To establish criteria for construction, renovation and maintenance regarding infection prevention and control measures.

Transcription

1 TITLE/DESCRIPTION: Construction, Renovation and Maintenance, Infection Prevention and Control Measures DEPARTMENT: All Departments PERSONNEL: All Personnel EFFECTIVE DATE: 2/08, REVISED: 2/09, 2/10, 6/11, 5/12 I. PURPOSE To establish criteria for construction, renovation and maintenance regarding infection prevention and control measures. II. POLICY It is the policy of Springhill Medical Center (SMC) to provide the safest possible environment for patients, associates, physicians, and visitors during the performance of programming, planning, design, construction, and maintenance. SMC will utilize the Infection Prevention and Control Risk Assessment methodology. DEFINITIONS 1. Infection Prevention and Control Risk Assessment (ICRA) - tool to assess the level of Infection Prevention and Control risk in an activity. The ICRA shall address, but not be limited to: Disruptions of essential services to patients, associates and physicians. Patient placement or relocation. Placement of effective barriers to protect susceptible patients, visitors and staff from airborne contamininants. Air handling and ventilation needs in critical areas such as surgery and isolation room, laboratories, and special exhaust systems. Determination of the required numbers of airborne infection isolation or protective environment rooms. Protection of the domestic water system to limit waterborne pathogens like Legionella. Protection of patients from construction project hazards such as planned or unplanned power outages, demolition and movement of debris, managing changes in ventilation and water systems, cleanup, certification, etc. SMC is responsible for providing the ICRA. The design professional is responsible for incorporating the specific construction-related requirements of the ICRA in the contract documents, which shall require the contractor to implement these specific requirements during construction. The contractor is responsible for implementing those specific requirements during construction. 2. Utility Disruption - an interruption of water, electric, gas (medical and natural), and vertical transportation (elevators).

2 III. PROCEDURE 1. Infection Prevention and Control, Engineering / Facilities Management, construction, ventilation, and safety will conduct and document an ICRA during the programming phase of every project and update it as the project proceeds through planning, design, and construction. 2. Key elements to be addressed during programming include, but are not limited to: handwashing facilities, ventilation, water systems, ante-rooms, traffic patterns, storage facilities and containment precautions. 3. To determine the level of Infection Prevention and Control activities required, perform the following 3 steps. Step 1: Using the following, identify the Construction Activity Type (A-D) TYPE A Inspection and Non-Invasive Activities Includes, but is not limited to: Removal of ceiling tiles for visual one minute inspection limited to 2 tiles per 50 square feet without the required use of a containment tent. Painting (but not sanding). 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. TYPE B Small scale, short duration activities that create minimal dust Includes, but is not limited to: Installation of telephone and computer cabling (may include above the ceiling tile activity). Access to chase spaces. Cutting of walls or ceiling where dust migration can be controlled. TYPE C Work that generates a moderate to high level of dust or requires demolition or removal of any fixed building components or assemblies Sanding of wall for painting or wall covering. Removal of floor coverings, ceiling tiles and casework. New wall construction. Minor ductwork or electrical work above ceilings. Major cabling activities. Any activity which cannot be completed within a single work shift must be considered for dry wall barrier. TYPE D Major demolition and construction projects Includes, but is not limited to:

3 Activities which require consecutive work shifts Activities which require heavy demolition or removal of a complete ceiling system New construction Step 2: Using the following table, identify the Patient Risk Group that will be affected. If more than one risk group will be affected, select the higher risk group: GROUP 1 LOWEST 1. Office areas 2. Administration 3. Public areas GROUP 2 MEDIUM 1. All patient care areas Not mentioned in groups 3 or 4 (example: Cardiac Rehabilitation, Neurophysiology) 2. Admission 3. Outpatient areas GROUP 3 MEDIUM HIGH 1. Emergency Department 2. Radiology/MRI 3. Post-Anesthesia Care Unit 4. Labor and Delivery 5. Nursery 6. Pediatrics 7. Nuclear Medicine 8. PT 9. Kitchen 10. Echocardiography 11. Laboratories 12. Respiratory Therapy 13. Selected medical / surgical units GROUP 4 HIGHEST 1. Operating Rooms; Central Sterile 2. Labor and Delivery Operating Rooms 3. Intensive Care Units 4. Cardiovascular Recovery 5. Cardiac Catheterization 6. Outpatient chemotherapy areas 7. Oncology 8. GI Lab 9. Pharmacy Admixture 10. Special Procedures Step 3: Match the Patient Risk Group (1, 2, 3, 4) with the planned Construction Activity Type (A, B, C, D) on the following Infection Prevention and Control Matrix to determine the Class of Infection Prevention and Control Procedures (I, II, III, IV). CONSTRUCTION ACTIVITY TYPE TYPE "A' TYPE "B" TYPE "C" TYPE "D" PATIENT RISK GROUP Group 1 Lowest I II II III /IV Group 2 Medium I II III IV Group 3 Medium High I III III / IV IV Group 4 Highest II III / IV III / IV IV NOTE: Infection Prevention and Control approval will be required when the Construction Project Activity Type and the Patient Risk Group indicate that Class III or Class IV Infection Prevention and Control procedures are necessary.

4 Infection Prevention and Control Construction Permit See Policy Attachment A 1. An Infection Prevention and Control Construction Permit is required for all Class III or IV projects. 2. Obtain an Infection Prevention and Control Construction Permit from the Infection Prevention and Control Department before beginning any demolition, construction renovation/decorating work. 3. The Infection Prevention and Control Construction Permit is to be displayed at the entrance to the work area during the entire construction project. Infection Prevention and Control General Guidelines Class I Execute work by a method that limits raising dust from construction Ceiling tiles: Immediately replace tiles displaced for visual inspection. Traffic: Visitor traffic routes should limit contact with patients and construction. Exposure of patients to construction should be rare and / or extremely limited. Maintain manpower and equipment including dust mops, brooms, buckets and clean wiping rags for cleaning fine dust from floors and other surfaces on adjacent occupied areas. Transportation route and / or storage for clean supplies will be directed away from contaminated materials. Utility Disruption: Schedule interruptions during low activity. Consult Infection Prevention and Control for recommendations. Class II in addition to points for Class I above Water: To keep dust particulate to a minim mist work surfaces when cutting and gondola wheels when transporting. HVAC: Exhaust air vents will be blocked and sealed before work is started. Return air vents should be HEPA filtered or sealed. Assure adjacent air filtering systems are functioning and protected from project particulate. Fresh air intakes must be 25 feet from exhaust outlets of the ventilation system, combustion equipment stacks, medical / surgical vacuum system, plumbing vents or areas near vehicular exhaust or other fumes. Monitor need to change or clean filters during projects. Areas contained to 1 room with complete walls from floor to ceiling: close door and duct tape frames and door or overlap Visquen 2 feet to protect the surrounding areas of the project when ingress and egress occur. Debris: gondolas are covered by attached lids or sealed and taped shut during transport when lids to not fit. Assigned elevators will be used for debris removal. Contractor will clean up dust tracked outside construction area frequently using a HEPA vacuum or damp mop. Dust: Wet-mop and place adhesive door mats at entrance. Mats shall be changed daily or more frequently as necessary.

5 Open wall areas greater than 4 hours must be Visquen contained. All projects lasting more than 1 work day must be drywall contained or have other approved containment for the duration of the project. Ceiling Tiles: A containment tent must be used for access. All ceiling tiles must be closed when unattended. Stained ceiling tiles must be sprayed with an approved hospital disinfectant and allowed to dry before removal and replacement. Water lines must be flushed at site and adjacent areas before patient occupancy Consult Infection Prevention and Control for recommendations. Class III and IV in addition to points for Classes I and II above: Consult Infection Prevention and Control for the construction permit, an education program plan and ICRA. Educate staff and project crew regarding risks and policy. Examine design of operational laundry / trash chutes for tight fitting closure of doors to prevent potential transmission of particulate inside the chute. Dust Minimization: Air tight partitions must be installed prior to starting (including construction above ceiling tiles). Plastic seams must be sealed with duct tape or zipper, drywall must be taped at seams. Debris: All barriers are considered debris at disposal. Chute for debris removal should be HEPA-filtered. Maintain HEPA filtered negative pressure in project area per permit requirements. Block off all existing ventilation ducts within project area. Capping of ducts must be dust tight and withstand airflow. Sinks: Foot, knee or sensor control units are recommended. Surrounding sink surfaces are nonporous to resist fungal growth. Sinks should be accessible for hand hygiene. Sinks should be designated as clean and utility (for soiled articles and instrument cleaning). Floor: Infection Prevention and Control Recommendation is for a solid sheet floor with cove baseboard. There should be no carpeting in patient rooms or in areas of frequent spillage or heavy soil. Water: Mains, branch mains, risers, and branches to a group of fixtures have stop valves. Obtain potable water supplies when needed for patient drinking and bathing. Project area must be cleaned before containment barriers are removed and before environmental services is notified to terminally clean the area for patient occupancy. Relocate patients to areas remote from construction projects when additional patient measures need to be addressed. 1. PERFORMANCE REQUIREMENTS A. Infection Prevention and Control is critical in all areas of all facilities. Project activities causing disturbance of existing dust, or creating new

6 dust, must be conducted within ventilation- controlled areas that minimize the flow of airborne particles into patient areas. B. SMC requires any subcontractor, sub-subcontractors, material suppliers, vendors, employees, or agents to be bound by these same requirements. Before any project on site begins, the Contractor's on-site management team shall attend a mandatory education program approved by Infection Prevention and Control for instruction on precautions to be taken. C. Construction site air pressure relationships must be negative with respect to adjacent spaces. Air from the construction site will be exhausted to the outside where permitted by code, or recirculated, if access to a suitable point of exhaust is not available as determined by site Engineering / Facilities Management and Infection Prevention and Control Staff. In either case, HEPA-equipped air filtration machines shall be utilized in the construction space. The filtration machines shall be connected to normal power controlled by a single switch for emergency shutoff, and operated per Infection Prevention and Control Permit recommendation during the project. Supply air ducts to the construction space will be closed off and sealed by capping the duct. Building exhaust and return intakes will be closed and sealed or covered with high efficiency filter media (95%) to prevent contamination of the ducts. Negative pressure within the zone will be monitored with an alarmed device. Negative pressure machines will be maintained and monitored by the contractor or site construction personnel. D. Whenever possible, air in the construction space will be exhausted to the outside of the building. HEPA-equipped air-filtration machines shall exhaust the air out of construction areas (through a window or duct to the outside,) creating negative pressure at barricade entrances, even when barricade doors are fully open. If it is not possible to vent directly to the outside, the space may be exhausted through the building exhaust system, with proper filtration and permission from the facility. Filtration machines can be connected directly to the building exhaust system only with the permission of the site Engineering Department. Such connections may require re-balancing of the existing air system to ensure that proper pressures are maintained to surrounding areas. Fans should be secured in the off position before opening ductwork for modifications. Therefore, reducing the risk of contamination from the workspace or the release of any potential debris from the ductwork. When making ductwork modifications, there should be no disruption in service to the air systems serving adjacent areas unless scheduled with site Plant Operations / Engineering Department. Measures will be taken to maintain proper air volumes and pressure relationships within the adjacent areas if affected by changes made in the construction area. E. The Project Manager or an Infection Prevention and Control Director may modify performance requirements for certain activities. Any modification

7 made by SMC staff does not relieve the contractor of compliance with proper Infection Prevention and Control practices. F. Infection Prevention and Control will make the determination for 12 to 24 hour uninterrupted negative air pressure in the project area. 2. SUBMITTALS A. The contractor shall agree with the requirements outlined in the ICRA (Attachment to the policy). B. The contractor shall submit product data for products used in the project as requested or as necessary. 3. QUALITY CONTROL A. Infection Prevention and Control Director may monitor particulate particle counts in vicinity of construction work as appropriate. Whenever safe levels are exceeded, contractor will be notified to correct conditions immediately. 1. All work shall be stopped on the project whenever a hazardous Infection Prevention and Control deficiency exists. 2. Contractor shall take immediate action to correct all deficiencies. 3. No work will proceed until corrective action is completed. 4. PRODUCTS and MATERIALS A. Sheet Plastic: Fire retardant polystyrene, 6-mil thickness. B. Barrier Doors: Solid core wood in metal frame, painted. C. High Efficiency Particulate Air-Equipped filtration machine. D. Exhaust Hoses: Heavy duty, flexible steel reinforced; Ventilation Blower Hose. E. Adhesive Walk-Off or Wet mats: minimum size of 24 inches x 36 inches. F. Disinfectant: Hospital-approved disinfectant or equivalent product. G. Portable containment tent for ceiling access. 5. BARRIERS A. Closed door with masking tape applied over the frame and door is acceptable for projects that can be contained in a single room. B. Construction, renovation / decorating or demolition not capable of containment within a single room must have the following barriers erected. 1. Airtight plastic barrier that extends from floor to ceiling. Seams must be sealed with duct tape or zipper to prevent dust and debris from escaping. Must be removed at the end of work shift. 2. Drywall barriers erected with joints covered or sealed to prevent dust and debris from escaping.

8 3. Seal all penetrations found above the drop ceiling. 4. Barriers are to be placed at penetration of ceiling envelopes, chases and ceiling spaces to stop movement of air and debris. 5. Provide an anteroom or double entrance openings that allow workers to remove protective clothing or vacuum off existing clothing. 6. CONTRACTOR RESPONSIBLITIES A. The Contractor is responsible for obtaining the Infection Prevention and Control Construction Permit. B. Infection Prevention and Control will evaluate the construction project plan. They reserve the right to add requirements to a project on an individual basis. 7. ENVIRONMENTAL MONITORING A. Contractor is responsible for maintaining equipment and replacement of High Efficiency Particulate Air filters and other filters in accordance with manufacturer's recommendations. B. The Project Manager will confirm specified air requirements whenever barricades are erected or modified. C. SMC personnel will monitor air quality throughout project as needed. D. The site's Infection Prevention and Control Director will make periodic visits to the work site to ensure compliance of Policy. 8. ENFORCEMENT A. For breach of this Infection Prevention and Control policy SMC will stop the work of the project. B. SMC's Project Manager will record the following: 1. Documentation of each violation. Photographs maybe helpful. 2. Maintain a record of all Infection Prevention and Control violations. IV. ATTACHMENTS A. Infection Prevention and Control Construction Permit B. Infection Prevention and Control Risk Assessment (ICRA) V. REFERENCES A. APIC Construction and Renovation Infection Prevention and Control Tool Kit Series. 2nd Edition by Judene Bartley. B. CDC and HICPAC Recommendations. Guidelines for Environmental Infection Prevention and Control in Health Care Facilities. MMWR, 6-03/Vol.52/No.RR-10.

9 Request : Springhill Medical Center Infection Prevention and Control Risk Assessment (ICRA) Project Plan Scope of Project Infection Prevention and Control Use Only Project Plan #: Project Manager: Pager: Duration of Project: Start : Completion : Location of Work: What is to be done? Barricades: (describe with drawing) Type of demolition: (describe with drawing) Will Ceiling access be necessary? (if yes, describe) Will floor or ceiling slabs be penetrated? (if yes, describe) Describe the route of workers, materials and waste removal to and from the project site. (make a drawing). Will there be air quality machines in the work area? If yes, how many and where will they be vented and when will the filters be changed? Are there any utility shutdowns required? If yes, which ones and what precautions will be required for shutdown and start up? List of names of contracting crew and date of in-service education, policy and procedure review by Infection Prevention and Control or project manager. Name Title Review Person Patient Risk Group: Construction Activity Type: Project Class: IC Coordinator:_Beck Beck

10 Springhill Medical Center Infection Prevention and Control Risk Assessment (ICRA) Project Plan List names of subcontractors to perform work and date of orientation, policy and procedure review. Name Title Company Review Person Has Environmental Services been contacted to remove necessary items from the area and given a review of expected services? If not, who will do this? Infection Prevention and Control Use Only Additional Cleaning Needs: Additional Recommendations: Visqueen Barrier Sticky Mat HEPA Filter Damp Mop Change & Bag HVAC Filters Seal doors / windows Re-route traffic Cover and seal waste for transport Seal off and block return air vents Construction Company Crew Leader: Sign Here G:\epi\beth\ICRA Project Plan

11 Infection Prevention and Control Construction Permit Permit no. Location of construction Project start date Project coordinator Estimated duration Contractor performing work Permit expiration date Supervisor Telephone YES NO CONSTRUCTION ACTIVITY YES NO INFECTION PREVENTION AND CONTROL RISK GROUP TYPE A: Inspection, non-invasive activity TYPE B: Small scale, short duration, moderate to high levels TYPE C: Activity generates moderate to high levels of dust, requires more than one work shift for completion TYPE D: Major duration and construction activities requiring consecutive work shifts CLASS I A 1. Execute work by methods to minimize raising dust from construction operations. 2. Immediately replace any ceiling tile displaced for visual inspection. Group 1: Least risk Group 2: Medium risk Group 3: Medium/High risk Group 4: Highest risk 3. Minor demolition for remodeling. 4. Minor plumbing, electric, duct work, installation of equipment. 5. Aesthetic improvements. Initials CLASS II B 1. Provides 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. Wipe surfaces with disinfectant. Initials CLASS III C 1. Obtain Infection Prevention and Control permit BEFORE construction begins. 2. Isolate HVAC system in area where work is being done to prevent contamination of the duct system. 3. Complete all critical barriers or implement control cube method before construction begins. 4. Maintain negative air pressure within worksite using HEPA-equipped air filtration units. 5. Do NOT remove barriers from work area until complete project is thoroughly cleaned by Env. Svcs. Department. Initials CLASS IV D 1. Obtain Infection Prevention and Control permit BEFORE construction begins. 2. Isolate HVAC system in area where work is being done to prevent contamination of the duct system. 3. Complete all critical barriers or implement control cube method before construction begins. 4. Maintain negative air pressure within worksite using HEPA-equipped air filtration units. 5. Seal holes, pipes, conduits and punctures appropriately. 6. Construct anteroom and require all personnel to pass through this room so they can be vacuumed using a HEPA vacuum cleaner before leaving worksite or they can wear cloth or paper coveralls that are removed each time they leave the worksite. 6. Contain construction waste before transport in tightly covered containers. 7. Wet mop and/or vacuum with HEPA-filtered vacuum before leaving work area. 8. Place dust mat at entrance and exit of work area. 9. Remove or isolate HVAC system in areas where work is being performed. 6. Vacuum work area with HEPA-filtered vacuums. 7. Wet mop with disinfectant. 8. Remove barrier materials carefully to minimize spreading of dirt and debris associated with construction. 9. Contain construction waste before transport in tightly covered containers. 10. Cover transport receptacles or carts. Tape covering to secure. 11. Remove or isolate HVAC system in areas where work is being performed. 7. All personnel entering work site are required to wear shoe covers. 8. Do not remove barriers from work area until completed project is thoroughly cleaned by the Environmental Services Department. 9. Vacuum work area with HEPA-filtered vacuums 10. Wet mop with disinfectant. 11. Remove barrier materials carefully to minimize spreading of dirt and debris associated with construction. 12. Contain construction waste before transporting in tightly covered containers. 13. Cover transport receptacles or carts. Tape covering to secure. 14. Remove or isolate HVAC system in areas where work is being done. Initials Additional requirements [ ] 12 hour uninterrupted negative air exchange required-- [ ] 24 hour uninterrupted negative air exchange required Initials Permit requested by INFECTION PREVENTION AND CONTROL EDUCATION COMPLETED Verification: Exceptions/Additions to this permit Initials are noted by attached memoranda Permit authorized by Beth Beck :