Every year, many lives are lost due to the spread of infections in hospitals. Health care workers can take steps to prevent the spread of infectious diseases. Identifying hazards that could potentially compromise patient care and implementing proper controls to reduce risk and minimize the impact of hazards created by renovation, demolition and new construction activities. Those projects could impact infection control, air or water quality, utility and equipment requirements, noise and vibration.
Healthcare workers are occupationally exposed to many infectious diseases during the performance of their normal duties. The delivery of healthcare services requires a broad range of workers, such as physicians, nurses, technicians, and clinical laboratory workers, first responders, building maintenance, security and administrative personnel. Since, healthcare workers have many different tasks or work in different parts of the facility each employee will be exposed to different infectious agents and in different amounts.
2. OBJECTIVES
Infection Control Risk Assessement
Physical and Biological Hazards
Reservoirs for Bio-Contaminants
Measures of Effective Control
3. Environmental Infection Control
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
4. Environmental Infection 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.
5. Environmental Infection 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
8. Environmental Infection 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
9. Environmental Infection Control > Contaminants
Other Contaminants
Gases/Fumes/Odors
Welding/Soldering
Cutting/Grinding
VOCs- off-gassing of new products, adhesives, etc.
Chemicals/Cleaners
10. Environmental Infection 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
11. Environmental Infection 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.
12. Environmental Infection 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)
13. Environmental Infection 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
14. 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
15. 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
16. 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
17. 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
18. 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!!
19. 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
20. Environmental Infection Control > Risk Assessment
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
21. Environmental Infection 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
22. Environmental Infection 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
23. Environmental Infection 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
24. Environmental Infection 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
25. Environmental Infection 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.
26. Environmental Infection 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
27. Environmental Infection 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)
28. Environmental Infection 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
29. Environmental Infection Control
Understand Air Flow in the Building
Positive vs. Negative Pressure
Air Flow Velocities
Affects of doors and window
Elevator shafts
30. 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