S02 Supplemental Attachments - EC-17 PROJECT DESIGN AND REVIEW.pdf

Butler VA Health Care Center Medical Center Memorandum EC-17 Butler, PA September 30, 2019

PROJECT DESIGN AND REVIEW (10)

I. PURPOSE: To establish policy and procedures for the design and review of construction projects to ensure compliance with all applicable code requirements.

II. POLICY: It is the policy of this facility to design projects that comply with VA Construction Standards, VA Barrier-Free Design Handbook, Life Safety Code, VHA Directive 2005-007 (Fire Code Reviews of Delegated Construction Projects), Uniform Plumbing Code, VA HVAC Design Criteria, Uniform Building Code, and current guidelines for design and construction published by the Facility Guidelines Institute (FGI).

Compliance to codes is documented at the 100 percent design review.

A. All designs for new construction will include accessibility to parking lots. All buildings will have at least one entrance/exit that is accessible to the handicapped. This includes, but is not limited to, handicap ramps, automatic doors or doors with appropriate hardware to render them accessible to the handicapped, Braille signage, tactile warning strips as appropriate, and handrails as appropriate.

B. Handicap accessibility will also be provided to all public areas, amenities, and elevators.

C. An Infection Control Risk Assessment (ICRA) is required for every renovation and new construction project. The ICRA is performed by a multidisciplinary team with expertise in infectious disease, facility design, construction, ventilation, epidemiology, and environmental specialties. The team will provide documentation of the risk assessment(s) during initial planning and in subsequent construction phases. Based on the ICRA, an Infection Control Construction Permit is issued for each project. See Attachment A.

D. All construction workers including in-house employees and subcontractors shall follow the infection control procedures as identified in the permit.

E. Infection control will participate in pre-construction meetings and complete regular construction site walk-through inspections as necessary.

F. Pest control employee(s) are involved in any phase of the construction process where infestation may present a problem. Pest control will conduct walk-through inspections as necessary.

III. RESPONSIBILITIES:

A. Contracting Officer’s Representative (COR) is responsible for certifying that each project complies with appropriate codes.

B. Project Manager(s) along with infection control and pest control are responsible for performing construction site inspections, as appropriate. Construction site inspection sheets are documented for each visit certifying compliance or non-compliance.

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C. The Project Manager is the COR and responsible for completing and addressing issues identified in the Pre-Construction/Safety Assessment, Attachment C.

D. The Facility Manager is the COR when or if the assigned COR or Project Manager is not able to perform the required duties.

IV. PROCEDURE:

A. Project Manager, Infection Control Specialist, Environmental Protection Specialist, and Pest Control assigned to the administration of construction projects will ensure compliance with this policy and all applicable codes. A Construction Site Inspection Sheet is utilized to document conformance. (See Attachment B).

B. Project Manager will insure that project drawings and specifications are submitted to the VISN Safety and Fire Protection Engineer for review and comment in accordance with VHA Directive 2005-007.

C. Planning and Construction Phase

1. Infection Control Specialist, Safety Officer, and Environmental Protection Specialist will participate in preconstruction meetings both for in-house work and outside contracted construction. The Sterile Processing Service (SPS) Supervisor is a stakeholder and participates in all design and construction meetings where medical equipment is used or re-processed or where supplies are to be stored. Pest Control is involved in that the extent of the project involves pest control concerns.

2. Infection Control Specialist is involved in the planning phases for all renovation and new construction projects specific to the following major components (schematic design):

a. Number and placement of isolation rooms

b. Air handling systems; use of adjunctive measures such as ultraviolet germicidal irradiation (UVGI)

c. Number and placement of hand-washing facilities

d. Staff and patient traffic patterns for the duration of the project

e. Relocation decisions regarding patient care areas, storage areas, etc.

f. Water supply and plumbing

g. Construction waste containment, transport, and disposal

h. Selection and installation of medical equipment as it relates to infection control

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i. Selection of finishes and surfaces that can be effectively cleaned

j. Accommodation of personal protective equipment (accessibility, security, sanitation, etc.)

k. Storage of moveable modular equipment

D. Operational Phase

1. Medical Waste

a. Hospital staff shall remove any medical waste, including sharps containers, from areas to be renovated or constructed PRIOR to the start of the project.

b. Infection Control Specialist and Environmental Protection Specialist are notified immediately if unexpected medical waste is encountered.

2. Barrier Walls: Construction or renovation sites must be separated from patient-care areas and other critical areas by barriers that keep the dirt and dust inside the worksite.

a. The integrity of the barrier walls must assure a complete seal of the construction area from adjacent areas.

b. Rigid construction or fire-rated plastic sheeting (4 to 6 mil thickness) is used depending on the location of the project, adjacent uses, and duration of the project.

c. Walls are dustproof with airtight seals maintained at the full perimeter of the walls as well as all penetrations.

3. Traffic Control

a. Designated entry and exit procedures are defined (in conjunction with any necessary Interim Life Safety Measures) for each construction project where applicable.

b. All egress pathways are free of debris.

c. Unauthorized personnel will not be allowed to enter the construction zone.

d. Only designated elevators are used for construction activities during scheduled times.

4. Cleaning

a. The construction zone and adjacent entry areas are maintained in a clean and sanitary manner by the contractors and are swept and damp mopped daily or more frequently as needed to minimize dust generation.

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b. Facilities Management will ensure completion of routine cleaning of adjacent areas by the contractor. Terminal cleaning of the construction zone prior to the opening of the newly renovated or constructed area is coordinated with Environmental Management Services. Specific responsibilities are defined in the construction contracts.

5. Personnel Requirements

a. Clothing is free of loose soil and debris upon exiting the construction zone.

b. Contractor will provide personal protective equipment, including face shields, gloves, and N95 respirators to be utilized as appropriate for the task at hand.

Personnel entering sterile/invasive procedure areas are provided with a disposable jump suit, head covering and shoe coverings which must be removed prior to exiting the work area.

(1) Tools and equipment must be damp-wiped prior to entry and exit from sterile and invasive procedure areas.

(2) Tools and equipment soiled with blood and body fluids are cleaned with an approved germicide.

c. Contractors will receive infection control training as it relates to construction at the pre-construction meeting.

6. Environmental Monitoring - Infection Control Specialist, in conjunction with Facilities Management and Environmental Protection Specialist will plan for environmental monitoring as appropriate for the project.

7. Interim Life Safety Measure Monitoring - Project Manager/COR will complete a daily inspection of the construction site to meet the interim life safety requirements. (See MCM SC-23, Interim Life Safety Measures, Attachment C).

E. Completion Phase

1. After completion of construction ventilation will meet specifications as mandated by regulatory bodies.

2. The area is thoroughly cleaned and disinfected before being placed into service.

3. Water supply lines are flushed before placing newly renovated or constructed areas into service. Infection Control Specialist is notified prior to the flushing.

F. Compliance Monitoring - The Project Manager, with the support of the Safety Officer, Infection Control Specialist, Environmental Protection Specialist, and the contractor (or designee), will conduct compliance monitoring as necessary. The following parameters are monitored:

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1. Air handling system;

2. Integrity of barrier walls;

3. Dress code;

4. Environmental control;

5. Noise;

6. Traffic control;

7. Personal protective equipment; and

8. Water supply.

V. REFERENCES:

VHA Directive 2005-007 NFPA 101, Life Safety Code (current edition).

The Joint Commission Comprehensive Accreditation Manual, Environment of Care Standards (current edition) Facility Guidelines Institute, Guidelines for Design and Construction, 2018 Medical Center Memorandum SC-23, Interim Life Safety Measures

VI. RESCISSIONS: Medical Center Memorandum EC-17, dated May 31, 2013

SHARON COYLE, MSN, RN, MBA

Interim Director

(Automatic Review Date: September 30, 2022)

ATTACHMENT A

INFECTION CONTROL RISK ASSESSMENT

MATRIX OF PRECAUTIONS FOR CONSTRUCTION & RENOVATION

Step One:

Using the following table, identify the Type of Construction Project Activity (Type A-D)

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

B

Small scale, short duration activities which create minimal dust

• installation of telephone and computer cabling

• access to chase spaces

• cutting of walls or ceiling where dust migration can be controlled

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 which cannot be completed within a single work shift

D

Major demolition and construction projects

• activities which require consecutive work shifts

• requires heavy demolition or removal of a complete cabling system

• new construction

STEP 1:____________________________________________________

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Step Two:

Using the following table, identify the Patient Risk Groups that are affected.

If more than one risk group is affected, select the higher risk group:

Low Risk Medium Risk High Risk Highest Risk

• Office areas

• Physical Therapy

• Radiology/MRI

• Respiratory Therapy

• Laboratories (specimen)

• Outpatient

• Pharmacy

• Central Sterile Supply

• Nursing Unit

• Negative pressure isolation rooms

STEP 2_____________________________________________________

Step Three: Match the Patient Risk Group (Low, Medium, High, Highest) with the planned Construction Project Type (A, B, C, D) on the following matrix, to find the Class of Precautions (I, II, III or IV) or level of infection control activities required.

Class I-IV or Color-Coded Precautions are delineated on the following page.

IC Matrix - Class of Precautions: Construction Project by Patient Risk

Construction 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

Note: Infection Control approval is required when the Construction Activity and Risk Level indicate that Class III or Class IV control procedures are necessary.

STEP 3_____________________________________________________

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DESCRIPTION OF REQUIRED INFECTION CONTROL PRECAUTIONS BY CLASS

During Construction Project Upon Completion of Project

C L

A S

S

I

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

2. Immediately replace a ceiling tile displaced for visual inspection.

None

C L

A S

S I

I

1. Provide active means to prevent airborne dust from dispersing into atmosphere.

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

3. Seal unused doors with duct tape.

4. Block off and seal air vents.

5. Place dust mat at entrance and exit of work area.

6. Remove or isolate HVAC system in areas where work is being performed.

7. Wipe work surfaces with disinfectant.

8. Contain construction waste before transport in tightly covered containers.

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

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

None

C L

A S

S

II

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

2. 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.

3. Maintain negative air pressure within work site utilizing HEPA equipped air filtration units.

4. Contain construction waste before transport in tightly covered containers.

5. Cover transport receptacles or carts.

Tape covering unless solid lid.

1. 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.

2. Remove barrier materials carefully to minimize spreading of dirt and debris associated with construction.

3. Vacuum work area with HEPA filtered vacuums.

4. Wet mop area with disinfectant.

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

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C L

A S

S

V

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

2. 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.

3. Maintain negative air pressure within work site utilizing HEPA equipped air filtration units.

4. Seal holes, pipes, conduits, and punctures appropriately.

5. 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.

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

7. 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.

1. Remove barrier material carefully to minimize spreading of dirt and debris associated with construction.

2. Contain construction waste before transport in tightly covered containers.

3. Cover transport receptacles or carts.

Tape covering unless solid lid.

4. Vacuum work area with HEPA filtered vacuums.

5. Wet mop area with disinfectant.

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

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 (eg, patient rooms, medication room, etc.).

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

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Step 7. Identify containment measures, using prior assessment. What types of barriers? (eg, solids wall barriers); Is HEPA filtration required?

(Note: Renovation/construction area is isolated from the occupied areas during construction and are negative with respect to surrounding areas)

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

Step 9. Work hours: Can or will the work be done during non-patient care hours?

Step 10. Do plans allow for adequate number of isolation/negative airflow rooms?

Step 11. Do the plans allow for the required number & type of hand washing sinks?

Step 12. Does the infection control staff agree with the minimum number of sinks for this project?

(Verify against AIA Guidelines for types and area)

Step 13. Does the infection control staff agree with the plans relative to clean and soiled utility rooms?

Step 14. Plan to discuss the following containment issues with the project team (eg, traffic flow, housekeeping, debris removal (how and when)).

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 communicated to the Project Manager.

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Infection Control Construction Permit

Permit No:

Location of Construction: Project Start Date:

Project Coordinator Estimated Duration:

Contractor Performing Work Permit Expiration Date:

Supervisor: Telephone:

YES NO CONSTRUCTION ACTIVITY YES NO INFECTION CONTROL RISK GROUP

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

TYPE B: Small scale, short duration, moderate to high levels

GROUP 2: Medium Risk

TYPE C: Activity generates moderate to high levels of dust, requires greater 1 work shift for completion

GROUP 3: Medium/High Risk

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 from construction operations.

2. Immediately replace any ceiling tile displaced for visual inspection.

3. Minor Demolition for Remodeling

CLASS II 1. Provide active means to prevent air-borne dust from dispersing into atmosphere.

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

3. Seal unused doors with duct tape.

4. Block off and seal air vents.

5. Wipe surfaces with disinfectant.

6. Contain construction waste before transport in tightly covered containers.

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

8. Place dust mat at entrance and exit of work area.

9. Remove or isolate HVAC system in areas where work is being performed.

CLASS III

Date

Initial

1. Obtain infection control permit before construction begins.

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

3. Complete all critical barriers or implement control cube method before construction begins.

4. Maintain negative air pressure within work site utilizing HEPA equipped air filtration units.

5. Do not remove barriers from work area until complete project is thoroughly cleaned by Env. Services Dept.

tightly covered containers.

6. Vacuum work with HEPA filtered vacuums.

7. Wet mop with disinfectant.

8. Remove barrier materials carefully to minimize spreading of dirt and debris associated with construction.

9. Contain construction waste before transporting

10. Cover transport receptacles or carts. Tape covering.

11. Remove or isolate HVAC system in areas where work is being performed.

CLASS IV

Date

Initial

1. Obtain infection control permit before construction begins.

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

3. Complete all critical barriers or implement control cube method before construction begins.

4. Maintain negative air pressure within work site utilizing HEPA equipped air filtration units.

5. Seal holes, pipes, conduits, and punctures appropriately.

6. 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.

7. All personnel entering work site are required to wear shoe covers.

8. Do not remove barriers from work area until completed project is thoroughly cleaned by the Environmental Service Dept.

9. Vacuum work area with HEPA filtered vacuums.

10. Wet mop with disinfectant.

11. Remove barrier materials carefully to minimize spreading of dirt and debris associated with construction.

12. Contain construction waste before transport in tightly covered containers.

13. Cover transport receptacles or carts. Tape covering.

14. Remove or isolate HVAC system in areas where is being done.

Additional Requirements:

Date Initials ___________ Exceptions/Additions to this permit Date Initials are noted by attached memoranda

Permit Request By: Permit Authorized By

Date: Date:

Butler VA Health Care System Medical Center Memorandum EC-17

ATTACHMENT B

DAILY INSPECTION LOG OF INTERIM LIFE SAFETY MEASURES

Project Title:__________________ Project #:____________Project Coord:__________

Instructions: One log sheet maybe used for one full week with dates entered at top of columns. If the area inspected is in compliance with life safety measures place a “Y” for yes in the box next to the item. If the area is not in compliance with life safety measures place a “N” for no in the box next to the item. If you mark any item with a “N” you must provide comments and actions to abate the situation.

Dates

AREAS INSPECTED COMMENTS/

ACTIONS

Means of egress is clear in construction areas.

Access for the fire department & emergency services is clear.

Buildings are accessible to fire department apparatus and personnel Roadways are maintained within 20 feet of all buildings.

Fire detection and sprinkler systems are functional.

Construction partitions are maintained.

Good housekeeping practices are used in the construction area. Flammables and combustible fire load is being kept to a minimum.

Buildings, grounds and equipment are being maintained in a safe manner (pay special attention to excavations, construction areas, and construction storage or field offices).

Smoking regulations are being followed.

Area found to be secured.

Signature of COTR/Project Coordinator Date

ATTACHMENT C

PRE-CONSTRUCTIONS/RENOVATION SAFETY RISK ASSESSMENT

Project:

Date of Risk Assessment:

Safety Risk Assessment:

Guidelines Y/N Risk Areas to be Impacted

Control Activities Needed

Will there be any compromise to the quality of building Air?

-Patient care areas?

-Non-Patient care area?

-Public access areas?

Will there be any compromise to the building ventilation?

-Public access areas?

Are there any anticipated utility disruptions?

-Communication/Telephone -Electrical -Generator -Temperature

-HVAC

-Medical Gases -Natural Gas -Vacuum -Sewer / Sanitary -Water -Other

-Electrical -Generator -Temperature

-HVAC

-Medical Gases -Natural Gas -Vacuum -Sewer / Sanitary -Water -Other

-Public access areas?

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Attachment C

Control Activities Needed

-Electrical -Generator -Temperature

-HVAC

-Medical Gases -Natural Gas -Vacuum -Sewer / Sanitary -Water -Other

Will there be any unusually loud or high-pitched noise levels?

-Public access areas?

Will vibration levels be excessive for hospital machinery to operate properly?

-Public access areas?

Does the construction present any conflicts with the emergency disaster management program?

-Public access areas?

Will the construction compromise the security of the hospital?

-Public access areas?

Will project be short duration, small scale, minimal dust?

-Public access areas?

Will there be work that generates moderate to high levels of dust?

-Public access areas?

Will there be major demolition or new construction?

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Attachment C

Control Activities Needed

-Public access areas?

Are there hazardous material concerns?

-Non-Patient care areas?

-Public access areas?

Key: No Risk – 0 Limited Risk – 3 High Risk - 5

Assessment Performed by: Review By:

Project Manager/COTR Infection Control

Project Designer Safety Officer

Facility Manager

Environmental Specialist