Contractor s Manual

Transcription

1 Improving health, comfort and life Contractor s Manual First Printing August 28, 2003 Last Revision May 29, 2014

2 Table of Contents Kalispell Regional Healthcare Contacts 2 Introduction 3 Point Personnel and Inspection Contacts 4 General Safety Considerations for all KRH Construction Projects 5 Environmental & Special Considerations for all KRH Construction Projects 6 KRH Code and Safety 7 Construction Process Flow Chart 8 Construction Plan Introduction 9 Life Safety Considerations and the Construction Plan 10, 11 General Safety Considerations and the Construction Plan 12 Infection Prevention Considerations and the Construction Plan 13 Construction Process Guidelines 14 Construction Plan 16, 17, 18, 19&20 Quick Reference to Abbreviations NFPA IBC NEC AIA CDC CMS ILSEC POM APIC OSHA KRH HC OHS HIT HIPAA WO National Fire Protection Association International Building Codes National Electrical Code American Institute of Architects Centers for Disease Control and Prevention Center for Medicaid and Medicare Systems Interim Life Safety Evaluation Committee Plant Operations and Maintenance Association for Professionals in Infection Control and Epidemiology Occupational and Safety Health Administration Kalispell Regional Healthcare Healthcenter Occupational Health Services Health Information Technology Health Insurance Portability and Accountability Act Work Order 1

3 Contacts Emergencies Dial from any facility phone 2213 or 9, Security from any facility phone 2420 Plant Operations Maintenance Department (POM) Mark Chitwood, Facility Manager (406) or ext Cell (406) Fax (406) Chad Wermer, Plant Operations Supervisor Cell (406) Mike Schlegel or John Sturzen, Engineer Fire Prevention and Suppression Systems: (406) All Plant Operation Engineers (406) Plant Operations Secretaries: Deborah Gilham & (406) Shannon Day (406) Design and Construction Marcello Pierrottet, Director of Design and Construction (406) Jan Blohm, Project Coordinator (406) Quality and Safety Services Troy Pilgeram, Environmental Safety Officer (406) Infection Prevention Melody Finch RN (406) Shari Courser, RN, MSN, CIC, CRNI (406) Environmental Services Thomas Theisen, Environmental Services Manager (406) or Page #393 Health Information Technology Sam Nunnally, HIT Telecom Supervisor (406) (406) (cell) MEMBERS OF THE Interim Life Safety Evaluation Committee (ILSEC) Mark Chitwood, Facility Manager Shannon Day, Plant Operations Randy Christenson, Clinical Engineering Bill Capps, Health Information Technologies Rita Lopez, Occupational Health Services Bill Boyd, Safety Officer Melody Finch, Infection Prevention and Control Shari Courser, Infection Prevention and Control Laura Bermel, HCNW Safety Thomas Theisen, Environmental Services Marcello Pierrottet, Architect Jan Blohm, Project Coordinator Troy Pilgeram, Environmental Safety Officer 2

4 Kalispell Regional Healthcare Improving health, comfort and life. The key to safely performing any task begins with communication. Kalispell Regional Healthcare is committed to providing a safe and healthy work environment. The guidelines put forth in this manual have been designed and are applicable to all employees of companies contracted (including subcontracted employees) performing work activities in and on properties of Kalispell Regional Healthcare. Work activities are defined as including, but not limited to, construction, remodeling, renovating, maintenance and/or repair. The purpose of these guidelines is to communicate environmental health and safety protocols pertinent to work activities performed on property by outside contractors. These guidelines are not intended nor designed to be comprehensive or address every situation on a work site. Contractors are required to provide their own safety plans. If a situation arises or a condition exists that is not addressed in this manual, contractors should first contact the Facilities Manager or Plant Operations Supervisor for guidance. 3

5 Point Personnel and Inspectors Mark Chitwood, Facility Manager Mark will be able to answer most any question about the building. If you have questions on firewalls, cable runs, etc; he will be able to assist. In a pinch, he will be able to inspect a job, but will always be able to appoint you an inspector. Deborah Gilham, Plant Operations Secretary Deb can assist you with the sign-in process and will issue keys if necessary. Upon completion of the project, she can locate an inspector for you. Mike Schlegel, Plant Operations Engineer Mike is well versed in all Life Safety for our organization. He is the primary contact for all your PERMIT needs and will be available to perform inspections. Sam Nunnally, Telecommunications Supervisor Sam is a Telecommunications Supervisor for HIT and has years of experience in network cable installation. He is STI Certified and is an inspector for all communication cable runs. Chad Wermer, Plant Operations Supervisor Chad is our Plant Operations Supervisor and has extensive working knowledge of the hospital and its systems. Chad will be able to check out a badge for you, perform inspections and/or assist you with any other needs you may have regarding the facility. Troy Pilgeram, Environmental Safety Officer Troy is our Environmental Safety Officer with extensive knowledge of Life Safety, OSHA and other KRH regulations. He is the primary inspector for all construction projects. Bill Capps, Telecommunications Tech Bill is our Telecommunications Technician for IT and has years of Telecommunications experience. He is an Inspector for all communication fire penetrations. 4

6 General Safety & Security Considerations for all KRH Construction Projects It is the responsibility of the contractor to ensure the safety of contracted employees, and that all work is performed in a healthy, safe and environmentally responsible manner. All contractors shall abide by all federal, state, local and KRH policies and guidelines. On an annual basis, contractors will be expected to review the Kalispell Regional Healthcare codes, policies, and safety protocols. Contractors are responsible for training of their employees. All work must meet or exceed CMS, IBC, NEC & NFPA Life Safety codes. CONFIDENTIALITY & PRIVACY: Protection of patient privacy is of paramount importance to our organization and compliant with Health Insurance Portability Accountability Act (HIPAA). It is the policy of KRH that contractors/vendors be contractually bound to protect health information to the same level as our policy endorses. TOBACCO-FREE CAMPUS: Smoking or tobacco use of any kind is prohibited on all KRH properties. GENERAL LIABILITY - WORKERS COMPENSATION & W9 IRS FORM: KRH requires that contracted work performed on KRH property must be under Liability & Workman s Compensation Insurance coverage. Provide copies to Plant Operations Department. If your company is new to our organization we must have on file a complete W9 Form before work commences. UTILITY SHUT-OFF S: The contractor will be responsible to notify owner at least 72 hours prior to a scheduled utility shut-down for adequate planning and staff/patient notifications. Both the Contractor/s involved, as well as, ILSEC members will formulate a construction plan and include provisions applicable to project. DUST CONTROL: Contractors are to include all precautions necessary to mitigate dust migration for any and all projects. Depending on the project; examples of dust control include, but are not limited to: sealing doors, sealing vents, water misting work surfaces, HEPA vacuum, walk-off mats, removal or isolation of HVAC system, and/or use of containment cube. CLEAN AND TIDY WORK SPACE: Contractors must always plan to keep corridors and exit doors clear at all times, including proper storage of construction materials and tools. Fire egress cannot be impeded without approved Interim Life Safety measures. In addition to inside, all external exit ways, walks, and drives must be kept free from debris, material, tools and vehicles. NOISE AND VIBRATION: Because we are a healthcare facility, it is especially important to consider noise and vibration as a contributing factor to providing a healing environment. Noise and vibration is an essential consideration of the contractor s Construction Plan and should include provisions to keep them to a minimum. BARRICADES, CONES AND SIGNAGE: Contractors are to utilize physical barricades to clearly identify work areas. In addition, signage is to be posted that clearly identifies the work area, or reroutes foot traffic, as well as identifies dangers. WORK ORDER NUMBERS: All projects must be assigned a Work Order Number. It is important to note that an invoice without an assigned number could be delayed. Be sure to get a work order number for each project. 5

7 Security Considerations for all KRH Construction Projects IDENTIFICATION: Contractors working in KRH facilities or on the properties are to have official identification (ID) badges issued by the Plant Operations Department. The ID shall be prominently displayed at all times. All ID badges must be returned to the Plant Operations Department upon completion of each project. PARKING: Contractors shall utilize designated parking areas for their vehicles. Ask the Facilities Manager for details on the location of your designated parking area. For larger construction projects, KRH will provide special provisions for parking. General or Lead Contractors will be responsible for ascertaining that their employees and subcontractors park in the designated areas. 6

8 Special Considerations for Pathways Construction Projects Pathways is a hospital setting that provides care and treatment for people with diagnoses of chemical dependency and behavioral and mental health illnesses. Acute crisis intervention and stabilization is the goal and thought of as the Intensive Care Unit of psychiatry and chemical dependency. Safety of the patients, staff and visitors and contractors is of utmost importance. The people we care for can at times be unable to think and/or act rationally and because of these and other factors, are at a significant level of risk. Environmental and special considerations must be attended to when visiting this facility to perform contractor duties. HIGH SECURITY AND ACCESS: To minimize risks; Pathways is a secure and locked unit, meaning all entry and exit is controlled by key-lock, camera monitoring, and strict check-in and out procedures. Not all of the locations within the Pathways building are secure areas, but once you have crossed the threshold of a secure door, certain key concepts and rules must be followed with great diligence. Contractors must check-out with the front-office staff or with the nurse station if front office is not available, before every departure of the building. Contractors will be denied access if they do not host a contractors badge and have not checked in with the proper personnel. SECURING TOOLS AND MATERIALS: No tools or materials will be left unattended at any time. This includes having your back to any and all equipment, supplies, etc. It is imperative that any and all items are secure at all times. Utilize a second contractor or ask the nursing staff for assistance. CONFIDENTIALITY & PRIVACY: Once in the locked and secure unit, interactions between you and the people in care at Pathway s will be very limited. If interactions with our patients become necessary for your job performance, please seek assistance from staff. Should you see anyone you recognize at Pathways, their presence SHALL NOT be acknowledged outside of Pathways as strict State and Federal Law insures patient privacy and confidentiality. 7

9 Environmental Safety Considerations for all KRH Construction Projects The contractor shall assume full responsibility and liability for the compliance with all applicable federal, state, and local regulations. The contractor shall hold the owner harmless for the failure to comply with any applicable work, hauling, disposal, safety, health or other regulations on the part of himself, his employees, or his subcontractors. HAZARDOUS WASTE MANAGEMENT: The contractor must provide KRH with a list of actual and potential hazardous wastes to be generated during the project. Hazardous waste generated by the contractor as part of its work is the responsibility of the contractor. Contractors must ensure that their hazardous waste is properly identified, stored, transported and disposed of in accordance with all applicable local, state, and federal laws. Contractors will maintain an adequate emergency plan and equipment to address spills, fire etc. ASBESTOS-CONTAINING MATERIALS (ACM) As a mandate of the Montana Department of Environmental Quality, all construction projects require an inspection for asbestos. As part of each construction planning protocol, KRH will have the proposed project site inspected by an accredited inspector. Should the area contain asbestos, abatement will be performed by an accredited remediation company and no project work will be performed until a final clearance inspection has been performed on the area. LEAD-BASED PAINT AND FUNGAL GROWTH: It is the responsibility of the contractor to notify the owner immediately if ACM, Lead-based Paint, or Fungal Growth is found before or during construction activities. All removal or abatement and disposal must be performed by firms licensed to perform such work. INDOOR AIR QUALITY: Contractors shall make every effort to maintain acceptable indoor air quality on KRH properties while performing their work, and to reduce the generation of unwanted odors, dust, vapors, gases and fumes that potentially can make their way into the spaces of employees or patients in adjacent areas and buildings. Strategies including: scheduling off-hours, the use of fans and even something as simple as not leaving a vehicle s engine running all can aide in ensuring indoor air quality and reduce/eliminate complaints that can delay projects. MATERIAL SAFETY DATA SHEETS (MSDS): MSDS are intended to outline special precautions, hazards, and controls necessary for the safe use and handling of chemical/hazardous materials. KRH requires written or printed material concerning a hazardous chemical that is prepared by the manufacturer for each hazardous chemical they produce. It is the responsibility of the contractor to have all MSDS on all products used for the project on site during construction. 8

10 Code and Safety Awareness Kalispell Regional Healthcare has determined that vendors and specialty contractors need to be aware of certain emergency codes and emergency situations that may arise while they are in the building. Code Blue: Code Red: Code Black: Code D : Code Purple: Code Pink: Code Green: Code Orange: Code Gray: This term is used when a patient, visitor or staff member has quit breathing, has no pulse, or is unresponsive. Non-hospital personnel will not be involved in any type of response or reaction other than to remain out of the way and to clear out of the way your equipment or material that could impede movement of emergency response personnel. If you discover an unresponsive person, announce Code Blue loud enough to be heard by a hospital employee, who will call in the code and activate the alarm system. This term is used when an actual fire is discovered or the fire alarm system has been activated. Non-hospital personnel should follow the instructions of hospital staff. Do not enter or use any elevator during a Code Red. Evacuate laterally to adjoining smoke compartment (behind closed double hallway doors) if smoke/flames are present in your work area. If you discover a fire, announce Code Red loud enough to be heard by a hospital employee, who will call in the code and activate the alarm system. Activate alarm pull stations, which are located near exits if you discover a fire. Always maintain appropriate fire safety measures in your work area. This term is used when the facility receives a bomb threat or if a potential explosive device is discovered in the facility. Non-hospital personnel should immediately discontinue use and turn off cell phones/radios/pagers, stop work and wait for instructions from hospital staff until an All Clear has been issued. If a non-hospital employee, vendor or contractor should discover a suspicious package/device, it should be reported to any hospital employee immediately. This term is used when the hospital has activated an internal or external disaster plan, in response to a significant emergency situation. Follow the instructions of hospital staff until the code is cleared. This term is used in the event of a missing child older than one year. Follow the instructions of hospital staff until the code is cleared. This term is used for suspected infant abductions. Follow the instructions of hospital staff until the code is cleared. This term is used whenever a report of a possible security threat involving a weapon. Follow the instructions of hospital staff until the code is cleared. This term is used for Hazardous Material Release Emergency Response. Non-hospital personnel should immediately remove themselves from the area. The vendor/contractor shall be knowledgeable about all Hazardous Materials they use on premises and comply with all applicable OSHA regulations. This term is used when emergency assistance is needed to subdue a violent/threatening patient, visitor or staff member. Stand aside from the conflict area and follow the instructions of hospital staff or leave the area until scene is cleared. 9

11 REQUIRED PERMITS RESTRICTED SPACE ACCESS PERMIT: Any work performed above ceiling grids or within utility closets are RESTRICTED spaces. Staff and contractors/vendors cannot access these areas without a permit. Access to these spaces is a privilege and all should comply with permitting. All work in-house labor or contractors planning on performing above ceiling work, or within utility closet MUST attain a RESTRICTED SPACE ACCESS PERMIT. A construction plan will not always be needed; however, a permit must be issued and posted on site. HOT WORK PERMITS: Any work involving open flames or producing heat and/or sparks will need an approved hot work permit. Hot work includes, brazing, cutting, grinding, soldering, torch-applied roofing and welding. All hot work must be approved by KRH Safety Officer or designee. No hot work shall be performed until all sections of HOT WORK PERMIT forms have been completed and approved. Should the project require hot work, the contractor must post the permit next to the project, along with the Construction Plan. EXAMPLES of PROVISIONS for Hot Work: Provide portable Fire extinguishers Utilize welding curtains or blankets/mats Removing combustibles, flammables and other ignitable materials from the vicinity Oxygen and acetylene bottles used by welders will be secured with a bracket or chain and kept far enough away so as to not be exposed to flying sparks and or hot metal. Valves and blinds isolating equipment for hot work shall be properly tagged and locked where necessary. RED TAG PERMITS: When fire protection equipment must be taken out of service a RED TAG PERMIT will be implemented and will assist in mitigating potential impairments. Our Plant Operations Life Safety team will notify FM Global, as well as, Montana state officials. UTILITY SERVICE INTERRUPTION: KRH requires that projects maintain uninterrupted utility services to insure patient and staff safety. Contractors will be responsible to notify Kalispell Regional Healthcare at least 72 hours prior to a scheduled utility shutdown for adequate planning. It is imperative that if there is to be a major utility shut-down or interruption due to construction, a detailed plan of action including interim measures be included in the construction plan. ILSEC along with the contractor will coordinate and determine the best plan of action for the outage. Interim measures such as: scheduling outage after work-hours, limiting the length of outage or providing portable wash stations are examples of provisions. 10

12 Construction Process Flow Chart Trained Personnel (Contractors that have attended annual contractors training). Emergency service. Contact Facilities Manager or Plant Operations Supervisor. Work affecting CDC Guidelines or NFPA Codes. Minor work not affecting CDC Guidelines or NFPA Codes. Submit a Construction Plan (Appendix A) to the Facilities Manager. Work approved by Facilities Manager. Risk Assessment of the proposed Construction Plan (expect 5 business days minimum). Workers sign-in. Hospital ID badges and/or keys are issued and work can begin. ILSEC approved Construction Plan. Request for final inspection from the Environmental Safety Officer, then submittal of invoice with the Work Order referenced, and then approval of payment. *Some projects will be subject to outside inspectors. Administration must approve payment 11

13 Construction Plan When the NFPA Codes or CDC Guidelines are affected, it is the responsibility of each contractor to develop a Construction Plan that addresses pertinent life safety and infection control provisions for the project. The following pages are a complete guideline on how to complete the Construction Plan. Once the contractor has completed the construction plan, an ILSEC meeting will be scheduled to review the plan. This meeting will require the attendance of committee members, contractor/s, as well as, key personnel of the affected department/s of the hospital. See copy of Construction Plan in the back of the book accompanied by the Infection Prevention Risk Assessment. 12

14 Construction Plan - Life Safety Provisions EGRESS: Fire Egress cannot be impeded or blocked without approved Interim Life Safety provisions. This includes egress for occupants, as well as, contractors. Corridors and exit doors must be kept clear at all times. All external exit ways, walks, and drives must be kept free from debris, material, tools and vehicles. Do not block fire extinguishers, fire alarm pull stations and/or fire-doors. Should the project potentially alter, impede or block fire egress at any time during the project, the contractor must describe in detail the provisions to assist egress. **It is often helpful to provide drawings or ask for walk-through of the proposed construction site should the plan entail complex plans and/or if the plan includes phases in project work. EMERGENCY AND EXIT LIGHTING: Emergency and Exit Signage/Lighting cannot be blocked or disconnected without Life Safety provisions. Should the project require the temporary blocking or disconnecting of Emergency Signage/Lighting, the contractor will describe in detail the provisions to be set in place to accommodate and add directional signage for patients, visitors and staff. EXAMPLES of Provisions for altering of Egress and/or Emergency Lighting: Signage will be placed that clearly mark an alternate pathway Coordinating and education staff of affected departments Storing of material and tools offsite so they do not impede on egress COMPARTMENTAL FIRE RATING: It is the contractor s responsibility for maintaining all fire and smoke rating requirements during the project, as well as, ensure the project area is returned to full NFPA compliance. The contractor shall examine the site prior to beginning any work. Any existing penetrations located during this visit shall be brought to the Plant Operations staff attention. Any penetrations not identified prior to beginning work shall be the responsibility of contractor to fire-stop. KRH requires that all contractors use approved STI fire and smoke sealing systems when running pipe, low voltage, data or electrical lines, and use of these should be noted in the construction plan. Inspections will take place periodically during the project to ensure that all penetrations have been sealed properly. Upon completion of the project, there will be final inspection verifying all penetrations have been sealed and ready for occupancy. Should the project require the smoke/fire walls/doors be compromised at any time during this project, it should be noted in the construction plan so that fire safety provisions to be implemented to protect surrounding departments and inspections to ensure that the fire rating is returned upon completion of project. FIRE DETECTION AND SUPPRESSION SYSTEMS: KRH requires detection and suppression be maintained during all construction projects. The contractor will be liable for any false alarm caused by dust created in their work areas or dust traveling beyond inadequate protection barriers. Contractor may be held responsible for damage resulting in false alarms. Contractors will be required to conduct a FIRE WATCH whenever fire detection or suppression systems are impaired for more than 4 consecutive hours in a 24-hour period. Should the project require either fire detection be serviced, turned off, or disconnected the contractor must describe in detail the provisions that will be implemented to ensure safety including coordinating shutdowns with the Plant Operations Departmental staff. In addition, if the project could potentially cause detection or suppression impairment (due to dust, paint or other construction practices) and/or requires cutting, welding or soldering the contractor is to include interim measures and provisions with a Hot Work Permit. EXAMPLES of provisions for Fire Detection/Suppression disconnect: Provide portable Fire extinguishers Install temporary construction partitions with fire rated material Coordinating efforts to disable and enable less than 4 hour increments with pertinent KRH staff Awareness and education for KRH personnel in adjacent areas, as well as a FIRE WATCH when necessary 13

15 Construction Plan - General Safety Provisions It is the responsibility of the contractor to ensure the safety of contracted employees, and that all work is performed in a healthy, safe, and environmentally responsible manner. All contractors shall abide by Federal, State, local and KRH policies and all work must meet or exceed CMS, NEC & NFPA Codes. All Construction Plans must address the following General Safety Provisions before commencement of any project. TRAINING: Contractors are responsible for training of their employees on all Kalispell Regional Healthcare codes, policies, and safety protocols. DUST MITIGATION: Describe in detail the plan to reduce dust and dust migration during the construction project. Tasks include sanding, removal of wall coverings baseboards, casework, countertops, new wall construction, duct work or electrical and cabling activities. Depending on the project; examples of dust control include, but are not limited to: sealing doors, sealing vents, water misting work surfaces, HEPA vacuum, walk-off mats, removal or isolation of HVAC system, and/or use of containment cube. SPECIAL PROVISIONS: Describe in detail the provisions in the plans that are unique or specific to this particular project. This could include steps to eliminate strong odors, time of day work to be performed not to disrupt patients, specific days of the week work to be performed for various reasons, and/or relocation of patients, etc. MATERIAL & TOOL STORAGE: Describe in detail the plan to store construction materials and tools during the project. Include how all external exit ways, walks, and drives will be kept free from debris, material, tools and vehicles. NOISE AND VIBRATION: Describe in detail the plan to keep noise and vibration to a minimum. Example: working off-hours and around surgeries, erecting containment walls that will reflect and absorb noise, etc. TRANSPORTING MATERIAL: Describe the strategic plan to transport material to and from the work area with fewer disturbances of patients and staff. Examples: covered carts, through window within the contained worksite, etc. BARRICADES, CONES AND SIGNAGE: Describe how you will locate, route around, and identify dangers for this particular project and any strategies you will use to assist in rerouting foot traffic. CLEAN AND TIDY WORK SPACE: Contractors must always plan to keep corridors and exit doors clear at all times, including proper storage of construction materials and tools. Fire egress cannot be impeded without approved Interim Life Safety measures. In addition to inside, all external exit ways, walks, and drives must be kept free from debris, material, tools and vehicles. RISK ASSESSMENT OF SURROUNDING AREAS: It is important to understand that while there may not be disruption to the immediate construction area, construction could affect surrounding departments or hospital areas. As part of the construction planning, it is important to identify the surrounding areas and identify potential risks. 14

16 Construction Plan - Infection Prevention Assessment and Provisions Construction Projects undergo an analysis to identify and mitigate potential risk for spread of disease-carrying agents during the construction project. For each Construction Plan it is imperative to follow the matrix to determine the Type of Construction - Risk Group and Class of the project. Once the Class has been determined, there are specific guidelines to follow for each Class. For each project, please follow the recommended provisions for each class and implement them. The form identifies the recommended class provisions both before and during the project, as well as, completion of each project. VENTILATION & ENVIRONMENTAL CONTROL - NEGATIVE AIR: It is the responsibility of the contractor as part of their Construction plan to set up a negative air system. This is to prevent any unnecessary exposure to dust, dirt, and/or fumes along with other potential airborne particles. An area will remain negative, which means; more air is removed from the area than is replaced. When used along with methods of containment, negative air assists in controlling contamination and reduces patient, visitor, staff and worker exposure to airborne dust and infectious agents. Typical methods used along with containing of the construction area are: taping unused doors, keeping exhaust fans operating, and checking that exiting door gaskets are sealed and closers work properly. As a contractor, it is important to understand how air flow works in the hospital. Typically, the overall direction of airflow will be from clean areas to dirty areas. There are some rooms that are kept at a positive pressure. These positive pressure rooms include but are not limited to: operating rooms, clean utility rooms, the central supply area, and some patient rooms. On the other hand, typical negative air flow rooms are areas such as utility rooms, mechanical, public restrooms. Mandated by the ICRA, negative air pressure must be maintained in the construction area. Use of a Hepa Filter System, when possible, will help maintain negative air pressure. 15

17 CONTAINMENT OF JOB SITE: It is the responsibility of each contractor to develop a Construction Plan that addresses job site containment. Containments are used to isolate a contaminated area from the adjacent work spaces, ductwork, and the rest of the hospital. A general overview of each class and its requirements are better defined on the Construction Plan and Required Infection Prevention Precautions page. While this gives a generalized summary of each class, each project will pose unique situations that will be analyzed with the Interim Life Safety Evaluation Committee during the assessment phase of the project. When planning for infection control it is important to also recognize the area surrounding the construction project area, and assessing potential impact to these areas as well. The ceiling is a prime area for major dust and debris. Mold and bacteria grow above the ceiling. Infection Prevention Rules: When looking above the ceiling for 5 minutes or less no containment is needed. If looking longer than 5 minutes or if working above the ceiling, (i.e., plumbing, replacing wiring, HVAC, cable pulls etc.) containment MUST be used. If a job, (regardless of type), includes disturbing existing dust, or creating new dust, containment must be used. Doors should be closed and sealed with duct tape to prevent the dust and debris from escaping. If the work area cannot be contained by walls and doors, use a plastic, fire rated barrier and seal all seams with duct tape. Tape up any holes. If working in high risk area (ICRA 3 or 4) a Hepa filter will be needed in the containment area. Reassess your containment area daily to assure dust is not escaping. Entry and exit routes must be limited to those openings that result in the least amount of exposure to patients, staff, and visitors. When possible use dedicated doors, elevators, and stairways. Supply ducts should be blocked off and return air ducts should be covered with pleated air filters. Exhaust fans may be used in conjunction with a Hepa Filter System and must run continuously. CREW DECONTAMINATION: It is the responsibility of each contractor to develop a Construction Plan that assesses the amount of dirt, dust and debris in and around the job site and, if applicable, include prevention of contamination through personnel transport including, but not limited to: *Paper Suits *Shoe Covers *Wipe off bottom of feet *HEPA Vacuum crew clothing when exiting jobsite Use the buddy system to clean dirt and debris from clothing to assure no dust is going out with you from the worksite ( a vacuum equipped a hepa filtration system can be used to remove dust from clothing.) Checklist for performing work in the hospital 1. Know the Infection Control Risk Assessment (ICRA) results. The Check list needs to be completed when working in a patient area or hallway 2. Understand requirements for working in ceilings (including pulling wire) 3. Establish dust and debris control. 4. Maintain ventilation and environmental controls. 5. Develop pedestrian and equipment traffic control. 6. Schedule continuous work site clean up. 16

18 CONSTRUCTION PLAN FORM 17

19 Contractor/s: Date: Address: Detailed Scope of Work: Construction Plan Project Name: Work Order: Please use a separate page to define the scope in its entirety and separate phases. Egress & Emergency Signage/Lighting Proposed Start Date: Duration of project: LIFE SAFETY PROVISIONS Will any egress pathways be altered, obstructed, or will there be restricted access to emergency services? If yes, include provisions below. Will emergency and exit signage be obstructed, or removed? Yes No Will an alternate route be necessary during this project? Alternate route mapped and is attached Yes No Yes No N/A If you answered yes to any of the above questions, identify provisions for the altered/obstructed access or emergency signage: *Provide a map that depicts the alternate routes for patients and/or staff members Compartmental Fire Rating Locations of where smoke/fire walls and doors or assemblies will be compromised and provisions that will be implemented for this project (provide a map and detailed scope. ILSEC will require a point of inspection upon completion of this work to ensure smoke walls are sealed in accordance) (When running pipe, low voltage, data or electrical lines, this Construction Plan will include KRH s approved fire & smoke sealing systems) Fire Suppression/ Detection Does the construction plan require that any of the smoke detection systems be Yes deactivated, covered or removed from service? If yes, attain a RED TAG PERMIT Detailed plan of action to communicate and correspondence regarding enabling and disabling: No Does the construction plan require any fire suppression systems to be taken out of service? If yes, attain a RED TAG PERMIT If yes, where are the locations, and detailed plan of action: Yes No Does the Construction Plan require a fire watch for this project? Yes No What is the detailed plan of action to achieve the fire watch requirement *include any departmental cooperation and necessary to accomplish this plan: Does the construction plan require a supplementary fire prevention device be in place for this project? Yes No Does the project require a Hot Work Permit due to: cutting, welding or soldering during construction? If yes, post permit next to construction site. Yes No ANYTIME a Hot Work Permit is approved, a fire safety plan will be implemented. Examine the area and determine the best fire exit plan, where/if you will store or remove combustible materials. Educate all construction workers, as well as, personnel adjacent to construction area (this plan must be on the HOT WORK PERMIT FORM) 18

20 Major Utility Service Interruptions Identify all utility services that may be interrupted, and have ILSEC determine if a shutdown and action plan is required. Air Conditioning Data Lines Electrical Gas Heat Security Telephone Ventilation H20 N/A Describe the interim measures necessary for the outage including a backup plan: Examples: Portable wash stations, available cell phone, laptops, etc. General Safety Provisions All construction workers/crew have been trained on fire safety and hospital fire safety protocols (if not please review this manual, along with the approved construction plan with your employees): Describe in detail your traffic flow plan for patient/staff/visitors: (exiting/entering, alternate routes; attach a map if necessary): Yes No Describe the measures to control dust migration during tasks, such as: sanding, removal of wall coverings baseboards casework countertops, new wall construction, minor duct work or electrical work above ceilings, and cabling activities. Examples of dust control: sealing doors, sealing vents, water mist work surfaces, HEPA vacuum, wet mop, walk-off mats, removal or isolate HVAC system in areas where work is being performed, and/or use containment cube. Describe the construction plan that identifies anything unique to this project that requires special procedures or protocols: Examples of special precautions: Coordinating specific time of day work to be performed, specific days of the week work to be performed, coordinating with hospital/departmental shift work or office shuffles move or relocation of patients, or environmental compliance rounds. Describe the construction plan to store materials and tools during construction: Describe the construction plan to minimize noise and vibration: Examples: containment walls that reflect and absorb noise, or perform most vibration-intensive work off-shift hours Describe the construction plan for transporting construction materials in to and around the facility: Example: Clean covered carts Describe the construction plan to address traffic hazards (signage, cones, etc.) ILSEC: Identify the areas surrounding the project area, assessing the potential impact: Unit Below: Unit Above: Lateral: Behind: Front: Potential Risk Assessment for other locations and precautions: 19

21 INFECTION PREVENTION RISK ASSESSMENT Table A: Types of Construction Activity Inspection and noninvasive activities. These include, but are not limited to: Removal of ceiling tiles for visual inspections (up to 4 sq. ft) Movement of equipment, building structures, etc. for visual inspection TYPE A Painting (but not sanding) Putting up wall covering, electrical trim work, minor plumbing, and activities which do not generate dust or require cutting of walls or access to ceilings other than for visual inspection Small scale, short duration activities that create minimal dust. These include, but are not limited to: Installation of telecommunications cabling TYPE B Access to chase spaces Cutting of walls or ceiling where dust migration can be controlled. Work that generates a moderate to high level of dust or requires demolition or removal of any fixed building components or assemblies (e.g., countertops, cupboards, sinks). These include, but are not limited to: Sanding of walls for painting or wall covering Removal of floor and wall coverings, baseboards, ceiling tiles and casework. TYPE C New wall construction Minor duct work or electrical work above ceilings Major cabling activities Any activity which cannot be completed within a single work shift Major demolition, construction and renovation projects. These include, but are not limited to: Activities that require consecutive work shifts TYPE D Heavy demolition or removal of a complete cabling system is required New construction Table B: Population and Geographic Risks Groups* Low Risk Medium Risk High Risk Highest Risk Office Areas Non-patient areas Lobby Materials Management Public corridors Clinical Labs Cafeteria Dietary Admissions/Discharge Table C: Construction Activity and Risk Group Matrix CONSTRUCTION ACTIVITY Emergency Room Radiology/CT Scan Labor and Delivery Intensive Care Units Microbiology/Virology Labs Intensive Care Units Newborn Nursery Long Term/Sub acute Units Dialysis Outpatient Surgery Pediatrics Pharmacy Post Anesthesia Care Units Surgical Units All Critical Care areas Comprehensive Cancer Center Peri-operative areas (including PACU, L&D OR) Sterile Processing Cardio-Pulmonary Acute Care Units Cardiac Catheterization & Angiography areas Dialysis areas Oncology Endoscopies areas Radiation Oncology Suite Pharmacy Admixture areas Ambulatory Surgery Center Pediatric/OB Center Operating Rooms including C-Section RISK LEVEL TYPE A TYPE B TYPE C TYPE D Low Risk Class I Class II Class II Class III/IV Medium Risk Class I Class II Class III Class IV High Risk Class II Class III Class III/IV Class IV Highest Risk Class III Class III/IV Class IV Class IV 20

22 CLASS I CLASS II ( Include Class I ) CLASS III ( Include Class II) Construction Plan and Required Infection Prevention Precautions by Class: BEFORE & DURING CONSTRUCTION PROJECT Execute work by methods to minimize raising dust from construction operations. Immediately replace any ceiling tile displaced for visual inspection. Provide active means to prevent air-borne dust from dispersing into atmosphere. Water mist work surfaces to control dust. Seal unused doors with tape. Air vents may require sealing, please consult Plant Operations. Place tack mats at entrance and exit of work area. Remove or isolate HVAC system in areas where work is being performed. Remove or Isolate HVAC system in area where work is being done to prevent contamination of duct system. Construct barriers (sheetrock, plywood, fire rated plastic) to seal construction site area from non-work area or implement Containment Cube method. (Cart with plastic covering and sealed connection to work site and hepa vacuum before construction begins). Explain what material the barrier will be constructed of and where it will be erected. Maintain negative air-pressure within work site utilizing HEPAequipped air filtration units. Contain construction waste before transport in tightly covered containers Place tack mats at entrance and exit of work area. Cover receptacles or carts. Tape covering unless the lid is solid. UPON COMPLETION OF CONSTRUCTION PROJECT Clean work area upon completion of task Wipe work surfaces with cleaner/disinfectant. Contain construction waste before transport in tightly covered containers. Wet mop and/or vacuum with HEPA-filtered vacuum before leaving work each day. On completion of work, restore HVAC system in areas where work was performed. Do not remove barriers from work area until completed project has been thoroughly cleaned by Environmental Services Department and has been inspected. Remove barrier and containment materials carefully (collapsing inward) to minimize spreading of dirt and debris. Wet mop area with cleaner/disinfectant. Vacuum with HEPA filtered vacuum before leaving work each day and final completion. On completion of work, restore HVAC system by communicating with Plant Operations personnel CLASS IV ( Include Class III) Isolate HVAC system in area where work is being done to prevent contamination of duct system. Construct barriers (sheetrock, plywood, fire rated plastic) to seal construction site area from non-work area or implement Containment Cube method. (Cart with plastic covering and sealed connection to work site and hepa vacuum before construction begins). Explain what material the barrier will be constructed of and where it will be erected. Maintain negative air-pressure within work site utilizing HEPAequipped air filtration units. Seal holes, pipes, conduits and punctures with HILTI products. Construct anteroom and require all personnel to pass through this room so clothing can be vacuumed using a HEPA vacuum cleaner before leaving work site OR provide cloth coveralls that are removed each time they leave the worksite. All personnel entering the worksite are required to wear shoe covers. Shoe covers must be changed each time the worker exits the work area. Place tack mats at entrance and exit of work area. Do not remove barriers from work area until completed project has been thoroughly cleaned by Environmental Services department and has been inspected by owner s safety team. Remove barrier and containment materials carefully (collapsing inward) to minimize spreading of dirt and debris. Contain construction waste before transport in tightly covered containers Cover receptacles or carts. Tape covering unless the lid is solid. (through-out the project) Vacuum work area with HEPA-filtered vacuums. Wet mop area with cleaner or disinfectant. On completion of work, restore HVAC system in areas where work was performed. 21