Presentation is loading. Please wait.

Presentation is loading. Please wait.

Infection control risk assessment with construction and renovation

Similar presentations


Presentation on theme: "Infection control risk assessment with construction and renovation"— Presentation transcript:

1 Infection control risk assessment with construction and renovation
Cara Cruz, BA, RN, CIC Infection control risk assessment with construction and renovation

2

3 CAH – Barton Memorial Hospital and Renown
23 beds Avg daily census: 1,000 avg ED visits per month Carson City – closest larger hospital About me: Quality Manager, Infection Control Officer, Patient Safety Officer, Environmental Services Manager (2014) RN since 2004, LVN 2003: House Supervisor, Inpatient Manager, ICU, Med/Surg, Ortho, SNF, OB, clinic settings No other disclosures

4 Scenario: You are the lone IP and your hospital is remodeling an existing radiology room into a new stereotactic mammography room. Your Facilities staff and Administrators just informed you that this project will be starting within the next month. What do you do?

5

6 Purpose OF ICRA To maintain an environment that is safe and functional for patients, families, staff and others in the organization by the prevention of infections during construction, renovation, alterations, and maintenance work. Proper infection prevention and control practices are important during dust generating work to minimize exposure of hospitalized patients, visitors, and staff to micro- organisms, most notably filamentous fungi. Completed by Infection Preventionist – not facilities, contractor, etc.! Living document – may change

7 IP role Part of the team Patient Safety Officer
Safety Officer (Interim life safety measures – ISLM) Facilities Involvement from initial planning phase to completion ICRA complete before bid – precautions likely change bid Oversee construction precautions and risk of project related to infection control Resource and expert for infection control related issues (design, process, etc.)

8 Buy in Comply with regulatory agencies
State, Facility Guidelines Institute (FGI), Joint Commission Demonstrate the value of the team/IP involvement Demonstrate how input from IPs results in an enhanced outcome and lack of input leads to adverse outcome (HAIs, employee/contractor illness, etc.) Nationally recognized resources (APIC, FGI, Joint Commission, CDC (isolation rooms), OSHA, etc.) Policy & Procedures (examples in APIC Construction text)

9 Step 1: gather information
2 basic questions: EXACTLY what type of work will be done? Where is the project taking place?

10 TYPE OF WORK TO BE DONE Looking specifically for DUST GENERATION or SPORE ARESOLIZATION Minor cutting/drilling New flooring/walls/doors/cabinetry Removal or addition of building structures Complete demolition/renovation Duration Hours? Days? Weeks? Months?

11 4 “types” of construction activity
Type A: Inspection and noninvasive activities Removal of ceiling tiles for visual inspection only, limited to one tile per 50 square feet (or 8 square feet of tile) Painting (but not sanding) Wall covering replacement Electrical trim work Minor plumbing Activities which do not require cutting into walls/ceilings/floors other than for visual inspection

12 Type B: Small-scale, short duration activities that create minimal dust
Short duration = 1 day Installation of telephone and computer cabling Access to chase spaces Cutting of walls or ceiling where dust migration can be controlled

13 Type C: Work that generates a moderate to high level of dust or requires demolition or removal of any fixed building components or assemblies Sanding of walls for painting or wall covering Removal of floor/wall coverings, ceiling tiles, and casework New wall construction Minor duct work or electrical work above ceilings Major cabling activities Any activity that cannot be completed within a single work shift

14 Type D: Major demolition and construction projects
Activities that require consecutive work shifts Activities that require heavy demolition or removal of a complete cabling system New construction

15 WHERE? Nursing unit Hallway? Patient room? Ceiling? Flooring?
Nurses’ station? Patient Care area? Occupancy? Business hours work? Night/weekend work? Patient care vs staff only?

16 4 levels of risk related to location
Low Risk Office areas not within or near patient care areas Office space in Medium Risk areas not near to patient care areas Unoccupied/Vacant areas Outpatient areas after business hours unless noted in high risk Non-patient care areas not otherwise specified

17 Medium Risk Echocardiography Nuclear Medicine Physical Therapy
Radiology Respiratory Therapy Outpatient Clinics unless noted in high risk Public areas and public corridors Corridors in Medium Risk areas Office space – near medium risk patient care areas Areas with staff working during construction who are diagnosed by a physician with severe dust allergies or immune-compromised

18 High Risk Emergency Room Medical/Surgical Units Labor and Delivery
Laboratories Post Anesthesia Care Unit Office space – near high risk patient care areas Corridors in high risk areas Areas with staff working during construction who are diagnosed by a physician with severe dust allergies or immune- compromised

19 Highest Risk • ICU • Operating/Procedure Rooms • Transplant units
• Pharmacy • Negative pressure isolation rooms • Any area currently caring for immune-compromised patients • Central Sterile Supply • Interventional Radiology • Infusion Areas • Oncology • Food preparation/eating areas • Outpatient Surgical Suites

20 Step 2: Determine construction class
Class = procedures to be followed during projects IP judgement Risk Area Construction Project Type Type A Type B Type C Type D Low Risk I II III/IV Medium Risk III IV High Risk Highest Risk

21 Class I During project Upon completion Execute work by methods to minimize raising dust from construction operations • Immediately replace a ceiling tile displaced for visual inspection Clean work area upon completion of task

22 Class II Upon completion During project
Provide active means to prevent airborne dust from dispersing into the atmosphere Water mist work surfaces to control dust while cutting Seal unused doors with duct tape Block off and seal air vents Place dust mat at entrance and exit of work area Remove or isolate HVAC system in areas where work is being performed Wipe work surfaces with cleaner/disinfectant Contain construction waste before transport in tightly covered containers Wet mop and/or vacuum with high-efficiency particulate air (HEPA) filtered vacuum before leaving work area Upon completion, restore HVAC system where work was performed

23 Class III During project Upon completion
Remove or isolate HVAC system in area where work is being done to prevent contamination of duct system Complete all critical barriers, e.g., sheetrock, plywood, plastic to seal area from non-work area or implement control cube method (cart with plastic covering and sealed connection to work site with HEPA vacuum for vacuuming prior to exit) before construction begins. Maintain negative air pressure within work site utilizing HEPA-equipped air filtration units Contain construction waste before transport in tightly covered containers Cover transport receptacles or carts. Tape covering unless lid is solid. Do not remove barriers from work area until completed project is inspected by the Infection Control or Safety Officer or representative and they are thoroughly cleaned by EVS staff. Remove barrier materials carefully to minimize spreading of dirt and debris associated with construction. Vacuum work area with HEPA-filtered vacuums. Wet mop area with cleaner/disinfectant. Upon completion, restore HVAC system where work was performed.

24 Class IV During project Upon completion
Isolate HVAC system in area where work is being done to prevent contamination of duct system. Complete all critical barriers, e.g. sheetrock, plywood, plastic to seal area from non-work area or implement control cube method (cart with plastic covering and sealed connection to work site with HEPA vacuum for vacuuming prior to exit) before construction begins. Maintain negative air pressure within work site utilizing HEPA-equipped air filtration units Seal holes, pipes, conduits, and punctures. Construct anteroom and require all personnel to pass through this room so they can be vacuumed using a HEPA vacuum cleaner before leaving work site or have them wear cloth or paper coveralls that are removed each time they leave work site. All personnel entering work site are required to wear shoe covers. Shoe covers must be changed each time the worker exits the work area. Do not remove barriers from work area until completed project is inspected by the Infection Control or Safety Officer or representative and they are thoroughly cleaned by CVMC EVS staff. Remove barrier materials carefully to minimize spreading of dirt and debris associated with construction. Contain construction waste before transport in tightly covered containers. Cover transport receptacles or carts. Tape covering unless solid. Vacuum work area with HEPA-filtered vacuums. Wet mop area with cleaner/disinfectant. Upon completion, restore HVAC system where work was performed.

25 Step 3: Permit Indicate construction class
IP, Facilities, Project Manager signatures All precautions in place before project start Project Name: Date Prepared: Location of project: Permit No: Project Manager: Project Start Date: Contractor Performing Work: Estimated Duration: Supervisor: Permit Expiration Date: Risk Group: Low Medium High Highest Telephone: Construction Class: Construction project type: A B C D

26

27 Step 4: Daily checklist Class III or IV projects only
Completed by Project Manager upon completion of every shift Returned to IP at least weekly IP also tours project area regularly to ensure all precautions are being followed IP should have the right to stop a project if out of compliance/safety issues discovered Has # for IP and EVS on form Monetary penalties if plan/precautions not followed?

28

29 Other considerations ICRA will differ from facility to facility with circumstances Prepare to encounter mold from the start Licensed mold abatement contractor in plan STOP all construction in the area until it is treated Not treated by contractor or EVS staff Dust, noise, smells, vibrations to other areas Upstairs/downstairs, air circulation Containment issues Hole/tear in tape or plastic Gap from floor/ceiling Negative pressure

30 Path of travel Construction workers/equipment Waste removal Air circulation Break areas/eating – construction workers Allowed in cafeteria? Infection Control training for contractors and sub-contractors Internal vs external projects Photos

31 Scenario: You are the lone IP and your hospital is remodeling an existing radiology room into a new stereotactic mammography room. Your Facilities staff and Administrators just informed you that this project will be starting within the next month. What do you do?

32 Type: sealing old door, adding new door, adding new sink, removal of cabinets, new flooring, cabling, new desk/cabinets Where: Radiology Duration: 2-3 weeks, during daytime

33

34

35

36 Fill out permit Forward for signatures Checklist will need to be completed every shift (class III) Since process already started (bid, plan, etc.): Speak with contractor/facilities/review contract Ensure all precautions are in place before project starts Ensure all needed equipment available (HEPA filter, fans, ventilation, etc.) Review plans for room meet IC standards, review FGI with Safety Officer (handwashing sink for procedure room, instrument cleaning sink, etc.) Make a map for path of travel; walk it Ensure plan for mold abatement just in case Consider other potentially effected areas (upstairs, downstairs, connected air vents, smells, etc.) Ensure compliance with start of project Checklist compliance

37 Scenario: Your facility is replacing the autoclave, old flooring and adding stainless steel wall coverings to your ORs, reprocessing, and sterile supply areas. What do you do?

38 Type: removing current flooring, replacing with new flooring, adding stainless steel wall coverings (drilling, cutting, gluing, etc.) Where: ORs Duration: 5 days (day and night work)

39

40

41

42 Fill out permit Forward for signatures Checklist will need to be completed every shift (class III) Surgery will need to be shut down for this time period Notify EMS, Surgeons, Hospitalists, ED physicians, other departments for which instruments are processed, Leadership, PR Work in phases – team to arrange phases Arrange plan for where sterile supplies will be moved New “red line” for each phase Make map for path of travel Have mold abatement plan Ensure meticulous disinfection after project

43 References/resources
Vogel, Richard, MS, CIC, et. al. (2015). Infection Prevention Manual for Construction and Renovation. Tools | ASHE. (n.d.). Retrieved March 10, 2016, from APIC list serve APIC text

44 Thank you!! Cara Cruz, BA, RN, CIC Carson Valley Medical Center (775)


Download ppt "Infection control risk assessment with construction and renovation"

Similar presentations


Ads by Google