36C25218B0920-009.pdf

FAX to Infection Control x22481 and to Safety x25613 or scan & attach via e-mail to “Hines Infection Control Service”

Infection Control Risk Assessment for Construction / Renovation Projects Project Name: Repair Steam Dist. in Bldg. 1 - Sec E, F, and G Project/ Work-Order Number: 578-17-043

Project Planner or Technician: Jake Kanuru Extension: 21149

Building Number: 1 Floor(s)/Room(s): Tunnel in E, F & G-Sections

Start date: 5-15-18 Projected completion date: 10 /15 /18

Construction Activity Infection control risk group

X TYPE A: Non-invasive activity, low noise, no vibration

DUST LEVEL Low

X GROUP 1: Low office areas, FMS areas, all non-patient care areas.

TYPE B: Small scale, short duration, low-moderate noise, low-moderate vibration

DUST LEVEL: Moderate to High

GROUP 2: Medium All other patient care areas including general medicine floors, ultrasound, Rehab, Occupational Therapy.

TYPE C: Requires more than one work shift to complete, low-moderate noise, moderate–high vibration DUST LEVEL Moderate to High

GROUP 3: Medium/High ED, Radiology/MRI, admissions, food service areas, laboratories.

TYPE D: Major demolition and construction activities Requiring consecutive work shifts, moderate-high noise, moderate-high vibration

DUST LEVEL High

GROUP 4: Highest Operating rooms, SPS, ICU’s, Outpatient areas, oncology, anesthesia, post anesthetic recovery, all endoscope areas, Pharmacy, Renal Dialysis

Project Class Determination Matrix Construction Activity

Risk Level

Type

“A”

Type

“B”

Type

“C”

Type

“D”

Group 1 I II II III

Group 2 I II III IV

Group 3 I III III IV

Group 4 III IV IV IV

Contractors Actions by Project Class

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

4. Emergency Preparedness training/posting/ID card.

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 tap

4. Block off and seal air vents.

5. Wipe surfaces with disinfectant.

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

7. Emergency Preparedness training/posting/ID card.

CLASS

III

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

2. Complete all critical barriers before any work begins.

3. Maintain negative air pressure within work area utilizing

HEPA-equipped air filtration units.

4. Provide dust mat at entrance and exit of work area.

5. Contain construction waste before transport in tightly-covered containers.

6. Wet mop or vacuum with HEPA-filtered vacuum before leaving work area.

7. Cover transport receptacles or carts. Tape covering.

8. Emergency Preparedness training/posting/ID card.

CLASS

IV

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

2. Complete all critical barriers before any work begins.

3. Maintain negative air pressure within work area utilizing

HEPA-equipped air filtration units.

4. Provide adhesive walk-off mat at entrance and exit of work area.

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

6. Vacuum the entire work area with HEPA vacuums or wet mop with disinfectant at the completion of project.

7. Do not remove barriers from work area until completed project is thoroughly cleaned by housekeeping and inspected by the Infection

Control Department, Safety Section, and Engineering Service.

8. Remove barrier materials carefully to minimize spreading dust 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 isolation of HVAC system in areas where work was performed at the end of the project.

12. Emergency Preparedness training/posting/ID card.

Risk Assessment for TB exposure: Does the project involve the building’s: a) HVAC Yes No x ; b) HEPA filters Yes

No__x__ ; c) Negative Pressure Room (s) Yes No x ? If any checked yes, an N95 mask will be required.

Classification ___I________ Contractor’s signature (for Projects only)

Project Planner or Technician Signature__________________________

Supervisor signature _________________________________________ Date_________________

VHAHINDoyleL Typewritten Text 3/22/18

VHAHINDoyleL Oval