University Health Network Infection Prevention and Control Requirements during Construction, Renovation and Building Maintenance

Transcription

1 University Health Network Infection Prevention and Control Requirements during Construction, Renovation and Building Maintenance Introduction University Health Network follows the Canadian Standard Association standard Z Infection Control during Construction, Renovation and Maintenance of Health Care Facilities. This document provides recommendations that establish preventive measures associated with various levels of construction/renovation/maintenance activities and patient risk categories and must be reviewed prior to commencing a project within a health care facility. It is required that all contractors and maintenance supervisors be certified in CSA Z Infection Control during Construction, Renovation and Maintenance of Health Care Facilities and that this standard is adhered to during any/all activities conducted within the sites of the University Health Network. In addition to CSA Z317.13, the following standards shall be adhered to during any/all activities conducted while working within sites of University Health Network. 1. Canadian Standards Association (CSA) Z Canadian Health Care Facilities, Canadian Standards Association (CSA) Z317.2 Special requirements for heating, ventilation and air-conditioning (HVAC) in health care facilities, Canadian Standards Association (CSA) Z317.1 Special requirements for plumbing installations in health care facilities, The goal of this document is to outline the requirements for the prevention of nosocomial infections associated with construction, renovation and building maintenance. The primary objectives are: 1. To control the level of dust generated to a minimum. 2. To protect patients from being exposed to potential disease-causing microorganisms. The following guideline provides an overview and offers a tool to assess risk. It does not replace the expectation that contractors are knowledgeable regarding the CSA Z standard.

2 Pre-Construction Phase 1. Construction Management, Infrastructure and Facilities Management are to ensure that contractors and its subcontractors are aware of the existence of this document and its contents. 2. Infection Prevention and Control (IPAC) must be involved in the pre-construction design phase. 3. The manager of the proposed construction project must inform all parties before the design stage of the exact location, the type of construction activity, and the start and end dates of the construction work (where possible). 4. Infection Prevention and Control should be notified, where appropriate, by construction project managers of meetings held by contractors, in order to discuss new and existing problems resulting from the project that may be pertinent to their respective areas, as the project progresses. Risk Assessment Prior to each project, project managers must conduct a risk assessment of the activity to be performed along with the details of the project to determine the Preventive Measures Classification and the appropriate measures to follow (see Appendix A-E). Infection Prevention and Control should be contacted to assist in determining a strategy. Construction Phase Traffic Control Patterns 1. Design a traffic pattern for construction workers and construction activities to minimize disruption to patient care areas. 2. Where possible, dedicated elevators should be made available for workers working in dust-generating activities. Otherwise, elevators should be serviced for construction work, and cleaned and disinfected following usage. 3. Patient traffic should be redirected away from construction work sites. Dust Containment Barriers 1. Plastic sheeting, plywood, drywall or other similar alternatives must be used to create a separation barrier between the construction project site and nonconstruction areas. The specific dust containment barrier required will depend on the Preventive Measures Classification. This barrier must be constructed and implemented before construction takes place. Infection Prevention and Control must approve and inspect all hoarding prior to work commencing. Plastic 6-mil poly is to be used only for short-term projects (less than 24 hours).

3 It must be non-punctured, impermeable and continuous in length. It must be sealed from ceiling to floor to walls. 2. Rigid materials (i.e., drywall) in addition to 2 layers of 6 mil poly for dust containment may be necessary depending on the Preventive Measures Classification (i.e. Preventive Measures Level III/IV) or for long-term construction project work (more than 24 hours). Drywall hoarding must: Be composed of an impermeable dust barrier erected from floor to the true ceiling, consisting of two layers of 6 mil poly and fire-rated Type X 5/8 gypsum wallboard protective layer. Be sealed at the seams with tape and at the metal studs where they meet the floor. Extend above the false ceiling to the true ceiling if false ceiling tiles are being removed in the construction site. Air from the construction site must not be able to travel into the spaces between drop-ceilings into nearby occupied areas. 3. All seams/penetrations to work area must be sealed (doors, plumbing, intake/exhaust vents, electrical outlets, screw heads, etc.), including those above false ceilings. 4. A dust mat/tack mat must be used within the construction site to prevent dust from being carried outside the construction site, an adhesive mat is recommended for the clean side of the construction access door. 5. The bottom of the door should have rubber stripping (weather-stripping, doorsweep), in order to create a seal from door to floor and the doors should have closers. 6. If an anteroom is required (i.e. Preventive Measures Level III and IV projects), the anteroom must: Be large enough to enable materials to be moved through without having to open both doors at the same time Barrier extends above false ceiling (either entrance or exit wall of the anteroom should be extended to the underside of the deck and any openings sealed) Entry doors have gasketed frames and closers Negative pressure: 2.5 Pa in anteroom relative to hospital zone Walk-off tack mats at entry to anteroom door and inside anteroom

4 7. A HEPA-vacuum should be available for workers to vacuum the dust from their clothing and footwear when traveling in or near areas where there are susceptible patients. Air Quality 1. Dust must not be entrained into the general ventilation system. 2. Negative pressure should be created inside the project site relative to the adjacent rooms and the hallways. The specific requirements for negative pressure will depend on the Preventive Measures Classification (see Appendices). A pressure monitoring device is required to monitor the relative pressurization. A daily log must be kept by the contractor. 3. Seal all supply and return/exhaust grills to prevent air from contaminating the ductwork and circulating throughout the hospital. Accessing Ceiling Space 1. See UHN Accessing Ceiling Tiles policy on A dust enclosure/barrier must be erected before conducting work above false ceiling. 3. All patient-related room doors located near to ceiling work must be closed. 4. All Hospital supplies and patient care equipment located near ceiling work must be removed or covered with an impervious material. 5. Ensure patients are not in the room where ceiling work is being performed. 6. False ceiling tiles must not be removed in areas not undergoing construction, information systems activities or building maintenance. If tiles must be removed, they must be replaced when work is not occurring or completed. Cleaning 1. A HEPA-equipped vacuum cleaner and wet mop and bucket for environmental cleaning must be available on site. Vacuuming and wet mopping are to be done as needed. 2. The contractor should have a person dedicated for ongoing clean-up of the area and area/hallways immediately outside of the site. 3. Once the construction is complete, and before barriers are removed, the site must be thoroughly cleaned by the contractors. The walls and all horizontal surfaces must be wet-wiped, and the floors must be wet-mopped.

5 4. Before occupancy by end users, the project manager and/or the end users must arrange for Environmental Services to clean the site thoroughly. IPAC must inspect the space prior to patient occupancy. Debris Removal 1. Any debris must be removed using a different traffic route than that used by the Hospital staff and patients, in order to minimize disruption and exposure of dust to patient care areas. 2. The removal should be during low traffic volume work hours, but preferably after Hospital hours. 3. The debris should be placed in sealed garbage bags and/or covered with a tightly sealed tarp during transportation. 4. Waste containers must be wiped down prior to leaving the construction site. 5. The debris should be removed in dedicated elevators, to which patients and UHN staff do not routinely have access. Post Construction Phase 1. IPAC must be notified prior to removal of construction barriers. 2. The contractor must thoroughly clean the construction area before and after barriers are removed. 3. Before occupancy by end users, the project manager and/or the end users must arrange for Environmental Services to clean the site thoroughly. 4. IPAC must inspect the space prior to patient occupancy. 5. If the water supply is disrupted for an extended period, the project manager should ensure that the water supply is flushed out for a minimum of 10 minutes. Depending on the situation, water lines may require disinfection. Contact Infection Prevention and Control for recommendations.

6 Appendix A Population Risk Group Population risk group Group 1 Lowest risk Group 2 Medium risk Group 3 Medium to high risk Group 4 Highest risk Typical areas Office areas Unoccupied wards Public areas Laundry and soiled linen sorting/storage Physical plant workshops Housekeeping rooms/closets Patient care areas unless listed in Groups 3 or 4 Outpatient clinics (except oncology and surgery) Admission and discharge units Waiting rooms Autopsy and morgue Occupational/physical therapy remote from patient care areas Emergency (except trauma) Diagnostic imaging Nuclear medicine Hydrotherapy Laboratories General medicine and surgical units Geriatric units Long-term care units Food preparation, serving and dining areas Respiratory therapy Clean linen handling and storage areas Intensive care units (ICU, CVICU, NCCU) Operating rooms (including prep, induction, post-anaesthetic care and scrub areas) Anaesthesia storage area and workrooms Oncology units and outpatient clinics Transplant units and outpatient clinics Dialysis units Cardiac catheterization and angiography Interventional radiology Cardiovascular and cardiology patient areas Endoscopy Bronchosopy Cystoscopy Pharmacy admixture rooms Medical device reprocessing Central sterile supply Clean and sterile storage Trauma rooms Dental procedure rooms Protective isolation rooms

7 Appendix B Construction Activity Type Construction activity type Type A Type B Type C Type D Description Inspection and non-invasive activities. These include, but are not limited to, a) activities that involve a single controlled opening in a wall or ceiling for minor work or visual inspection, that is accessed by i) removing no more than one ceiling tile; or ii) opening of an access panel on a wall or ceiling; b) painting (but not sanding) and wall covering; c) electrical trim work; d) minor plumbing work that disrupts the water supply to a localized patient care area (i.e., one room) for less than 15 min; and Small-scale, short-duration (e.g., less than 2 h) activities that create minimal dust. These include, but are not limited to, a) activities involving access to and use of chase spaces; b) cutting a small opening in a contained space where dust migration can be controlled, e.g., cutting of walls or ceilings to provide an access point for installing or repairing minor electrical work, ventilation components, telephone wires, or computer cables; c) sanding or repair of a small area of a wall; and d) plumbing work that disrupts the water supply of one or more patient care areas for less than 30 min. Activities that generate a moderate to high level of dust, cause a moderate service disruption, require demolition, require removal of a fixed facility component (e.g., a sink) or assembly (e.g., a countertop or cupboard), or cannot be completed in a single work shift. These include, but are not limited to, a) activities that require sanding of a wall in preparation for painting or wall covering; b) removal of floor coverings, ceiling tiles, and casework; c) new wall construction; d) minor ductwork; e) electrical work above ceilings; f) major cabling activities; and g) plumbing work that disrupts the water supply of one or more patient care areas for more than 30 min, but less than 1 h. Activities that generate high levels of dust, activities that necessitate significant service disruptions, and major demolition and construction activities requiring consecutive work shifts to complete. These include, but are not limited to, a) soil excavation; b) new construction that requires consecutive work shifts to complete; c) activities that involve heavy demolition or removal of a complete cabling system; or d) plumbing work that disrupts the water supply of more than one patient care area (i.e., two or more rooms) for 1 h or more.

8 Appendix C Risk Assessment Matrix Preventive Measures Analysis Patient Risk Group Construction Type A Construction Type B Construction Type C Group 1 I II II III/IV* Group 2 I II III IV Group 3 I III III/IV* IV Group 4 I-III* III/IV* III/IV* IV *Where a range of levels is indicated, the Infection Control Practitioner shall be consulted to determine the most appropriate preventive measure level. Construction Type D

9 Appendix D Preventive Measures Analysis Form Project Name: Project Start: Project Completion: Project Manager: Contractor: Project Location: Multidisciplinary Team: Preventive Measures analysis A preventive measures analysis of the construction or renovation project described below has been undertaken in accordance with this Standard and incorporated into the project design development contract which includes drawings and specifications. Description of construction or renovation project (including activities involved): Preventive measure analysis: Population risk group of construction area (1, 2, 3, or 4): Area above construction space: Area below construction space: Area laterally adjacent to construction space: Others areas potentially impacted (ie/ connected by ducts, conduits, etc.) Construction activity type (A, B, C, or D): Preventive measure (I, II, III, or IV): Additional requirements: (include additional information/drawings as necessary) Multidisciplinary Team Signature: Project Manager Signature: Contractor Signature: Infection Control Practitioner Signature: Date: Date: Date: Date:

10 Appendix E: Preventive Measures Checklist Note: The list below is a suggested checklist for the implementation of preventative measures for the project. It should not be taken as comprehensive, as project-specific considerations could necessitate the addition or revision of specific items Element Compliance Notes Yes No N/A 1.0 Level I Measures 1.1 Identify high risk patients that should be temporarily moved away from work area 1.2 Remove/protect patient care equipment and supplies 1.3 Work performed during periods of low user activity 1.4 New materials kept clean and dry 1.5 Use methods that minimize the generation and dispersion of dust (i.e. HEPA vacuums or drills) 1.6 Identify water and/or ventilation systems that could be impacted. 1.7 Work area is HEPA vacuumed and/or wet mopped as necessary throughout project and upon completion 1.8 Plumbing is in accordance with CSA Z Level II Measures All Level I measures shall be implemented in addition to the following: 2.1 Use methods that minimize dispersion of dust (i.e. HEPA vacuums or air handling units, poly barriers, drop sheets) 2.2 Doors and openings sealed with tape or poly 2.3 HVAC system supply and return/exhaust air ducts sealed or isolated 2.5 Walk off/tack mats at entrance/exit to site and changed as needed 2.6 Safe route for transportation of clean/sterile supplies 2.7 Traffic pattern for construction workers to avoid patient care areas 2.8 Proper debris removal procedures are defined (i.e. after hours removal, covered carts, carts wiped down before leaving site) 2.10 Water lines in construction area are flushed for 10 min before patient occupancy 2.11 Terminal clean by housekeeping prior to patient occupancy 3.0 Level III and IV Measures All Level I and II measures shall be implemented in addition to the following: Before Project Begins 3.1 Multidisciplinary Team (MDT) meetings set up and identification of essential services that could be disrupted 3.2 Discussion with staff in the work area for awareness and education of infection risks and work activities

11 3.3 ICRA form completed and signed by PM and ICP 3.4 Any changes to project scope are reviewed with ICP/MDT 3.5 Water disruptions: Temperature standards established (CSA Z317.1) Alternate potable water source, if needed Cleaning water systems affected by major plumbing activities (i.e. flushing, superheating, hyperchlorination, etc.) Scheduled during low user activity 3.7 Impermeable dust barrier erected from floor to the true ceiling, consisting of two layers of 6 mil poly and gypsum wallboard protective layer 3.8 Anteroom (when required) Large enough to enable materials to be moved through without having to open both doors at the same time Barrier extends above false ceiling (either entrance or exit wall of the anteroom should be extended to the underside of the deck and any openings sealed) Entry doors have gasketed frames and closers Negative pressure: 2.5 Pa in anteroom relative to hospital zone Walk off tack mats at entry to anteroom door and inside anteroom 3.9 All seams/penetrations to work area are sealed (doors, plumbing, intake/exhaust vents, electrical outlets, screw heads, etc.), including those above false ceilings 3.10 Negative air pressure 7.5 Pa (0.03 in wc) Pressure gauge in place and data logged. Device alarmed when deemed necessary by MDT Construction air handling unit(s) (CAHUs) Confirm number of units required for size of space HEPA filtration DOP tested on site prior to start of project or within last 12 months (min.), with documentation Filters changed as needed Air is exhausted to the outside unless permitted by the multi disciplinary team 3.12 Designate a service elevator for use if possible. During Project 3.13 Dust barrier integrity is inspected frequently and

12 breaches are immediately repaired 3.14 Dust suppression within work area (water misting work surfaces, HEPA filtered vacuums, walk off sticky mats, etc.) 3.15 HEPA vacuum mechanical and electrical systems, and interior cavities before installation of hard or T bar ceiling or closing walls 3.17 Construction workers to HEPA vacuum clothes or wear a containment suit prior to leaving construction area and entering patient care areas 3.18 HVAC: ductwork protected from dust and moisture (ductwork must be stored in a clean area and ends sealed until installation) 3.19 Plumbing: Dead leg water pipes removed at the connection to the main line 3.20 Excavation: Ensure building windows/doors kept closed Intake filters changed more frequently Continuously water down soil to minimize dust migration 3.21 Requirement for air sampling discussed with MDT prior to work commencing. Baseline sampling, sampling procedures and plan for when results are not within range of baseline established Routine site visits by members of the MDT throughout the project End of Project 3.23 If water lines are shut down or accessed during construction, they are flushed before reusing (minimum of 10 minutes). Consideration should be given to disinfecting water systems affected by major plumbing activities (i.e. superheating, hyperchlorination, etc.) 3.24 Work area is thoroughly cleaned and barriers are cleaned before dismantling 3.25 Air filters changed/cleaned as necessary in work areas; and ventilation systems are functioning properly and are cleaned if contaminated during work activities 3.26 Dust barriers/anterooms removed carefully to minimize dust migration 3.27 Final visual inspection of the of the work area and terminal clean before patients are readmitted to the area 3.28 Review project and effectiveness of preventative measures

13 References 1) CSA Infection Control during Construction, Renovation and Maintenance of Healthcare Facilities. Canadian Standard Association (CSA). December ) CSA Z8000 Canadian Health Care Facilities. Canadian Standard Association (CSA). September ) CSA Z317.2 Special requirements for heating, ventilation and air-conditioning (HVAC) in health care facilities. Canadian Standard Association (CSA). February ) CSA Z317.1 Special requirements for plumbing installations in health care facilities. Canadian Standards Association (CSA). August 2009.