Healthcare Environment and Infection Control
STATEMENT OF PROBLEM AND SPECIAL INFORMATION FOR HOSPITALS
The healthcare environment starts with the emergency medical services that may be bringing the patient to the medical facility. The healthcare facilities are a mixture of temporary or permanent housing and health management practices which include primary care, diagnostic care, acute care, complex health care, rehabilitation, and continuing care. These actions take place in hospitals, stand-alone surgical units, nursing homes, facilities for the aged, rehabilitation centers, assisted living facilities, and individual homes and doctors’ offices. For the purposes of this discussion, the greatest amount of information will be about the hospital and its environment and then much briefer material will be provided on some of the other facilities (See endnotes 1, 6).
The hospital is a small, very complex community with highly vulnerable individuals (patients) who are the recipients of preventive measures, or seeking diagnosis of conditions or diseases or treatment for a variety of diseases and/or injuries. Patients with infections or healthy carriers of disease frequently move from one area of the hospital to another. Highly susceptible individuals are concentrated in specialized units for newborn infants, burn patients, intensive care patients, and surgical patients. The emergency department is of special concern because of the vulnerability of the patients coming in with traumas, acute diseases, or chronic conditions. The emergency department also may be extremely crowded for short periods of time and therefore disease may spread more easily.
The employees, with their own range of health and safety problems, carry out a vast variety of tasks which require different levels of education and skills. However, their overriding concern is to do no harm while performing their many duties. The presence of visitors and vendors increases concerns for health and safety within the institution. All of these individuals interact with each other and with the environment of the hospital or facility for the elderly. They are exposed to the various environmental health, safety, and infection control problems in their homes, neighborhoods, occupational environments, and in other situations and then bring the result of these exposures to the hospital environment, thereby potentially increasing hospital health hazards. All of these people then become the means of transmission of disease and environmental hazards from the hospital to the community. The health and safety hazards may be microbiological, chemical, or physical in nature.
Medical errors and healthcare-associated infections are among the leading causes of death in the United States. Patients and medical personnel are rightfully very concerned and frustrated because these problems have not been resolved in a positive manner. Peer-reviewed studies have shown that multiple patients in a room, noise, lighting, ventilation, ergonomic design, and poor workplaces and layouts contribute to errors, safety hazards, stress, poor sleep, pain, healthcare-associated infection, and other poor outcomes.
The acute care hospital, ambulatory surgery center, inpatient rehabilitation facility, outpatient dialysis facility, long-term acute care hospital, and long-term care facilities such as nursing homes, assisted living, residential care, and chronic care facilities, and skilled nursing facilities have many responsibilities for the care of the individuals within the particular institution. Problems of an environmental nature include infection control, injury control, medication errors, environmental hazards internal to the facility, and pollution hazards external to the facility.
Various surfaces, equipment, and linens may become rapidly contaminated with a variety of microbiological agents. Problems of indoor air increases substantially. Water utilized in various treatments may become contaminated. A large quantity of highly contaminated materials is produced in the hospital and then may go out to the outer community.