3THE MISSIONProvide 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.
4THE CHALLENGEHospital 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 HAIs99,000 patients die from these infections5,000 HAI deaths are from construction related activitiesStudies indicate invasive aspergillosis can occur during construction and renovation
5OBJECTIVESDescribe the various risks and challenges involved in working in occupied health care facilitiesExplain how to develop a health and safety plan between the facility owner and contractorIdentify different effective procedures to protect patients, staff, workers, and the public from any hazardous materials, contaminants or infectious agentsRecognize and understand the remediation of hazardous materials, contaminants or infectious agentsDifferentiate the responsibilities of the contractor, architects, and facility owner
6HEALTH CARE FACILITIES The primary goal is to maintain the patients’ healthPatients are vulnerable to infections and diseases due to weakened immune systemsImmunocompromised patients include burns, premature babies, organ & bone marrow transplant, ventilator, dialysisDaily operation of facility is criticalProtect PATIENTS, staff, workers and the public
7HAZARDOUS MATERIALSWhen working with or around hazardous materials it is essential to warn others of the possible dangers using:PlacardsLabelsContainersMSDS
8HAZARDOUS MATERIALSMaterials that pose risk to: health, safety, and the environmentPresent at jobsites within health care facilities in many different formsAcute and chronic health effects can result from exposures over OSHA’s PEL
9HAZARDOUS MATERIALSMaterials that pose risk to: health, safety, and the environmentPresent at jobsites within health care facilities in many different formsAcute and chronic health effects can result from exposures over OSHA’s PELPermissible Exposure Levels – What is your level?What are some Hazardous Materials you see at work?
10HAZARDOUS SUBSTANCES Hazards found in occupied building: Asbestos Lead FungiSilicaChemicalsAsbestos 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.
11HAZARDOUS SUBSTANCES Hazards found in occupied buildings: Bacteria MoldRadiationMercuryMedical WasteBacteria, 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.
12I.L.S.M. TEAMInterim Life Safety Measures (ILSM) team’s goal is to ensure safety of patientsImplements emergency evacuation plans and identifies fire, safety, and security measuresMust have and maintain an unimpeded exit plan. If construction work blocks the exit plan, the ILSM team must have an alternate planPATIENT safety must come first
13I.C.R.A. TEAMInfection 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 hazardsMatrix: Matches project type and patient risk groupto determine work area classificationICRA forms – required by The Joint Commission (TJC)
14CONSTRUCTION PROCEDURES Classification determines the type of barriersCan change if mold, lead or asbestos are foundAir tight seals are essentialPortable cubesSoft wallsHard wallsAnteroomsPositive and/or negative air pressures
15PORTABLE ISOLATION CUBE Small single person containment used for inspection or short termCollapsible barrier that can be easily maneuvered and deployedGreat for working above ceilingsNegative HEPA air seal and vacuum cleanerWhat is the estimated total cost of all the items in this picture?
16SOFT WALL SYSTEM Quick and safe Suitable for short term Convenient for emergenciesZipper door for accessWill this work with negative and/or positive air pressure?
17HARD WALL SYSTEM Long term temporary partition Protects patients and the public from contaminantsBuilt with common construction materials like metal studs and drywallSealing is essentialSustains impacts from gurneys
18ANTEROOM Changing room for PPA Extra protection in sensitive areas May be hard or soft wall systemsExcellent transition between differential air pressures
19AIR PRESSURE Positive Negative Equal Monitoring: Flutter gaugeBall gaugeMagnehelicDocumentation - using data from an air particulate counter
20PERSONAL PROTECTIONPersonal protection equipment (PPE) is worn inside contaminated and protects workers from hazards or contaminated materialPPE is donned prior to entering contaminated area and removed prior to entering patient occupied areaWhat is PPA?
21PATIENT PROTECTION APPAREL Protective apparel designed to prevent transferring of contaminants from worker to patientsUsed when entering or exiting the containment area
22WORKSITE PREPARATIONBefore construction work commences existing finishes must be protectedFixtures, furniture, floors, computers, walls, floors, doors, windows, window treatments, casework and contents, elevator cabs and all equipmentProtective materials – polyethylene sheeting, hardboard, plywood, cardboard, tape and self sticking floor protectorDecommission any equipment or computers in cooperation with hospital staff.Patient privacy must be protected at all times, ie.. charts
23JOB COMPLETION Obtain inspection documents Jobsite cleaned and disinfected by contractor and the hospitals environmental services teamFire alarms and smoke detectors testedHVAC systems functioning properlyRemove barriers and signsFinal cleaning performed by the facility
24WORKER TRAININGUBC members get a 24 hour class that includes classroom and “hands on” shop activities8 hour Trades Awareness class available to everyoneAIA continuing education class – 1 ½ hour lunch and learnLook at the shop picture, see anything wrong or concerning?
25WORKING 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)
26Infection 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
28Training and Qualification Program Construction ICRA:Best Practices in Healthcare ConstructionThe Carpenters International Training Fund responded by creating:Construction ICRA:Best Practicesin Health CareConstructionin OccupiedFacilitiesTraining and Qualification ProgramRefer to course syllabus.
29Best Practices in Healthcare Construction CurriculumConstruction ICRA:Best Practices in Healthcare ConstructionNovember 2008Training Program GoalsDevelop comprehensive skill-sets to address the concerns of health care administrators for containing pathogens, protecting patients, and working without disrupting operationsHeighten the sense of accountability and responsibility by those working in occupied facilitiesCreate a workforce for all levels of the project: From apprentices and journeymen, to foremen and superintendentsOur 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 upWe have a curriculum development process in place to develop additional training materials to meet the current and future needs of our industry partners.
30Best Practices in Healthcare Construction CurriculumConstruction ICRA:Best Practices in Healthcare ConstructionNovember 2008Developing Core Training ProtocolsConsulted with industry experts in pathogen containment during construction work in occupied facilities to collect relevant, up-to-date technical materialResearched which best practices would deliver the trained professionals that a health care jobsite requiresEstablished a system for the ongoing review of all training materials with industry experts to refine technical information and anticipate emerging job site requirementsTake a look at the Professionals who helped write the course. Andy Streifel, Judene BartleyUBC takes pro-active approach to all training
31Best Practices in Healthcare Construction Construction ICRA:Best Practices in Healthcare ConstructionCurriculumTraining DeliveryTier 1: Train-the-TrainerPrerequisite: CITF Master Instructor StatusParameters:40-hours of hands-on training in simulated conditions at the CITCFrequent refresher courses are requiredQualification certificates issued by CITFRe-certification mandatory every monthsBase comments on slide contentNovember 200831
32Best Practices in Healthcare Construction Construction ICRA:Best Practices in Healthcare ConstructionCurriculumTraining DeliveryTier 1: Train-the-Trainer:Topics focus on awareness and best practices in:Blood-Borne PathogensHazmat Material OverviewRecognizing Hazardous MaterialLead, Asbestos, Silica and MoldControlling ExposureExposure LimitsRoutes of EntryHealth EffectsSite-Specific ConsiderationsWork PracticesHealth Care Facility AwarenessIndividual ResponsibilitiesRegulatory Agencies and OrganizationsRisk EvaluationBase comments on slide content32November 200832
33Best Practices in Healthcare Construction Construction ICRA:Best Practices in Healthcare ConstructionCurriculumTraining DeliveryTier 1: Train-the-Trainer:Instruction also covers…DocumentationContaminants and InfectiousAgentsControlling ContaminantsAir PressureContaining the Work AreaPre-work ActivitiesWork ActivitiesWork Area ClassificationsMold in a Health Care FacilityPre-Remediation Activities andConsiderationsPersonal ProtectionRemediationWork Practices for MoldBase comments on slide content33November 200833
34Best Practices in Healthcare Construction Construction ICRA:Best Practices in Healthcare ConstructionCurriculumTraining DeliveryTier 2: UBC member training24 HOURS of TOTAL TRAINING(16 hrs. of class time/8 hrs. hands on)Training spans all levels needed on a health care jobsiteApprentices - JourneymenForemen - SuperintendentsQualification cards earned:Best Practices in Health Care ConstructionRefresher & ongoing training courses requiredRe-certification mandatory every 4 yearsBlood Borne Pathogens CardRe-certification available every yearWe 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.34November 200834
35Best Practices in Healthcare Construction Construction ICRA:Best Practices in Healthcare ConstructionCurriculumTraining DeliveryTier 2: UBC member trainingProtocol and skill development addresses:Hazardous Materials AwarenessLead, Asbestos, Silica, and MoldIndividual Responsibilities to PatientsThe Structure of the ICRA FormRegulatory Agencies and OrganizationsHow to Deal with Hospital PersonnelContaining the Work AreaBase comments on slide contentNovember 200835
36Best Practices in Healthcare Construction Construction ICRA:Best Practices in Healthcare ConstructionCurriculumTraining DeliveryTier 2: UBC member trainingProtocols and skill development addresses:Work Area ClassificationsAnteroom ConstructionErecting and Sealing a Soft WallWorking Within a Portable Isolation CubeHow to Establish a Negative PressureEnvironmentPersonal Protective Equipment FamiliarizationHow Secondary Infections are AcquiredBase comments on slide contentNovember 200836
37The ICRA form is broken down into steps Step 1: Project Type
38Step 2: Patient Risk Group The four types of Patient Risk Groups are:Low Risk GroupMedium Risk GroupHigh Risk GroupHighest Risk Group
39Step 3: ICRA MatrixThe ICRA matrix is the graph used to match project type and patient risk to determine work area classification I, II, III, or IV.
40Step 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.
41Step 5: Identify Specific Site The specific site is recorded: patient room, clean utility room, medication room, or other.Step 6: Related IssuesAll issues related to facility systems such as ventilation, plumbing, and electrical.The probability of system outages is indicated.
42Step 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 DamageInformation is determined and recorded, such as:potential risk of water damageinformation concerning structural members and sprinkler or plumbing pipes to be removed or alteredAny potential risk of compromising structural integrity is determined.
43Steps 10–13: Facility Design Step 9: Work HoursThe 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 Designbuilding codesAmericans with Disabilities Act (ADA)American Institute of Architects® guidelines (AIA)Step 14: Placement of ContainmentBarrier placement is determined by:traffic patterns, debris removalhousekeeping needs, fire codes
44Infection Control Construction Permit completed and issued by the ICRA teamissued only for a Class III or Class IV project per the TJCChanges in Work ClassificationThe 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.
45Best Practices in Healthcare Construction CurriculumConstruction ICRA:Best Practices in Healthcare ConstructionNovember 2008How 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 nowWhat 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.
468 hour awareness for other trades or maintenance CurriculumConstruction ICRA:Best Practices in Healthcare ConstructionNovember 20088 hour awareness for other trades or maintenanceCan your maintenance personnel use some brushing up?Educate hospital staff, RN’s, and FM’s on the basics of Construction ICRAWhat 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.**
47Best Practices in Healthcare Construction CurriculumConstruction ICRA:Best Practices in Healthcare ConstructionNovember 20088 HOUR OVERVIEWGain a better understanding of infection control in an occupied facilityAdhere to all work class precautionsHave the ability to recognize hazardsBasic understanding of barriers, HEPA machines, air changes, regulatory agencies, finding mold, etc.Understand their responsibilities during emergency situationsGo off slide
48How Can You Help Yourselves? CurriculumConstruction ICRA:Best Practices in Healthcare ConstructionNovember 2008How 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.
49How Can You Help Yourselves? CurriculumConstruction ICRA:Best Practices in Healthcare ConstructionNovember 2008How 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 cardsWe 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**
50Best Practices in Healthcare Construction AGC 2009Construction ICRA:Best Practices in Healthcare Construction31 March 2017Coalition BuildingOur 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
51Best Practices in Healthcare Construction Construction ICRA:Best Practices in Healthcare ConstructionEST PPtJanuary 22, 2009A Collaborative Approach Meeting the Needs of Health Care Organizations…This Best Practices program is designed toenhance the existing craft skills of UBCmembersIts training is consistent with the CITF’sstandard protocol of industry-based,expert-reviewed, certified-instructorcurriculum deliveryThe needs of the end-user remain a focalpoint during training, so that UBC membersmeet and exceed project expectationsUBC 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.
52Best Practices in Healthcare Construction AGC 2009Construction ICRA:Best Practices in Healthcare Construction31 March 2017Working TogetherHealthcare facility managers who understand the procedures involved in construction-related infection control help to reduce the risksArchitects who understand the specific risks involved help to communicate the facility’s needs to the contractorContractors and workers who understand the issues involved when working in a healthcare facility help to add value, safety and professionalism to healthcare construction projectsCommunication is key!
53Best Practices in Healthcare Construction AGC 2009Construction ICRA:Best Practices in Healthcare Construction31 March 2017Q & A*Thank you for your time and we enjoyed speaking to you about our Construction ICRA Training*