ENVIRONMENTAL INFECTION CONTROL DURING CONSTRUCTION AND RENOVATION Presented By: Doug Marshall

WHAT IS IT?  Identifying hazards that could potentially compromise patient care  Implementing proper controls to reduce risk and minimize the impact of hazards created by demolition, renovation, and/or new construction activities Environmental Infection Control

What is it? (cont.) Environmental Infection Control Impacts may include those on air or water quality, infection control, utility and equipment requirements, noise and vibration, emergency procedures, etc.

 Sensitive patients, physically and/or mentally  Compromised immune systems (illness or medication)  Critical medical procedures  Critical services, utilities, and equipment that cannot be damaged or disrupted  Need for stable indoor environment Why the concern? Environmental Infection Control

 Air- Particulates  Dust  Microbials  Gases/Fumes/Odors  Waterborne Contaminants  Misc. Nuisances  Noise/Vibration Contaminants of Concern Environmental Infection Control

DUST PARTICULATES  General Dust  Demolition/Dismantling  Sanding/Cutting Environmental Infection Control > Contaminants

 Microbial “reservoirs” in flooring, wall cavities, HVAC systems, materials affected by water damage or high humidity, or spores brought in from outdoors  May include molds that are pathogenic, toxic, and/or allergenic (especially Aspergillus)  May include bacterial growth Microbial Particulates Environmental Infection Control > Contaminants

 Gases/Fumes/Odors  Welding/Soldering  Cutting/Grinding  VOCs- off-gassing of new products, adhesives, etc.  Chemicals/Cleaners Other Contaminants Environmental Infection Control > Contaminants

 Not necessarily environmental contaminants, but potentially disruptive  Increased foot and vehicle traffic  Alternate routes of building exit/entry  Alternate emergency/fire evacuation routes and procedures  Abnormal “loads” on utilities or equipment Misc. Issues Environmental Infection Control > Contaminants

May affect patients and/or employees  premature neonates  recent ICH or stroke  neurological/psychiatric disorders May affect critical procedures/testing  EEG or EKG  hearing assessments  neurological studies  fine motor skill procedures  certain laboratory procedures  sleep studies, etc. Noise & Vibration Environmental Infection Control

The Joint Commission (TJC) AIA Guidelines for the Design and Construction of Hospital and Health Care Facilities (mandated by state law) CDC Guidelines on Environmental Infection Control State Licensure (depending upon state ) Current Regulations & Guidelines Environmental Infection Control

EC.8.30  Demolition, Construction or Renovation, and Maintenance  Proactive risk assessment  Identify hazards that could potentially compromise patient care  Address impact on requirements/procedures TJC Environment of Care Std. Environmental Infection Control > Regulations & Guidelines

EC8.30 CONSTRUCTION, DEMOLITION, AND MAINTENANCE/REPAIR  Infection Control Risk Assessment  (Multi-disciplinary team approach to project review for prevention of airborne & waterborne nosocomial disease.)  design and function of new area  At risk patients  dust and moisture containment  Noise/vibration  What contingency plans are in place for unexpected outages Environmental Infection Control > Regulations & Guidelines

CDC GUIDELINES FOR EIC Construction, Renovation, Remediation, Repair and Demolition ICRA (Infection Control Risk Assessment) Multi-disciplinary team Risk assessment of project P&P to protect patients Procedures to correct problems rapidly Environmental Infection Control > Regulations & Guidelines

CDC GUIDELINES FOR EIC CDC Guidelines- Major Air Quality Issues Air Sampling External and Internal demolition- Are Barriers Required?  Working with plumbing in sensitive areas  Exposure of ceiling spaces  Crawling into ceiling spaces  Work on elevator shafts  Demo of wallboard, plaster, ceramic tile, ceiling tile Environmental Infection Control > Regulations & Guidelines

CDC GUIDELINES FOR EIC (CONT.)  Major Air Quality Issues (cont.)  Removal of flooring  Removal of windows and doors  Removal of casework  HVAC systems design and filtration  HVAC maintenance and repair  duct cleaning  system shutdown  moisture in system  backup emergency power Environmental Infection Control > Regulations & Guidelines

AIA GUIDELINES (CHAPTER 5) For all new construction and renovation Consultation from infection control professionals, and safety professionals Development of an ICRA Initiated in planning and design and continued through construction/renovation Performed by multi-disciplinary panel Documented!! Environmental Infection Control > Regulations & Guidelines

CHAPTER 5 ICRA- BASIC ELEMENTS  Impact of disrupting essential services  Patient placement and relocation  Placement of barriers  Evaluation of ventilation needs  Number of AII and PE rooms  Patient protection from:  Demolition  Un-planned outages  Movement of debris  Patient flow through building Environmental Infection Control > Regulations & Guidelines

ICRA MATRIX  Aids in determining proper work practices and types of engineering controls, and monitoring required.  Assesses risk based upon the patient risk group and types of activities performed Environmental Infection Control > Risk Assessment

 Type A- (Inspection and Non-invasive)  removing ceiling tile for inspection  painting without sanding  wall-covering  electrical trim  minor plumbing  Type B (Work Activities)  Small scale/ short duration  Minimal dust created ICRA Matrix (cont.) Environmental Infection Control > Risk Assessment

Type C (Work Activities)  Demolition/removal of fixed building parts  Moderate-high dust, including sanding, flooring removal, ceiling tiles & casework, major cabling,  Can’t be done in 1 shift Type D (Work Activities)  Major demolition/construction  High dust created, including heavy demo, removal of walls, new construction  Required consecutive work shifts ICRA Matrix (cont.) Environmental Infection Control > Risk Assessment

Containment of Dust and Debris  Controlling construction related activities  Envelope penetrations  Building shafts, chutes, stairwells and elevators  Removal of materials from building  Electrical and water system shutdowns  HVAC system shutdowns, potential for passive ventilation Engineering Controls Environmental Infection Control > Engineering Controls

 Defining contractor points of entry/exit  Use of tacky mats and disposable suits  General containment barriers  Control cubes for point of entry  Negative pressure requirements  HVAC system protection and isolation Common Controls Environmental Infection Control > Engineering Controls

Short-duration  Fire-resistant plastic  Airtight with Negative Pressure Long Duration  Install plastic barrier while building rigid barrier  Drywall on metal studs  Floor to floor construction  Seal and tape all joints, edges, holes, etc. Types of Barriers Environmental Infection Control > Engineering Controls

Protect building ventilation systems (i.e. fresh- air intakes) Control building entrances Window/door infiltration Access to construction zones Building tie-ins Street cleaning Emergency response Consider Outside Influences Environmental Infection Control > Engineering Controls

 Establish background bio-aerosol levels prior to construction  Compare levels during and after construction to these baselines  Include viable and non-viable particles  Monitor ventilation (air changes, filtration, pressure) Monitoring Environmental Infection Control

Baseline and before occupancy (“Commissioning”)  Insure proper ventilation and cleanliness  Provides comparison data for later if necessary Ongoing Surveillance  Pressure differentials  Air Exchanges  Particle count for filtration efficiency When Should You Sample? Environmental Infection Control > Monitoring

 Positive vs. Negative Pressure  Air Flow Velocities  Affects of doors and window  Elevator shafts Understand Air Flow in the Building Environmental Infection Control

OVERALL GOALS:  Save Lives through:  Changing attitudes toward construction and maintenance  Use proper techniques even if not the Easiest/cheapest  Planning ahead Environmental Infection Control

QUESTIONS AND ANSWERS ?