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Safely Managing Construction/Renovation and Maintenance in Healthcare: A Facilities Management Perspective

February 10, 2009

Environmental Health & Engineering, Inc.800-825-5343 • www.eheinc.com

Safely Managing Construction/Renovation and

Maintenance in Healthcare

A Facilities Management Perspective

Bryan Connors, MS, CIH, HEMHealthcare Practice Leader, EH&EFebruary 10, 2009

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Agenda Agenda

• The Joint Commission Requirements • Case Studies (What Can Go Wrong)• Management of Data and Program

Documents • Proven Management Techniques


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Why Do We Care About PCRA?Why Do We Care About PCRA?

• Outbreaks of hospital-acquired mold infections

• Minimizing liability• Compliance • Improving flow of work

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Proven Success Strategies Proven Success Strategies

• Clear Responsibilities• Central Coordination • Consistent Review Process

Committee, Inspections, Permits

• Competencies/Skills• Metrics, Follow-up• Contactor Training


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Construction in Healthcare Construction in Healthcare

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Examples of the Risks Examples of the Risks


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PCRA Components PCRA Components

PCRA Risk Mitigation Program

ILSM

Utility Impacts, Noise, Vibration, IAQ

ICRA


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Joint Commission RequirementsJoint Commission Requirements

The PCRA process should identify:1) Potential impacts on air quality

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2) Potential impacts on fire and life safety


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Interim Life Safety MeasuresInterim Life Safety Measures

• Major deficiencies in the life safety code • May be due to construction or other

causes of deficiencies

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Life Safety Case StudyLife Safety Case Study

• Hot work + sprinkler impairment = ?


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3) Effects of noise and vibration4) Utilities and medical equipment

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5) Potential impacts on Infection Control


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Infection Control Risk MitigationInfection Control Risk Mitigation

• Construction = Dust• Dust = Mold• Mold + High Risk Patients = Elevated Risk

Construction Project Type

IVIII/IVIIIIHighest risk groupIVIII/IVIIIHigh risk group

IVIIIIIIMedium risk groupIII/IVIIIIILow risk group

Type DType CType BType APatient risk group

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ICRA Case Study ICRA Case Study


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Good Bad

View from inside site

Examples: Containment Practices Examples: Containment Practices

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Example: Life Safety Risks Example: Life Safety Risks


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What Can Go Wrong What Can Go Wrong

• Nosocomial fungal infections • Staff injury and illness• OSHA inspections• Joint Commission Accreditation • Insurance premiums and liability • Staff complaints and dissatisfaction

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Root Causes of FailureRoot Causes of Failure

• Interdepartmental responsibilities = ambiguity, lack of “ownership”

• Construction contractors focused on job completion & schedule

Subcontractor management • Limited hospital resources/resource

allocation • Contractor orientation & unfamiliarity with

healthcare environment


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Consistent PCRA ProcessConsistent PCRA Process

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Permits for Each ProjectPermits for Each Project


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Inspection Data and Program Inspection Data and Program MetricsMetrics

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Other Issues to Consider Other Issues to Consider

• Site inspections, deficiency resolution • Contractor vetting and selection

Management of sub-contractors • Include PCRA and safety performance

requirements in contract documents• OSHA compliance issues

Asbestos, LO/TO, confined space• Above the ceiling permit,

fire stopping, hot work permit


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• Define the management process

• Clearly define roles• Assure accountability

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• Vet/select contactors and subcontractors

Train contactors

• Determine vulnerabilities

Act to address the vulnerabilities


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Safely Managing Construction/Renovation and

Maintenance in Healthcare

A Facilities Management Perspective

Bryan Connors, MS, CIH, HEMHealthcare Practice Leader

[email protected]