36C24218B0068-006.pdf

BATH/CANANDAIGUA VA MEDICAL CENTER APPENDIX A

INFECTION CONTROL RISK ASSESSMENT (ICRA)

Project: ______________________________Date: ______________________

Step 1

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 which 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 which 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.

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 floorcoverings, 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 which require consecutive work shifts requires heavy demolition or removal of a complete cabling system new construction.

Step 2

Patient Risk Groups Low Risk Medium Risk High Risk Highest Risk

Office areas

Auditorium Meeting rooms Elevators Warehouse Laundry Chapel

Cardiology Echocardiography Physical Therapy Radiology Respiratory

Therapy

Laboratories (specimen)

Ambulatory care ( MVAC/ Specialty)

Pharmacy Domiciliary BVAC clinic

Any area caring for immunocompromised patients

Sterile processing department

Community living center units

If more than one risk group will be affected, select the higher risk group

Step 3

Safety Matrix - Class of Precautions: Construction Project by Patient Risk & Project Type

Patient Risk Group TYPE A TYPE B TYPE C TYPE D

LOW Risk Group I II II III/IV

MEDIUM Risk Group I II III IV

HIGH Risk Group I II III/IV IV

HIGHEST Risk Group II III/IV III/IV IV

Description of Infection Prevention Precautions by Class –Select applicable actions: CLASS __

During Construction Project Upon Completion of Project

C L

A S

S I

Execute work by methods to minimize raising dust from construction operations.

Immediately replace a ceiling tile displaced for visual inspection

Coordinate work with on-site staff to prevent noise or vibration issues

C L

A S

S

II

Provide active means to prevent airborne dust from dispersing into 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.

Coordinate work with on-site staff to prevent noise or vibration issues

Wipe work 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.

Remove isolation of HVAC system in areas where work is being performed.

C L

A S

S

II

I

Remove or Isolate HVAC system in area where work is being done to prevent contamination of duct system.

Complete all critical barriers i.e.

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 solid lid.

Establish times that demo work would be most appropriate for the area, and adjacent areas if applicable, with Care/Service Line in which the work is being performed

Do not remove barriers from work area until completed project is inspected by the owner’s Safety Department and Infection Control Department and thoroughly cleaned by the owner’s Environmental Services Department.

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 disinfectant.

Remove isolation of HVAC system in areas where work is being performed.

Clean work area upon completion of task(s).

C

L A

S S

IV

Remove or Isolate HVAC system in area where work is being done to prevent contamination of duct system.

Complete all critical barriers i.e.

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 appropriately.

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 they can wear cloth or paper coveralls that are removed each time they leave the 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 owner’s Safety Department and Infection Prevention Department and thoroughly cleaned by the owner’s Environmental Services Department.

Establish times that demo work would be most appropriate for the area, and adjacent areas if applicable, with Care/Service Line in which the work is being performed

Supervisor prepared to meet with IC, Safety, and/or on-site staff to review problems with dust, noise, or vibration.

Remove barrier material 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 lid

Vacuum work area with HEPA filtered vacuums.

Wet mop area with disinfectant.

Remove isolation of HVAC system in areas where work is being performed.

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Step 4: Identify the areas surrounding the project area, assessing potential impact.

Unit Below Unit Above Lateral Lateral Behind Front

Risk Group Risk Group Risk Group Risk Group Risk Group Risk Group

Step 5: Identify specific site of activity e.g. patient rooms, medication rooms, clinics, etc.

Step 6: Identify any issues related to: ventilation, plumbing, electrical in terms of the occurrence of probable outages.

Step 7: Identify Containment measures, using prior assessment. What types of barriers (e.g. solid wall barriers); will HEPA filtration be required?

Step 8: Consider potential risk of water damage. Is there a risk due to compromising structural integrity? (E.g. wall, ceiling roof)

Step 9: Work hours: Can or will the work be done during off shifts- evenings, nights, weekends?

A Tuberculosis Risk Assessment is completed for Bath/Canandaigua VAMC annually. Our current risk assessment identifies Bath/Canandaigua VAMC as a _____ risk facility.

TB screening for contractors working on this project is not indicated

TB screening for contractor working on this project is indicated

We have reviewed this project and specified Contractor/facility actions to reduce safety and health issues associated with the project to patients, visitors, and personnel.

Infection Prevention Coordinator: _______________________________ Date:_________

Infection Control Construction Permit This Permit must be posted in Construction and Remodel Areas During Work

Location of Construction:

Permit No:

Project Start Date:

Project Coordinator: Estmated Duration:

Contractor Performing work: Permit Expiration Date

Supervisor:

YesYes No NoCONSTRUCTION ACTIVITY INFECTION CONTROL RISK GROUP

TYPE A: Inspection, non-invasive activity GROUP 1: Low Risk

TYPE B: Small Scale, short duration, moderateto high levels GROUP 2: Medium Risk

GROUP 3: Medium/High RiskTYPE C: Activity generates moderate to high levels of dust, requires greater than1 work shift for completion.

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

Class I

1. Execute work by methods to minimize raising dust 2. Immediately Replace any ceiling tile displace for from construction operations. visual inspection.

3. Clean work area upon completion of task(s)

Class II

Class III

Class IV

1. Provide active means to prevent air-board dust from 6. Contain construction waste before transport tin tightly dispersing into the atmosphere. covered containers

2. Water mist work surfaces to control dust while cutting. 7. Wet mop and/or vacuum with HEPA filtered vacuum

3. Seal unused door with duct tape. with HEPA filtered vacuum before leaving work area.

3. Seal unused door with duct tape. 8. Place dust mat at entrance and exit or work area.

4 Block off an seal air vents. 9. Remove or isolate HVAC system in areas where work is being

5. Wipe Surfaces with disinfectant. performed.

1. Obtain infection control permit before construction begins. 7. All personnel entering work site are required to wear shoe covers.

2. Isolate HVAC system in area where work is being done 8. Do not remove barriers from work area until completed to prevent contamination of duct system. project is thoroughly cleaned by the Environmental project is thoroughly

3. Complete all critical barriers or implement control cube cleaned by the Environmental Service Dept.

method before construction begins. 9. Vacuum work area with HEPA filtered vacuums.

4. Maintain negative air pressure within work site utilizing 10. Wet mop with disinfectant.

HEPA equipped air filtration units. 11. Remove barrier materials carefully to minimize spreading of dirt and

5. Seal holes, pipes, conduits, and punctures appropriately. debris associated with construction.

6. Construct anteroom and require all personnel to pass through 12. Contain construction waste before transport in tightly covered this room so they can be vacuumed using a HEPA vacuum cleaner containers before leaving work site or they can wear cloth or paper coveralls 13. Cover transport receptacles or carts. Tape covering.

can wear cloth or paper coveralls that are removed each 14. Remove or isolate HVAC system in areas where work is being done.

time they leave the work site.

1. Obtain infection control permit before construction begins. 6. Vacuum work work area with HEPA filtered vacuums.

2. Isolate HVAC system in area where work is being done to . 7. Wet mop with disinfectant prevent contamination of duct system. 8. Remove barrier materials carefully to minimize spreading of dirt and

3. Complete all critical barriers or implement control cube method debris associated with construction.

before construction begins. 9. Contain construction waste before transport in tightly covered containers.

4. Maintain negative air pressure within work site utilizing HEPA 10. Cover transport receptacles or carts. Tape covering.

equipped air filtration units. 11. Remove or isolate HVAC system in area where work

5. Do not remove barriers from work area until complete is being performed.

project is thoroughly cleaned by Env. Services Dept.

Additional Requirements:

Telephone

Steps 1-3 Adapted with permission V Kennedy, B Barnard, St Luke Episcopal Hospital, Houston TX ; C Fine, CA Steps 4-14 Adapted with permission Fairview University Medical Center, Minneapolis MN by ECSI Inc 2001 Forms modified and provided courtesy of J Bartley, ECSI Inc 2002

Appendix: Identify and communicate the responsibility for project monitoring that includes infection control concerns and risks. The ICRA may be modified throughout the project. Revisions must be communicatedto the Project Manager by the Requestor.

Supervisor Infection Control Officer Signature signifies Approval