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Construction Risk Assessment

Construction Risk Assessment. An Overview of Environmental Infection Control and Construction Related Activities.

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Construction Risk Assessment

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  1. Construction Risk Assessment An Overview of Environmental Infection Control and Construction Related Activities 2002 Update

  2. 2002 Update

  3. 2002 Update

  4. “Indoor-air-quality (IAQ) challenges out number all others in the health-care industry. Unfortunately, the cost-conscious powers that be have failed to make the management of critical infection-control systems a top priority.” Andy Streifel, MPH, REHS 2002 Update

  5. A typical commercial airliner transports approximately 100 passengers and if the same number of deaths occurred in the aviation industry as a result of airline crashes it would equate to 17 commercial airliner crashes a week. Of which approximately 4 per month would have to do with construction/maintenance related activities. Commercial Airline Analogy 2002 Update

  6. Here’s Our Problem! 2002 Update

  7. Current Regulations and Guidelines • Joint Commission on Accreditation of Healthcare Organizations • Guidelines for the Design and Construction of Hospital and Health Care Facilities (mandated by state law) • CDC – Guidelines on Environmental Infection Control • State Licensure (in many states) 2002 Update

  8. JCAHO • Environment of Care Standards EC.3.2.1 • Patient Safety Standard 2002 Update

  9. EC.3.2.1 – effective 1/1/02 • Demolition, Construction or Renovation • Proactive Risk Assessment • Identify hazards that could potentially compromise patient care • Address impact on: • air quality requirements, infection control, utility requirements, noise, vibration, and emergency procedures. 2002 Update

  10. Construction & Renovation • Disruption of settled dust • Disruption of ceiling tiles • Repair/renovation of elevator shafts • Repair of under sink cabinets • Pulling up carpeting • Disturb “environmental reservoirs” 2002 Update

  11. Construction, Demolition, and Repair • Multi-disciplinary team approach to review: • design and function of new area • risk assessment in preventing airborne nosocomial disease • dust and moisture containment • barrier walls • negative pressure differential 2002 Update

  12. CDC Guidelines for Environmental … What it Covers • Air • Water • Environmental Services • Laundry and Bedding • Animals in Healthcare Facilities • Regulated Medical Waste 2002 Update

  13. CDC Guidelines for Environmental Infection Control - Air • HVAC System • Design • Temperature • Humidity • ACH • Mixing of air in the room • Filtration • Filter Types and Efficiencies • HEPA • Where they are required • Portable units • Maintenance 2002 Update

  14. CDC Guidelines for Environmental Infection Control - Air • Infection control impact of system maintenance and repair • Duct cleaning • System shutdowns • Moisture in the system • Backup emergency electrical power 2002 Update

  15. CDC Guidelines for Environmental Infection Control - Air • Construction, Renovation, Remediation, Repair and Demolition • ICRA (Infection Control Risk Assessment) • Multidisciplinary team • Risk assessment of project • P&P to protect patients • Procedure to Correct Problems Rapidly 2002 Update

  16. CDC Guidelines for Environmental Infection Control - Air • Construction, Renovation, Remediation, Repair and Demolition • Preliminary considerations • Resources for education of internal staff and contractors • Penalties for non-compliance with contract documents • Contingency Plans for Utility Disruption 2002 Update

  17. CDC Guidelines for Environmental Infection Control - Air • Construction, Renovation, Remediation, Repair and Demolition • Air sampling • External and internal demolition (Barriers Required?) • Working with plumbing in sensitive areas • Exposure of ceiling spaces • Crawling into ceiling spaces • Work on elevator shafts • Demo of wallboard, plaster, ceramic tile, ceiling tile • Removal of flooring • Removal of windows and doors • Removal of casework 2002 Update

  18. AIA Guidelines • 2001 Guidelines for Design and Construction of Hospitals and Health Care Facilities – Chapter 5 2002 Update

  19. Chapter 5 – Planning and Design • All new and existing construction • Due to the hazards of construction consultation from: • Infection control professionals • Safety professionals • Development of an Infection Control Risk Assessment (ICRA) 2002 Update

  20. Chapter 5 – Elements of an ICRA • Continuous process • Component of the facility functional program or master program • Initiated in planning and design and continued through construction/renovation • Performed by a multidisciplinary panel • Documented 2002 Update

  21. Chapter 5 – Elements of an ICRA • Key Elements • Impact of disrupting essential services • Patient placement or relocation • Placement of barriers • Evaluation of ventilation needs in existing sensitive areas • Number of AII and PE rooms 2002 Update

  22. Chapter 5 – Elements of an ICRA • Key Elements • Patient protection from: • Demolition • Unplanned power outages effect on ventilation and water • Movement of debris • Patient flow through the building 2002 Update

  23. Chapter 5 – Bid Documents • Project bid documents shall include: • Control of airflow (clean to dirty) • Interruption of utility and/or building service equipment • Communications of the construction process manager and the facility staff 2002 Update

  24. Role of the ICP. . . Overview • Help identify those effected by project • Know your facility • Facilitate teams & communication • Populations at risk • Decreased immunity • Allergies, asthma, COPD • Noise and vibration • Assist w/ education, P&P, documentation 2002 Update

  25. Know Your Facility • Types of patients based upon services • Layout of services • 3-D considerations • Location of inpatient units • Venues for outpatient specialties • Ancillary support functions • TB risk in community - OSHA/CDC • Long & short term planning • Applicable regulations & guidelines 2002 Update

  26. 2002 Update

  27. Facilitate Teamwork • Existing committees • Reporting structure • Responsibilities & authority • Ownership - P&P (CRP) • Ad hoc team projects • Key & ancillary members • Communication • Internal & external • Documentation • Epidemiology 2002 Update

  28. Noise and Vibration • Patients and/or employees • Recent myocardial infarction • Premature neonates • Recent ICH or stroke • Neurological/psychiatric disorders 2002 Update

  29. Noise and Vibration • Procedures or testing • EEG or EKG • Hearing assessments • Neurological studies • Fine motor skill procedures, such as microsurgery • Certain laboratory procedures • Sleep studies 2002 Update

  30. Developing ICRA(1 of 3) • Determine potential spread of infectious agents in the healthcare environment • Provided by facility “owner” • Continuous; essential part of facility’s master program to provide a safe environment of care • Initiate at design & planning phase 2002 Update

  31. Developing ICRA(2 of 3) • Continue during renovation/construction through commissioning • ICRA limited to only affected areas • Multidisciplinary team / expertise in: • IC, risk, facility design, construction, ventilation, safety and epidemiology • Team provides documentation of the risk assessment during PDC 2002 Update

  32. Developing ICRA(3 of 3) • Design professional incorporates specific construction-related requirements of ICRA into contract documents • Contract documents require contractor to implement these specifics into renovation/construction activities • Consistent with JCAHO-EC and OSHA 2002 Update

  33. ICRA Considerations • Regulations & guidelines • Infectious agents & hazards change • Microbiological ecology influenced by patients & HCWs • Physical surroundings • Documents & reports • Use as QI/PI activity? 2002 Update

  34. 2002 Update

  35. 2002 Update

  36. 2002 Update

  37. Physical Surroundings • Structure: HVAC, air flow, plumbing • Fixtures: Handwashing sinks, “hoppers”, showers, toilets • Maintenance: Reservoirs and wet, porous surfaces may support microbial growth • Equipment: Location, fixed vs. moveable, storage, prevent contamination • Design: Flow; form follows function 2002 Update

  38. PATIENT Risk Group TYPE A TYPE B TYPE C TYPE D LOW Risk Group I II II III / IV MEDIUM Risk Group I II III IV HIGH Risk Group I II III / IV IV HIGHEST Risk Group II III / IV III / IV IV ICRA Matrix 2002 Update

  39. IC Construction Permit • Suggest use based upon IC precautions • Some require for Classes III & IV • Outlines steps required • Assists in documentation • Project parameters • Sign-off • Customize to your organization by ICRA team consensus 2002 Update

  40. Effective Program Elements • Traffic patterns & patient relocation • People, signage, supplies & equipment, waste, populations at risk; think 3-D • Barriers - planning & monitoring • Type & integrity, approvals, checklists • Education for construction workers, management, HCWs, others • Level & content as appropriate (tomorrow) • Involve experts; ask key questions • Resources, content experts, site visits 2002 Update

  41. Controlling Construction and Maintenance Activities • Need for containment • General containment barriers – and hindrances to barriers • Point of entry control units • Negative pressure requirement • HVAC system protection and isolation 2002 Update

  42. How Do We Do It? • Define contractor building entry and path to the construction zone • Define the construction zone maintenance procedures and use of tacky mats and “bunny suits” • Identify HVAC System and how to isolate it from the construction zone • Establish background bioaerosols level prior to construction 2002 Update

  43. Type Of Construction • Minor repairs • Major system upgrades • Area renovation and tenant improvements Major additions and remodels – both yours and your neighbors • New construction – both yours and your neighbors • Landscaping – both yours and your neighbors 2002 Update

  44. Envelope Penetrations • Ceiling cavities • Wall panels and service access ports • Dumb waiters 2002 Update

  45. Envelope Penetrations • Building shafts and chutes • Stairwells • Elevators 2002 Update

  46. Environmental Containment Unit Photo courtesy of Mintie Corporation 2002 Update

  47. Construction Barriers Photo courtesy of Mintie Corporation 2002 Update

  48. Who Applies It? • It can be applied by hospital staff if they have the manpower available. • Most healthcare organizations use an outside third party contractor that specializes in containment programs. - Dedicated expertise - IMC contractor assumes the liability 2002 Update

  49. NEW CONSTRUCTION • Constructing problems OUT of the building. • General clean up: How clean is clean? 2002 Update

  50. NEW CONSTRUCTION Condition at time of pre-inspection Photo courtesy of Rob Case, RCCS 2002 Update

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