PCRA Example.pdf

CONSTRUCTION ASSESSMENT DOCUMENTATION APPROVALS

Project Title: Project Number:

Estimated Start Date: Estimated Duration:

Obtain the following approvals, in the order listed, as applicable:

1. VA Supervisor responsible for area under construction Date

2. Infection Preventionist Date

3. VA Police Representative Date

4. Project Manager/COR/Shop Supervisor Date

5. Maintenance Control Manager, Engineering Service Date

6. Projects/Construction/Technical Team Supervisor, Engineering Service Date

7.a. Fire Safety Program Manager, Safety & Emergency Management Date

7.b. Construction Safety Specialist(CSS), Safety & Emergency Management Date

8. Chief, Engineering Service Date

Recommend collaboration between COR/CSO and SEM (Fire or CSS) on Construction Safety Responsibilities

9. Chief, Safety and Emergency Management Service Date

Concur with collaboration between COR/CSO and SEM (Fire or CSS) on Construction Safety Responsibilities

Weekly Work Site Hazard Surveillance Team Membership

COR-

CSO

OSH

CSS

Infection Preventionist

Patient Safety

OSH

Fire Safety

VA Police GEMS Manager

Other

SME

X

Project Title Project Number

NEPA Risk Assessment to be completed utilizing NEPA Interim Guidance for Projects PG 18-17 http://www.cfm.va.gov/til/etc/NEPAGuidance.pdf

Project Title: Project Number:

Location:

Date: Type of Project: Operation and Maintenance Repairs/Renovation New Construction Lease Other

Construction Start Date: Estimated Duration: Completion Date:

Project Description:

Level of NEPA Analysis:

Categorical Exclusion

Environmental Assessment (EA) Needed

Environmental Impact Statement (EIS) Needed

Other Environmental Permits/Analysis Needed:

Project Impacts Would the proposed activity involve or generate any of the following?

Source Yes No Source Yes No Source Yes No Air Emissions including GHGs

Liquid Effluent RCRA or CERCLA Sites

Asbestos Petroleum Storage Wetlands Excess Noise Solid Waste Permit Modification Utility Modification Hazardous Waste Chemical Use/Storage Soil Disturbance Biological Resources Water/Well use Water Treatment Radioactive Waste Other:

Water Flow Modification

Mixed Waste

Determination I find the proposed project qualifies as a CATEGORICAL EXCLUSION with no extraordinary circumstances. Specify which CATEX:

I find that the proposed project MAY have a significant effect on the environment; therefore, an ENVIRONMENTAL ASSESSMENT (EA) will be prepared.

ENVIRONMENTAL IMPACT STATEMENT (EIS)

Project Manager:

GEMS Manager:

http://www.cfm.va.gov/til/etc/NEPAGuidance.pdf

PCRA Introductory Information and Instructions

Use this template as a baseline for performing facility Pre-Construction Risk Assessments (PCRA) for Construction, Renovation, and Maintenance work (referred to as the “activity” in this document). The template provides minimum requirements for categorizing activity type(s) and safety risk to determine the level of precautions needed to prevent impact related to Construction, Renovation and Maintenance on patients, employees, and contractors.

Ensure that the activity statement of work and any drawings available are used for the PCRA assessment and included in the project file with the completed PCRA.

Communication and coordination by the COR/CSO of all types of activity with affected areas are to be included among the control measures. The development of communication and coordination plans must begin during the activity planning phase.

NOTE: This VHA PCRA template pertains specifically to non-infection-related safety for Construction, Renovation, and Maintenance activities. It must be used in conjunction with the VHA Infection Control Risk Assessment (ICRA) for the activity, if required, which specifically addresses infection risks outside the scope of this PCRA.

PERMIT: See the page 8 of this document for a fillable permit form to be used for posting at the activity site.

Activity Location:

Activity Name, Number, and/or Brief Description:

Table 1 - Construction, Renovation, and/or Maintenance Activity Type and Control Measures NOTE: If any of the bulleted criteria in a higher activity type pertains to the work that will be done (even if the other criteria are in a lower type), use the higher activity type for the VHA PCRA.

Controls defined in Table 1 for the activity must be in place before the activity begins and maintained until work is completed and the area is activated. Control measures for each activity must also include the control measures in the preceding row(s).

As the activity progresses, a full re-evaluation of remaining activity type and risk is required prior to changing the level of control measures.

Activity Type determined from Table 1:

Activity Type and Description Control Measures Inspection/upkeep generally defined as follows:

• Work can be completed in a single shift, not to exceed 10 hours.

• Patients, employees and/or visitors may be in the area depending on the activity.

• Work that does not create dust or debris.

• Work that does not create vapors or fumes.

• Removal of ceiling tile or access to mechanical or electrical chase for visual inspection that will not impair fire safety systems and are limited to 1 tile per 50 square feet with limited

1. Immediately replace any ceiling tile, close access panels, etc., upon completion of work.

2. Site visits of construction area are required weekly by member of multi-disciplinary team.

Site visits will be documented on standard checklist.

3. Site specific safety plan, task hazard analysis, and hazard communication required to be provided by the contractor and approved where a contact is in place. For internal work the exposure time (not to exceed an hour for each tile) within the shift.

• Minor interior updates (e.g., replacing floor or ceiling tiles, carpentry work to include hanging signage, and painting with hand tools) that do not create vibration or noise.

• Limited building system maintenance that does not require Lock Out Tag Out (LOTO) such as plumbing on potable systems limited to faucet replacement, steam trap replacement etc. and electrical work such as replacement of bulbs, receptacles, or switches.

shop involved must work with Safety to ensure proper precautions are in place.

4. Must address identified hazards and controls that will be implemented to ensure minimal impact to patients, employees, contractors and facility.

5. Communication and coordination plan for all affected areas.

6. Floors and work area must be clean upon completion of work.

Small scale Construction, Renovation and general maintenance/repair work, generally defined as follows:

• Prolonged work that may take longer than a single shift but not exceeding six months.

• Patients and employees are not to be in the area until activity is completed.

• Work that creates some noise and vibration due to power tool use.

• Selective demolition/removal of preexisting floor covering, casework, lay-in ceiling, or other architectural elements that may o disturb asbestos, lead or silica o create the potential for falling objects o create vibration and/or noise in excess of 80 dB(A) in surrounding areas.

o cause penetrations in fire or smoke barrier

• Plumbing work such as the installation of new sinks, showers and toilets and associated plumbing that requires utility outages or work on the steam system that may require:

o LOTO o The use of compressed gas cylinders

• Electrical work such as installation of conduit and wire for lighting, receptacles and switches for an area, the installation of conduit and wire for new devices such as terminal units, fans etc. Electrical work such as installation of cabling/wiring/conduit for a single device, installation of new device such as a light fixture that require LOTO.

• Air Handler and/or fan shutdown/startup and HVAC work such as replacement of a single diffuser, single terminal unit, a single device and the installation of ductwork, diffusers, and terminal units for an area that may require:

o Work on ladders o Rigging, hoisting or lifting of equipment or materials overhead

• Modification of existing fire alarm and suppression systems requiring system outages and ILSMs or obstruction of exits and or impact on corridors.

• Architectural, structural, or any other work that may cause vapors or fumes such as:

o Roofing work o Flooring work o Painting or other large-scale use of such substances.

All control measures in the row above and the following:

1. Hazard communication chemical inventory required to be provided by the contractor and approved.

2. Where construction, Renovation and maintenance are done in an accredited facility, and ILSM assessment is required to be done and ILSMs put into place in accordance with TJC LS.01.02.01 and the local facility policy including Fire watch if necessary. Staff is trained and the ILSM is verified regularly.

3. Daily Hot Work or burn permits in place and staff trained

4. LOTO procedures in place and staff trained on their use

5. Site visits will be reviewed using the criteria in standardized guide.

6. Daily inspections of the site are to be conducted by the General Contractor or shop supervisor and documented on their daily log.

Large-scale construction, renovation, or maintenance generally defined as follows:

• Work exceeding 6 months in duration.

• Patients and employees are not to be in the area until activity is completed.

All control measures in the two rows above and the following Activity Hazard Analyses and Control Plans (check all that apply):

1. Excavation safety plan in place

2. Dust control plan in place

• Excavation or heavy equipment use taking place o Dig safe required utility location o Trench safety o Dust control plan o Equipment exhaust, Noise, Vibration

• Confined space entry required (permit required or not)

• Requires crane work o General crane work o Lift over buildings

• Includes elevated work o Roof work, fall protection o Window work, scaffolding and fall protection o Odor control

• Welding, cutting or use of torches requiring burn permits

• Demolition of building components and infrastructure including removal of multiple doors, walls, framing, ceilings, flooring, piping, electrical and HVAC that may o require asbestos, lead or silica abatement o create the potential for falling objects o create vibration and/or noise in excess of 90 dB(A) in surrounding areas.

o cause breaches to fire or smoke barrier

• The installation building components such as new walls, ceilings and doors including framing, drywall and associated plaster work that requires transport of significant materials through building and up elevators i.e., weight limits of floors and elevators

• Plumbing work requiring LOTO and system shutdown and startup such as the installation of:

o new medical gas systems, o steam/heating hot water, condensate systems, o Potable water and sanitary drainage, multiple sinks, showers and toilets including associated plumbing.

• Electrical work such as installation of electrical feeders, distribution panels, conduit and wire for lighting, receptacles and switches for an area, the installation of conduit and wire for new devices such as terminal units, fans etc. requiring LOTO and system isolation.

• Installation of fire alarm and suppression systems requiring outages of those systems and ILSMs or closure of exits/corridors

• Mechanical work such as the installation of air handling equipment, associated ductwork, diffusers, heat exchangers, terminal units and controls requiring lifting and support of equipment and systems.

3. Pollution prevention plan in place

4. Dig safe paper work in place

5. Crane lift plan in place

a. Crane placement

b. Crane swing

c. Crane load evaluation

6. Fall protection plan in place and staff trained

7. Confined entry plan in place and staff trained

Table 2. Affected Adjacent Area Assessment In addition to the minimum precautions noted above for the Activity Type, it is critical that the activity be coordinated with the areas adjacent to the activity to ensure operations in those areas are not disrupted or impacted. List the adjacent areas in Table 2 below and develop activity-specific coordination plans and associated communication plans with each area to address activity work that could impact or disrupt the operation of the areas, in general as follows:

• If adjacent area is vacant (e.g., work outside, construction of new building, etc.):

o Coordination is typically not necessary other than potentially traffic flow and pedestrian access.

• If adjacent area is non-continuously occupied (e.g., areas where outpatient care is provided, employee health, etc.):

o Develop a list of activities that will potentially impact or disrupt the operation of the area (e.g., work involving noise, vibration or exit obstruction) and meet with POC to coordinate execution of work in a way that mitigates the impact (e.g., conduct work after hours).

• If adjacent area is occupied continuously (e.g., areas where inpatient care is provided, residential areas such as Community Living Centers, etc.):

o Develop a list of activities that will potentially impact or disrupt the operation of the area (e.g., work involving noise, vibration or exit obstruction) and meet with POC to coordinate execution of work in a way that mitigates the impact (e.g., move affected party temporarily).

Area Service(s)/Type(s) of Area(s)

(e.g., OR, Unit/Ward, Sterile Processing, Administrative, etc)*

Point of Contact

(POC)

POC Contact Information

Construction plan communicated to POC?

Activity Area**

Area Above

Area Below

Adjacent Area 1

Adjacent Area 2

Adjacent Area 3

Adjacent Area 4

* There may be more than one Service/type of area for each row. List all. The information entered on this table must be used in the ICRA if required.

** List the area(s) in which the construction/renovation/maintenance activity will occur.

Infection Control Risk Assessment (ICRA)

Consult with Infection Prevention and Control regarding the assessment of potential infection risks associated with the activity and the need for control measures. See VHA Directive 7715 and the VHA ICRA Template for more information.

Is an ICRA required for the Activity? Yes No

Pre-Construction Risk Assessment (PCRA) Permit This page must be posted at the entrance to the project area, or other designated area

Unique permit number:

Location and brief description of construction/renovation/maintenance Project manager Project start date Contact phone number Completion date Contractor or lead shop Permit expiration date

Activity Type Inspection/Upkeep, Small-scale, or Large-scale)

Activity Type Control measures to be in place for the duration of the activity (Check the box for the Activity Type to indicate the Control Measures)

Inspection/Upkeep

1. Immediately replace any ceiling tile, close access panels, etc., upon completion of work.

2. Site visits of construction area are required weekly by member of multi-disciplinary team. Site visits will be documented on standard checklist.

3. Site specific safety plan, task hazard analysis, and hazard communication required to be provided by the contractor and approved.

4. Must address identified hazards and controls that will be implemented to ensure minimal impact patients, employees, contractors and facility.

5. Communication and coordination plan for all affected areas

Small-scale All control measures in the row above and the following:

1. Hazard communication chemical inventory required to be provided by the contractor and approved.

2. ILSMs in place and staff trained on situation

3. Hot Work or burn permits in place and staff trained

4. LOTO procedures in place and staff trained on their use

5. Site visits will be reviewed using the criteria in standardized guide.

6. Daily inspections of the site are to be conducted by the General Contractor and documented on their daily log.

Large-scale All control measures in both rows above and the following Activity Hazard Analyses and Control Plans as applicable (check all that apply):

1. Excavation safety plan in place

2. Dust control plan in place

3. Pollution prevention plan in place

4. Dig safe paperwork in place

5. Crane lift plan in place

a. Crane placement

b. Crane swing

c. Crane load evaluation

6. Fall protection plan in place and staff trained

7. Confined entry plan in place and staff trained

*The location of all Activity Hazard Analyses and Control Plans (excavation, dust, pollution, etc.) as applicable shall be identified on this permit and shall be made available to all workers on the job.

Additional requirements:

Is an Infection Control Risk Assessment (ICRA) required for the Activity? Yes No

Infection Prevention and Control signature:

Date:

Project Manager signature Date

Safety Officer signature Date

Chair, Construction Safety Committee signature

Date

Interim Life Safety Measure (ILSM) Evaluation for Construction/Renovation Projects

Project Name: Date: Project Manager

(COR):

Instructions: Use this evaluation to identify and implement activities to protect occupants during construction and renovations and during periods when the building and/or construction area does not meet the applicable provisions of the Life Safety Code. This evaluation is to be updated throughout the project to identify code deficiencies that cannot be immediately corrected and the ensuing special measures to be taken to compensate for increased life safety risk. Check all conditions that apply and add any other identified deficiencies and additional special measures:

Evaluation Criteria: Deficiency Description and Location: ILSM required to compensate for increased life safety risk:

Building/area egress routes blocked or altered. This applies to the construction area as well as surrounding areas.

Egress routes for all personnel (including construction workers) must be maintained at all times.

List blocked egress route locations: 1. Provide alternate means of egress.

Personnel in the area shall be given additional training when alternative egress routes are designated. Signage shall be posted identifying the location of the alternate means of egress or exit to everyone affected.

2. Exits in affected area(s) shall be inspected daily.

3. Conduct one additional fire drill per shift per quarter in the affected area.

Required

Required

Required

N/A

N/A

N/A

Obstructed or altered access to emergency services and for fire, police, and other emergency forces.

List access routes blocked: 1. Provide and mark alternate access routes.

2. Inspect routes daily.

Required

Required

N/A

N/A

Fire alarm, detection, and/or suppression List each system out of service: 1. Provide temporary, equivalent alarm and Required N/A systems out of service. Each outage will detection systems.

be assessed based on duration, location, building occupancy, existing fire 2. Inspect and test temporary systems Required N/A barriers, and type of system out of List each temporary system required: monthly. The completion date of the test shall service to determine necessary measures. be documented.

Compliance with the applicable chapter of the LSC required. 3. Fire alarm, detection, and suppression Required N/A system outages > 4 hours in a 24-hour period require a fire watch and fire dept. notification.

Fire watch shall be documented.

4. Conduct one additional fire drill per shift Required N/A per quarter in the affected area.

Evaluation Criteria: Deficiency Description and Location: ILSM required to compensate for increased life safety risk:

Temporary construction separation requirements (see attached “Construction Partition Evaluation Criteria”)

List project separation requirements and locations:

Inspect partitions daily. Ensure all smoke tight and fire barrier features are in place at the end of each workday.

Required N/A

Additional fire-fighting equipment:

Minimum requirement for all projects = properly maintained fire extinguisher every 75 ft. Assess all construction work and require other equipment based on criteria contained in NFPA 241.

List all additional fire fighting equipment:

1. Fire Extinguisher(s)

1. Contractor to provide equipment and properly train all personnel in the use of all additional fire fighting equipment. Training shall be documented. Equipment shall be properly maintained.

2. Provide additional fire fighting equipment and training to medical center staff.

Required

Required N/A

Hot Work: evaluate all stages of List hot work tasks/locations: 1. Obtain Hot Work Permit in accordance with construction to determine the type of hot medical center procedure/project work to be conducted. specifications.

Required N/A

2. Provide additional fire fighting equipment. Required N/A

3. Provide fire watch in accordance with Required N/A NFPA 241. Documentation required.

4. Additional requirements for hot work Required N/A operations and fire prevention precautions, including permits and fire watches, shall be in accordance with NFPA 51 and 51B as applicable. List other requirements:

Smoking prohibited in all buildings and in and near construction areas.

Applicable to all projects. Strict enforcement of no smoking policy. Required

Storage, housekeeping, and debris removal practices will be conducted to ensure the building’s flammable and combustible fire load is reduced to the lowest feasible level.

Applicable to all projects. Accumulations of combustible waste material, dust, and debris shall be removed from the construction area and the immediate vicinity at the end of each work shift or more frequently as necessary for safe operations.

Required

Fire/smoke barrier penetrations.

Determine if construction will require the penetration of existing fire and/or smoke barriers.

List locations of project fire/smoke barriers required to be maintained for the duration of the project:

1. Floor and ceiling barriers.

All barrier penetrations shall be properly sealed at the end of each work shift. Sealing methods shall be in accordance with VA specifications.

Required N/A

Increased hazard surveillance is required when any Life Safety Code deficiency is identified during period of construction.

Required for construction in occupied buildings.

List LSC deficiencies: Increase surveillance of building(s), grounds, and equipment, giving special attention to construction areas and storage (lay down locations), excavation, and field offices as applicable.

Required N/A

Construction occurring adjacent to occupied areas of the building.

List ILSMs implemented for this project: Department specific education to promote awareness of building deficiencies, construction hazards, and temporary measures implemented to maintain fire safety. This is the responsibility of the area Supervisor with assistance from the COR and Safety & Emergency Management Service.

Required N/A

During construction the building’s structural or compartmental fire safety features (fire zones) are impaired or altered.

List features impaired: Medical Center workers in the affected building will be trained to compensate for impaired structural or compartmental fire safety features (fire zones). This is the responsibility of the COR and Safety & Emergency Management Service.

Required N/A

Construction Partition Evaluation Criteria:

The VA Fire Safety Design Manual:

C. Separate all occupied areas from demolition, renovation, or construction activities by temporary smoke-tight construction partitions of gypsum board or other approved non-combustible or limited-combustible material. Partitions shall be full height, extending through suspended ceilings to the floor slab or roof deck above and shall be one-hour fire rated, unless sprinklers are installed and are operational on both sides of the temporary partition where upon the partition may be permitted to terminate at the ceiling in accordance with NFPA

241. Where the ceiling on one side of the temporary construction barrier has been removed, the temporary partition must extend to the deck above.

Note: This requirement is due to the inherently greater potential for fire or hazardous materials incidents associated with the combustibles and operations of demolition/construction. This risk is made worse by the likelihood of compromised fire protection systems and fire or smoke resistant construction. This does not obviate the need to provide other protective measures to contain dust and debris as specified by VA Master Specification Section 01 35 26 1.14 (D). Sprinklers are considered to be operational when they are installed in accordance with NFPA 13 (spacing, protection, distance from the ceiling, etc.) and there is a sufficient automatic water supply. If the ceiling was removed and the sprinklers remain at the original ceiling level, they would likely not be considered operational. A change to the 2021 edition of NFPA 101 (18/19.7.9.3) addresses separation requirements for short duration nonhazardous construction activities. The change permits the use of fire-retardant plastic as a temporary barrier.

NFPA 101 Chapter 4

4.6.10 Construction, Repair, and Improvement Operations.

4.6.10.1* Buildings, or portions of buildings, shall be permitted to be occupied during construction, repair, alterations, or additions only where required means of egress and required fire protection features are in place and continuously maintained for the portion occupied or where alternative life safety measures acceptable to the authority having jurisdiction are in place.

4.6.10.2 Where required by Chapters 11 through 43, construction alteration and demolition operations shall comply with NFPA 241 4.6.10.3* In buildings under construction, adequate escape facilities shall be maintained at all times for the use of construction workers.

Escape facilities shall consist of doors, walkways, stairs, ramps, fire escapes, ladders, or other approved means or devices arranged in accordance with the general principles of the Code insofar as they can reasonably be applied to buildings under construction.

A.4.6.10.1 Fatal fires have occurred when, for example, a required stair has been closed for repairs or removed for rebuilding, or when a required automatic sprinkler system has been shut off to change piping.

A.4.6.10.3 See also NFPA 241, Standard for Safeguarding Construction, Alteration, and Demolition Operations.

NFPA 241 Chapter 4

4.13.4 Temporary Construction Barriers.

4.13.4.1 Barriers shall be provided to separate an occupied portion of the structure from a portion of the structure undergoing alteration, construction, or demolition operations when such operations have a higher level of hazard than the occupied portion of the building.

4.13.4.1.1 Barriers shall have at least a 1-hour fire resistance rating.

4.13.4.1.2 Opening protectives shall have at least a 45-minute fire protection rating.

4.13.4.2 Barriers in buildings protected throughout with approved, automatic sprinkler systems that are not impaired in accordance with NFPA 25 shall be permitted to be noncombustible material, limited-combustible material, or fabric or plastic films meeting the requirements of 4.13.1

4.13.4.3 (References this document.) In conjunction with the Fire Prevention Program, as an alternative to 4.13.1 and 4.13.2, a risk assessment shall be permitted to determine the required protective measures between an occupied portion of the structure and the portion of the structure undergoing alteration, construction, or demolition operations.

4.13.4.4 Barriers when erected shall not interfere with the operation of any fire and life safety system or devices.

CVAHCS requirement fabric or plastic films permitted by NFPA 241 4.13.4.2 shall be stamped as fire-retardant.

ILSM Implementation List

Project Name: Date: Project Manager or VA Supervisor:

Instructions: List all “required” actions from the above ILSM evaluation.

1. Applicable to all projects: Contractor to provide and maintain fire extinguishers and other fire-fighting equipment, on-site.

2. Applicable to all projects: Strict enforcement of no smoking policy.

3. Applicable to all projects: Storage, housekeeping, and debris removal practices will be conducted to ensure the building’s flammable and combustible fire load is reduced to the lowest feasible level.

4.

5.

6.

7.

8.

9.

10.

11.

12.

13.

14.

Requestor to complete the following to prepare for discussions with Infection Prevention:

Project Description/Number:

Work Location: Project start date:

Project manager/Phone Number: Estimated Duration:

Contractor: Permit expiration date:

• Table 1 (below) – Construction, Renovation, and/or Maintenance Activity Category

• Table 2 (pg. 16)- Affected Area Assessment

• Once complete, call 5-7627 to discuss project with Infection Preventionist

Table 1 - Construction, Renovation, and/or Maintenance Activity Category Select the highest identified activity category, even if other criteria are in a lower category:

Category A

Inspection and/or facility upkeep generally defined as follows:

• Work can be completed in a single shift, not to exceed 10 hours.

• Patients and/or employees may be in the area depending on the activity.

• Work that does not create dust or debris.

• Removal of ceiling tile or access to mechanical or electrical chase for visual inspection limited to 1 tile per 50 square feet with limited exposure time (not to exceed an hour for each tile) within the shift.

• Minor interior updates (e.g., replacing floor or ceiling tiles, carpentry work to include hanging signage, and painting without sanding) that do not create dust or debris.

• Limited building system maintenance such as plumbing on potable systems limited to faucet replacement etc. and electrical work such as replacement of bulbs, receptacles, or switches.

Category B

General maintenance and repair work generally defined as follows:

• Prolonged inspection and work that may take longer than a single shift but not exceeding a week.

• Patients and employees are not to be in the area until activity is completed.

• Work that creates minimal dust and debris.

• Interior finish or surface repairs, updates, or modifications such as repair of firewalls and barriers, and new flooring that produces minimal dust and debris. Controlled sanding activities (e.g., wet or dry sanding) that produce minimal dust and debris.

• Plumbing work such as installation or replacement of a single fixture or piping for a single fixture. Any work on sanitary plumbing including snaking of drains.

• Electrical work such as installation of cabling/wiring/conduit for a single device, installation of new device such as a light fixture that produces minimal dust and debris.

• Air Handler and/or fan shutdown/startup and HVAC work such as replacement of a single diffuser, single terminal unit or a single device that produces minimal dust and debris.

Category C

Small-scale construction, renovation, or maintenance generally defined as follows:

• Work requiring longer than a single week to complete but not exceeding 6 months.

• Patients and employees are not to be in the area until activity is completed.

• Demolition/removal of preexisting floor covering, casework, lay-in ceiling, or other architectural elements.

• Demolition/removal of more than 32 ft2 of drywall/framing, hard ceilings, and doors/framing and minimal infrastructure such as electrical circuits and branch piping.

• Installation of new walls, ceilings and doors including framing, drywall/plaster and associated work.

• Plumbing work such as the installation of new sinks, showers and toilets and associated plumbing.

• Shut down of sections of potable water systems.

• Electrical work such as installation of conduit and wire for lighting, receptacles and switches for an area, the installation of conduit and wire for new devices such as terminal units, fans etc.

• Modification of existing fire alarm and suppression systems.

• Mechanical work such as the installation of ductwork, diffusers, and terminal units for an area.

Category D

Large-scale construction, renovation, or maintenance generally defined as follows:

• Work exceeding 6 months in duration.

• Patients and employees are not to be in the area until activity is completed.

• Large-scale demolition of building components and infrastructure including removal of multiple doors, walls, framing, ceilings, flooring, piping, electrical and HVAC.

• The installation building components such as new walls, ceilings and doors including framing, drywall and associated plaster work.

• Plumbing work such as the installation of:

o new medical gas systems, o steam/heating hot water, condensate systems, o multiple sinks, showers and toilets including associated plumbing.

• Shutdown of potable water, steam/heating hot water, condensate, and medical gas systems.

• Electrical work such as installation of electrical feeders, distribution panels, conduit and wire for lighting, receptacles and switches for an area, the installation of conduit and wire for new devices such as terminal units, fans etc.

• Installation of fire alarm and suppression systems.

• Electrical shutdown of multiple panels.

• Mechanical work such as the installation of air handling equipment, associated ductwork, diffusers, heat exchangers, terminal units and controls.

Table 2 - Affected Area Assessment Identify the areas and associated patients that will be affected by the construction/renovation/maintenance activity (see the Figure for a visual representation of adjacent affected areas).

Figure: Isometric drawing of affected area assessment

Area Service(s)/Type(s) of Area(s) (e.g., OR, Unit/Ward, Sterile

Processing, Administrative, etc.)* Point of Contact (POC) POC Contact Information

Activity Area**

Area Above

Area Below

Adjacent Area 1

Adjacent Area 2

Adjacent Area 3

Adjacent Area 4

* There may be more than one Service/type of area for each row. List all.

** List the area(s) in which the construction/renovation/maintenance activity will occur. NOTE: When the Activity Category is B, C, or D, the control measures are determined by the Patient Risk in the adjacent affected areas.

Table 3 - Patient Risk Category-

Select the overall Patient Risk Category (greatest risk):

Location Group 1-Low

Risk

Non-patient care areas such as:

Location Group 2- Medium Risk

Patient care support areas such as:

Location Group 3- High Risk

Patient care areas such as:

Location Group 4- Highest Risk

Procedural, invasive, sterile support and highly compromised patient care areas such as:

• The following locations when not in clinical areas:

o Public hallways o Office areas o Breakrooms o Bathrooms or locker rooms o Mechanical/elect rical rooms

• Engineering

• Environmental

Services

• HIM

• Morgue

• Outside projects or excavation near air intakes

• Waiting areas

• Clinical engineering (biomedical)

• Materials management

• Sterile processing department – dirty side

• Kitchen, cafeteria, gift shop, coffee shop

• Patient care rooms and areas (i.e., Prosthetics, rehab/ PT/OT/ST, Respiratory Care)

• All acute care units, including mental health (i.e., Acute Nursing Units-2W, 4W, IP Mental Health)

• All outpatient units and clinics (i.e., CBOC, Primary Care, Specialty Clinics, dental, dermatology, echocardiography, endoscopy/GI, Cardiology)

• Emergency department

• Community Living Centers

• Employee health

• Pharmacy – general work zone

• Medication rooms and clean utility rooms

• Imaging suites – diagnostic imaging (i.e., MRI, CT, Nuclear Med)

• Laboratory

• Clean linen storage

• Sterile Supply Storage Areas

• All intensive care units (i.e., ICU/SDU)

• All oncology units and chemotherapy/infusion centers

• OR theaters and restricted areas (i.e., anesthesia areas, OR, Holding/PACU)

• Hemodialysis units

• Procedural rooms (i.e., Bronch Suite, Pain clinic, Cardiac Cath lab, Endovascular/GI Suites) *

• Pharmacy compounding area

• Sterile processing department – clean side

• Transfusion services

• Imaging suites – interventional imaging (i.e., CT)

• Negative pressure isolation rooms/wards

* Procedural Rooms are designated for the performance of patient care activities that may require high-level disinfected or sterile instruments and some environmental controls but is not required to be performed with the environmental controls of an operating room (OR). The room is intended for procedures that are performed in an aseptic surgical field and penetrates the protective surfaces of a patient’s body (e.g., subcutaneous tissue, mucous membranes, cornea) or entry into or opening of a sterile body cavity. Examples of these spaces include Cardiac Catheterization Suites, Electrophysiology Suites, Endovascular/GI Suites, Angio Suites and other spaces which may have high risk patient populations.

Table 4 - Level of Infection Prevention and Control Precautions Match Overall Patient Risk Category (Low, Medium, High, Highest) with the Construction, Renovation, Maintenance Activity Category (A, B, C, D) to determine the minimum Precautions.

Level of Precautions determined from Table 4 (I, II, III, or IV):

• The Infection Prevention Controls outlined for each class provide the minimum precaution requirements identified for the activity and must be in place before the activity begins and maintained until work is completed and the area is activated.

• Control measures for each Precaution Level must also include the control measures in the preceding Level(s).

• As the activity progresses, a full re-evaluation of remaining activity type and patient risk is required prior to downgrading the Level of Precautions.

☐ Review of Activity and Risk Categories indicates that an ICRA is not required for this project.

Rationale, if needed:

Patient Risk Category

Activity Category A B C D

Group 1- Low Risk I II II III*

Group 2- Medium Risk I II III* IV*

Group 3- High Risk I II IV* IV*

Group 4- Highest Risk II III* IV* IV*

Infection Prevention and Control Construction/Renovation/Maintenance Permit Project Description/Number:

Work Location: Project start date:

Project manager/Phone Number: Estimated Duration:

Contractor: Permit expiration date Activity Level: Patient Risk Level: Required Infection Prevention and Control Precautions:

Level of Precautions: Check all levels of control measures that are required to be followed during this project.

Pre- and During Construction Requirements Upon Completion of Project Level

I

1. Perform work activity in a manner that does not create dust.

2. Immediately close above ceiling access upon work completion.

3. Materials/equipment brought into the facility must be free of contaminants/loose material.

4. Use control cube for ceiling access when >1 ceiling tile removed per 50 sq. ft.

Complete for both Level I and II Projects:

• Consult with IP prior to barrier removal to determine if inspection is required.

• Remove tape from sealed doors

• Clean work areas including all environmental surfaces, high horizontal surfaces, and flooring materials with approved disinfectant.

• Check all supply and return air registers for dust accumulation on upper surfaces and air diffuser surfaces.

• Remove isolation of HVAC system in job site. Verify that HVAC systems are clean/operational.

• Verify the HVAC systems meet original airflow/air exchange design specifications. Test and balance

• Until the potable water system is activated and in use, flushing shall continue at least twice per week ( VHA Directive 1061).

• ICRA Permit will be removed by Infection Control or designee after inspection and before barrier removal

• Following barrier removal, contractor must provide initial cleaning, followed by terminal cleaning with hospital-approved disinfectant by EMS prior to occupancy.

Level

II

All control measures in Level I and the following:

1. Provide active means to control airborne dust from dispersing into occupied areas (i.e., water mist surface, Control cube)

2. Worker clothing is clean and free of visible dust before leaving the job site.

3. Remove or isolate air diffusers (supply and return) to protect the HVAC system from dust and reduce air turbulence. Rebalance system to address diffuser isolation.

4. When the work involves/impacts potable water systems (i.e., stagnation due to reduced usage) the piping shall be flushed twice a week or isolated from the main system.

5. Seal doors, to prevent dust migration.

6. Equipment, tools, or materials removed from the job site must be in sealed containers and/or cleaned of dust and debris prior to removal from job site.

7. Contain all trash and debris in the job site. Use nonporous/smooth, cleanable containers with a hard lid to transport trash/debris. The containers must be damp-wiped cleaned and free of visible dust/debris before leaving the contained job site. Perform daily cleaning and disposal of trash from job site using an identified exit route.

8. Install a sticky dust collection mat at entrance of contained work area. Sticky mats must be changed routinely and when adhesive is not effective.

9. Maintain clean surroundings by damp mopping or HEPA vacuuming surfaces at least daily.

Level

III

All control measures in Levels I and II and the following:

1. Ensure availability of equipment for cleaning hands.

2. Construct and complete critical barriers meeting NFPA 241 requirements. Barriers must extend to the ceiling or if ceiling tile is removed, to the deck above.

3. All (plastic or hard) barrier construction activities must be completed in a manner that prevents dust release. Plastic barriers must be effectively affixed to floor and ceiling (or floor/roof deck above) and secure from movement or damage.

4. Seal all penetrations in containment barriers, including floors and ceiling, using approved materials (UL schedule firestop if applicable for barrier type).

5. Maintain .01 inches/water gauge negative pressurization of the entire workspace by use of HEPA exhaust air systems directed outdoors (unless a work specific waiver is approved by VHA’s Office of Healthcare Engineering); this must be maintained continuously 24/7 for the duration of the project. Exhaust discharged directly to the outdoors that is 25 feet or greater from entrances, air intakes and windows is not required to be HEPA-filtered. Exhausting discharged air into shared or recirculating HVAC systems, or other shared exhaust systems (e.g., bathroom exhaust) is prohibited.

6. Install a differential pressure sensing device (e.g., magnehelic, manometer, or digital monitoring) on exterior of work containment to continually monitor/document negative pressurization.

All measures for Levels I and II Projects and the following:

• Construction areas must be inspected by an infection preventionist and engineering representative (and others as determined by the facility) for final activity/project close out and removal of infection prevention and control measures.

• Critical barriers must remain in place during all work involving drywall removal, creation of dust and activities beyond simple touch-up work. The barrier may NOT be removed until a work area cleaning has been performed.

Additional cleaning may be needed after removal of barrier.

• All (plastic or hard) barrier removal activities must be completed in a manner that prevents dust release. Use the following precautions when removing hard barriers:

• Carefully remove screws and painter tape.

• If dust will be generated during screw removal, use hand-held HEPA vacuum.

• Drywall cutting is prohibited during removal process.

• Clean all stud tracks with HEPA vacuum before removing outer hard barrier.

• The use of negative air must be designed to remove contaminants from the work area.

• Negative air devices (fans, filters, monitoring and documentation equipment) must always remain operational and in place for a period after completion of dust creating activities to remove contaminants from the work area and before removal of critical barriers.

• Verify and document through a TAB the HVAC systems meets original airflow and air exchange design specifications.

Level

IV

All control measures in Levels I, II and III and the following:

1. Barriers must be hard barriers.

2. Containment must include an anteroom to ensure pressure control, Anteroom must be large enough for equipment staging, cart cleaning, workers’ PPE, and cleaning.

3. Worker clothing and/or PPE must be removed or clean/ free of visible dust before leaving the anteroom. HEPA vacuuming of clothing or use of cover suits is acceptable.

4. Workers must wear shoe covers or have a method to clean shoes in anteroom. Shoe covers must be removed prior to exiting the anteroom to the occupied space/non-work area. Damaged shoe covers must be changed immediately.

5. Project manager/team responsible for PPE trash removal

Additional Requirements:

Project Manager Signature: Infection Preventionist Signature:

Signature109: