Controlling ambient biohazards; what you can't see can hurt.

The effective control of ambient biohazards is clearly a team effort. This team includes the EM, the risk manager, the infection control practitioner, purchasing, facilities management, and others. Control measures relate to many different risk factors, such as the environment at the healthcare facility, the healthcare personnel, the procedure, the use of certain devices, or the actual infection host (patient). Usually, only environment-related risk factors are of concern to the EM. For fungal infections, such as Aspergillus, CDC recommends that control of environmental risk factors requires routine maintenance of hospital air-handling systems and the rooms of immunosuppressed patients, as well as extra protection designs when there is new construction. This can be very costly. For Legionella infections, CDC recommends proper design, placement, and maintenance of cooling towers; routine maintenance of water-supply systems; and when contaminated water supplies are identified, appropriate decontamination. CHEM believes that the CDC recommendations are a good way to control these ambient biohazards, but is concerned about some of the costs to meet all the Aspergillus recommendations. Hospitals must weigh costs before proceeding, especially with Category II recommendations that are only "suggested for ... many hospitals." For example, at facilities with no cases of infection, if following the CDC recommendations means that filters need to be changed and ducts cleaned more frequently than usual, the costs may not be worth it. On the other hand, if there have been a series of confirmed cases of nosocomial Aspergillus pneumonia, the cost of HVAC retrofitting or using a portable HEPA filtration systems may be worth it.(ABSTRACT TRUNCATED AT 250 WORDS)