Attachment_12_Infection_Control_Risk_Assessment_Policy_IC.2014.17.0.pdf

DEPARTMENT OF HEALTH AND HUMAN SERVICES

INDIAN HEALTH SERVICE

WESTERN OREGON SERVICE UNIT

CHEMAWA INDIAN HEALTH CENTER

DEPARTMENT

INFECTION CONTROL

TOPIC:

INFECTION CONTROL RISK ASSESSMENT

POLICY #

IC.2014.17.0

POLICY:

The patient care environment throughout the Western Oregon Service Unit (WOSU) will be maintained in a state of cleanliness that meets professional standards in order to protect patients and employees from potentially infectious microbial airborne contamination.

PURPOSE:

To control microbial airborne contamination in occupied patient care areas during demolition, renovation, and new construction projects.

DEFINITIONS:

Health Center – Chemawa Indian Health Center (WOSU) School – Chemawa Indian School

STAFF GOVERNED BY THIS POLICY:

All contractors, subcontractors, and staff involved in construction or renovation activities.

Effective Date:

New/Revised Date:

9/14/15

Approved By:

Infection Control Officer

AAAHC# Chapter 8.P.

1.0 General Policy:

1.1 A multidisciplinary team that includes Infection Control and Facilities Management will conduct a proactive ICRA during the design and planning phase for all demolition, renovation, and new construction projects.

1.2 The team will provide ongoing planning and monitoring during area preparation;

throughout demolition, renovation, or construction activities; clean up and preparation activities for return to service; and final project review phases.

1.3 ICRAs will focus on prevention, but will also address monitoring, testing, and intervention when problems are identified.

2.0 Responsibilities:

2.1 Chief Executive Officer (CEO):

a. Appoint a multidisciplinary team that includes Infection Control and Facilities

Management to ensure adequate air quality precautions are in place and strictly enforced whenever construction, renovation, or demolition activities are performed in occupied areas within the Health Center.

b. Approve/disapprove Infection Control recommendations for moving patients and staff to another area of the facility that is not affected by construction.

2.2 Facility Manager:

a. Shall identify at-risk construction, renovation, and demolition activities.

b. Coordinate Class II and higher Demolition, renovation, and construction projects with the Chief Executive Officer, the Infection Control Officer or her/his designee, the Safety Officer, the Fire Department if appropriate, housekeeping, staff of the affected program, and the contracting officer’s representative

(COR)/contractor.

c. Ensure contract documents require contractors to implement ICRA requirements during construction by including the following, or similar language in all contracts: “THE INFECTION CONTROL OFFICER OR HER/HIS DESIGNEE

SHALL APPROVE PROJECTS INVOLVING MANIPULATION OF CEILING TILES,

PERFORMANCE OF DUST GENERATING ACTIVITIES, MANIPULATION OF

HEATING, VENTILATION, AND AIR CONDITIONING (HVAC) SYSTEMS, PLUMBING,

AND/OR OTHER MAINTENANCE REPAIRS PRIOR TO THE INITIATION OF THE

PROJECT.”

d. Initiate an ICRA in the design and planning phase for each construction project.

e. Routinely monitor construction for contractor compliance with the ICRA.

f. Inspect construction areas after final cleaning and approve opening/reopening of the area.

g. Verify that construction personnel receive orientation and training in the infection prevention and control measures identified on the ICRA prior to start of work.

2.3 Infection Control Officer or her/his designee:

a. Identify high-risk patient populations or areas in consultation with the Medical

Supervisor or his/her designee.

b. Determine whether construction poses sufficient increased risk to require/recommend that patients be moved to an area of the facility that is not affected by construction.

c. Assist the Facilities Manager in preparing contractor expectations for infection control practices and criteria for emergency work interruptions.

d. Educate staff about risks associated with potential exposure to microbial contamination, inorganic particulates, and volatile organic chemicals resulting from construction activities.

e. Inspect construction areas after final cleaning and approve opening/reopening of the area.

f. Conduct routine surveillance to identify nosocomial illness, initiate environmental and epidemiological investigations (including retrospective reviews) to identify and eliminate sources of infection if more than one case is found, alert clinicians caring for high-risk patients, and establish a system for prospective surveillance for additional cases.

g. Maintain all ICRA records in accordance with IHS policy and procedures.

2.4 Assigned Housekeeping staff will:

a. Work with Infection Control to identify areas that need to be damp mopped/cleaned and clean these areas as scheduled.

b. Thoroughly clean new and renovated areas before admitting or readmitting patients.

c. Coordinate inspection of final cleaning with Infection Control and the Facilities

Manager prior to opening/reopening the area.

2.5 The Director of Nursing will:

a. Work with Infection Control to identify high-risk patients/areas.

b. Follow procedures in approved ICRAs during construction.

2.6 The Safety Officer will:

a. Oversee the implementation of and compliance with the ICRA and related

Infection Control Construction Permit.

b. Report all ICRA-related activities to the Risk Management Committee on a monthly basis.

3.0 Procedures:

3.1 Conduct and document ICRAs by completing the following steps 1 through 6:

(1) Define the Construction Activity using Table 1 included in Attachment 1.

(2) Identify the Risk Category using Table 2 included in Attachment 1.

(3) Define the risk using Table 3 included in Attachment 1.

(4) Prepare the Infection Control Construction Permit using Tables 4, 4A, and 4B in

Attachment 2.

(5) Complete daily monitoring to ensure workers/contractors follow infection control guidelines and policies, using Attachment 3.

(6) Complete final infection control inspection upon completion of construction or renovation, using Attachment 4.

3.2 Nosocomial Infections:

a. If a nosocomial infection occurs during construction, intensify surveillance to identify additional cases, searching both prospectively and retrospectively. If no evidence of ongoing transmission is discovered, continue with routine infection control measures. In the event more than one case is found, conduct environmental and epidemiological investigations to identify and eliminate the source of infection.

4.0 References:

Adapted from a recommendation from Matthew Ellis, MPH, REHS

Lieutenant Commander, USPHS, Institutional Environmental Health Officer

Attachment 1

Table 1: Definitions of Construction Activities Construction Type Description

A Inspections 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 with minimal dust production; installing wall covering; electrical trim and minor plumbing work; and activities that do not generate dust or require cutting of walls or access to ceilings other than for visual inspections.

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.

C Any work that generates a moderate to high-level amount of dust or requires demolition or removal of any fixed building components or assemblies. Includes, but is not limited to sanding of wall for painting or wall covering, removal of floor coverings, ceiling tiles and case work, new wall construction, minor duct or electrical work above ceilings, major cabling activities, and any activity that cannot be completed within a single work shift.

D Major demolition and construction projects. Includes but is not limited to activities that require consecutive work shifts, require heavy demolition or removal of a complete ceiling system, and new construction.

Table 2: Infection Control Risk Assessment (Circle One) Low Medium Medium-High High

Office areas

Other:

All patient care areas (unless stated in medium to high or high risk areas)

Other:

Radiology

Pharmacy

Dental Department

Dining Facility/Break Room

Laboratories (specimens)

Special Procedures

Other:

Sterile Processing Areas

Pharmacy Mixture Areas

Other:

Table 3: Risk Assessment Matrix Construction Activity

Risk Group A B C D

Low I II II III/IV

Medium I II III IV

Medium-High I II III/IV IV

High III III/IV III/IV IV

Attachment 2

Table 4: Infection Control Construction Permit Project Number/Description: Project Type:

Maintenance Renovation

Demolition New Construction

Maintenance Other

Estimated Start Date: Estimated Completion Date:

Facility Manager: Phone:

Contractor: Phone:

Infection Control Officer or her/his designee: Phone:

Location: Supervisor/Phone:

Construction Type: (Circle One)

A B C D

Risk Group (circle one) Risk Assessment: (Circle One)

I II III III/IV IV Low Medium

Medium-High High

Projected Utility Outages Impacting Infection Control (Mark all that apply) Electrical

Power HVAC Potable

Water Sewage Disposal

Medical Vacuum Other:

List all construction equipment that may generate noise, vibration, and/or interference with Medical Equipment (Electro Magnetic Interference):

NOISE VIBRATION VIBRATION

COMMENTS:

Table 4A: Prevention and Control Measures (Mark all that apply) Risk Assessment Prevention/Control Measure

I Use work practices that will minimize generation of dust from construction operations.

Immediately replace any ceiling tiles displaced for visual inspection.

II Provide means (e.g., fire-rated plastic sheeting) to prevent airborne dust from dispersing into the atmosphere.

Water mist work surfaces to control dust while cutting.

Seat unused doors with low tack.

Block off and seal air vents.

Wipe surfaces with disinfectant.

Contain construction waste before transport in tightly covered containers.

Wet mop and/or vacuum with HEPA filtered vacuum before leaving work area.

Place dust mat at work area entrances and exits.

Isolate HVAC system in work area.

III Isolate HVAC system in work area.

Install fire-rated barriers or implement control cube method before construction begins.

Maintain negative air pressure within work area, utilizing HEPA equipped air filtration units.

Keep barriers in tact until project is completed and area is thoroughly cleaned by housekeeping.

Vacuum work area with HEPA-filtered vacuums frequently.

Wipe surfaces with disinfectant.

Remove barriers carefully to minimize spreading dirt and debris associated with construction.

Contain construction waste before transport.

Cover waste transport containers or carts, tape coverings if lids or covers are not tight.

IV Isolate HVAC system in work area.

Install fire-rated barriers or implement control cube method before construction begins.

Maintain negative air pressure within work area, utilizing HEPA equipped air filtration units.

Seal holes, pipes, conduits, and punctures appropriately.

Construct anteroom and require all personnel to pass through this room so then can be vacuumed with HEPA vacuum cleaner before leaving work area, or wear cloth or paper coveralls that are removed each time they leave the work area.

Require all personnel entering work area to wear shoe covers.

Keep barriers in tact until project is complete and thoroughly cleaned by housekeeping.

Vacuum work with HEPA-filtered vacuums daily or more frequently as needed.

Wet mop adjacent areas with disinfectant daily or more frequently as needed.

Remove barriers in a manner to minimize spreading dirt and debris associated with construction.

Contain construction waste before transport.

Cover waste transport containers or carts, tape coverings if lids or covers are not tight.

Table 4B: Other Risk-Reduction Strategies Keep patient doors adjacent to the construction area closed.

Seal exterior windows to minimize infiltration from excavation debris.

Designate alternate routes in the facility that detour staff, patients, and visitors around the construction site.

Schedule major construction projects during winter months when risk of fungal infection is lowest.

Designate a construction-only elevator, entrance, and walkway for construction crew.

Remove construction debris through a window on floors above the ground level.

Relocate high-risk patients to an area removed from the construction site.

Post signage related to non-authorized entry into the work area.

Designate storage areas for construction materials.

Train and educate healthcare staff, facility workers, construction workers (Mark all that apply):

Infection Control Exposure Control Plans

Hazardous Chemicals

Life Safety

Accident Reporting

First Aid

Personal Protective Equipment

Reporting unexpected environmental emergencies (e.g., lead-based paint, asbestos-containing material, etc.)

Other:

Prepared/Reviewed by:

Infection Control Officer or her/his designee Date

Approved by:

Laura Herbison, Chief Executive Officer Date

Attachment 3

Table 5: Infection Control Checklist (to be used during Construction/Renovation)

Inspector:

Location: Date: Time:

Barriers Air Handling

Construction signs posted All windows behind barrier closed

Doors properly closed and sealed Negative air pressure at barrier entrance

Holes, pipes, conduits, punctures, etc. sealed Portable air flow units used to maintain negative pressure running Dust barriers intact and sealed

Floor and horizontal surfaces free of dust Trash and Debris

Ceiling tiles free of moisture No visible evidence of insects (flies)

Traffic Control Trash placed in appropriate containers

All doors and exits free of debris Routine cleaning performed in work area

Restricted to construction workers and essential staff

“Sticky” dust mats appropriately placed/clean

No evidence of dust outside the construction area

Personal Protective Equipment (PPE) Debris removed in covered container daily

Workers wearing appropriate PPE Regulated medical waste containers removed from work area before work is started

COMMENTS/ACTIONS TAKEN:

Attachment 4

Table 6: Final Infection Control Checklist (to be used upon completion of Construction/Renovation)

Inspector:

Location: Date: Time:

Equipment

Soap dispensers properly installed and filled. Towel dispensers properly installed and filled.

Sinks functional. Sharps containers properly installed

Housekeeping Waste and excess equipment/supplies removed. Surfaces and floors dust free.

Ventilation Appropriate pressure relationships verified. Protective coverings removed from intake and exhaust vents.

COMMENTS/ACTIONS TAKEN:

Infection Control Officer or her/his designee

Signature Date

Chief Executive Officer

Signature Date