Every year, many lives are lost due to the spread of infections in hospitals. Health care workers can take steps to prevent the spread of infectious diseases. Identifying hazards that could potentially compromise patient care and implementing proper controls to reduce risk and minimize the impact of hazards created by renovation, demolition and new construction activities. Those projects could impact infection control, air or water quality, utility and equipment requirements, noise and vibration. Healthcare workers are occupationally exposed to many infectious diseases during the performance of their normal duties. The delivery of healthcare services requires a broad range of workers, such as physicians, nurses, technicians, and clinical laboratory workers, first responders, building maintenance, security and administrative personnel. Since, healthcare workers have many different tasks or work in different parts of the facility each employee will be exposed to different infectious agents and in different amounts.

1. ENVIRONMENTAL INFECTION CONTROL
DURING CONSTRUCTION AND RENOVATION
Presented By: Doug Marshall
amienvironmental.com

2. OBJECTIVES
Infection Control Risk Assessement
 Physical and Biological Hazards
 Reservoirs for Bio-Contaminants
 Measures of Effective Control

3. Environmental Infection Control
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

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

5. Environmental Infection Control
Why the concern?
 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

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

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

8. Environmental Infection Control > Contaminants
Microbial Particulates
 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

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

10. Environmental Infection Control > Contaminants
Misc. Issues
 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

11. Environmental Infection Control
Noise & Vibration
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.

12. Environmental Infection Control
Current Regulations & Guidelines
 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)

13. Environmental Infection Control > Regulations & Guidelines
TJC Environment of Care Std.
 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

14. 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

15. 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

16. 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

17. 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

18. 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!!

19. 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

20. Environmental Infection Control > Risk Assessment
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

21. Environmental Infection Control > Risk Assessment
ICRA Matrix (cont.)
 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

22. Environmental Infection Control > Risk Assessment
ICRA Matrix (cont.)
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

23. Environmental Infection Control > Engineering Controls
Engineering Controls
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

24. Environmental Infection Control > Engineering Controls
Common 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

25. Environmental Infection Control > Engineering Controls
Types of Barriers
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.

26. Environmental Infection Control > Engineering Controls
Consider Outside Influences
 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

27. Environmental Infection Control
Monitoring
 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)

28. Environmental Infection Control > Monitoring
When Should You Sample?
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

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

30. 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

31. QUESTIONS AND ANSWERS
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