1 Construction and Renovation Activities in Healthcare Facilities What construction crews should know, but were afraid to ask!

2 Construction/Renovation and Infections Describe how construction and renovation may be associated with infections in certain patients. Review methods to control infections associated with construction and renovation.

3 Definitions Airborne Infections Aspergillus Legionella Immunocompromised patients High efficiency particulate air (HEPA) filters Negative air pressure ventilation

4 Aspergillus (I) Is a mold: found everywhere Very hardy: spores difficult to get rid of Collects in dust and thrives in moisture: –ventilation systems –false ceilings –walls Becomes airborne when disturbed

5 Aspergillus (II) Construction and renovation makes spores airborne In immunocompromised patients: –lung infection: inhaled –sinus and brain infections: inhaled –skin infections: settles on broken skin –infection in other parts of the body: eye, liver, bone, heart

6 Immunocompromised Patients Transplant recipients, especially bone marrow Chemotherapy Chronic Diseases: lung Premature infants Intensive care unit patients

7 Disturbing the Peace: Come Fly with Me Removing and demolishing: –fireproofing material –ceiling tiles –plasterboard –cabinets –wet material: plumbing fixtures Transportation of uncovered debris

8 Hospital control and Patrol: Hold the Dust Provide floor to ceiling barriers that completely enclose the work areas: –For small projects: thick plastic (visqueen) dust abatement curtain: must be well-sealed –Moderate and large projects: wall boards and door with caulked seams

9 Hospital Control and Patrol Hold the Dust Dust mats –at places of entry and exits –replace when soiled Cover work clothes for high risk areas –use head gear –shoe covers –coveralls

10 Hospital Control and Patrol: Hold the Dust (II) Negative air flow: all corridor air is sucked into work area: –HEPA filter in work area removes spores –Exhaust fans allow external venting –Closed windows and doors maintain negative air flow –Block ventilation ducts prevent contamination of ventilation system

11 Hospital Control and Patrol: Hold the Dust (III) Traffic patterns –Use designated elevators, stairs –Go from clean to dirty Use wet mops to remove dust in work areas and path of debris carts Clean equipment before entry and removal from work areas Use HEPA filter vacuum for heavy dust

12 The Intrusive Water and Asperillus Stop the leak and dry completely Molds will grow if spills are not dried within 48 hours Molds grow well in humidity > 60% Use meter to detect wetness Notify project manager and infection control if area still wet after 48 hours

13 The Watchful Eye Monitor air flow in construction area daily Keep barriers in place Prevent dust accumulation Seal debris and debris carts Careful with work clothes Questions? Ask Infection Control!

14 Legionella: Water Distribution Excavation may aerosolize organism from soil: –contaminate cooling towers –air intake systems –water pipes Causes severe pneumonia Inhalation of contaminated aerosol

15 Outdoor Construction and Demolition Locate fresh air intake systems –Change filters more frequently Control dust with water mist Fracture of the water lines may contaminate water supply