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Patient Infection Prevention Critical During Construction Projects

DocOfficeInfections acquired during hospital care are a leading cause of death in the United States, striking 4.5 of every 100 patients admitted to hospitals. According to the National Healthcare Quality Report in 2011, an estimated 1.7 million Hospital Acquired Infections (HAI) occur each year in hospitals in the United States, leading to about 100,000 deaths.

When construction or renovation work is being done within a healthcare facility, HAIs are a very serious concern for the patients and the hospital due to construction work bringing in opportunistic pathogens. The prevention of HAIs is such an important part of hospital care and it is critical to the hospital’s accreditation by the Joint Commission (JC). Terracon has helped clients during project planning and implementation to directly support the hospital quality of service in the prevention of HAIs.

The Healthcare Infection Control Practices Advisory Committee (HICPAC) in 2003 published the Guidelines for Environmental Infection Control in Health-Care Facilities, used today during planning and execution of projects in hospitals and other healthcare settings to control the migration of pathogens.

Construction and engineering firms should be familiar with these guidelines in order to implement proper planning for hospital projects.

  • Incorporate mandatory adherence agreements for infection control in construction contracts with penalties for non-compliance.
  • Implement infection control measures for external and internal construction activities, including erecting construction barriers to prevent dust from entering patient care areas, seal off and block return air vents, implement dust control measures on surfaces, and relocate patients whose rooms are adjacent to work zones (depending on their immune status, scope of work, etc.).
  • Use airborne particle sampling as a tool to evaluate barrier integrity.
  • Commission the HVAC system before occupancy and use, with emphasis on ensuring proper ventilation for operating rooms, patient rooms, and patient exam areas.

The chart at the bottom of the page is a tool used during the assessment of the construction or renovation work to help determine the precaution class level of requirements that is necessary to implement during the project to control the migration of contaminants into planned or current patient areas. For example, demolition of a wall and other interiors to renovate a hospital wing that is next to the intensive care and a cardiac unit might be classified as a Type C activity with Group 4 patient risk. This intersection would require Class III or IV precautionary steps be developed and included in the design plans to assure that contaminants do not migrate or contribute to HAIs during construction.

At the beginning of a project, develop a plan that incorporates methods that mitigate the potential for infectious agents to migrate into patient areas. Following these steps and integrating them into the project can minimize, if not eliminate, the potential for HAIs.

Step 1: Establish the Project Team

A team consisting of representatives of infection control, design engineer, architect, industrial hygiene services, administration and risk management should address the scope and design of the construction project, the risks for airborne disease and opportunities for prevention, control measures to contain dust and moisture, and how to manage infection control procedures.

Step 2: Conduct a Risk Assessment

The next step is to conduct an Infection Control Risk Assessment (ICRA) to determine the level of controls and protocols to be implemented during project work using the table below previously discussed.

Step 3: Provide Training

Upon completion of the ICRA, training must be conducted to educate the staff and construction employees regarding airborne and waterborne infection risks associated with construction projects and methods to control them.

Step 4: Implement Control Measures

The contractor sets up the control measures as developed using the ICRA, such as isolation barriers, sealing doors and windows, controlling air flows, personal protective equipment, and air or water sampling.

Step 5: Conduct Monitoring

An environmental engineering or industrial hygiene professional should monitor the air quality of the site and adjacent areas, taking baseline readings prior to setting up the enclosures and frequent samples during construction work.

Step 6: Perform Post Construction Inspection and Clearance Testing

At the completion of the construction, final inspections and clearance testing need to be conducted before turning the new space over to the hospital.

Contact us today if we can help you with a healthcare facility project.