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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