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Presented By: Kary S. Amin Nova Environmental, Inc.

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1 Presented By: Kary S. Amin Nova Environmental, Inc.

2 Issues and Concerns Preconstruction Planning Contaminants Generated By Construction Proper Containment and Isolation Post-Construction & Clean-up Development of Infection Control Policy Nova Environmental, Inc.

3 Unique concerns in hospitals… Continual occupancy Increased suseptability - Immune Deficiency/HAI (Hospital Acquired Infection) Constructions effect on accessibility and impact on emergency planning Nova Environmental, Inc.

4 Unique concerns in hospitals Minor problems can be deadly Jackhammer could dislodge years of build-up in plumbing system, releasing bacteria into the water supply. Dust from drywall demolition could enter the HVAC and disperse to operating areas. Rain could blow into open windows, creating moisture intrusion that can lead to mold growth. Nova Environmental, Inc.

5 Complete an ICRA (infection control risk assessment) Documented guideline. Diverse group of employees involved, including infection control staff. Begins early in design stage. Intended to evaluate design and constructions impact on occupants and the environment. Nova Environmental, Inc.

6 Design to support infection control and in compliance with relevant guidelines, standards, codes and regulations. HVAC, recommended ventilation and filtration Mechanical systems involving water supply and plumbing Number and type of hand-washing fixtures, soap, paper towels, lotions Sharps disposal unit placement Accommodation for PPE Type of surfaces, ceiling tiles, walls, counters, floor coverings, furniture, etc. Nova Environmental, Inc.

7 Proximity to high risk areas (Surgery, Mother/Baby, Intensive Care, Emergency Room, Oncology, etc.) Nova Environmental, Inc.

8 Size of work area Length of construction schedule Scope and degree of activities Number of workers Contractor shifts Accessibility, egress External excavation/construction Nova Environmental, Inc.

9 Demolition of components Pre-planning for asbestos, lead, mold, dust & debris generation Evaluation of HVAC isolation Shut off or reroute Negative/postitive air pressure Construction area air filtration and movement Installation of new furnishings and building components Odors (VOCs) Nova Environmental, Inc.

10 Intent is to ensure complete isolation of potential construction contaminants from building occupants and environment Needs to be detailed and identified within construction documents Coordination through construction managers or general contractors Determination of standards for accountability Nova Environmental, Inc.

11 Consider air monitoring, especially when construction is adjacent to high risk areas Consider establishing criteria for level of cleanliness expected upon completion of construction work, (visual, clearance sampling) Nova Environmental, Inc.

12 Asbestos Fibrous mineral that can be incorporated into any building component (inhalation hazard) Nova Environmental, Inc.

13 Lead Element that has commonly been used in paint and incorporated into drywall used in X-Ray areas of hospitals (inhalation and ingestion hazard) Nova Environmental, Inc.

14 Mold Fungi that can develop or grow on organic building components (inhalation and ingestion hazard) Nova Environmental, Inc.

15 Bacteria Potentially hazardous microorganisms that have needs similar to mold, nutrients and moisture (various routes of entry) Nova Environmental, Inc.

16 Dust and Debris Particulate (and potential fumes) common during construction and renovation (inhalation hazard) Nova Environmental, Inc.

17 Isolation of construction zones from rest of building Small short projects with minimal dust generation, fire rated polyethylene, sealed entryway Larger projects require rigid dust-proof and fire rated barrier walls, (such as drywall) with caulked seams for tight seal All stationary items seal with critical barriers Barrier to extend above ceilings, below floors (tunnels) if applicable Verify that everything is properly sealed (Need to consider egress and accessibility issues) Nova Environmental, Inc.

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23 HVAC Shut off or temporarily modify Critical barriers over all vents/diffusers/ducts Construction must be under negative pressure with respect to adjacent areas at all times, may need portable ventilation systems Exhaust from construction should be exhausted directly outside if at all possible. If re-circulated, must be flowed through HEPA filtration system Nova Environmental, Inc.

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25 Decontamination Ensuring workers and equipment coming out of construction zone dont contaminate non-construction areas Workers to HEPA vacuum dust/debris off cloths prior to exiting work area Tacky mats and disposable boot coverings should be used Equipment and supplies cleaned prior to exiting work area Debris removed from construction sites in carts with tight- fitting covers Designate elevators for construction traffic only Adjacent areas mopped daily or as needed to control dust Nova Environmental, Inc.

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27 Plans should include vacuuming of construction areas and flushing debris from water systems before re-occupancy Sufficient ventilation to vacate odors from new furnishings All surfaces within construction zone should be dust-free Visual inspection by hospital representatives a must Nova Environmental, Inc.

28 Intended to document that renovated area is safe for re-occupancy. After cleaning, prior to barriers being removed Consider: General particulate air sampling Dust sampling for lead TO sampling for VOCs Nova Environmental, Inc.

29 Clean during process of barrier dismantlement Final cleaning of areas, including locations of barriers. This should be performed with HEPA vacuums, not brooms! Nova Environmental, Inc.

30 Written program with following components: Infection Control Risk Assessment Construction Design Phase Requirements for containment & Isolation Contaminant control methods Post-construction cleanup and sampling Clearance criteria Nova Environmental, Inc.

31 Ensure that infection control staff are involved from initial stages of design; Ensure that infection control procedures are taken seriously by all contractors and that there is accountability; Ensure that post-construction cleanup is extremely thorough; Consider third party clearance sampling to provide occupant documentation of cleanliness. Nova Environmental, Inc.

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