Construction in Healthcare facilities- What you need to know

Transcription

1 Construction in Healthcare facilities- What you need to know

2 Objectives 1. Describe the important role Infection Prevention plays in construction/renovation in healthcare facilities 2. Examine the components of an ICRA 3. Describe the risk to patients, families and healthcare workers if Infection prevention measures are not followed during construction/renovation 4. Identify safety hazards Infection Prevention Staff need to be aware of during construction/renovation

3 Why construction/renovation? Old/ outdated buildings Updated building codes for safer patient environments Growing populations Mold/asbestes Natural disasters

4 What can construction/renovation consist of? Minor construction/ renovation Ceiling tile replacement (temporary) Painting (not sanding) Minor electrical/plumbing that does not generate dust Major construction/renovation Sanding of walls for painting/wall covering New wall construction Major cabling Any new construction

5 BUT we all know things change Mold was found Cables are not where they were supposed to be Flooring was more difficult to get up No sanding was expected during painting but the wall was found to be uneven Construction worker accidently punched a hole in a wall with new equipment Sprinkler system accidently activated

6 How should IP be involved? Construction/renovation planning Is the project necessary/feasable? How will workflow be affected? Appropriate number of negative/positive air pressure rooms? Adequate size room for the intended use? Appropriate number and locations of sinks and hand hygiene products? Sinks deep enough? Location of clean supply and soiled utility rooms? Fixtures/wall coverings/flooring cleanable? Any other regulatory issues? Is staging of the project required? Any infection Prevention related needs are put included into the cost of the project (dust barriers, HEPA machines etc. ) Patient placement

7 Let s look at some plans!

8 Plans cont.

9 Let s look at a legend

10 Patient Care areas Patient supplies and equipment are removed prior to construction starting Pillows, linen, bedding Supply carts Cover/keep closed what can t be removed Tape cabinets if needed

11 After the planning stage- construction begins Starts with demo Typically the dirtiest part of construction IP should be highly visible during this phase Rounding AT LEAST weekly Attendance at project progress meetings with contractors IP or other designated personnel should have the authority to stop construction projects if Infection Prevention measures are not being followed!

12 Communication! Set expectations early in the project Know who to talk to and be specific if issues arise Remember, construction crew are teammates and NOT enemies Construction workers may not know all hospital regulations/rules- reminders are okay Verify and reverify issues has been resolved

13 What are we looking for? Appropriate negative air pressure within the construction zone Plastic barriers pulling in HEPA machines Consider use of manometer to monitor negative air Intact barriers No holes Floor to ceiling, taped if needed Zipped at all times Clean construction zones Responsibility of all workers Encourage staff to report lapses Tacky mats MUST be sticky Changed frequently Can do wet/dry mats along with tacky mats in high dust construction areas

14 What are we looking for? Mold Typically found near windows, floors & ceilings Mold remediation plan Containment and transport of construction materials and debris Anything leaving the construction zone needs to be in a covered cart/bin Covers should be clean Carts should be wiped off prior to leaving construction area Isolation of HVAC systems to ensure correct air flow Cover or close off any return air systems in the construction zone

15 Barrier Examples Open barrier Improper air handling Hanging barrier

16 Great negative air! Barrier Examples

17 Negative Air Pressure Negative air pressure Bathroom fans Vent to Ceiling OR outside barrier HIGH Exhaust fan vent to outside HEPA machine Change filters Keep door/barriers closed

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19 Examples Too dirty! Cleaner Dusty!

20 Tacky mats

21 Mold

22 Transportation of construction debris

23 Other IP considerations

24 Other IP considerations

25 ICRA Infection Control Risk assessment Multidisciplinary team to include IP, Safety, risk management, Facilities, Construction team leaders, and clinic/unit management, any other pertinent persons Team evaluates risk factors and potential hazards Project risk is determined by scope of the project AND types of patients that may be affected ICRA should be considered for ALL construction/renovation Scope changes- ICRA changes

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27 Patient Risk groups

28 Then match patient risk group with the project type

29 Class 1 Includes Type A construction- Low, Medium and High risk patient areas During construction: Minimize dust Replace ceiling tiles after visual inspection Upon completion of construction: Clean work area upon completion of task

30 Class 2 Includes construction Type A construction- high and highest risk patient areas, Type B construction- low, medium and High risk patient areas AND Type C construction- low risk patient areas During construction: Prevent airborne dust from dispersing into atmosphere Water mist work surfaces to control dust while cutting Seal unused doors Block off and seal air vents Use tacky mats at exit of site Remove/isolate HVAC system in construction zone Upon completion of construction: Wipe work surfaces with cleaner/disinfectant Transport construction debris in covered container/cart Wet mop and/or vacuum with HEPA Restore HVAC

31 Class 3 Includes Type B construction- highest risk patient areas, Type C construction- Medium, High and Highest risk patient areas AND Type C construction- low risk patient areas During construction: Remove/isolate HVAC in construction zone Hard/soft barriers prior to construction beginning Maintain negative air within construction area with HEPA equipment Contain construction dust/debris in tightly covered carts/containers Transportation cover should be taped unless solid lid Upon completion of project: Do NOT remove barriers from work area until completed project inspected by IP and or safety AND cleaned by environmental services Barriers removed carefully to minimize aerosolization of dust/debris particles Wet mop area with cleaner/disinfectant HVAC system turned back on when all above is complete

32 Class 4 Includes Type C construction- High and highest risk patient areas AND Type D construction- Low, Medium, High and Highest risk patient areas During construction: Remove/isolate HVAC system Hard/soft barriers Maintain negative air pressure Seal holes, pipes, conduits and punctures Anteroom required where all personnel to use HEPA vacuum cleaner before leaving work site OR cloth or paper coveralls are removed each time they leave the work site Shoe covers, changed each time the worker leaves the area Upon completion of project Do NOT remove barriers until IP and/or Safety has done final inspection AND environmental services cleans the area Barriers are removed carefully to minimize aerosolization of dust/debris Construction waste is contained prior to transport Cover transport receptacles/carts tape covers unless solid lid Vacuum work area with HEPA filtered vacuums Wet mop area with cleaner/disinfectant Turn HVAC back on only with the above has been completed

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36 Tidbit of info Estimated 99,000 deaths due to construction-related infections occur each year in healthcare settings.

37 What are the risks? Fungal infections Demolition dust Patient populations adjacent to construction (NICU, ICU, OR) Construction waste transport Dirty construction workers Waterborne pathogens Legionella Pseudomonas Stenotrophomonas Flooding Where? Moisture Patients below flood?

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40 WHAT??? Fungus, mold and bacteria can be released when: Walls being demolished Plumbing is accessed Ceiling tiles are removed Carpet is pulled up ANY OTHER construction demolition

41 Why are we concerned? It s just mold right Some molds have spores that are easily disturbed and waft into the air Other molds have sticky spores that will cling to surfaces and are dislodged by brushing against them or by other direct contact Spores may be able to grow for years in the right conditions Issues cause by exposure to mold includes: Allergic reactions by inhaling or touching mold or mold spores Asthma symptoms Lung infections Issues can be immediate or delayed based upon the amount and duration of exposure and individual factors such as immunosuppression

42 What are we MOST worried about? Aspergillus and other fungi/molds Naturally present in indoor and outdoor air Found in soil, dust debris etc. Spread by aerosols of spores Can remain viable in dry locations Legionella Mild flu-like illness typically but can lead to more severe cases Can lead to heart, kidney and GI involvement 14% mortality rate in health-care associated legionnaires disease

43 Let s talk about how big these particles are

44 Preventing construction related infections COMMUNICATION! ALL construction workers follow hospital construction requirements Know who to contact if same construction staff not compliant Staff stay out of construction zones High risk patients may need to be relocated If not able to be relocated, consider masking patients in hallways

45 Contamination of Water supply Soil entering the water supply system during construction Infection Prevention is notified of ALL water shutdowns Need to flush systems after maintenance/tie-ins etc Turing water back on after a shut-down Flushing protocols Hard stop points in pipes

46 Outbreaks Toronto Hospital- 8 cases of invasive fungal sinusitis, 5 deaths Found related to increase spore counts from soil excavation during hospital construction Operating room- 5 patients with severe postoperative Aspergillus endophathalmitis Found to be related to aqueous or vitreous tap while construction was happening at the facility All 5 pateints needed evisceration (removal of eye contents) or enucleation (removal of eye) even with high doses of antifungals

47 Outbreaks 900 bed tertiary care hospital 4 cases of surgical and burn wound aspergillosis Traced back to construction dust on packages of dressings/supplies in central supplies Radiology 6 immunosuppressed housed in different areas of the hospital Developed aspergillus infections Found to be related to exposure in central radiology suite that was under construction 4 cases of surgical and burn wound aspergillosis Traced back to construction dust on packages of dressings/supplies in central supplies

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49 How to drive Tracey & Sherrie CRAZY Project started and Infection Prevention and/or safety had no idea Zip walls unzipped Incompletely taped or hanging plastic barriers Required negative air is not functioning or is not turned on Untacky tacky mats Foot prints/cart tracks down the hallway Ceiling tiles out and no one is around Blocked exits No fire extinguishers in area Contractors with no identification badges

50 Other Infection Control for Construction workers Circulation and traffic control procedures Contractors should not work at any healthcare facility when sick Fever, chills, cough Good personal hygiene Wear clean clothing Work only when healthy Recommend keeping immunizations up to date

51 I told you last week they were starting today."

52 Objective #4 - Safety Hazards in Construction 1. WORKING AT HEIGHTS FALL PROTECTION/FALL ARREST SYSTEM 2. MOVING OBJECTS 3. SLIPS, TRIPS AND FALLS 4. MUSCULOSKELETAL

53 Objective #4 - Safety Hazards in Construction 5. ELECTRICAL 6. FIRE RISK 7. HAZARDOUS MATERIALS 8. CONFINED SPACE 9. UNSAFE ACTS VIDEO:

54 After Watching the Video QUESTION: 1. AFTER WATCHING THE VIDEO, HOW MANY OF THOSE INCIDENTS APPLY TO THE LISTING I JUST TALKED ABOUT? ANSWER: ALL BUT 1 OF THEM, - CONFINED SPACE QUESTION: 2. OF THOSE, WHICH ONES DO YOU THINK APPLY TO SAFETY IN HEALTHCARE? ANSWER: ALL OF THEM

55 Objective #4 Safety Hazards 1. WORKING AT HEIGHTS A. FALL PROTECTION GUARD RAILS SAFETY NETS B. FALL ARREST SYSTEM HARNESS LANYARD ANCHOR POINT

56 Objective #4 Safety Hazards 2. MOVING OBJECTS LOTO 3. SLIPS, TRIPS AND FALLS 4. NOISE (HEARING CONSERVATION), VIBRATION (MUSCULOSKELETAL) 5. ELECTRICAL GROUNDING PIN FRAYED EXTENSION CORD FIRE SAFETY

57 Objective #4 Safety Hazards 6. FIRE SAFETY HOTWORK BARRIERS, VENTILATION, PERMIT SPRINKLER SYSTEM FIRE EXTINGUISHER ACCESS TO EXITS STORAGE OF COMPRESSED GAS 7. HAZARDOUS MATERIALS ASBESTOS, SILICA, CHEMICALS

58 Objective #4 Safety Hazards CONFINED SPACE VERY SPECIFIC TO ENSURE SAFETY HAZARDS GAS MONITOR LACK OF OXYGEN FLAMMABLE, COMBUSTIBILITY TOXIC AIR CONTAMINATES PPE, FALL PROTECTION RESCUE POLICIES AND PROCEDURES PERMIT REQUIRED

59 How do we reduce the risk of illness or injury during the construction phase? SAFETY HIERARCHY OF CONTROLS IS USED (6) 1. ELIMINATE THE HAZARD 2. REDUCE THE IMPACT 3. ENGINEERING CONTROLS 4. WARNINGS/ALARMS 5. ADMINISTRATIVE CONTROLS 6. PPE (PROTECTED PERSONAL EQUIPMENT)

60 Fire Safety - Smoking SMOKING SMOKING IS PROHIBITED ON ANY AVERA PROPERTY ALL AVERA PROPERTY IS CONSIDERED TOBACCO FREE

61 Cutting/Welding/Soldering Open Flame or Sparks POLICY FIRE EXTINGUISHER MONTHLY CHCKS WITHIN 5 OF WORK HOT WORK PERMIT FLYING EMBERS REMOVE COMBUSTIBLE MATERIALS

62 Cutting/Welding/Soldering Open Flame or Sparks FLAMMABLE LIQUIDS, DUST, LINT AND OILY DEPOSITS STORED APPROPRIATELY EXPLOSIVE ATMOSPHERE IN AREA ELIMINATED FLOORS SWEPT CLEAN ALL WALL AND FLOOR OPENINGS ARE COVERED OR FIRE CAULKED

63 Cutting/Welding/Soldering Open Flame or Sparks COMBUSTIBLE FLOORS ARE WET DOWN AND COVERED WITH DAMP SAND OR FIRE RESTIVE SHEETS COMBUSTIBLES HAVE BEEN REMOVED OR COVERED WITH FIRE RESISTANT TARPAULINGS OR NONCOMBUSTIBLE SHIELDS FIRE-RESISTIVE TARPAULINS SUSPENDED BENEATH WORK FLOORS SWEPT CLEAN

64 Penetrations Smoke/Fire Walls POLICY ANY PENETRATIONS THROUGH SMOKE AN FIRE WALLS MUST BE FILLED WITH APPROVED, FIRE- RATED MATERIAL (UL) FIRE CAULK MUST BE OF THE SAME COLOR FIRE AND SMOKE WALLS LABELED 1,2 HOUR FIRE WALL 1 HOUR SMOKE WALL

65 Construction Areas Fire Detection Devices (smoke, heat, sprinklers) POLICY DEVICES MUST BE PROTECTED FROM DUST AND DEBRIS SPRINKLER PIPING (LAYING ATOP OR FROM) DEVICES RETURNED TO SERVICE VERIFIED BY FACILITY MANAGER FIRE WATCH FIRE EXTINGUISHER PRESENT

66 Construction Areas Fire Detection Devices (smoke, heat, sprinklers) FIRE EMERGENCIES RACE PASS PLAIN LANGUAGE OVERHEAD PAGING OVERHEAD PAGING GIVE EXACT LOCATION (ROOM #)

67 Noise QUIET TIME HEALTH AND WELL- BEING OF OUR PATIENTS, WE MUST MAINTAIN A QUIET AND RELAXED ATMOSPHERE RADIOS, TAPE, CD OR DVD (LOW VOLUME) ABUSIVE SUGGESTIONS AND PROFANE LANGUAGE ACTIONS SHALL NOT BE PERMITTED OR TOLERATED

68 Safety Data Sheet (SDS) IMPORTANT INFORMATION ON THE CHEMICAL OR HAZARD MUST BE ACCESSIBLE UEL, LEL FIRST AID DISPOSAL FIRE FIGHTING MEASURES PPE STORAGE OF AND USE FLAMMABLE LIQUIDS AND GASES IN ACCORDANCE WITH ALL APPLICABLE CODES AND REGULATIONS.

69 Questions? Thank you for keeping our patients safe!!