Designing for infection control

The NHMRC updated the guidelines in May 2019, working with the Australian Commission on Safety and Quality in Health Care. The Commission describes them as evidence-based recommendations on the critical parts of infection prevention and control, built around core principles and priority areas for action.

Two things on the NHMRC’s page are worth holding together. The guidelines were developed specifically to support better infection prevention and control in acute health settings, and every healthcare facility is asked to weigh the risk of transmission in its own setting and apply the recommendations to suit its circumstances. Infections linked to health care are not a hospital problem only: the NHMRC names general practice clinics, dental clinics and community health facilities among the settings where they can occur.

The guidelines give a risk-management framework, and the NHMRC encourages risk assessment as part of deciding how to use the recommendations, because the level of risk differs between kinds of facility. The Commission adds that they support healthcare workers and organisations to build their own local protocols.

Part D of the Australasian Health Facility Guidelines (AusHFG) changed its advice on hand hygiene facilities for two reasons it names: alcohol-based hand rub is the preferred form of hand hygiene in most clinical settings, and more is known about the risk of infection spreading from handwash basins. The same revision moved its recommendations on where basins should sit, in response to research on splashing from sinks and drain outlets, and on where dispensers for personal protective equipment go, to reduce cross-contamination from splashed water.

The model code also lists places where hygiene matters, among them kitchens, laundries, pharmacies, laboratories, bathrooms and change rooms. It says hand rub should come in disposable cartridges with disposable nozzles, made for dispensing without touching, and that refillable dispensers should not be used, because of the risk of contamination.

The AusHFG’s Part D now covers doors, windows and privacy curtains, surface materials and information technology in its section on surfaces and finishes, because these, too, can carry infection from one person to the next. Victoria’s Department of Health makes the cleaning case: dust, soil and microbes that settle on surfaces can pass on infection, which is why thorough cleaning matters, in work areas above all. Some of its cleaning frequencies, as Victoria’s Department of Health gives them:

Safe Work Australia’s model code sets one rule for every kind of ventilation: air moves from clean areas toward less clean ones, so contaminated air is not spread around. In high-risk settings, it says, opening windows and doors may not be appropriate, since that can carry a biological hazard elsewhere, and HVAC systems with HEPA filters may be needed instead.

For a fitout, the code’s most direct line is about timing: when an area is being designed or refitted, it suggests asking a ventilation engineer or an occupational hygienist about the best ventilation, and it says HVAC systems should be serviced to the manufacturers’ instructions under an agreed maintenance plan, with a record kept. Water is in scope as well: Part D of the AusHFG updated its water system requirements to reduce risks carried by water.

The AusHFG’s Health Planning Unit for ambulatory care expects items that need reprocessing, podiatry instruments for example, to go to a centralised sterilising services unit.

The same rooms are a workplace. Safe Work Australia says healthcare workers face a much greater risk of exposure to biological hazards than workers in other industries, and among the duties it lists is “providing adequate and accessible facilities (e.g. for handwashing)”. Its advice on controlling risk reads like a design brief: “Eliminate the risks of biological hazards as much as you reasonably can, including through good work design.”

Safe Work Australia also points to the National Safety and Quality Health Service Standards’ Preventing and Controlling Infections Standard, and adds a caution: “Complying with these standards does not guarantee compliance with WHS laws, and vice versa.”

Where clinical waste is held and collected is set out on sheet A-104, clinical waste in the fitout. How Part D sits among the other AusHFG parts is on sheet A-105, the health facility guidelines, and clear openings for wheelchairs, trolleys and beds are on sheet A-103, access for everyone. All five sheets are listed in the index of sheets.