14 SOW Attachment 14 - IRCA.NEXTGen WiFi Riverton.pdf

SVAHCS HEALTHCARE SYSTEM

Infection Control Risk Assessment (ICRA)

Project Name: NextGen WiFi Update Project Number: N/A

Construction Location: Riverton CBOC Impact to area: Entire Facility Identify areas surrounding the project area and potential impact.

o Above: N/A o Below: N/A o Adjacent Areas: N/A

Project COR: Nicole Perez Telephone: 307-675-7385

Project CPs: OIT escort, CBOC point of contact Project Start Date: 08/12/2022

Estimated Duration: 1 Day

Contractor: AT&T SUB Contractor: TekSynap Corporation

Completion Date: 08-12-2022

GC Supervisor: Telephone:

Check applicable CONSTRUCTION ACTIVITY TYPE

Check applicable

IC PATIENT RISK

GROUP

TYPE A: Inspection, non-invasive activities, minimum dust levels GROUP 1: Low Risk

X TYPE B: Small scale, short duration, moderate dust levels X GROUP 2: Medium Risk

TYPE C: Generates moderate to high levels of dust, requires greater than one work shift for completion GROUP 3: Medium/High Risk

TYPE D: Major duration and construction activities requiring consecutive work shifts GROUP 4: Highest Risk

Project Construction Class:

REQUIREMENTS (in addition to page 4)

• Will remove a maximum of two ceiling tiles at one time

• Limit patient flow through work areas - SVA staff responsibility to ensure compliance

• Damp clean after work – all horizontal surfaces, including floors - SVA staff responsibility to perform

• Contractor is responsible for using a HEPA vac if drilling into walls

• Contractor is responsible for cover items on desks/counter if they will be removing ceiling tiles/working above the area with plastic

• Contractor is responsible for dry sweeping any debris generated

• Higher risk areas (related to drilling or cable pulling), such as supply rooms, lab, med rooms/pharmacy, and procedure rooms that may need items/equipment covered PROCEDURE ROOM

• SVA staff will need to assess high risk patients ie immunocompromised, cancer patients etc. and reschedule if necessary

• Wear face masks per facility requirements

• Notify OIT escort when work is finished

Infection Contol Digital Signature:

8/4/2022

X

Signed by: CAROLYN MELISSA INGALLS

Project COR / CP:

X

Implementation Checklist:

[X] Reviewed construction scope [] Notified Contractor of their responsibilities relative to ICRA.

Date Meeting was held: ___________________________

Persons Present: ____________________________________________, _ [] Developed a plan and train both appropriate hospital staff as well as construction personnel relative to

ICRA including a written and signed document attesting to said training.

[] Contractor will provide daily inspections and reports on construction site relative to ICRA.

See Attachment A and b [X] COR will notify Infection Prevention relative to all potential infection control deficiencies.

[X] Multidisciplinary team has been notified and concurs with plan.

[] Multidisciplinary team will review, and document weekly or other intervals as decided by the team.

STEP 1: Using the following table, identify the Type of Construction Activity

TYPE A

Inspection and Non-Invasive Activities. Includes, but is not limited to:

• Removal of ceiling tiles for visual inspection limited to 1 tile per 50 square feet.

• Painting (but not sanding).

• Wall covering, electrical trim work, minor plumbing and activities that do not generate dust or require cutting of walls or access to ceilings other than for visual inspection.

TYPE B

Small scale, short duration activities that create minimal dust. Includes, but is not limited to:

• Installation of telephone and computer cabling.

• Access to chase spaces.

• Cutting of walls or ceiling where dust migration can be controlled.

• Chipping and sanding of tile flooring <4 sq. feet

TYPE C

Work that generates a moderate to high level of dust or requires demolition or removal of any fixed building components or assemblies. Includes, but is not limited to:

• Sanding of walls for painting or wall covering.

• Removal of floor 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.

TYPE D

Major demolition and construction projects. Includes, but is not limited to:

• Activities that require consecutive work shifts.

• Requires heavy demolition or removal of a complete cabling system.

• New construction.

Step 1 Determination: TYPE:

Step 2: Using the following table, identify the Patient Risk Groups that will be affected.

Low Risk- Group 1

Medium Risk- Group 2

High Risk- Group 3

Highest Risk- Group 4 o Office areas o Library, o Chapel, o EMS o FMS o Ambulatory Care/ Outpatient Clinics, o Blind Rehabilitation o Audiology, Speech

Pathology o Echocardiography o Food Service Areas/Main patient hall o Laundry o Imaging (eg, Radiology, MRI, Nuclear Med) o Rehabilitation Svc o Prosthetics o Respiratory Therapy o Sleep Laboratory o Patient Access Hall o Clinical Labs o Pathology & Laboratory Svc o Echocardiography o Endoscopy o Emergency Department o Distribution o Pharmacy o Medical-Surgical Day Units o Patient Wards (eg, CLC, Medical, Surgical, Spinal Cord Injury, Psychiatry)

Areas caring for immunocompromised patients Bronchoscopy Cardiac Cath Lab Intensive Care Units (eg, CCU, MICU, PCU, SICU) Interventional Radiology SPS (Sterile Processing Service) Cardiac Catheter, Electrophysiology (EP) Laboratories Dental Clinic Dialysis unit Negative Pressure Isolation Rooms Pharmacy Admixture Areas Oncology (Radiation Therapy & Chemotherapy) Operating Rooms and PACU Procedural areas (ex. Cysto, Derm, etc.)

Step 2 Determination: RISK:

CONSTRUCTION PROJECT CLASS

Patient Risk Group TYPE A TYPE B TYPE C TYPE D

LOW Risk Group I II II III/IV

MEDIUM Risk I II III IV

HIGH Risk Group I II III/IV IV

HIGHEST Risk II III/IV III/IV IV

Step 3 Project/ Construction Class: CLASS

INFECTION CONTROL RISK ASSESSMENT – ADMINISTRATIVE ACTIONS

Applicable ICRA Administrative Action

Tightly seal construction perimeter and inspect critical barriers for integrity. Verify negative air pressure with airflow from clean (hospital/clinic/support spaces) to dirty areas (construction areas).

Construction site has proper traffic flow and warning signage. Demonstrate compliance with traffic flow patterns including demolition/construction movement.

Track dirt compliance aids are in place at the doors leading to the hospital/clinic/support spaces.

Housekeeping performed frequently to prevent accumulation and spread of dirt and fine dust including regular HEPA vacuuming and damp wiping construction perimeter barriers.

Demonstrate active means that prevents airborne particles from migrating to hospital, clinical, support care areas including: HEPA vacuums, automatic self-closing construction doors, appropriate exhaust machines, debris chutes.

Block off, seal, remove or isolate open pipes, open conduits, penetrations, barrier punctures, HVAC system air vents in work area to prevent dirt and fine dust migration.

X Surfaces in adjacent hospital, clinical, support areas frequently inspected for visible dirt or fine dust and cleaned immediately with suitable materials.

Demonstrate appropriate debris transport … covered cart, dedicated elevator, designated route, etc.

Immediate control of water leakage must be handled in an emergency fashion in occupied areas. Large leaks may necessitate drying. (<72 Hrs.).

Compliance with coverall clothing when indicated by Class Precaution.

Tools and equipment damp-wiped prior to entry and exit from sterile and invasive procedure areas.

Windows, access doors, and debris chutes are closed and secured at the end of each day.

X Areas cleaned, and trash disposed at the end of each working day.

X Pest control … No visible signs of birds, insects, rodents or other vermin.

X Compliance with the required Infection Control Activities by Class Precautions.

Conduct infection control training and education to ensure awareness of construction hazards, infection control deficiencies, and compliance with the required infection control measures.

X Conduct infection control risk assessment (ICRA).

Infection Control Activities by Class Precautions During Project Construction Upon Project Completion

C la ss I

1. Keep area free of debris & trash.

2. Immediately reinstall ceiling tiles displaced for inspections.

3. Traffic Flow: Decrease exposure of patients/staff to construction.

4. Utility Shutdowns: If necessary, schedule interruptions during low activity.

5. Pest Control: Address any visible signs of birds, insects, rodents or other vermin.

6. Vacuum/sweep and wet mop surfaces daily and as needed to control debris/dust.

7. Execute work by methods to minimize dust production & migration from construction operations.

Perform clean up and disposal in accordance with contract requirements.

C la ss

II

In a dd iti on to C la ss

I

1. Dust containment barriers secure at perimeter edges.

2. Ceiling tiles in place at adjacent areas outside barrier.

3. Water mist work surfaces to control dust while cutting.

4. Unused openings (doors, windows) properly closed and sealed with masking tape.

5. Block-off, seal, remove or isolate HVAC system air vents to prevent contamination migration.

6. Place walk-off mat at work areas to prevent tracking of construction dust into surrounding areas.

7. Provide active means to prevent airborne dust from dispersing into atmosphere. HEPA vacuums, automatic self-closing construction doors, appropriate exhaust machines, debris chutes.

a. Clean work surfaces with HEPA vacuum.

b. Remove HVAC system isolation where work is complete.

c. Mop and/or wipe work surfaces with approved disinfectant.

C la ss

II

I In a dd iti on to C la ss

II

1. Inspect adjacent areas for dust migration and correct immediately.

2. Tightly cover material transport receptacles/carts. Contain construction waste in tightly covered containers before transport.

3. Maintain negative air pressure within work site utilizing HEPA air filtered machines.

4. Disinfect tools and equipment prior to entry and exit from sterile and invasive procedure areas.

5. Complete all critical barriers, i.e. sheetrock, plywood, plastic to seal area from non-work area or implement control cube method (container with suitable cover and sealed connection to work site with HEPA vacuum for cleaning prior to exit).

a. Clean remaining impacted areas with HEPA vacuum.

b. Mop/Wipe remaining impacted areas with approved disinfectant.

c. Tightly cover material transport receptacles/carts. Contain construction waste in tightly covered containers before transport.

d. Do not remove barriers from work areas until completed project is thoroughly cleaned and inspected by the VA Safety Officer and Infection Control Practitioner.

e. Clean & remove barrier materials carefully to minimize spreading of dirt and debris associated with construction. C la ss

IV

In a dd iti on to

C la ss

II

I

1. Temporarily relocate staff/patients away from impacted areas if possible.

2. Seal holes, pipes, conduits, penetrations and barrier punctures to prevent dirt and fine dust migration.

3. All personnel entering the work site are required to wear shoe covers. Shoe covers must be removed each time the worker exits the work area.

4. d. Either construct anteroom and require all personnel to pass through this room and be HEPA vacuumed clean before leaving the work site or optionally require all personnel to wear cloth/paper coveralls that are removed each time the worker exits the work area.

Attachment A

INFECTION CONTROL RISK ASSESSMENT (ICRA) DAILY INSPECTION FORM

INSTRUCTIONS: This form is to be utilized when infection controls are impacted, or construction activities are in progress.

ICRA must be implemented upon project start and continuously enforced through project completion to provide a level of infection control comparable to that required by EPA, OSHA and the Life Safety Code. Submit completed forms to the VA Infection Control Practitioner & Project Engineer.

Project Name: Project Number:

Construction & Impact Description: Construction Locations:

Identify areas surrounding the project area and assess potential impact.

Project Start Date:

Project COTR: Project Start Date:

Project CPs: Estimated Duration:

Completion Date:

Contractor:

GC Supervisor: Telephone:

Contractor CP:

Inspection Comments/Findings: (PROVIDE DETAILED EXPLAINATION OF EXCEPTIONS/DEFICIENCIES)

Signature/Date:

Project CPs GC Safety Manager

Attachment B

INFECTION CONTROL RISK ASSESSMENT (ICRA) DAILY INSPECTION FORM

Locations

IC Measure and Class Precaution

C L

A

SS

Inspection Date

SUN

MON

TUE

WED

THR

FRI

SAT

CP

Initials

BARRIERS

1. Dust containment secure at perimeter edges II

2. Doors/Windows properly closed/sealed II

3. Inspect integrity of dust critical barriers III

4. Relocate staff/patients from impact areas IV

5. Seal openings/penetrations daily IV

6. Verify anteroom operation IV

AIR HANDLING

7. Isolate/Shutdown HVAC II

8. Seal off building air ducts/vents II

9. Negative air machines running III

10. Negative air properly exhausted III

11. Verify negative air pressure frequently III

12. Negative air machines cleaned daily III

PROJECT AREA

13. Minimize raising dust I

14. Area free of debris & trash I

15. Area free of birds, insects, rodents, vermin I

16. Wash hands frequently I

17. Wet mop daily& as needed I

18. Housekeeping performed as needed I

19. Reinstall SAT displaced for inspections I

20. Prevent dust dispersion into atmosphere II

21. Contain SAT & fiberglass as removed II

22. Water mist work surfaces as needed II

23. Wipe surfaces with disinfectant II

24. Adjacent area SAT in place II

25. HEPA vacuum frequently II

26. Sticky mats in use II

27. Debris/Trash in covered container III

28. Inspect adjacent areas for dust migration III

TRAFFIC CONTROL

29. Route flow away from construction I

30. Traffic flow/warning signs posted I

DRESS CODE

31. Workers wear head covers IV

32. Workers wear/change shoe covers IV

33. Workers wear coveralls IV

34. Vacuum self upon leaving area IV

OTHER

35. Use drills with vacuum II

36. Use saws with vacuum II