ENVIRONMENTAL INFECTION CONTROL DURING CONSTRUCTION AND RENOVATION Presented By: Doug Marshall
Jan 31, 2016
ENVIRONMENTAL INFECTION CONTROL DURING CONSTRUCTION AND RENOVATION
Presented By: Doug Marshall
WHAT IS IT?
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
Environmental Infection Control
What is it? (cont.)
Environmental Infection Control
Impacts may include those on air or water
quality, infection control, utility and
equipment requirements, noise and
vibration, emergency procedures, etc.
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
Why the concern?
Environmental Infection Control
Air- Particulates Dust Microbials Gases/Fumes/Odors
Waterborne Contaminants Misc. Nuisances Noise/Vibration
Contaminants of Concern
Environmental Infection Control
DUST PARTICULATES
General Dust Demolition/Dismantling Sanding/Cutting
Environmental Infection Control > Contaminants
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
Microbial Particulates
Environmental Infection Control > Contaminants
Gases/Fumes/Odors
Welding/Soldering
Cutting/Grinding
VOCs- off-gassing of new products,
adhesives, etc.
Chemicals/Cleaners
Other Contaminants
Environmental Infection Control > Contaminants
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
Misc. Issues
Environmental Infection Control > Contaminants
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.
Noise & VibrationEnvironmental Infection Control
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)
Current Regulations & GuidelinesEnvironmental Infection Control
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
TJC Environment of Care Std.
Environmental Infection Control > Regulations & Guidelines
EC8.30 CONSTRUCTION, DEMOLITION, AND MAINTENANCE/REPAIR
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
Environmental Infection Control > Regulations & Guidelines
CDC GUIDELINES FOR EIC
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
Environmental Infection Control > Regulations & Guidelines
CDC GUIDELINES FOR EIC 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
Environmental Infection Control > Regulations & Guidelines
CDC GUIDELINES FOR EIC (CONT.) 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
Environmental Infection Control > Regulations & Guidelines
AIA GUIDELINES (CHAPTER 5) 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!!
Environmental Infection Control > Regulations & Guidelines
CHAPTER 5 ICRA- BASIC ELEMENTS 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
Environmental Infection Control > Regulations & Guidelines
ICRA MATRIX 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
Environmental Infection Control > Risk Assessment
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
ICRA Matrix (cont.)
Environmental Infection Control > Risk Assessment
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
ICRA Matrix (cont.)
Environmental Infection Control > Risk Assessment
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
Engineering Controls
Environmental Infection Control > Engineering 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
Common ControlsEnvironmental Infection Control > Engineering Controls
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.
Types of Barriers
Environmental Infection Control > Engineering Controls
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
Consider Outside Influences
Environmental Infection Control > Engineering Controls
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)
Monitoring
Environmental Infection Control
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
When Should You Sample?
Environmental Infection Control > Monitoring
Positive vs. Negative Pressure
Air Flow Velocities
Affects of doors and window
Elevator shafts
Understand Air Flow in the Building
Environmental Infection Control
OVERALL GOALS: Save Lives through:
Changing attitudes toward construction and
maintenance
Use proper techniques even if not the
Easiest/cheapest
Planning ahead
Environmental Infection Control
QUESTIONS AND ANSWERS
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