Developed and Presented by: Wisconsin Healthcare Engineering Association

Transcription

1 Infection Control Risk Assessment (ICRA) Developed and Presented by: Wisconsin Healthcare Engineering Association

2 What is an ICRA? An Infection Control Risk Assessment is a tool devised to protect patients from infections while in the hospital during construction and maintenance activities. Identifies what measures need to be implemented during construction or renovation activities in an occupied healthcare facility to prevent construction related infections.

3 Infection Control Risk Assessment The tool is facility specific Developed with the input of contractors, facility staff, clinical staff and infection prevention.

4 Infection Control Risk Assessment (ICRA) Not Just for Construction FGI 2010 and FGI 2014 include Infection Prevention guidelines in the design phase as well as during the actual construction phase

5 Infection Control Risk Assessment (ICRA) Design Construction Mitigation Monitoring

6 Infection Control Risk Assessment (ICRA) Design Long range planning Include the final processes and work flow for the occupants

7 Long Range Planning in the Design Phase Location of hand washing sinks Sinks with emergency power Integral back splashes Alcoves for linen carts Finishes and Surfaces Isolation and Protective rooms Storage

8 Infection Control Risk Assessment (ICRA) Construction Impact to occupants, work flow, safety, egress Who will occupy the space Future renovation should be considered Emergency Management build in Utilities disruptions when the least disruption Contingencies in place in budget

9 Infection Control Risk Assessment (ICRA) Mitigation What do you do to protect occupants Activities to prevent infections related to construction Educate construction team and sub contractors on requirements

10 Infection Control Risk Assessment (ICRA) Monitoring How will you continuously monitor compliance Who is responsible for monitoring How often will monitoring be done Process if there is a failure and work is stopped Who can do this

11 Performing a Infection Control Risk Assessment For demonstration purposes we use a generic tool published by ASHE in the back of your binder Activities: Three step process that requires input from contractors, facilities staff, and clinical staff

12 When is an ICRA Needed? Pre construction Demolition Intra construction Post construction and cleanup activities Educational and monitoring needs, before, during and after construction/renovation.

13 Step One: Level Activity What Type of activity will you be performing Type A Inspection or noninvasive activities Type B Small scale, short duration which create minimal dust Type C Work that generates a moderate to high level of dust or requires demolition or removal of any fixed building components or assemblies Type D Major demolition and construction projects

14 ICRA Matrix Step One

15 Step Two: Patient Risk Group Group 1, 2, 3, or 4 Identify the Patient Risk Group that will be affected by the project.

16 Step Three: Identify the Classification Using the Activity Level (Step 1) and the Risk Group (Step 2): Match Construction Activity with Risk Area to define the Construction Class

17 Step Three: Identify the Classification This defines the Construction Project Protection Class Class I, II, II or IV Use Class information to define measures to be implemented during the project and after completion. *Reference ASHE, AIA Guidelines and EUA/ASHE Matrix

18 CLASS I During Construction Project 1. Execute work by methods to minimize raising dust from construction operations. 2. Immediately replace a ceiling tile displaced for visual inspection Class I Upon Completion of Project 1. Clean work area upon completion of task. Schedule utility interruptions during low activity. If plumbing, flush lines prior to reuse, observe for discolored water, verify water temperatures, ensure gaskets and materials do not support legionella, report any noted leaks.

19 Class II CLASS II During Construction Project 1. Provide active means to prevent airborne dust from dispersing into atmosphere. 2. Water mist work surfaces to control dust while cutting. 3. Seal unused doors with duct tape. 4. Block off and seal air vents. 5. Place dust mat at entrance and exit of work area 6. Remove or isolate HVAC system in areas where work is being performed. Upon Completion of Project 1. Wipe work surfaces with cleaner/disinfectant. 2. Contain construction waste before transport in tightly covered containers. 3. Wet mop and/or vacuum with HEPA filtered vacuum before leaving work area. 4. Upon completion, restore HVAC system where work was performed.

20 Class II Dust Control Minimize dust generation Wet mop and/or vacuum as necessary Use drop sheets to control dust Use water misting work surfaces while cutting Seal windows and unused doors with duct tape Place dust mat at entrance to and exit from work areas Ventilation Disable the ventilation system Monitor need to change and/or clean

21 Class II Debris Removal & Cleanup Contain debris in covered containers or cover before transporting for disposal Plumbing Activities Avoid collection tanks and long pipes that allow water to stagnate Consider hyperchlorinating or superheating stagnant potable water (especially if Legionella is already present in potable water supply)

22 Class II During Construction Project CLASS III 1. Remove or Isolate HVAC system in area where work is being done to prevent contamination of duct system. 2. Complete all critical barriers i.e. sheetrock, plywood, plastic, to seal area from non work area or implement control cube method (cart with plastic covering and sealed connection to work site with HEPA vacuum for vacuuming prior to exit) before construction begins. 3. Maintain negative air pressure within work site utilizing HEPA equipped air filtration units. 4. Contain construction waste before transport in tightly covered containers. 5. Cover transport receptacles or carts. Tape covering unless solid lid. Upon Completion of Project 1. Do not remove barriers from work area until completed project is inspected by the owner s Safety Department and Infection Prevention & Control Department and thoroughly cleaned by the owner s Environmental Services Department. 2. Remove barrier materials carefully to minimize spreading of dirt and debris associated with construction. 3. Vacuum work area with HEPA filtered vacuums. 4. Wet mop area with cleaner/disinfectant. 5. Upon completion, restore HVAC system where work was performed.

23 Class III Same as Class II plus: Risk Reduction Ensure that ICP consultation and control measures have been approved Dust Control Erect an impermeable dust barrier from true ceiling to the floor Ensure that windows, doors, plumbing penetrations, electrical outlets and intake and exhaust vents are properly sealed with plastic and duct taped Vacuum air ducts and spaces above ceilings if necessary Ensure that construction workers wear protective clothing if appropriate Do not remove dust barrier until the area has been cleaned and inspected Remove dust barrier carefully to minimize spreading dust

24 Class III Ventilation Maintain negative pressure within construction zone by using HEPA units Ensure air is exhausted directly outside and away from intake vents or filtered through a HEPA filter before being recirculated Ensure ventilation system is functioning properly and is cleaned if contaminated by soil or dust Debris Removal & Cleanup Remove debris at the end of the work day Erect an external chute if the construction is not taking place on ground level Vacuum work area with HEPA filtered vacuums daily or more frequently if needed. Plumbing Activities Flush water lines at construction or renovation site and adjacent patient care areas before patients are readmitted

25 Class III Environmental Services Increase frequency of cleaning in areas adjacent to the construction Ensure that construction zone is thoroughly cleaned when work is complete Infection Prevention and Control Personnel Risk Reduction Move high risk patients who are in or adjacent to the construction area Ensure that construction zone is thoroughly cleaned when work is complete Inspect dust barriers Traffic Control In collaboration with the facility project manager designate a traffic pattern for construction workers that avoids patient care areas and a traffic pattern for clean or sterile supplies and equipment that avoids the construction area.

26 Class IV All Class III requirements plus: Seal penetrations appropriately. Critical barriers need to be fire rated. Construct an anteroom with HEPA vacuum or create separate entrance for construction works.

27 Class IV During Construction CLASS IV 1. Isolate HVAC system in area where work is being done to prevent contamination of duct system. 2. Complete all critical barriers i.e. sheetrock, plywood, plastic, to seal area from non work area or implement control cube method (cart with plastic covering and sealed connection to work site with HEPA vacuum for vacuuming prior to exit) before construction begins. 3. Maintain negative air pressure within work site utilizing HEPA equipped air filtration units. 4. Seal holes, pipes, conduits, and punctures. 5. Construct anteroom and require all personnel to pass through this room so they can be vacuumed using a HEPA vacuum cleaner before leaving work site or they can wear cloth or paper coveralls that are removed each time they leave work site. 6. All personnel entering work site are required to wear shoe covers. Shoe covers must be changed each time the worker exits the work area.

28 Class IV Upon Completion CLASS IV 1. Do not remove barriers from work area until completed project is inspected by the owner s Safety Department and Infection Prevention & Control Department and thoroughly cleaned by the owner s Environmental Services Dept. 2. Remove barrier material carefully to minimize spreading of dirt and debris associated with construction. 3. Contain construction waste before transport in tightly covered containers. 4. Cover transport receptacles or carts. Tape covering unless solid lid. 5. Vacuum work area with HEPA filtered vacuums. 6. Wet mop area with cleaner/disinfectant. 7. Upon completion, restore HVAC system where work was performed.

29 Dust Control Class IV Upon Completion Erect an impermeable dust barrier that also has an anteroom Place walk off mat outside the anteroom in patient care areas and inside the anteroom Ensure workers leave the construction zone through the anteroom to be vacuumed with a HEPA filtered vacuum before leaving the work site; or that they wear cloth or paper coveralls that are removed each time they leave the work site All personnel entering the construction zone wear shoe covers Change the shoe covers each time they leave the work site Repair holes in walls or seal them temporarily

30 Ventilation Class IV Upon Completion Ensure negative pressure is maintained within the anteroom and construction zone Ensure ventilation systems are working properly in adjacent areas Review ventilation system requirements in the construction area with ICP to ensure system is appropriate and is functioning properly Plumbing Activities If there are concerns about Legionella, consider hyperchlorinating stagnant potable water or superheating and flushing all distal sites before restoring or repressurizing the water system

31 Step Four: Implementation Requires Infection Control Review and approval prior to start of project. Requires implementation of measures as determined by the ICRA. Required monitoring and documentation of monitoring with corrective action documented for deficiencies noted.

32 Particle Counts No construction standard Consider former clean room standards USP 797 references Class V for sterile preparations < 100 particles at 0.5 microns/cu ft. Class VII for ante preparation area < 10,000 particles at 0.5 microns/cu ft.

33 Particle Counter

34 Gather baseline samples Strategy for Monitoring 3 samples of 1 minute duration counting at 0.5 microns or larger Include outside air samples Compare counts during construction and after terminal cleaning process Suggest investigating any counts more than 2 x the baseline

35 ISO Classification of Particulate Matter in Room Air (limits are in particles of 0.5 mm and larger per cubic meter [current ISO] or cubic feet [former Federal Standard No. 209E)* ISO U.S. FS Particle Counts Class 209E ISO m 3 209E ft 3 3 Class Class Class 100 3, Class 1,000 35,200 1,000 7 Class 10, ,000 10,000 8 Class 100,000 3,520, ,000 *Adapted from former Federal Standard No. 209E, General Service Administration, Washington, DC, (September 11, 1992) ISO : 1999 Clean rooms and associated controlled environments

36 References ISO Classification of Particulate Matter in Room Air (limits are in particles of 0.5 mm and larger per cubic meter ISO : 1999 Clean rooms and associated controlled environments Former Federal Standard No. 209E measures particles in cubic feet.

37 Air Differential Pressure Monitor

38 Ante Rooms and HEPA Unit

39 Temporary Exhaust Systems HEPA Filtering

40 HVAC Protection

41 Construction Walls

42 Do Small Projects Need an Assessment? All maintenance and small construction projects need to be assessed and performed with the same level of attention to the ICRA. Small projects may also require an assessment for interim life safety, noise and vibration, asbestos and essential services disruption.

43 Problem Areas for Small Projects or Maintenance 1. Not conducting an ICRA 2. Inadequate negative pressure system 3. Conducting renovations on off hours 4. Improper barrier and anteroom design 5. Failure to follow industry protocol for mold

44 Facility Modification Risk Assessment (FMRA) Needed for internally completed projects May be viewed as maintenance rather than construction Includes a quick assessment of impact on multiple life safety features of the facility

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47 Mold Remediation Consider the size of the affected area Guidelines for clean water only Not for sewage or chemically contaminated water Potential for lead or asbestos

48 New York Protocols New York City Dept of Health and Mental Hygiene 2008 defines protocols: <10 total square feet square feet >100 square feet Includes specific training and competency assessment of all involved in the construction or maintenance process

49 Mold Remediation Avoid breathing in mold or mold spores Wear gloves Wear goggles that do not have ventilation holes Use plastic coverings and HEPA filtered equipment Moisten surface with soap and water Work in unoccupied areas

50 Questions?