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Environmental Infection Control During Construction and Renovation

Environmental Infection Control During Construction and Renovation. Presented By: Doug Marshall. What is it ?. Environmental Infection Control. Identifying hazards that could potentially compromise patient care

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Environmental Infection Control During Construction and Renovation

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  1. Environmental Infection Control During Construction and Renovation Presented By: Doug Marshall

  2. What is it? EnvironmentalInfection Control • Identifying hazards that could potentially compromise patient care • Implementing proper controls to reduce risk and minimize the impact of hazards created by demolition, renovation, and/or new construction activities

  3. EnvironmentalInfection Control What is it? (cont.) Impacts may include those on air or water quality, infection control, utility and equipment requirements, noise and vibration, emergency procedures, etc.

  4. EnvironmentalInfection Control Why the concern? • Sensitive patients, physically and/or mentally • Compromised immune systems (illness or medication) • Critical medical procedures • Critical services, utilities, and equipment that cannot be damaged or disrupted • Need for stable indoor environment

  5. EnvironmentalInfection Control Contaminants of Concern • Air- Particulates • Dust • Microbials • Gases/Fumes/Odors • Waterborne Contaminants • Misc. Nuisances • Noise/Vibration

  6. Dust Particulates EnvironmentalInfection Control > Contaminants • General Dust • Demolition/Dismantling • Sanding/Cutting

  7. EnvironmentalInfection Control > Contaminants Microbial Particulates • Microbial “reservoirs” in flooring, wall cavities, HVAC systems, materials affected by water damage or high humidity, or spores brought in from outdoors • May include molds that are pathogenic, toxic, and/or allergenic (especially Aspergillus) • May include bacterial growth

  8. EnvironmentalInfection Control > Contaminants Other Contaminants • Gases/Fumes/Odors • Welding/Soldering • Cutting/Grinding • VOCs- off-gassing of new products, adhesives, etc. • Chemicals/Cleaners

  9. EnvironmentalInfection Control > Contaminants Misc. Issues • Not necessarily environmental contaminants, but potentially disruptive • Increased foot and vehicle traffic • Alternate routes of building exit/entry • Alternate emergency/fire evacuation routes and procedures • Abnormal “loads” on utilities or equipment

  10. EnvironmentalInfection Control Noise & Vibration May affect patients and/or employees • premature neonates • recent ICH or stroke • neurological/psychiatric disorders May affect critical procedures/testing • EEG or EKG • hearing assessments • neurological studies • fine motor skill procedures • certain laboratory procedures • sleep studies, etc.

  11. EnvironmentalInfection Control Current Regulations & Guidelines • The Joint Commission (TJC) • AIA Guidelines for the Design and Construction of Hospital and Health Care Facilities (mandated by state law) • CDC Guidelines on Environmental Infection Control • State Licensure (depending upon state)

  12. EnvironmentalInfection Control > Regulations & Guidelines TJC Environment of Care Std. • EC.8.30 • Demolition, Construction or Renovation, and Maintenance • Proactive risk assessment • Identify hazards that could potentially compromise patient care • Address impact on requirements/procedures

  13. EC8.30 Construction, Demolition, and Maintenance/Repair EnvironmentalInfection Control > Regulations & Guidelines • Infection Control Risk Assessment • (Multi-disciplinary team approach to project review for prevention of airborne & waterborne nosocomial disease.) • design and function of new area • At risk patients • dust and moisture containment • Noise/vibration • What contingency plans are in place for unexpected outages

  14. CDC Guidelines for EIC EnvironmentalInfection Control > Regulations & Guidelines • Construction, Renovation, Remediation, Repair and Demolition • ICRA (Infection Control Risk Assessment) • Multi-disciplinary team • Risk assessment of project • P&P to protect patients • Procedures to correct problems rapidly

  15. CDC Guidelines for EIC EnvironmentalInfection Control > Regulations & Guidelines • CDC Guidelines- Major Air Quality Issues • Air Sampling • External and Internal demolition- Are 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

  16. CDC Guidelines for EIC (cont.) EnvironmentalInfection Control > Regulations & Guidelines • Major Air Quality Issues (cont.) • Removal of flooring • Removal of windows and doors • Removal of casework • HVAC systems design and filtration • HVAC maintenance and repair • duct cleaning • system shutdown • moisture in system • backup emergency power

  17. AIA Guidelines (Chapter 5) EnvironmentalInfection Control > Regulations & Guidelines • For all new construction and renovation • Consultation from infection control professionals, and safety professionals • Development of an ICRA • Initiated in planning and design and continued through construction/renovation • Performed by multi-disciplinary panel • Documented!!

  18. Chapter 5 ICRA- Basic Elements EnvironmentalInfection Control > Regulations & Guidelines • Impact of disrupting essential services • Patient placement and relocation • Placement of barriers • Evaluation of ventilation needs • Number of AII and PE rooms • Patient protection from: • Demolition • Un-planned outages • Movement of debris • Patient flow through building

  19. ICRA Matrix EnvironmentalInfection Control > Risk Assessment • Aids in determining proper work practices and types of engineering controls, and monitoring required. • Assesses risk based upon the patient risk group and types of activities performed

  20. EnvironmentalInfection Control > Risk Assessment ICRA Matrix (cont.) • Type A- (Inspection and Non-invasive) • removing ceiling tile for inspection • painting without sanding • wall-covering • electrical trim • minor plumbing • Type B (Work Activities) • Small scale/ short duration • Minimal dust created

  21. EnvironmentalInfection Control > Risk Assessment ICRA Matrix (cont.) Type C (Work Activities) • Demolition/removal of fixed building parts • Moderate-high dust, including sanding, flooring removal, ceiling tiles & casework, major cabling, • Can’t be done in 1 shift Type D (Work Activities) • Major demolition/construction • High dust created, including heavy demo, removal of walls, new construction • Required consecutive work shifts

  22. EnvironmentalInfection Control > Engineering Controls Engineering Controls Containment of Dust and Debris • Controlling construction related activities • Envelope penetrations • Building shafts, chutes, stairwells and elevators • Removal of materials from building • Electrical and water system shutdowns • HVAC system shutdowns, potential for passive ventilation

  23. EnvironmentalInfection Control > Engineering Controls Common Controls • Defining contractor points of entry/exit • Use of tacky mats and disposable suits • General containment barriers • Control cubes for point of entry • Negative pressure requirements • HVAC system protection and isolation

  24. EnvironmentalInfection Control > Engineering Controls Types of Barriers Short-duration • Fire-resistant plastic • Airtight with Negative Pressure Long Duration • Install plastic barrier while building rigid barrier • Drywall on metal studs • Floor to floor construction • Seal and tape all joints, edges, holes, etc.

  25. EnvironmentalInfection Control > Engineering Controls Consider Outside Influences • Protect building ventilation systems (i.e. fresh-air intakes) • Control building entrances • Window/door infiltration • Access to construction zones • Building tie-ins • Street cleaning • Emergency response

  26. EnvironmentalInfection Control Monitoring • Establish background bio-aerosol levels prior to construction • Compare levels during and after construction to these baselines • Include viable and non-viable particles • Monitor ventilation (air changes, filtration, pressure)

  27. EnvironmentalInfection Control > Monitoring When Should You Sample? Baseline and before occupancy (“Commissioning”) • Insure proper ventilation and cleanliness • Provides comparison data for later if necessary Ongoing Surveillance • Pressure differentials • Air Exchanges • Particle count for filtration efficiency

  28. EnvironmentalInfection Control Understand Air Flow in the Building • Positive vs. Negative Pressure • Air Flow Velocities • Affects of doors and window • Elevator shafts

  29. Overall Goals: EnvironmentalInfection Control • Save Lives through: • Changing attitudes toward construction and maintenance • Use proper techniques even if not the Easiest/cheapest • Planning ahead

  30. Questions and Answers ?

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