Environmental

surveillance
D r . M alathi M M D D T M &H
H ospital Inf ection C ontrol Of f icer
C M C , Vellor e
Background
Before 1970, U.S. hospitals, regularly scheduled culturing of the air and
environmental surfaces

1970, CDC & American Hospital Association (AHA) were advocating the
discontinuation of routine environmental culturing

Guidelines for Environmental Infection Control in Health-Care Facilities (2003)

Environmental sampling
Microbiological sampling of Air, Water and inanimate surfaces
expensive

time-consuming process

complicated by many variables in protocol, analysis, and interpretation

Guidelines for Environmental Infection Control in Health-Care Facilities (2003)

Indications for environmental
sampling
Outbreak investigation

Research

To monitor a potentially hazardous environmental condition

Quality assurance

Guidelines for Environmental Infection Control in Health-Care Facilities (2003)

Factors affecting the microbial
count
Number of people in that environment
Amount of activity
Amount of moisture
Presence of material capable to support the survival of microorganisms
Rate at which the organisms are removed in air
Disinfection strategies applied
Cleaning and
disinfection of
environmental
surfaces
Why it is important?
Evidence that the environment plays a role in the transmission of HAIs

Clean and disinfect “high-touch” surfaces more frequently than

housekeeping surfaces (seldom touched by patients & healthcare workers)

“high-touch” surfaces: bed rails, over bed tables, surfaces in and around
patient toilets, nurse call buttons

Huslage et al. Infection control and hospital epidemiology, 2010

High Touch Areas
Methods for Assessing Cleaning
Practices
Visual inspection
Marking surfaces with fluorescent dye, and checking to see if marker
was removed during cleaning
Culturing surfaces (aerobic colony counts)
ATP bioluminescence assays to measure cleanliness

Griffith CJ et al. J Hosp Infect 2000;45:19,Cooper RA et al. Am J Infect Control 2007;35:338,Lewis T et al. J Hosp Infect 2008;69:156;
Dancer SJ J Hosp Infect 2009;73:378
 ATP Bioluminescence Assay Systems

Step 1 Step 2 Step 3

Use special swab Place swab in reaction tube Place tube in luminometer
to sample surface Results: Relative Light Units
Culturing surfaces
Sample/rinse method
moistened swab/sponge/wipe
frequently used
Method Advantages Disadvantages
Visual inspection Simple Does not provide reliable
assessment of
cleanliness
Fluorescent marker Inexpensive Must mark surfaces
system Minimal equipment before cleaning, and
needed check them after cleaning
Aerobic colony counts Relatively simple More expensive
Detects presence of Results not available for
pathogens 48 hrs
ATP bioluminescence Provides quantitative More expensive
assay systems measure of cleanliness Requires special
Quick results equipment
In CMC
Environmental sampling done in…..
Monthly surveillance in protected areas
In high risk areas like BMTU, OR etc.
After reformation works near high risk areas
Outbreak of infections to find the source of infection
Commissioning of new patient care area like ICU/ HDU/ OR etc
Environmental sampling
Surveillance carried out by HICC & Microbiology department
High risk areas selected
High touch areas are identified by the infection control nurses
Carried out every month
Schedule drawn by Microbiology lab
Areas covered
ICUs
Other critical care areas
Operation theatres
Response from areas after
cleaning
Repeat sampling (after cleaning)
Water surveillance
Safe Drinking Water
Clear
Colourless
Devoid of any disagreeable taste or smell
Free from pathogenic microorganisms and chemical substances

Deciding Factors for Consumption:

•Colour, Odour, Taste (Absent)
•Organisms Indicative of
contamination (Absent)
Objectives of water surveillance
Identify and evaluate the factors which could pose risk to the public and
health
Plan preventive and remedial measures
Develop strategies for supply of safe and portable water
Sampling techniques
Water sampling
Storage and transport
Time between collection & analysis should not exceed >6 hours

Placed in light proof, insulated boxes containing ice packs

If no ice packs, should not exceed > 2 hours

Sodium thiosulphate should be added to the bottles to neutralize

chlorine
In CMC
Chemical parameters testing
Every month 5 parameters to be checked in
the pharmacy
2 months once government opinion
Methods of analysis
Presumptive coliform count (Multiple tube method)
Differential coliform count (Eijkman test)
Membrane filter paper method
Interpretation and results
Presence of any coliform bacilli in 100ml of chlorinated water: unsatisfactory
(treatment is inefficient)

In untreated water:

Coliform count/100 ml Interpretation

0 Highly satisfactory
1-2 Satisfactory
3-10 Suspicious
More than 10 Unsatisfactory
 Report Recommendations

Presence of coliform bacilli Adequate chlorination

Presence of Pseudomonas and Shows stagnation of water. Suggest

NFGNB thorough cleaning of the tank
Air sampling
Air sampling
Biological contaminants occur in the air as aerosols and may include
bacteria, fungi, viruses and pollens

Microbiologic air sampling: determine the numbers and types of

microorganisms, or particulates in indoor air
Air Sampler: HiMedia
Description of Instrument
Container to accommodate a petri dish with nutrient agar / any other
media
Perforated cover, perforations of predetermined size
Vacuum pump draws air
Slit sampler
Interpretation: clean room classification
according to cleanliness class (JIS B 9920-
1998)
Class 5 and 6 Special operating room (Transplant 0 -10
theatres, cardio thoracic theatres), special
treatment rooms (burns and leukaemia
treatment rooms)

Class 6 and 7 Recovery room (ICU, CCU, NICU) 10 -100

Class 7 and 8 Regular operating rooms, all laboratories, 100 - 200

pharmaceutical rooms, rooms for infectious
diseases
Infection control nurse using Air sampler to check the
microbial load in air in the high risk area
Summary
Environmental surveillance is important for assessing the quality of
hospital environment
It also plays an important role in outbreak investigations and research
activities
Water surveillance to done routinely to check for any contamination of
water bodies
Air surveillance is required to check for the air quality
Environmental surveillance schedule should be decided based on your
own hospital policies
THANK YOU