2. Infection Control Risk Assessment - ICRA 101

3. THE MISSION
Provide the health care facility with the best trained, knowledgeable and qualified construction workforce in order to get the job done right and protect the health and safety of patients, staff, workers and the public with minimal disruption of daily activities and operations.

4. THE CHALLENGE
Hospital associated infections (HAIs) like MRSA and aspergillus continue to be a problem in health care facilities.
It is estimated that each year in the US:
1.7 million patients acquire HAIs
99,000 patients die from these infections
5,000 HAI deaths are from construction related activities
Studies indicate invasive aspergillosis can occur during construction and renovation

5. OBJECTIVES
Describe the various risks and challenges involved in working in occupied health care facilities
Explain how to develop a health and safety plan between the facility owner and contractor
Identify different effective procedures to protect patients, staff, workers, and the public from any hazardous materials, contaminants or infectious agents
Recognize and understand the remediation of hazardous materials, contaminants or infectious agents
Differentiate the responsibilities of the contractor, architects, and facility owner

6. HEALTH CARE FACILITIES
The primary goal is to maintain the patients’ health
Patients are vulnerable to infections and diseases due to weakened immune systems
Immunocompromised patients include burns, premature babies, organ & bone marrow transplant, ventilator, dialysis
Daily operation of facility is critical
Protect PATIENTS, staff, workers and the public

7. HAZARDOUS MATERIALS
When working with or around hazardous materials it is essential to warn others of the possible dangers using:
Placards
Labels
Containers
MSDS

8. HAZARDOUS MATERIALS
Materials that pose risk to: health, safety, and the environment
Present at jobsites within health care facilities in many different forms
Acute and chronic health effects can result from exposures over OSHA’s PEL

9. HAZARDOUS MATERIALS
Materials that pose risk to: health, safety, and the environment
Present at jobsites within health care facilities in many different forms
Acute and chronic health effects can result from exposures over OSHA’s PEL
Permissible Exposure Levels – What is your level?
What are some Hazardous Materials you see at work?

10. HAZARDOUS SUBSTANCES Hazards found in occupied building: Asbestos Lead
Fungi
Silica
Chemicals
Asbestos is < 3 microns, human hair is 70. Can be friable (reduced to dust) and remain airborne for days. Lead can cause headaches, seizures and brain damage. Silica, 2nd most common material in the earth’s crust. Fungi, over 60,000 species, (mold, yeast and mushrooms). Mold, needs food, oxygen and moisture to grow (your lungs). Mold is 25% of the living matter on earth.

11. HAZARDOUS SUBSTANCES Hazards found in occupied buildings: Bacteria
Mold
Radiation
Mercury
Medical Waste
Bacteria, exposure can result from breathing, touching or ingestion. Mercury can cause birth defects and damage the central nervous system. One thermometer can contaminate a 60 acre lake. Radiation, depending on intensity, amount and duration can cause acute and chronic conditions from headaches and sterility to death. Electromagnetic (MRI), Mechanical (sound waves), Particle (X-Rays). Fungi: over 100,000 species. Medical waste: needles, instruments, and dressings that can transfer bloodborne diseases such as hepatitis and HIV.

12. I.L.S.M. TEAM
Interim Life Safety Measures (ILSM) team’s goal is to ensure safety of patients
Implements emergency evacuation plans and identifies fire, safety, and security measures
Must have and maintain an unimpeded exit plan. If construction work blocks the exit plan, the ILSM team must have an alternate plan
PATIENT safety must come first

13. I.C.R.A. TEAM
Infection Control Risk Assessment (ICRA) team’s goal is to minimize risk of hospital acquired infections (secondary infections)
Studies scope of work to be done and evaluates risk factors and potential hazards
Matrix: Matches project type and patient risk group
to determine work area classification
ICRA forms – required by The Joint Commission (TJC)

14. CONSTRUCTION PROCEDURES
Classification determines the type of barriers
Can change if mold, lead or asbestos are found
Air tight seals are essential
Portable cubes
Soft walls
Hard walls
Anterooms
Positive and/or negative air pressures

15. PORTABLE ISOLATION CUBE
Small single person containment used for inspection or short term
Collapsible barrier that can be easily maneuvered and deployed
Great for working above ceilings
Negative HEPA air seal and vacuum cleaner
What is the estimated total cost of all the items in this picture?

16. SOFT WALL SYSTEM Quick and safe Suitable for short term
Convenient for emergencies
Zipper door for access
Will this work with negative and/or positive air pressure?

17. HARD WALL SYSTEM Long term temporary partition
Protects patients and the public from contaminants
Built with common construction materials like metal studs and drywall
Sealing is essential
Sustains impacts from gurneys

18. ANTEROOM Changing room for PPA Extra protection in sensitive areas
May be hard or soft wall systems
Excellent transition between differential air pressures

19. AIR PRESSURE Positive Negative Equal Monitoring:
Flutter gauge
Ball gauge
Magnehelic
Documentation - using data from an air particulate counter

20. PERSONAL PROTECTION
Personal protection equipment (PPE) is worn inside contaminated and protects workers from hazards or contaminated material
PPE is donned prior to entering contaminated area and removed prior to entering patient occupied area
What is PPA?

21. PATIENT PROTECTION APPAREL
Protective apparel designed to prevent transferring of contaminants from worker to patients
Used when entering or exiting the containment area

22. WORKSITE PREPARATION
Before construction work commences existing finishes must be protected
Fixtures, furniture, floors, computers, walls, floors, doors, windows, window treatments, casework and contents, elevator cabs and all equipment
Protective materials – polyethylene sheeting, hardboard, plywood, cardboard, tape and self sticking floor protector
Decommission any equipment or computers in cooperation with hospital staff.
Patient privacy must be protected at all times, ie.. charts

23. JOB COMPLETION Obtain inspection documents
Jobsite cleaned and disinfected by contractor and the hospitals environmental services team
Fire alarms and smoke detectors tested
HVAC systems functioning properly
Remove barriers and signs
Final cleaning performed by the facility

24. WORKER TRAINING
UBC members get a 24 hour class that includes classroom and “hands on” shop activities
8 hour Trades Awareness class available to everyone
AIA continuing education class – 1 ½ hour lunch and learn
Look at the shop picture, see anything wrong or concerning?

25. WORKING TOGETHER AWARENESS – COMMUNICATION - PROTOCOL
To minimize risks of secondary infection and other issues, contractors and workers must understand procedures of working in an occupied health care facility (29 CFR 1926, OSHA, NYC Guidelines for mold remediation)
Knowledgeable facility managers and employees will help reduce risk of secondary infections (CDC, TJC, CMS, ASHE)
Architects recognize the risks and protocol involved and inform contractors and facility managers of specific precautions. Recognize the importance of a highly trained workforce. (FGI edition)

26. Infection Control Risk Assessment - ICRA 101
The United Brotherhood of Carpenters and Joiners of America is a Registered Provider with The American Institute of Architects Continuing Education Systems (AIA/CES) for AIA members. Certificates of Completion for both AIA members and non-AIA members are available upon request.
This program is registered with the AIA/CES for continuing professional education. As such, it does not include content that may be deemed or construed to be an approval or endorsement by the AIA of any material of construction or any method or manner of handling, using, distributing, or dealing in any material or product.
Questions related to specific materials, methods, and services will be addressed at the conclusion of this presentation

28. Training and Qualification Program
Construction ICRA:
Best Practices in Healthcare Construction
The Carpenters International Training Fund responded by creating:
Construction ICRA:
Best Practices
in Health Care
Construction
in Occupied
Facilities
Training and Qualification Program
Refer to course syllabus.

29. Best Practices in Healthcare Construction
Curriculum
Construction ICRA:
Best Practices in Healthcare Construction
November 2008
Training Program Goals
Develop comprehensive skill-sets to address the concerns of health care administrators for containing pathogens, protecting patients, and working without disrupting operations
Heighten the sense of accountability and responsibility by those working in occupied facilities
Create a workforce for all levels of the project: From apprentices and journeymen, to foremen and superintendents
Our mission is to provide trained – productive workers to our industry partners.
We have a large training infrastructure that works together to achieve our mission.
We have the highest quality training material available.
The UBC is the 6th largest producer of training manuals.
UBC spends around 200 mill. On training top down and bottom up
We have a curriculum development process in place to develop additional training materials to meet the current and future needs of our industry partners.

30. Best Practices in Healthcare Construction
Curriculum
Construction ICRA:
Best Practices in Healthcare Construction
November 2008
Developing Core Training Protocols
Consulted with industry experts in pathogen containment during construction work in occupied facilities to collect relevant, up-to-date technical material
Researched which best practices would deliver the trained professionals that a health care jobsite requires
Established a system for the ongoing review of all training materials with industry experts to refine technical information and anticipate emerging job site requirements
Take a look at the Professionals who helped write the course. Andy Streifel, Judene Bartley
UBC takes pro-active approach to all training

31. Best Practices in Healthcare Construction
Construction ICRA:
Best Practices in Healthcare Construction
Curriculum
Training Delivery
Tier 1: Train-the-Trainer
Prerequisite: CITF Master Instructor Status
Parameters:
40-hours of hands-on training in simulated conditions at the CITC
Frequent refresher courses are required
Qualification certificates issued by CITF
Re-certification mandatory every months
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November 2008 31

32. Best Practices in Healthcare Construction
Construction ICRA:
Best Practices in Healthcare Construction
Curriculum
Training Delivery
Tier 1: Train-the-Trainer:
Topics focus on awareness and best practices in:
Blood-Borne Pathogens
Hazmat Material Overview
Recognizing Hazardous Material
Lead, Asbestos, Silica and Mold
Controlling Exposure
Exposure Limits
Routes of Entry
Health Effects
Site-Specific Considerations
Work Practices
Health Care Facility Awareness
Individual Responsibilities
Regulatory Agencies and Organizations
Risk Evaluation
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November 2008 32

33. Best Practices in Healthcare Construction
Construction ICRA:
Best Practices in Healthcare Construction
Curriculum
Training Delivery
Tier 1: Train-the-Trainer:
Instruction also covers…
Documentation
Contaminants and Infectious
Agents
Controlling Contaminants
Air Pressure
Containing the Work Area
Pre-work Activities
Work Activities
Work Area Classifications
Mold in a Health Care Facility
Pre-Remediation Activities and
Considerations
Personal Protection
Remediation
Work Practices for Mold
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November 2008 33

34. Best Practices in Healthcare Construction
Construction ICRA:
Best Practices in Healthcare Construction
Curriculum
Training Delivery
Tier 2: UBC member training
24 HOURS of TOTAL TRAINING
(16 hrs. of class time/8 hrs. hands on)
Training spans all levels needed on a health care jobsite
Apprentices - Journeymen
Foremen - Superintendents
Qualification cards earned:
Best Practices in Health Care Construction
Refresher & ongoing training courses required
Re-certification mandatory every 4 years
Blood Borne Pathogens Card
Re-certification available every year
We don’t want to push dozens of carpenters through the training. 8 members per instructor.
We want them to get it the first time and use what they’ve learned all the time. 34
November 2008 34

35. Best Practices in Healthcare Construction
Construction ICRA:
Best Practices in Healthcare Construction
Curriculum
Training Delivery
Tier 2: UBC member training
Protocol and skill development addresses:
Hazardous Materials Awareness
Lead, Asbestos, Silica, and Mold
Individual Responsibilities to Patients
The Structure of the ICRA Form
Regulatory Agencies and Organizations
How to Deal with Hospital Personnel
Containing the Work Area
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November 2008 35

36. Best Practices in Healthcare Construction
Construction ICRA:
Best Practices in Healthcare Construction
Curriculum
Training Delivery
Tier 2: UBC member training
Protocols and skill development addresses:
Work Area Classifications
Anteroom Construction
Erecting and Sealing a Soft Wall
Working Within a Portable Isolation Cube
How to Establish a Negative Pressure
Environment
Personal Protective Equipment Familiarization
How Secondary Infections are Acquired
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November 2008 36

37. The ICRA form is broken down into steps
Step 1: Project Type

38. Step 2: Patient Risk Group
The four types of Patient Risk Groups are:
Low Risk Group
Medium Risk Group
High Risk Group
Highest Risk Group

39. Step 3: ICRA Matrix
The ICRA matrix is the graph used to match project type and patient risk to determine work area classification I, II, III, or IV.

40. Step 4: Surrounding Project Area
Potential impact to rooms surrounding the project area is assessed.
The patient risk group above, below, and around the project area is determined.

41. Step 5: Identify Specific Site
The specific site is recorded: patient room, clean utility room, medication room, or other.
Step 6: Related Issues
All issues related to facility systems such as ventilation, plumbing, and electrical.
The probability of system outages is indicated.

42. Step 7: Containment Measures
Are containment measures needed?
If so, is a soft or hard wall barrier needed?
Is HEPA filtration required?
Step 8: Potential Risk of Water Damage
Information is determined and recorded, such as:
potential risk of water damage
information concerning structural members and sprinkler or plumbing pipes to be removed or altered
Any potential risk of compromising structural integrity is determined.

43. Steps 10–13: Facility Design
Step 9: Work Hours
The actual time the work will be performed is recorded:
Will it be done during nonpatient hours?
Will it be done in segments?
Steps 10–13: Facility Design
building codes
Americans with Disabilities Act (ADA)
American Institute of Architects® guidelines (AIA)
Step 14: Placement of Containment
Barrier placement is determined by:
traffic patterns, debris removal
housekeeping needs, fire codes

44. Infection Control Construction Permit
completed and issued by the ICRA team
issued only for a Class III or Class IV project per the TJC
Changes in Work Classification
The classification level can change during the course of the project.
Changes may occur due to processes that create dust or due to the discovery of mold or other hazardous material in the containment area.
If there are any hazardous materials discovered on the jobsite, the supervisory staff must be notified immediately.
Communication is essential for the success and safety of projects.

45. Best Practices in Healthcare Construction
Curriculum
Construction ICRA:
Best Practices in Healthcare Construction
November 2008
How Can We Help You?
We aren’t looking to re-write your hospital’s protocol; we simply want to work collectively ensuring the patients safety remains the
#1 Priority!
Use the resources that are available to you right now
What do you see a need for?
Specialized training?
More training in a specific area?
Training for your hospital staff or yourselves?
We can tailor this training to fit the needs of your facility.

46. 8 hour awareness for other trades or maintenance
Curriculum
Construction ICRA:
Best Practices in Healthcare Construction
November 2008
8 hour awareness for other trades or maintenance
Can your maintenance personnel use some brushing up?
Educate hospital staff, RN’s, and FM’s on the basics of Construction ICRA
What do insurance carriers think about Continuing Education?
Remember, this training can be tailored to fit your Hospital’s needs
*Worker training is a critical component of a multifaceted approach to Infection Control*
Explain the 8 hour Training.
Does your maintenance personnel or FM's have any continuing education or monthly safety meetings?
Everyone who comes in contact with a hospital renovation project should have some understanding of what they may see and what to expect while the project is going on.
**Mention the hand out on worker continuing education.**

47. Best Practices in Healthcare Construction
Curriculum
Construction ICRA:
Best Practices in Healthcare Construction
November 2008
8 HOUR OVERVIEW
Gain a better understanding of infection control in an occupied facility
Adhere to all work class precautions
Have the ability to recognize hazards
Basic understanding of barriers, HEPA machines, air changes, regulatory agencies, finding mold, etc.
Understand their responsibilities during emergency situations
Go off slide

48. How Can You Help Yourselves?
Curriculum
Construction ICRA:
Best Practices in Healthcare Construction
November 2008
How Can You Help Yourselves?
*You have the resources available NOW to implement the Construction ICRA Qualification in your Facilities*
*Put language in your Pre-bid Docs, Hospital Spec Docs, and Construction Docs.*
We welcome the opportunity for the IP’s or FM’s to sit in on Training.
Take the time to evaluate the training.

49. How Can You Help Yourselves?
Curriculum
Construction ICRA:
Best Practices in Healthcare Construction
November 2008
How Can You Help Yourselves?
**REQUIRE OR MANDATE ALL CARPENTERS WHO WORK IN YOUR FACILITY SHOW PROOF THEY HAVE TAKEN THE UBC 24 HOUR CONSTRUCTION ICRA TRAINING**
Both stickers and qualification cards
We can help with that or the contractor can have a letter head from the training centers showing proof the members have this training and the date of expiration.
**SHOW RECOMMENDATION LETTER**

50. Best Practices in Healthcare Construction
AGC 2009
Construction ICRA:
Best Practices in Healthcare Construction
31 March 2017
Coalition Building
Our ICRA Leads are members of various Healthcare organizations and are AIA Providers. We’re members because we share the same concerns as you do and we want to make sure when we attend the various chapter meetings we gain a better knowledge of the roles you play on Infection Control and we can pass on the valuable information to our members and contractors. They are the ones on the front lines in the prevention of secondary infections on Hospital renovations. 50

51. Best Practices in Healthcare Construction
Construction ICRA:
Best Practices in Healthcare Construction
EST PPt
January 22, 2009
A Collaborative Approach Meeting the Needs of Health Care Organizations…
This Best Practices program is designed to
enhance the existing craft skills of UBC
members
Its training is consistent with the CITF’s
standard protocol of industry-based,
expert-reviewed, certified-instructor
curriculum delivery
The needs of the end-user remain a focal
point during training, so that UBC members
meet and exceed project expectations
UBC members work a huge number of hours in the Interior Systems industry. We cover the core and advanced skills required in the Interior Systems industry. Ceilings, walls, and soffits – lath, metal studs, and drywall – Interior walls and exterior curtain walls – it’s all here – it’s up to date – it’s ready to go.

52. Best Practices in Healthcare Construction
AGC 2009
Construction ICRA:
Best Practices in Healthcare Construction
31 March 2017
Working Together
Healthcare facility managers who understand the procedures involved in construction-related infection control help to reduce the risks
Architects who understand the specific risks involved help to communicate the facility’s needs to the contractor
Contractors and workers who understand the issues involved when working in a healthcare facility help to add value, safety and professionalism to healthcare construction projects
Communication is key!

53. Best Practices in Healthcare Construction
AGC 2009
Construction ICRA:
Best Practices in Healthcare Construction
31 March 2017
Q & A
*Thank you for your time and we enjoyed speaking to you about our Construction ICRA Training*