Presented By: Kary S. Amin Nova Environmental, Inc.

1. Michigan Association for the Healthcare EnvironmentInfection Control During Construction & Renovation Presented By: Kary S. Amin Nova Environmental, Inc. Nova Environmental, Inc.

2. Infection Control During Construction & Renovation • Issues and Concerns • Preconstruction Planning • Contaminants Generated By Construction • Proper Containment and Isolation • Post-Construction & Clean-up • Development of Infection Control Policy Nova Environmental, Inc.

3. Issues and Concerns • Unique concerns in hospitals… • Continual occupancy • Increased suseptability - Immune Deficiency/HAI (Hospital Acquired Infection) • Construction’s effect on accessibility and impact on emergency planning Nova Environmental, Inc.

4. Issues and Concerns • Unique concerns in hospitals • “Minor problems can be deadly” • Jackhammer could dislodge years of build-up in plumbing system, releasing bacteria into the water supply. • Dust from drywall demolition could enter the HVAC and disperse to operating areas. • Rain could blow into open windows, creating moisture intrusion that can lead to mold growth. Nova Environmental, Inc.

5. Pre-Construction Planning • Complete an ICRA (infection control risk assessment) • Documented guideline. • Diverse group of employees involved, including infection control staff. • Begins early in design stage. • Intended to evaluate design and construction’s impact on occupants and the environment. Nova Environmental, Inc.

6. Pre-Construction PlanningDesign • Design to support infection control and in compliance with relevant guidelines, standards, codes and regulations. • HVAC, recommended ventilation and filtration • Mechanical systems involving water supply and plumbing • Number and type of hand-washing fixtures, soap, paper towels, lotions • Sharps disposal unit placement • Accommodation for PPE • Type of surfaces, ceiling tiles, walls, counters, floor coverings, furniture, etc. Nova Environmental, Inc.

7. Pre-Construction PlanningLocation of Construction • Proximity to high risk areas (Surgery, Mother/Baby, Intensive Care, Emergency Room, Oncology, etc.) Nova Environmental, Inc.

8. Pre-Construction PlanningExtent of Construction • Size of work area • Length of construction schedule • Scope and degree of activities • Number of workers • Contractor shifts • Accessibility, egress • External excavation/construction Nova Environmental, Inc.

9. Pre-Construction PlanningType of Construction • Demolition of components • Pre-planning for asbestos, lead, mold, dust & debris generation • Evaluation of HVAC isolation • Shut off or reroute • Negative/postitive air pressure • Construction area air filtration and movement • Installation of new furnishings and building components • Odors (VOCs) Nova Environmental, Inc.

10. Pre-Construction PlanningType of Containment • Intent is to ensure complete isolation of potential construction contaminants from building occupants and environment • Needs to be detailed and identified within construction documents • Coordination through construction managers or general contractors • Determination of standards for accountability Nova Environmental, Inc.

11. Pre-Construction PlanningMonitoring – Determine Cleanliness • Consider air monitoring, especially when construction is adjacent to high risk areas • Consider establishing criteria for level of cleanliness expected upon completion of construction work, (visual, clearance sampling) Nova Environmental, Inc.

12. Contaminants GeneratedBy Construction • Asbestos • Fibrous mineral that can be incorporated into any building component (inhalation hazard) Nova Environmental, Inc.

13. Contaminants GeneratedBy Construction • Lead • Element that has commonly been used in paint and incorporated into drywall used in X-Ray areas of hospitals (inhalation and ingestion hazard) Nova Environmental, Inc.

14. Contaminants GeneratedBy Construction • Mold • Fungi that can develop or grow on organic building components (inhalation and ingestion hazard) Nova Environmental, Inc.

15. Contaminants GeneratedBy Construction • Bacteria • Potentially hazardous microorganisms that have needs similar to mold, nutrients and moisture (various routes of entry) Nova Environmental, Inc.

16. Contaminants GeneratedBy Construction • Dust and Debris • Particulate (and potential fumes) common during construction and renovation (inhalation hazard) Nova Environmental, Inc.

17. Proper Containment & Isolation • Isolation of construction zones from rest of building • Small short projects with minimal dust generation, fire rated polyethylene, sealed entryway • Larger projects require rigid dust-proof and fire rated barrier walls, (such as drywall) with caulked seams for tight seal • All stationary items seal with critical barriers • Barrier to extend above ceilings, below floors (tunnels) if applicable • Verify that everything is properly sealed (Need to consider egress and accessibility issues) Nova Environmental, Inc.

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23. Proper Containment & Isolation • HVAC • Shut off or temporarily modify • Critical barriers over all vents/diffusers/ducts • Construction must be under negative pressure with respect to adjacent areas at all times, may need portable ventilation systems • Exhaust from construction should be exhausted directly outside if at all possible. If re-circulated, must be flowed through HEPA filtration system Nova Environmental, Inc.

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25. Proper Containment & Isolation • Decontamination • Ensuring workers and equipment coming out of construction zone don’t contaminate non-construction areas • Workers to HEPA vacuum dust/debris off cloths prior to exiting work area • Tacky mats and disposable boot coverings should be used • Equipment and supplies cleaned prior to exiting work area • Debris removed from construction sites in carts with tight-fitting covers • Designate elevators for construction traffic only • Adjacent areas mopped daily or as needed to control dust Nova Environmental, Inc.

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27. Post-Construction & Clean-Up • Plans should include vacuuming of construction areas and flushing debris from water systems before re-occupancy • Sufficient ventilation to vacate odors from new furnishings • All surfaces within construction zone should be dust-free • Visual inspection by hospital representatives a must Nova Environmental, Inc.

28. Post Construction Sampling • Intended to document that renovated area is “safe” for re-occupancy. • After cleaning, prior to barriers being removed • Consider: • General particulate air sampling • Dust sampling for lead • TO sampling for VOCs Nova Environmental, Inc.

29. Post Construction Cleanup • Clean during process of barrier dismantlement • Final cleaning of areas, including locations of barriers. This should be performed with HEPA vacuums, not brooms! Nova Environmental, Inc.

30. Development of Renovation ConstructionInfection Control Policy • Written program with following components: • Infection Control Risk Assessment • Construction Design Phase • Requirements for containment & Isolation • Contaminant control methods • Post-construction cleanup and sampling • Clearance criteria Nova Environmental, Inc.

31. Presentation Summary • Ensure that infection control staff are involved from initial stages of design; • Ensure that infection control procedures are taken seriously by all contractors and that there is accountability; • Ensure that post-construction cleanup is extremely thorough; • Consider third party clearance sampling to provide occupant documentation of cleanliness. Nova Environmental, Inc.

32. Thank you for participatingNova Environmental, Inc.5340 Plymouth RoadSuite 210Ann Arbor, MI 48105(734) 930-0995www.nova-env.com Nova Environmental, Inc.