Integrating infection prevention into life safety efforts

Historic hospital fires, such as the infamous Hartford Hospital fire in Connecticut in 1961, helped to form today’s health care life safety requirements. Efforts spearheaded in the fire’s wake by the National Fire Protection Association (NFPA) and other like-minded organizations have helped to prevent incidents like it from occurring since. Jonathan Flannery, MHSA, CHFM, FASHE, FACHE, senior associate director of advocacy at the American Society for Health Care Engineering, says there are many valuable lessons learned from the focus on life safety that can be transferred to other critical aspects of health care, namely, infection prevention and control.

“For decades we have focused on life safety within the physical environment and have spent hundreds of millions of dollars every year maintaining the integrity of life safety protections — from testing of fire alarms and sprinklers to fire barriers,” Flannery says. “But when you look at the fact that more than 70,000 people die each year from health care-associated infections (HAIs), we have to ask if we are putting forth the same effort to reduce deaths due to infection issues within our hospitals.”

Flannery and a panel of experts will address this topic at the upcoming ASHE Annual Conference in Boston July 17-20 during a concurrent session titled: “A Debate on Safety — Life Safety vs. Infection Prevention.”

The July 19 session will highlight potential conflicts between life safety requirements and infection prevention efforts. The panel also will provide insights into how to leverage these efforts, both of which are vital for providing a safe and healing physical environment that protects patients, staff and visitors from hazards within health care settings.

Flannery, who will be hosting the session, says the panel also will dig into specific pain points between the two fields, such as:

• How life safety requirements regarding flammables limit a hospital’s ability to store alcohol-based hand rub;
• Balancing the need for outsourced life safety testing in areas that serve immunocompromised patients; and
• Going beyond the minimum life safety requirements to help improve infection prevention.

Three of the panel’s four experts recently spoke with HFM to give us a sneak preview into their thoughts prior to the debate.

• Josh Brackett, Regulatory Director, Facilities Operations, Banner Health
• Michelle Harris Williams, Director of Infection Prevention, University of Maryland Medical Center
• Richie Stever, Vice President of Real Estate and Property Management, University of Maryland Medical Center

Why is this upcoming debate important?

Brackett: As an industry, for good reason, a significant focus is placed on the life safety of patient care environments. For decades we have fought to and have successfully reduced the number of fires and fire-related deaths in hospitals. We cannot lose focus on this effort. However, we can strike a balance through collaboration with our infection prevention teams and our planning, design and construction teams to develop a better mousetrap. This debate will uncover means and methods to limit construction and facilities teams from unnecessarily introducing the potential of HAIs during necessary construction and maintenance efforts.

Stever: For several decades, the health care industry spent a tremendous amount of time and effort improving life safety in buildings through code development, education and enforcement. These efforts have dramatically reduced death and injury in health care.  This debate will showcase the need to spend a similar amount of time and effort improving infection control. Talking about it at the ASHE Annual Conference will get the wheels of change moving.

In what ways do life safety priorities conflict with infection prevention efforts?  

Harris: The goal of infection prevention is to provide an environment that reduces the incidence of HAIs and spread of infectious diseases, while also creating a safe and effective environment for staff to preform care and for all those who enter our facilities. Life safety is guided by multiple codes and regulations that need to be followed in designing and building. Sometimes in following those guidelines we make it difficult for health care providers to provide safe and effective care in the realm of preventing infections and the spread of infections among all who enter our facility.

Brackett: There are numerous ways in which we have conflict. It is very difficult for the human brain to constantly be on point with fighting the invisible battle of infection prevention and transmission. An example of this is monthly testing of battery-powered operating room (OR) task lights. Each month, we must confirm these lights are functioning properly in the event of a power failure. This is critical for ensuring the surgical team can continue operations. However, each time a facilities employee accesses the OR to test, they are introducing unnecessary potential points of failure in the infection prevention process. Another way includes the [life safety] requirement to limit the combustibles within a 64-square-foot area. This is to ensure the fire sprinkler system can contain the spread of the fire. However, this can cause issues, especially when considering the infection control and prevention process for airborne infection isolation rooms and the donning and doffing of necessary clinical personal protective equipment.

How can life safety experts and infection preventionists work together?

Stever: In order for life safety and infection prevention professionals to work collaboratively to address the most important thing in health care — the safety of the patient — they need to come together as a team, discuss process, develop plans and execute the plans as designed. Without teamwork, collaboration and the appreciation for each other’s point of view, patients will continue to suffer.

Harris: I see life safety and infection prevention working with each other from the inception of the project. I believe that the earlier the teams begin to collaborate the easier it becomes to create an optimal environment that both aids in the prevention of infectious diseases and HAIs, and facilitates meeting the code and structural requirements to create a safe environment.  We often don’t realize we are trying to achieve the same goal but from different perspectives. Understanding each other’s worlds helps us to come up with solutions on the front end so that we are not trying to mitigate issues that may become costly and time consuming later on.

To attend this and other sessions, register for the ASHE Annual Conference and view the full conference program to plan your schedule.