1. 1 Jobsite Orientation New York - Presbyterian For Construction Employees April 7, 2015 Welcome to the Team!

2. 2 NewYork-Presbyterian Hospital Columbia University Medical Center U NewYork-Presbyterian Hospital Weill Cornell Medical Center D We Put Patients First Table of Contents Introduction to project Hospital safety standards Project specific safety standards

3. 3 We Put Patients First Hospital Standards Important Acronyms RACE – Rescue, Alarm, Confine, Extinguish / Evacuate PASS – Pull, Aim, Squeeze, Sweep ICRA – Infection Control Risk Assessment ILSM – Interim Life Safety Mitigation CODE RED = FIRE CODE PINK = INFANT/CHILD ABDUCTION CODE GREY = PSYCHIATRIC ELOPEMENT CODE FREEZE = PERSON WITH A WEAPON

4. 4 We Put Patients First Infection Control ICRA – Infection Control Risk Assessment What drives the need for ICRA during construction? Hospitalized patients are at greater risk of infection from opportunistic pathogens Numerous outbreak suggest the need for a more pro-active strategy for controlling exposure to pathogens. Litigation Cost

5. 5 We Put Patients First Mold & Airborne Pathogens Toxic molds are common in a hospital atmosphere – especially dust. Mold thrives in: Darkness Moisture Food (insulation, wood, drywall) Lack of air movement Concerns: Immuno-suppressed Patients

6. 6 We Put Patients First Mold & Airborne Pathogens Who qualifies as an “immuno- suppressed” patient? Bone marrow transplant patients Chemo-therapy patients Open heart surgery patients Organ transplant patients Tuberculosis patients Concerns: Aspergillus (type of mold) has a 95% fatality rate in immuno- suppressed patients.

7. 7 We Put Patients First Mold & Airborne Pathogens What increases airborne Aspergillus levels? Building, demolition, construction, renovations, and repairs Bird droppings near intake ducts that supply high risk patient care areas. Contaminated fireproofing material Damp sheetrock/wood 3 Rules of the Road Controlled Access “Negative Pressure” Containment

8. 8 We Put Patients First Regulatory Authorities Center for Medicare & Medicaid Services (CMS) The Joint Commission NY State Department of Health NY State Office of Mental Health NYC Department of Buildings FDNY OSHA EPA (Federal) NY State DEC Etc.

9. 9 We Put Patients First Regulatory Authorities Joint Commission ICRA – Infection Control Risk Assessment ILSM – Interim Life Safety Measures Required as part of 7 total Project Assessments Ultimate goal is to provide patient safety while construction is ongoing

10. 10 We Put Patients First Regulatory Authorities Good Planning will ensure that: Patients are not disrupted or relocated Essential services are not interrupted Barriers are used to prevent the spread of airborne contaminants Negative pressure is maintained in the construction site

11. 11 We Put Patients First Regulatory Authorities Good Planning continued: Hospital Emergency Procedures are communicated and followed Quality control monitoring is in place Good Housekeeping on the site Communication procedures are in place Permits are in place including NYP Hot Work

12. 12 We Put Patients First Regulatory Authorities Critical Barriers When to use them: Repair jobs with significant dust dispersions Dust-abatement, fire-resistant plastic sheets sealed from ceiling to floor, HEPA, negative pressure Demolition of internal structures Walls, ceilings, ceiling tiles, floors Removal of ceiling or floor tiles, carpet, doors, windows, etc. Exposure of ceiling spaces or workers crawling in the ceiling space for repair s Plumbing work in high-risk areas Repair, construction – elevator shafts

13. 13 We Put Patients First Regulatory Authorities Critical Barriers Maintaining them: Seal windows, doors, plumbing penetrations, electrical outlets and intake an exhaust vents Vacuum air ducts and spaces above ceilings if necessary Ongoing cleaning dirt and dust Use sticky mats to collect dust/dirt from shoes Vacuum work area with HEPA filtered vacuums daily or as needed

14. 14 We Put Patients First Regulatory Authorities Critical Barriers Maintaining them: Cover garbage dumpsters Only use the approved path to move materials in and out of the construction site Do not leave debris or store materials in tunnels 1 broken bag of concrete can contaminate 100’s of feet of tunnel

15. 15 We Put Patients First Regulatory Authorities Noise Suppression Power tools create sound pressure levels much higher than recommended (110 – 125 dBA) W.H.O. and U.S. EPA recommend hospital noise be limited to 30-40 dBA or as low as possible This is why many things are done by hand or on off hours – We Put Patients First!

16. 16 We Put Patients First Personal Protective Equipment All Entrants to sites must wear: Hard hats Safety Glasses High visibility clothing Gloves (workers only) For excessively dusty/dirty sites: Booties “Bunny” Suits Change inside the project area

17. 17 We Put Patients First NYP Rules HOUSE KEEPING It is your company’s responsibility to place all of garbage in piles – keep all debris piles neatly stacked. Any spillage must be cleaned up immediately and correctly. Garbage may not be left in any public areas, at any time. Materials may not be stored in stairways, public corridors, emergency egresses or in front of fire fighting equipment.

18. 18 We Put Patients First NYP Rules Fire Prevention Hot Work Any work with an open flame or that causes sparks Including grinding, burning, brazing, sweating, etc. Hot Work requires an NYP Hot Work Permit If the sprinkler is shut down, additional FDNY permits are required 24 hour notice to get a hot work permit

19. 19 We Put Patients First NYP Rules Hot Work (continued) Must be renewed daily Torch Operator Certificate of Fitness Issued by FDNY Fire Guard Certificate of Fitness Issued by FDNY 1 per Torch Operator Additional As Necessary Fire Extinguisher All of this is per FDNY C of F

20. 20 We Put Patients First NYP Rules Above Ceiling Work Inspection\Maintenance Permit Penetration Approval from Fire Safety, Infection Control, & Facilities Containment Cubes & Temporary Partitions ILSM Above Ceiling Work Vest

21. 21 We Put Patients First NYP Rules Waste Disposal All waste must be moved via the approved travel path Light fixtures, lamps, ballasts Must be disposed of in proper NYP supplied containers Do not throw out in regular trash

22. 22 We Put Patients First NYP Rules Regulatory Agencies Are ALWAYS at some campus of NYP Look into anything they want whenever they want Because we are NYP, we are held to a higher standard Regulatory Compliance (NYP) performs Daily Site Inspections NYP Project Manager, Safety, Infection Control conduct weekly inspections

23. 23 We Put Patients First NYP Rules Regulatory Agencies (continued) No Smoking on NYP property This includes e-cigarettes and any type of “Vaping” FDNY, Joint Commission, and NYC Law No flammable material storage over 2 1/2 gallon are permitted on site without the required FDNY permits and storage facility. Aerosol Cans stored in Flammable Storage cabinet, not job box Powder Charge ammo stored per FDNY regulations – ammo locker marked “Danger – Ammunition” Danger Ammunition

24. 24 We Put Patients First NYP Rules Regulatory Agencies (continued) Top 3 findings – consistent for more than 2 years Fire Extinguishers On the ground Undercharged Not inspected / tag missing Blocked Egress / Incorrect Egress lights Barriers Not smoke tight Unsecured site We can all do better!!!

25. 25 We Put Patients First Video

26. 26 We Put Patients First Imagine in the video: The fire alarm going off… The patient in the wheelchair waiting for a garbage container to go by… The patient trying to hear their doctor over a noisy construction site We put patients first! We want you to also!!!

27. 27 We Put Patients First Questions ? Special thanks to Skanska Construction for assistance with the presentation