Construction in Healthcare: Does it put Patients or Workers at Risk? Not if we do ICRA correctly! Infection Control Risk Assessment (ICRA)

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1 Infection Control Risk Assessment (ICRA) What Does it Mean? Deb Hess, RN, CIC Supervisor Infection Control & Prevention Lancaster General/Penn Medicine Construction in Healthcare: Does it put Patients or Workers at Risk? Not if we do ICRA correctly! 1

2 10/20/2016 Fall 2016: Construction at LGH Who wants to join me in climbing the crane? 2

3 Purpose of ICRA: To provide parameters for safe design, construction, maintenance, and sustainability in the healthcare environment ICRA Infection risks, interventions, and control strategies must be considered in planning for new construction and/or renovation of healthcare facilities Developed for all projects that may impact the health of patients Multidisciplinary Document assessment process Proactively identifies and mitigate risks from infection that could occur Consider patient populations, scope of the project, & potential risk of transmission of contaminants Before starting and construction project: Complete ICRA with all key individuals at table: Construction Supervisors Facility Project Managers Safety Officer Infection Control & Prevention Safety considerations include Patients Visitors Hospital staff Construction workers Construction dust can: Cause infections in some patients Trigger allergies in some patients or staff Worsen breathing in some patients or staff Clog medical instruments Set off smoke detectors 3

4 Step 1: Define Risk Group Definition of Risk Groups Group I: Lowest Office areas Environmental Services Facilities Management Group 2: Medium All other Patient Care Areas not in Group 3 or 4 Group 4: Highest Group 3: Medium High Emergency Room Radiology/MRI Labor and Delivery Newborn Nursery Pediatrics Nuclear Medicine Admission/Discharge Areas PT- tank areas Cafeteria/Kitchen Special Procedures- Radiology Laboratories Operating Room, PACU, & Preoperative areas Sterile Processing Department Critical Care & Cardiac Units Labor & Delivery OR C-Section rooms Cardiac Catheterization & Angiography Areas Dialysis areas Oncology Units Radiation Therapy Endoscopy areas Pharmacy Transplant Unit Bone Marrow Transplant Pulmonary Function 4

5 Step 2: Determine Construction Type or Dust Level TYPES OF CONSTRUCTION / Dust Level Minimal Dust Inspections and non-invasive activity that do not make dust such as: Removal of ceiling tiles for visual inspection ONLY. Limited to 1 tile per 50 square feet Painting (No sanding) Wall covering application Electrical trim work Minor plumbing No removal of sinks or wall cutting 5

6 TYPES OF CONSTRUCTION / Dust Level Low Dust Small scale, short duration activities which create minimal dust: Installation of telephone and computer cables Cabling through ceiling with no more than 2 tiles removed Access to chase spaces Minor cutting of walls and ceilings where dust migration can be controlled (<1 sq. ft. diameter) Sanding of walls for painting or wall covering to ONLY REPAIR small patches TYPES OF CONSTRUCTION / Dust Level Moderate/High Dust: Short duration Work that generates a moderate to high level of dust: Demolition or removal of any fixed building components Breach in the building shell Sanding of walls for more than small patch repair Removal of floor coverings and casework New wall construction Minor ductwork or electrical work above ceilings Major cabling activities Removal of > 50 square feet of ceiling tile Cutting holes in existing walls of > 1 square foot Any activity that cannot be completed in a single work shift 6

7 TYPES OF CONSTRUCTION / Dust Level High Dust: Long duration Major demolition and construction projects: Heavy demolition or removal of a complete cabling or ceiling system Removal of drywall ceilings New construction requiring consecutive shifts to complete Step 3: Identify Class based on Steps 1 & 2 7

8 Identify Class Dust Level Risk Level Class Determines IC Measures Needed for Project Infection Control & Prevention Measures Class I Only remove 1 ceiling tile Intact tile Minor demolition for remodeling Execute work by methods to minimize raising dust from construction operations Immediately replace any ceiling tile displaced for visual inspection 8

9 Infection Control & Prevention Measures (Class II) Provides means to prevent airborne dust from dispersing into atmosphere. Water mist work surfaces to control dust while cutting Seal unused doors with duct tape Block off and seal air vents Infection Control & Prevention Measures (Class II) Provides means to prevent airborne dust from dispersing into atmosphere. Wipe 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 area Place dust mat at entrance and exit of work area Isolate HVAC system in areas where work is being performed; restore when work completed 9

10 Infection Control & Prevention Measures (Class III) Always: Obtain infection control permit before construction begins & Include all barriers in Class II and additional barriers on next slides Infection Control & Prevention Measures (Class III) Isolate HVAC system in area where work is being done to prevent contamination of the duct system. Complete all critical barriers or implement control cube method before construction begins. 10

11 Infection Control & Prevention Measures (Class III cont. ) Maintain negative air pressure within work site utilizing HEPA-equipped air filtration units. Do not remove barriers from work area until complete project is checked by Infection Prevention & Control and thoroughly cleaned by Environmental Services. Plastic ICRA floor to deck with negative pressure Infection Control & Prevention Measures (Class III cont.) Vacuum work with HEPA-filtered vacuums Wet mop with cleaner/disinfectant Remove barrier materials carefully to minimize spreading of dirt and debris associated with construction 11

12 Infection Control & Prevention Measures (Class IV) Do everything as in level III & the following: Seal holes, pipes, conduits, and punctures appropriately Construct anteroom and require all personnel to pass through this room so they can be vacuumed using a HEPA vacuum cleaner before leaving work site or they can wear cloth or paper coveralls that are removed each time they leave the work site. Require all personnel entering work site to wear shoe covers. Anteroom Door HEPA filtered air may be vented into space when no window available 12

13 How to keep on track! Review Blueprints ASAP 13

14 10/20/2016 Planning includes everyone involved with that project New Construction When Feasible; Mock Up Room 14

15 Weekly Construction Meetings 15

16 Conclusion Very important for Infection Control to be involved from the beginningof projects whether renovations or new construction big or small Meet regularly with construction team and project managers Don t be afraid to ask questions or stop the work until the appropriate barriers are in place and tight Have fun with this you can learn so much!! Worksite Checklist Special thanks to LGH Infection Control & Prevention team and Benchmark Construction for providing insights and pictures. Reference: APIC. (2015). Infection Prevention Manual for Construction & Renovation. Washington DC: APIC. 16