guidelines as minimum standards where state or local regulations are not in place for design and construction of ventilation systems in new or renovated health-care facilities. Ensure that existing structures continue to meet the specifications in effect at the time of construction (1). Category IC (AIA: 1.1.A, 5.4)
2. Monitor ventilation systems in accordance with engineers' and manufacturers' recommendations to ensure preventive engineering, optimal performance for removal of particulates, and elimination of excess moisture (1--8). Category IB, IC (AIA: 7.2, 7.31.D, 8.31.D, 9.31.D, 10.31.D, 11.31.D, Environmental Protection Agency [EPA] guidance)
   
   1. Ensure that heating, ventilation, air conditioning (HVAC) filters are properly installed and maintained to prevent air leakages and dust overloads (2,4,6,9). Category IB
   2. Monitor areas with special ventilation requirements (e.g., AII or PE) for ACH, filtration, and pressure differentials (1,7,8,10--26). Category IB, IC (AIA: 7.2.C7, 7.2.D6)
   
       a. Develop and implement a maintenance schedule for ACH, pressure differentials, and filtration efficiencies by using facility-specific data as part of the multidisciplinary risk
           assessment. Take into account the age and reliability of the system.
       b. Document these parameters, especially the pressure differentials.
   
   3. Engineer humidity controls into the HVAC system and monitor the controls to ensure adequate moisture removal (1). Category IC (AIA: 7.31.D9)
   
       a. Locate duct humidifiers upstream from the final filters.
       b. Incorporate a water-removal mechanism into the system.
       c. Locate all duct takeoffs sufficiently downstream from the humidifier so that moisture is completely absorbed.
   
   4. Incorporate steam humidifiers, if possible, to reduce potential for microbial proliferation within the system, and avoid use of cool-mist humidifiers. Category II
   5. Ensure that air intakes and exhaust outlets are located properly in construction of new facilities and renovation of existing facilities (1,27). Category IC (AIA: 7.31.D3, 8.31.D3,
       9.31.D3, 10.31.D3, 11.31.D3)
   
       a. Locate exhaust outlets >25 ft from air-intake systems. 
       b. Locate outdoor air intakes >6 ft above ground or >3 ft above roof level.
       c. Locate exhaust outlets from contaminated areas above roof level to minimize recirculation of exhausted air.
   
   6. Maintain air intakes and inspect filters periodically to ensure proper operation (1,11--16,27). Category IC (AIA: 7.31.D8)
   7. Bag dust-filled filters immediately upon removal to prevent dispersion of dust and fungal spores during transport within the facility (4,28). Category IB
   
       a. Seal or close the bag containing the discarded filter.
       b. Discard spent filters as regular solid waste, regardless of the area from which they were removed (28).
   
   8. Remove bird roosts and nests near air intakes to prevent mites and fungal spores from entering the ventilation system (27,29,30). Category IB
   9. Prevent dust accumulation by cleaning air-duct grilles in accordance with facility-specific procedures and schedules and when rooms are not occupied by patients (1,10--16).
       Category IC, II (AIA: 7.31.D10)
   10. Periodically measure output to monitor system function; clean ventilation ducts as part of routine HVAC maintenance to ensure optimum performance (1,31,32). Category IC, II
         (AIA: 7.31.D10)
    
3. Use portable, industrial-grade HEPA filter units capable of filtration rates in the range of 300--800 ft3/min to augment removal of respirable particles as needed (33). Category II
   
   1. Select portable HEPA filters that can recirculate all or nearly all of the room air and provide the equivalent of >12 ACH (34). Category II
   2. Portable HEPA filter units placed in construction zones can be used later in patient-care areas, provided all internal and external surfaces are cleaned, and the filter replaced or its
       performance verified by appropriate particle testing. Category II
   3. Situate portable HEPA units with the advice of facility engineers to ensure that all room air is filtered (34). Category II
   4. Ensure that fresh-air requirements for the area are met (33,35). Category II
    
4. Follow appropriate procedures for use of areas with through-the-wall ventilation units (1). Category IC (AIA: 8.31.D1, 8.31.D8, 9.31.D23, 10.31.D18, 11.31.D15)
   
   1. Do not use such areas as PE rooms (1). Category IC (AIA: 7.2.D3)
   2. 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 are met (1,34). Category IC (AIA:
       7.2.C3)
    
5. Conduct an infection-control risk assessment (ICRA) and provide an adequate number of AII and PE rooms (if required) or other areas to meet the needs of the patient population (1,2,7,8,17,19, 20,34,36--43). Category IA, IC (AIA: 7.2.C, 7.2.D)
6. When ultraviolet germicidal irradiation (UVGI) is used as a supplemental engineering control, install fixtures 1) on the wall near the ceiling or suspended from the ceiling as an upper air unit; 2) in the air-return duct of an AII area; or 3) in designated enclosed areas or booths for sputum induction (34). Category II
7. Seal windows in buildings with centralized HVAC systems, including PE areas (1,3,44). Category IB, IC (AIA: 7.2.D3)
8. Keep emergency doors and exits from PE rooms closed except during an emergency; equip emergency doors and exits with alarms. Category II
9. Develop a contingency plan for backup capacity in the event of a general power failure (45). Category IC (Joint Commission on Accreditation of Healthcare Organizations [JCAHO]: Environment of Care [EC] 1.4)
   
   1. Emphasize restoration of appropriate air quality and ventilation conditions in AII rooms, PE rooms, operating rooms, emergency departments, and intensive care units (1,45).   
       Category IC (AIA: 1.5.A1; JCAHO: EC 1.4)
   2. Deploy infection-control procedures to protect occupants until power and systems functions are restored (1,36,45). Category IC (AIA: 5.1, 5.2; JCAHO: EC 1.4)
    
10. Do not shut down HVAC systems in patient-care areas exept for maintenance, repair, testing of emergency backup capacity, or new construction (1,46). Category IB, IC (AIA: 5.1, 5.2.B, C)
    
    1. Coordinate HVAC system maintenance with infection-control staff and relocate immunocompromised patients if necessary (1). Category IC (AIA: 5.1, 5.2)
    2. Provide backup emergency power and air-handling and pressurization systems to maintain filtration, constant ACH, and pressure differentials in PE rooms, AII rooms, operating
        rooms, and other critical-care areas (1,37,47). Category IC (AIA: 5.1, 5.2)
    3. For areas not served by installed emergency ventilation and backup systems, use portable units and monitor ventilation parameters and patients in those areas (33). Category II
    4. Coordinate system startups with infection-control staff to protect patients in PE rooms from bursts of fungal spores (1,3,37,47). Category IC (AIA: 5.1, 5.2)
    5. Allow sufficient time for ACH to clean the air once the system is operational (Table 1) (1,33). Category IC (AIA: 5.1, 5.2)
     
11. HVAC systems serving offices and administrative areas may be shut down for energy conservation purposes, but the shutdown must not alter or adversely affect pressure differentials maintained in laboratories or critical-care areas with specific ventilation requirements (i.e., PE rooms, AII rooms, operating rooms). Category II
12. Whenever possible, avoid inactivating or shutting down the entire HVAC system, especially in acute-care facilities. Category II
13. Whenever feasible, design and install fixed backup ventilation systems for new or renovated construction of PE rooms, AII rooms, operating rooms, and other critical-care areas identified by ICRA (1). Category IC (AIA: 1.5.A1)

II. Construction, Renovation, Remediation, Repair, and Demolition

1. Establish a multidisciplinary team that includes infection-control staff to coordinate demolition, construction, and renovation projects and consider proactive preventive measures at the inception; produce and maintain summary statements of the team's activities (1,9,11--16,38,48--51). Category IB, IC (AIA: 5.1)
2. Educate both the construction team and health-care staff in immunocompromised patient-care areas regarding the airborne infection risks associated with construction projects, dispersal of fungal spores during such activities, and methods to control the dissemination of fungal spores (11--16,27,50,52--56). Category IB
3. Incorporate mandatory adherence agreements for infection control into construction contracts, with penalties for noncompliance and mechanisms to ensure timely correction of problems (1,11,13--16,27,50). Category IC (AIA: 5.1)
4. Establish and maintain surveillance for airborne environmental disease (e.g., aspergillosis) as appropriate during construction, renovation, repair, and demolition activities to ensure the health and safety of immunocompromised patients (27,57--59). Category IB
   
   1. Using active surveillance, monitor for airborne infections in immunocompromised patients (27,37,57,58). Category IB
   2. Periodically review the facility's microbiologic, histopathologic, and postmortem data to identify additional cases (27,37,57,58). Category IB
   3. If cases of aspergillosis or other health-care--associated airborne fungal infections occur, aggressively pursue the diagnosis with tissue biopsies and cultures as feasible (11,13--
       16,27,50,57--59). Category IB
    
5. Implement infection-control measures relevant to construction, renovation, maintenance, demolition, and repair (1,16,49,50,60). Category IB, IC (AIA: 5.1, 5.2)
   
   1. Before the project gets under way, perform an ICRA to define the scope of the activity and the need for barrier measures (1,11,13--16,48--51,60). Category IB, IC (AIA: 5.1)
   
       a. Determine if immunocompromised patients may be at risk for exposure to fungal spores from dust generated during the project (13--16,48,51).
       b. Develop a contingency plan to prevent such exposures (13--16,48,51).
   
   2. Implement infection-control measures for external demolition and construction activities (11,13--16,50,61,62). Category IB
   
       a. Determine if the facility can operate temporarily on recirculated air; if feasible, seal off adjacent air intakes.
       b. If this is not possible or practical, check the low-efficiency (roughing) filter banks frequently and replace as needed to avoid buildup of particulates.
       c. Seal windows and reduce wherever possible other sources of outside air intrusion (e.g., open doors in stairwells and corridors), especially in PE areas.
   
   3. Avoid damaging the underground water system (i.e., buried pipes) to prevent soil and dust contamination of the water (1,63). Category IB, IC (AIA: 5.1)
   4. Implement infection-control measures for internal construction activities (1,11,13--16,48-- 50,64). Category IB, IC (AIA: 5.1, 5.2)
   
       a. Construct barriers to prevent dust from construction areas from entering patient-care areas; ensure that barriers are impermeable to fungal spores and in compliance with local fire
           codes (1,45,48,49,55,64--66).
       b. Seal off and block return air vents if rigid barriers are used for containment (1,16,50).
       c. Implement dust-control measures on surfaces and divert pedestrian traffic away from work zones (1,48,49,64).
       d. Relocate patients whose rooms are adjacent to work zones, depending on their immune status, the scope of the project, the potential for generation of dust or water aerosols, and
           the methods used to control these aerosols (1,64,65).
    
   5. Perform those engineering and work-site related infection-control measures as needed for internal construction, repairs, and renovations (1,48,49,51,64,66). Category IB, IC (AIA:
       5.1, 5.2)
   
       a. Ensure proper operation of the air-handling system in the affected area after erection of barriers and before the room or area is set to negative pressure (39,47,50,64). Category
           IB
       b. Create and maintain negative air pressure in work zones adjacent to patient-care areas and ensure that required engineering controls are maintained (1,48,49,51,64,66).
       c. Monitor negative airflow inside rigid barriers (1,67).
       d. Monitor barriers and ensure integrity of the construction barriers; repair gaps or breaks in barrier joints (1,65,66,68).
       e. Seal windows in work zones if practical; use window chutes for disposal of large pieces of debris as needed, but ensure that the negative pressure differential for the area is
           maintained (1,13,48).
       f. Direct pedestrian traffic from construction zones away from patient-care areas to minimize dispersion of dust (1,13--16,44,48--51,64).
       g. Provide construction crews with 1) designated entrances, corridors, and elevators wherever practical; 2) essential services (e.g., toilet facilities) and convenience services (e.g.,
           vending machines); 3) protective clothing (e.g., coveralls, footgear, and headgear) for travel to patient-care areas; and 4) a space or anteroom for changing clothing and storing
           equipment (1,11,13--16,50).
       h. Clean work zones and their entrances daily by 1) wet-wiping tools and tool carts before their removal from the work zone; 2) placing mats with tacky surfaces inside the entrance;
           and 3) covering debris and securing this covering before removing debris from the work zone (1,11,13--16,50).
       i. In patient-care areas, for major repairs that include removal of ceiling tiles and disruption of the space above the false ceiling, use plastic sheets or prefabricated plastic units to
          contain dust; use a negative pressure system within this enclosure to remove dust; and either pass air through an industrial-grade, portable HEPA filter capable of filtration rates of
          300--800 ft3/min., or exhaust air directly to the outside (16,50,64,67,69).
       j. Upon completion of the project, clean the work zone according to facility procedures, and install barrier curtains to contain dust and debris before removing rigid barriers (1,11,13-
          -16,48--50).
       k. Flush the water system to clear sediment from pipes to minimize waterborne microorganism proliferation (1,63).
       l. Restore appropriate ACH, humidity, and pressure differential; clean or replace air filters; dispose of spent filters (3,4,28,47).
    
6. Use airborne-particle sampling as a tool to evaluate barrier integrity (3,70). Category II
7. Commission the HVAC system for newly constructed health-care facilities and renovated spaces before occupancy and use, with emphasis on ensuring proper ventilation for operating rooms, AII rooms, and PE areas (1,70--72). Category IC (AIA: 5.1; ASHRAE: 1-1996)
8. No recommendation is offered regarding routine microbiologic air sampling before, during, or after construction, or before or during occupancy of areas housing immunocompromised patients (9,48,49,51,64,73,74). Unresolved issue
9. If a case of health-care--acquired aspergillosis or other opportunistic environmental airborne fungal disease occurs during or immediately after construction, implement appropriate follow-up measures (40,48,75--78). Category IB
   
   1. Review pressure-differential monitoring documentation to verify that pressure differentials in the construction zone and in PE rooms are appropriate for their settings (1,40,78).
       Category IB, IC (AIA: 5.1)
   2. Implement corrective engineering measures to restore proper pressure differentials as needed (1,40,78). Category IB, IC (AIA: 5.1)
   3. Conduct a prospective search for additional cases and intensify retrospective epidemiologic review of the hospital's medical and laboratory records (27,48,76,79,80). Category IB
   4. If no epidemiologic evidence of ongoing transmission exists, continue routine maintenance in the area to prevent health-care--acquired fungal disease (27,75). Category IB
    
10. If no epidemiologic evidence exists of ongoing transmission of fungal disease, conduct an environmental assessment to find and eliminate the source (11,13--16,27,44,49--51,60,81). Category IB
    
    1. Collect environmental samples from potential sources of airborne fungal spores, preferably by using a high-volume air sampler rather than settle plates (2,4,11,13--
        16,27,44,49,50,64,65,81--86). Category IB
    2. 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 (49,60). Category IB
    3. Use an EPA-registered antifungal biocide (e.g., copper-8-quinolinolate) for decontaminating structural materials (16,61,66,87). Category IB
    4. 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
        (88,89). Category IB
    5. If possible, perform molecular subtyping of Aspergillus spp. isolated from patients and the environment to compare their strain identities (90--94). Category II
     
11. If air-supply systems to high-risk areas (e.g., PE rooms) are not optimal, use portable, industrial-grade HEPA filters on a temporary basis until rooms with optimal air-handling systems become available (1,13--16,27,50). Category II

III. Infection Control and Ventilation Requirements for PE rooms

1. 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 (e.g., vacuuming or disruption of ceiling tiles) (37,48,51,73). Category IB
2. Minimize the length of time that immunocompromised patients in PE are outside their rooms for diagnostic procedures and other activities (37,62). Category IB
3. Provide respiratory protection for severely immunocompromised patients when they must leave PE for diagnostic procedures and other activities; consult the most recent revision of CDC's Guideline for Prevention of Health-Care--Associated Pneumonia for information regarding the appropriate type of respiratory protection. (27,37). Category II
4. Incorporate ventilation engineering specifications and dust-controlling processes into the planning and construction of new PE units (Figure 1). Category IB, IC
   
   1. Install central or point-of-use HEPA filters for supply (incoming) air (1,2,27,48,56,70, 80,82,85,95--102). Category IB, IC (AIA: 5.1, 5.2, 7.2.D)
   2. Ensure that rooms are well-sealed by 1) properly constructing windows, doors, and intake and exhaust ports; 2) maintaining ceilings that are smooth and free of fissures, open joints,
       and crevices; 3) sealing walls above and below the ceiling; and 4) monitoring for leakage and making any necessary repairs (1,27,44,100,101). Category IB, IC (AIA: 7.2.D3)
   3. Ventilate the room to maintain >12 ACH (1,27,37,100,101,103). Category IC (AIA: 7.2.D)
   4. Locate air supply and exhaust grilles so that clean, filtered air enters from one side of the room, flows across the patient's bed, and exits from the opposite side of the room
       (1,27,100,101). Category IC (AIA: 7.31.D1)
   5. Maintain positive room air pressure (>2.5 Pa [0.01-inch water gauge]) in relation to the corridor (1,3,27,100,101). Category IB, IC (AIA: Table 7.2)
   6. 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 (1,13). Category IC (AIA: 7.2.D6)
   7. Install self-closing devices on all room exit doors in PE rooms (1). Category IC (AIA: 7.2.D4)
    
5. Do not use laminar air flow systems in newly constructed PE rooms (99,101). Category II
6. Take measures to protect immunocompromised patients who would benefit from a PE room and who also have an airborne infectious disease (e.g., acute VZV infection or tuberculosis).
   
   1. Ensure that the patient's room is designed to maintain positive pressure.
   2. Use an anteroom to ensure appropriate air-balance relationships and provide independent exhaust of contaminated air to the outside, or place a HEPA filter in the exhaust duct if the
       return air must be recirculated (1,100) (Figure 2). Category IC (AIA: 7.2.D1, A7.2.D)
   3. 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 (33). Category II
    
7. Maintain backup ventilation equipment (e.g., portable units for fans or filters) for emergency provision of required ventilation for PE areas and take immediate steps to restore the fixed ventilation system (1,37,47). Category IC (AIA: 5.1)

IV. Infection-Control and Ventilation Requirements for AII Rooms

1. Incorporate certain specifications into the planning and construction or renovation of AII units (1,34,100,101,104) (Figure 3). Category IB, IC
   
   1. Maintain continuous negative air pressure (2.5 Pa [0.01 inch water gauge]) in relation to the air pressure in the corridor; monitor air pressure periodically, preferably daily, with
       audible manometers or smoke tubes at the door (for existing AII rooms), or with a permanently installed visual monitoring mechanism. Document the results of monitoring
       (1,100,101). Category IC (AIA: 7.2.C7, Table 7.2)
   2. Ensure that rooms are well-sealed by properly constructing windows, doors, and air-intake and exhaust ports; when monitoring indicates air leakage, locate the leak and make
       necessary repairs (1,99,100). Category IB, IC (AIA: 7.2.C3)
   3. Install self-closing devices on all AII room exit doors (1). Category IC (AIA: 7.2.C4)
   4. Provide ventilation to ensure >12 ACH for renovated rooms and new rooms, and >6 ACH for existing AII rooms (1,34,104). Category IB, IC (AIA: Table 7.2)
   5. Direct exhaust air to the outside, away from air-intake and populated areas. If this is not practical, air from the room can be recirculated after passing through a HEPA filter (1,34).
       Category IC (AIA: Table 7.2)
    
2. Where supplemental engineering controls for air cleaning are indicated from a risk assessment of the AII area, install UVGI units in the exhaust air ducts of the HVAC system to supplement HEPA filtration or install UVGI fixtures on or near the ceiling to irradiate upper room air (34). Category II
3. Implement environmental infection-control measures for persons with diagnosed or suspected airborne infectious diseases.
   
   1. Use AII rooms for patients with or suspected of having an airborne infection who also require cough-inducing procedures, or use an enclosed booth that is engineered to provide 1)
        >12 ACH; 2) air supply and exhaust rate sufficient to maintain a 2.5 Pa (0.01-inch water gauge) negative pressure difference with respect to all surrounding spaces with an exhaust 
       rate of >50 ft3/min; and 3) air exhausted directly outside away from air intakes and traffic or exhausted after HEPA filtration before recirculation (1,34,105--107). Category IB, IC
       (AIA: 7.15.E, 7.31.D23, 9.10, Table 7.2)
   2. Although airborne spread of viral hemorrhagic fever (VHF) has not been documented in a health-care setting, prudence dictates placing a VHF patient in an AII room, preferably  
       with an anteroom, to reduce the risk of occupational exposure to aerosolized infectious material in blood, vomitus, liquid stool, and respiratory secretions present in large amounts 
       during the end stage of a patient's illness (108--110). Category II
   
       a. If an anteroom is not available, use portable, industrial-grade HEPA filters in the patient's room to provide additional ACH equivalents for removing airborne particulates.
       b. Ensure that health-care workers wear face shields or goggles with appropriate respirators when entering the rooms of VHF patients with prominent cough, vomiting, diarrhea, or
           hemorrhage (109).
   
   3. Place smallpox patients in negative pressure rooms at the onset of their illness, preferably using a room with an anteroom, if available (36). Category II
    
4. No recommendation is offered regarding negative pressure or isolation for patients wi