1 / 71

Construction Risk Assessment

Construction Risk Assessment. An Overview of Environmental Infection Control and Construction Related Activities.

Olivia
Download Presentation

Construction Risk Assessment

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Construction Risk Assessment An Overview of Environmental Infection Control and Construction Related Activities 2002 Update

  2. 2002 Update

  3. 2002 Update

  4. “Indoor-air-quality (IAQ) challenges out number all others in the health-care industry. Unfortunately, the cost-conscious powers that be have failed to make the management of critical infection-control systems a top priority.” Andy Streifel, MPH, REHS 2002 Update

  5. A typical commercial airliner transports approximately 100 passengers and if the same number of deaths occurred in the aviation industry as a result of airline crashes it would equate to 17 commercial airliner crashes a week. Of which approximately 4 per month would have to do with construction/maintenance related activities. Commercial Airline Analogy 2002 Update

  6. Here’s Our Problem! 2002 Update

  7. Current Regulations and Guidelines • Joint Commission on Accreditation of Healthcare Organizations • Guidelines for the Design and Construction of Hospital and Health Care Facilities (mandated by state law) • CDC – Guidelines on Environmental Infection Control • State Licensure (in many states) 2002 Update

  8. JCAHO • Environment of Care Standards EC.3.2.1 • Patient Safety Standard 2002 Update

  9. EC.3.2.1 – effective 1/1/02 • Demolition, Construction or Renovation • Proactive Risk Assessment • Identify hazards that could potentially compromise patient care • Address impact on: • air quality requirements, infection control, utility requirements, noise, vibration, and emergency procedures. 2002 Update

  10. Construction & Renovation • Disruption of settled dust • Disruption of ceiling tiles • Repair/renovation of elevator shafts • Repair of under sink cabinets • Pulling up carpeting • Disturb “environmental reservoirs” 2002 Update

  11. Construction, Demolition, and Repair • Multi-disciplinary team approach to review: • design and function of new area • risk assessment in preventing airborne nosocomial disease • dust and moisture containment • barrier walls • negative pressure differential 2002 Update

  12. CDC Guidelines for Environmental … What it Covers • Air • Water • Environmental Services • Laundry and Bedding • Animals in Healthcare Facilities • Regulated Medical Waste 2002 Update

  13. CDC Guidelines for Environmental Infection Control - Air • HVAC System • Design • Temperature • Humidity • ACH • Mixing of air in the room • Filtration • Filter Types and Efficiencies • HEPA • Where they are required • Portable units • Maintenance 2002 Update

  14. CDC Guidelines for Environmental Infection Control - Air • Infection control impact of system maintenance and repair • Duct cleaning • System shutdowns • Moisture in the system • Backup emergency electrical power 2002 Update

  15. CDC Guidelines for Environmental Infection Control - Air • Construction, Renovation, Remediation, Repair and Demolition • ICRA (Infection Control Risk Assessment) • Multidisciplinary team • Risk assessment of project • P&P to protect patients • Procedure to Correct Problems Rapidly 2002 Update

  16. CDC Guidelines for Environmental Infection Control - Air • Construction, Renovation, Remediation, Repair and Demolition • Preliminary considerations • Resources for education of internal staff and contractors • Penalties for non-compliance with contract documents • Contingency Plans for Utility Disruption 2002 Update

  17. CDC Guidelines for Environmental Infection Control - Air • Construction, Renovation, Remediation, Repair and Demolition • Air sampling • External and internal demolition (Barriers Required?) • Working with plumbing in sensitive areas • Exposure of ceiling spaces • Crawling into ceiling spaces • Work on elevator shafts • Demo of wallboard, plaster, ceramic tile, ceiling tile • Removal of flooring • Removal of windows and doors • Removal of casework 2002 Update

  18. AIA Guidelines • 2001 Guidelines for Design and Construction of Hospitals and Health Care Facilities – Chapter 5 2002 Update

  19. Chapter 5 – Planning and Design • All new and existing construction • Due to the hazards of construction consultation from: • Infection control professionals • Safety professionals • Development of an Infection Control Risk Assessment (ICRA) 2002 Update

  20. Chapter 5 – Elements of an ICRA • Continuous process • Component of the facility functional program or master program • Initiated in planning and design and continued through construction/renovation • Performed by a multidisciplinary panel • Documented 2002 Update

  21. Chapter 5 – Elements of an ICRA • Key Elements • Impact of disrupting essential services • Patient placement or relocation • Placement of barriers • Evaluation of ventilation needs in existing sensitive areas • Number of AII and PE rooms 2002 Update

  22. Chapter 5 – Elements of an ICRA • Key Elements • Patient protection from: • Demolition • Unplanned power outages effect on ventilation and water • Movement of debris • Patient flow through the building 2002 Update

  23. Chapter 5 – Bid Documents • Project bid documents shall include: • Control of airflow (clean to dirty) • Interruption of utility and/or building service equipment • Communications of the construction process manager and the facility staff 2002 Update

  24. Role of the ICP. . . Overview • Help identify those effected by project • Know your facility • Facilitate teams & communication • Populations at risk • Decreased immunity • Allergies, asthma, COPD • Noise and vibration • Assist w/ education, P&P, documentation 2002 Update

  25. Know Your Facility • Types of patients based upon services • Layout of services • 3-D considerations • Location of inpatient units • Venues for outpatient specialties • Ancillary support functions • TB risk in community - OSHA/CDC • Long & short term planning • Applicable regulations & guidelines 2002 Update

  26. 2002 Update

  27. Facilitate Teamwork • Existing committees • Reporting structure • Responsibilities & authority • Ownership - P&P (CRP) • Ad hoc team projects • Key & ancillary members • Communication • Internal & external • Documentation • Epidemiology 2002 Update

  28. Noise and Vibration • Patients and/or employees • Recent myocardial infarction • Premature neonates • Recent ICH or stroke • Neurological/psychiatric disorders 2002 Update

  29. Noise and Vibration • Procedures or testing • EEG or EKG • Hearing assessments • Neurological studies • Fine motor skill procedures, such as microsurgery • Certain laboratory procedures • Sleep studies 2002 Update

  30. Developing ICRA(1 of 3) • Determine potential spread of infectious agents in the healthcare environment • Provided by facility “owner” • Continuous; essential part of facility’s master program to provide a safe environment of care • Initiate at design & planning phase 2002 Update

  31. Developing ICRA(2 of 3) • Continue during renovation/construction through commissioning • ICRA limited to only affected areas • Multidisciplinary team / expertise in: • IC, risk, facility design, construction, ventilation, safety and epidemiology • Team provides documentation of the risk assessment during PDC 2002 Update

  32. Developing ICRA(3 of 3) • Design professional incorporates specific construction-related requirements of ICRA into contract documents • Contract documents require contractor to implement these specifics into renovation/construction activities • Consistent with JCAHO-EC and OSHA 2002 Update

  33. ICRA Considerations • Regulations & guidelines • Infectious agents & hazards change • Microbiological ecology influenced by patients & HCWs • Physical surroundings • Documents & reports • Use as QI/PI activity? 2002 Update

  34. 2002 Update

  35. 2002 Update

  36. 2002 Update

  37. Physical Surroundings • Structure: HVAC, air flow, plumbing • Fixtures: Handwashing sinks, “hoppers”, showers, toilets • Maintenance: Reservoirs and wet, porous surfaces may support microbial growth • Equipment: Location, fixed vs. moveable, storage, prevent contamination • Design: Flow; form follows function 2002 Update

  38. PATIENT Risk Group TYPE A TYPE B TYPE C TYPE D LOW Risk Group I II II III / IV MEDIUM Risk Group I II III IV HIGH Risk Group I II III / IV IV HIGHEST Risk Group II III / IV III / IV IV ICRA Matrix 2002 Update

  39. IC Construction Permit • Suggest use based upon IC precautions • Some require for Classes III & IV • Outlines steps required • Assists in documentation • Project parameters • Sign-off • Customize to your organization by ICRA team consensus 2002 Update

  40. Effective Program Elements • Traffic patterns & patient relocation • People, signage, supplies & equipment, waste, populations at risk; think 3-D • Barriers - planning & monitoring • Type & integrity, approvals, checklists • Education for construction workers, management, HCWs, others • Level & content as appropriate (tomorrow) • Involve experts; ask key questions • Resources, content experts, site visits 2002 Update

  41. Controlling Construction and Maintenance Activities • Need for containment • General containment barriers – and hindrances to barriers • Point of entry control units • Negative pressure requirement • HVAC system protection and isolation 2002 Update

  42. How Do We Do It? • Define contractor building entry and path to the construction zone • Define the construction zone maintenance procedures and use of tacky mats and “bunny suits” • Identify HVAC System and how to isolate it from the construction zone • Establish background bioaerosols level prior to construction 2002 Update

  43. Type Of Construction • Minor repairs • Major system upgrades • Area renovation and tenant improvements Major additions and remodels – both yours and your neighbors • New construction – both yours and your neighbors • Landscaping – both yours and your neighbors 2002 Update

  44. Envelope Penetrations • Ceiling cavities • Wall panels and service access ports • Dumb waiters 2002 Update

  45. Envelope Penetrations • Building shafts and chutes • Stairwells • Elevators 2002 Update

  46. Environmental Containment Unit Photo courtesy of Mintie Corporation 2002 Update

  47. Construction Barriers Photo courtesy of Mintie Corporation 2002 Update

  48. Who Applies It? • It can be applied by hospital staff if they have the manpower available. • Most healthcare organizations use an outside third party contractor that specializes in containment programs. - Dedicated expertise - IMC contractor assumes the liability 2002 Update

  49. NEW CONSTRUCTION • Constructing problems OUT of the building. • General clean up: How clean is clean? 2002 Update

  50. NEW CONSTRUCTION Condition at time of pre-inspection Photo courtesy of Rob Case, RCCS 2002 Update

More Related