Infection Control Regulations: A Plea for Building Codes and Patient Safety

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A landmark event in the history of hospital regulatory codes was a tragic fire in the Hartford Hospital in 1961. A lit cigarette butt, thrown into a trash chute, sparked a fire on the 9th floor that spread rapidly. Patients and staff on this floor were engulfed by intense heat and black smoke which poured through open doors. Before the fire could be contained, sixteen people had perished, including patients, visitors, and medical staff.

Hartford hospital patient escorted by a fireman.

The day after this horrendous fire, the hospital director required every staff member to walk through the disaster scene to understand the extent of the tragedy and to see how building characteristics had contributed to the fire. From the devastation and lost lives of this unprecedented tragedy, the hospital director recognized the greater good that could come from the fire by bringing attention to it, assessing the conditions that allowed the flames to spread. Important fire safety lessons were learned and mandatory building codes were required in hospitals nationwide. Smoking in hospitals and the use of trash chutes were immediately banned. Doors in hospitals were required to use positively latching hinges instead of the rolling latches, which allowed the pressure from fires to push doors open. All material finishes such as wallpaper, paint, and ceiling tiles were to be made of fire-retardant materials. Sprinkler systems, fire escapes, and fire drills became mandatory. All healthcare architects and engineers are now well informed about fire and smoke codes which require smoke compartments, safe handicap-accessible waiting areas, exit doors on hallways greater than 30 feet, and double doors replacing 8-foot fire doors, to name a few.

The main purpose of building codes is to provide minimum construction and occupancy standards to protect the health and safety of the users. There are building codes specific to fire safety, swimming pools, and natural disasters, yet there are few codes to ensure the prevention of healthcare-associated infections (HAIs), even though the number of deaths and cost related to HAIs is much greater.

HAIs vs Fires

Sources: National Fire Protection Association and CDC


What infection control regulations are in place?

Building design codes for infection control are few, and are mandated only for new hospitals. These regulations include single patient rooms and frequent placement of hand hygiene stations; however existing hospitals are NOT required to comply.

Responses to a breach in infection control protocol are determined only by the individuals involved. But, what happens if an infection control pressurized room loses the positive or negative pressure? Is laminar airflow in the operating room checked for non-turbulence? How are the numbers of room air changes measured? Are there relative humidity monitors in clinical spaces? Why is there this tremendous difference in safety regulations? Where are the “infection extinguishers” on the walls? Is the difference that fires can be seen, heard, and smelled, but HAIs are not easily recognizable?

When there is a hospital loss from a fire, insurance provides financial reimbursement for replacement construction. There are usually no punitive federal fines or non-reimbursement policies leveraged on the facility. Yet, when HAIs are reported, the hospital experiences insurance non-reimbursement, federal and state fines, and land in the black-list on the Hospital Safety Score website.

This problem is not confined to the US. In July of 2014, the United Kingdom Prime Minister, David Cameron said, “Most NHS facilities are failing even to measure the total number of cases of, and deaths from, infections. They have no idea of the total number of extra nights each year that patients stay in a hospital owing to an infection, or the total financial cost. This must change.”

The statistics show it’s time for change. Hospitals need mandatory, cost-effective and research-based infection control codes and standards that will result in improved quality of care and decreased patient harm.

What can be done to increase awareness and regulations for infection control? Share your ideas below.

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