S06 36C24423Q0252 0001 RFQ Attachment ICRA Example.pdf

Adapted with permission V Kennedy, B Barnard, St Luke Episcopal Hospital, Houston TX ECSI ASHE PDC 2001

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) ▪wallcovering, 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 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 workshift.

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 1: TYPE C

Low Risk

▪Office areas

Steps 1-3 Adapted with permission V Kennedy, B Barnard, St Luke Episcopal Hospital, Houston TX, and ECSI

Steps 4-14 adapted from Fairview University Medical Center, Minneapolis MN with permission ASHE PDC 2001

Step 3: Class IV

IV

IV

II

II

IV

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

III/IV

III

III/IV

III/IV

MEDIUM Risk Group HIGH Risk Group HIGHEST Risk Group

I I

II

TYPE B TYPE C

LOW Risk Group I II II III/IV

Step 2: High Risk

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 Patient Risk Group TYPE A TYPE D

Highest RiskHigh RiskMedium Risk

▪Cardiology ▪Echocardiography ▪Endoscopy ▪Physical Therapy ▪Radiology ▪Respiratory Therapy ▪Outpatient Clinics

Step Two:

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

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

▪Urgent Care Center (UCC) ▪Laboratories (specimen) ▪Food Service Areas ▪Laundry ▪Outpatient Surgery ▪Pharmacy ▪Surgical Units

▪Central Sterile Supply ▪Medical Unit ▪Negative pressure isolation rooms ▪Oncology Clinic ▪Operating rooms ▪Community Living Centers

CL

AS

S I

CL

AS

S

II

CL

AS

S

III

CL

AS

S

IV

Steps 1-3 Adapted with permission V Kennedy, B Barnard, St Luke Episcopal Hospital, Houston TX, and ECSI Steps 4-14 adapted from Fairview University Medical Center, Minneapolis MN with permission ASHE PDC 2001

control cube method (cart with plastic covering and sealed connection to work site with HEPA vacuum for vacuuming prior to exit) before construction begins.

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. 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.

control cube method (cart with plastic covering and sealed connection to work site with HEPA vacuum for vacuuming prior to exit) before construction begins.

Description of Required Infection Control Precautions by Class

During Construction Project Upon Completion of Project

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

2. Immediately replace a ceiling tile displaced for visual inspection

Unit Below Unit Above Lateral N Lateral S Behind E Front W Basement Offices Common N/A Common UCC renovation of xray department rooms

ICRA Permit must be posted at each location.

Containment follows general requirements

Steps 1-3 Adapted with permission V Kennedy, B Barnard, St Luke Episcopal Hospital, Houston TX, and ECSI

Steps 4-14 adapted from Fairview University Medical Center, Minneapolis MN with permission ASHE PDC 2001

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

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

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

Step 7. Identify containment measures, using prior assessment. What types of barriers? (E.g., solids wall barriers); Will HEPA filtration be required? See permit for Infection Control requirements. Requires 4 phases of project. Xray, Sonography, Dexascan, CT rooms, Storage, Exam, halls, and lobby. Hardwall/sealed.

Vents sealed to utilize negative pressure with filter. Use of Hepa vacuum. UCC doors sealed. Sticky mats used. Cart used to remove items must be clean, including wheels, and covered to take out into halls.

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

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

Step 14. Plan to discuss the following containment issues with the project team.

Appendix: Identify and communicate the responsibility for project monitoring that includes infection control concerns and risks. The ICRA may be modified throughout the project.

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

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

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

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

Step 11. Do the plans allow for the required number & type of handwashing sinks? N/A

YES NO YES NO

X X

INFECTION CONTROL CONSTRUCTION PERMIT

Location of construction: Radiology Renovation Project Project start date: 02/14/22 Permit #: 22-07

Project Coordinator: Philip Tsang (814-860-2207) Estimated duration: 18 weeks Contractor performing work: Rocky Bleier Construction Group Permit expiration: 06/24/22 Supervisor: Jacob Bennefield Telephone: 724-456-7425

GROUP 4: Highest Risk

TYPE B: Small scale, short duration, moderate to high levels TYPE C: Activity generates moderate to high levels of dust, requires >1 work shift for completion TYPE D: Major duration and construction activities, requires consecutive work shifts

TYPE A: Inspection, non-invasive activity

INFECTION CONTROL RISK GROUPCONSTRUCTION ACTIVITY

GROUP 1: Low Risk GROUP 2: Medium Risk

GROUP 3: Medium/High Risk

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.

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 transport in tightly covered containers.

10.Cover transport receptacles or carts. Tape covering.

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

CLASS III

DATE/

INITIAL

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

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

3. Minor demolition for remodeling

CLASS I

CLASS II

1. Provides 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.

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.

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 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 Environmental Services Dept.

Date:

Permit authorized by:

Date: 02/11/22

Additional requirements: Note attached Infection Control Plan- to be kept posted with this permit at each work location

DATE/INITIAL: Exceptions/Additions to this permit are noted by attached memoranda: Date/Initials:

Permit request by: