36C25218Q1052-012.doc

695-xx-xxx, _________________________

November 21, 2015

Milwaukee VAMC

SECTION 01 01 10 - ic Infection Control

DESCRIPTION

Step 1. Identify Construction Activity – see specification section 01 01 10 1-HR

A. This section specifies the control of environmental infection control and risk assessment that the Contractor must consider for construction & renovation projects in the medical facility. It includes Precautionary management of, Inspections and Non invasive activities, small scale, short duration activities, that create minimal dust. Major demolition and construction projects that generate a moderate to high levels of dust. Movement of materials and equipment, and resources that are encountered or generated by the Contractor. The Contractor is obligated to consider the specified control measures with the costs included within the various contract items of work. An Infection Control Risk Assessment Matrix of Precautions for construction and renovation for activities follows.

TYPE A

Minimal

Fire Risk 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.

· Removal of floor tile less than 25 square feet, non-ACM and no grinding or dust generating activities

TYPE B

Limited

Fire Risk 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

Moderate

Fire Risk 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 construction or renovations over 3 days duration

· major duct work, plumbing, piping, or electrical work

· soldering or brazing operations

· ANY activity that requires a burn permit

TYPE D

Significant Fire Risk 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 building system

· new construction or renovations over 3 days duration

B.

Infection Control Risk and damage is defined as the presence of chemical, physical, or biological elements or agents which:

1.

Adversely effect human health or welfare,

2. Unfavorably alter ecological balances of importance to human life.

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:

Step 2. Identify Patient Risk Group

· Office areas

· Cardiology

· Echocardiography

· Endoscopy

· Nuclear Medicine

· Physical Therapy

· Radiology/MRI

· Respiratory Therapy

· CCU

· Emergency Room

· Labor & Delivery

· Laboratories (specimen)

· Newborn Nursery

· Outpatient Surgery

· Pediatrics

· Pharmacy

· Post Anesthesia Care Unit

· Surgical Units

· Linen

· Kitchen & Canteen

· Any area caring for immunocompromised patients

· Burn Unit

· Cardiac Cath Lab

· Central Sterile Supply

· Intensive Care Units

· Medical Unit

· Negative pressure isolation rooms

· Oncology

· Operating rooms including C-section rooms

· Dialysis

C. Match the Patient Risk Group with Construction Project Type on the following matrix to find the level of infection control activities required.

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.

1) Infection Control approval will be required when the Construction Activity and Risk Level indicate that Class III or Class IV control procedures are necessary. Contact the VA Project engineer and the infection control officer before proceeding.

Step 3. Identify Level of Infection Control Activities Required

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

Construction Project Type

D.

Description of Required Infection Control Precautions by Class

During Construction Project

Upon Completion of Project

2. Immediately replace a ceiling tile displaced for visual inspection

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.

1. Wipe work surfaces with disinfectant.

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

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

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

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.

* Use window for negative HEPA air exhaust when accessible. Obtain V.A, resident engineer approval for exhausting in existing exhaust ductwork.

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.

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.

E. Identify the area surrounding the project area, assessing potential impact.

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.

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 3 Bartley, ECSI Inc 2002 Step 4. Identify the areas surrounding the project area, assessing potential impact

Step 5. Identify specific site of activity eg, patient rooms, medication room, etc.

(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? (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 handwashing 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)

Step 6. Identify 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? (Eg, solids wall barriers); Will HEPA filtration be required?

Infection Control Construction Permit

Permit No:

Location of Construction:

Project Start Date:

Project Coordinator:

Estimated Duration:

Contractor Performing Work

Permit Expiration Date:

Supervisor:

Telphone:

TYPE A: Inspection, non-invasive activity

GROUP 1: Low Risk

TYPE B: Small scale, short duration, GROUP 2: Medium Risk moderate to high levels

TYPE C: Activity generates moderate to high levels of

GROUP 3: Medium/high Risk dust, re Lures eater 1 work shift for completion

TYPE. D: Major duration arid construction activities

GROUP 4: Highest Risk

Requiring consecutive work shifts

construction operations.

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

dispersing into atmosphere covered containers.

3. Seal unused doors with duct tape.

before leaving work area.

is being performed.

3. Complete all critical barriers or implement control cube spreading of dirt and debris associated with method before construction begins.

construction.

tightly covered containers.

project is thoroughly cleaned by Env. Services Dept.

is being performed/

shoe covers

3. Complete all critical barriers or implement control cube project is thoroughly cleaned by the Environmental method before construction begins.

Service Dept.

6. Construct anteroom and require all personnel to pass spreading of dirt and debris associated with through this room so they can be vacuumed using a HEPA construction.

cloth or paper coveralls that are removed each time they covered containers.

bein done.

Additional Requirements:

Exceptions/Additions to this permit Date

F. Apply Life Safety and standards (APIC) and the following criteria would need to be assured in order to maintain the supply air side open during Class 4 construction activity:

· The air supply is 100% fresh air and the site and adjacent areas can be kept under negative pressure at all times.

· There is no re circulated air in this section

· There is no duct work involved in this section of the demolition

· The site can never be positive to the adjacent areas (i.e. keep the negative air machines on at all times or for 1-2 hours post site work until the negative action can be maintained.

· A log is maintained to document that the negative pressure is checked and has been maintained during those hours when the negative air machines are turned off. (An alarmed device is recommended for this purpose and should be maintained and monitored by the construction personnel).

PART 2 - PRODUCTS, MATERIALS AND EQUIPMENT

2.1 MATERIALS AND EQUIPMENT

GENERAL REQUIREMENTS

A. All materials shall be delivered in their original package, container or bundle bearing the name of the manufacturer and the brand name (where applicable). When transporting new materials & equipment though the hospital use 4 mil Poly sheeting encasing materials, tools and equipment or use a totally enclosed cart.

B.

Store all materials subject to damage off the ground, away from wet or damp surfaces and under cover sufficient enough to prevent damage or contamination. Flammable materials cannot be stored inside buildings. Replacement materials shall be stored outside of the regulated/work area until construction is completed.

C.

The Contractor shall not block or hinder use of buildings by patients, staff, and visitors to the VA in partially occupied buildings by placing materials/equipment in any unauthorized place.

D.

The Competent Person shall inspect for damaged, deteriorating or previously used materials. Such materials shall not be used and shall be removed from the worksite and disposed of properly.

E. Demolition materials must be transported in totally enclosed containers.

1) Demolition on above ground floors may use a window debris chute to convey materials to an enclosed dumpster that provides dust and noise control. The contractor is responsible to maintain the original appearance of the building fascia.

2.1.2 NEGATIVE PRESSURE FILTRATION SYSTEM

The Contractor shall provide enough negative air machines to completely exchange the regulated area air volume 4 actual times per hour. The Competent Person shall determine the number of units needed for each regulated area by dividing the cubic feet in the regulated area by 15 and then dividing that result by the actual cubic feet per minute (cfm) for each unit to determine the number of units needed to effect 4 air changes per hour. Provide a standby unit in the event of machine failure and/or emergency in an adjacent area.

2.1.3 DESIGN AND LAYOUT

Before start of work for each phase of the project, the contractor is to submit for approval, an infection control plan which will include the design and layout of the regulated area to include the type and location of infection control construction barriers to be used, access points, ante room location, etc. The submittal shall indicate the number of, location of and size of negative air machines and exhaust route & location of the windows to be used. The point(s) of exhaust, air flow within the regulated area, anticipated negative pressure differential, and supporting calculations for sizing shall be provided. In addition, submit the following:

1.

Manufacturer's information on the negative air machine(s).

2.

Method of supplying power to the units and designation/location of the panels.

3.

Description of testing method(s) for correct air volume and pressure differential. Provide manufacturer's product data on the pressure differential measuring device used.

4. If auxiliary power supply is to be provided for the negative air machines, provide a schematic diagram of the power supply and manufacturer's data on the generator and switch.

5. Location of isolation negative air pressure monitor.

6. The following is a SAMPLE plan:

Sample Infection control plan

2.1.4 NEGATIVE AIR MACHINES

A.

Negative Air Machine Cabinet: The cabinet shall be constructed of steel or other durable material capable of withstanding potential damage from rough handling and transportation. The width of the cabinet shall be less than 30" in order to fit in standard doorways. The cabinet must be factory sealed to prevent dust from being released during use, transport, or maintenance. Any access to and replacement of filters shall be from the inlet end. The unit must be on casters or wheels.

B.

Negative Air Machine Fan: The rating capacity of the fan must the air moving capacity under actual operating conditions. Manufacturer's typically use "free-air" (no resistance) conditions when rating fans. The fan must be a centrifugal type fan.

A. Negative Air Machine Final Filter:

1) When exhausting directly to the outside from a window or penetration the filter shall be a minimum MERV 8 pleated filter media completely sealed on all edges within a structurally rigid frame.

2) When exhausting to a exhaust duct: the final filter shall be a HEPA filter. The filter media must be completely sealed on all edges within a structurally rigid frame. The filter shall align with a continuous flexible gasket material in the negative air machine housing to form an air tight seal. Each HEPA filter shall be individually tested and certified by the manufacturer to have an efficiency of not less than 99.97% when challenged with 0.3 m dioctylphthalate (DOP) particles. Testing shall have been done in accordance with Military Standard MIL- STD-282 and Army Instruction Manual 136-300-175A. Each filter must bear a UL586 label to indicate ability to perform under specified conditions. Each filter shall be marked with the name of the manufacturer, serial number, air flow rating, efficiency and resistance, and the direction of test air flow.

D.

Negative Air Machine Pre-filters: The pre-filters, which protect the final HEPA filter by removing larger particles, are required to prolong the operating life of the HEPA filter. Two stages of pre-filtration are required. A first stage pre-filter shall be a low efficiency type for particles 10 m or larger. A second stage pre-filter shall have a medium efficiency effective for particles down to 5 m or larger. Pre-filters shall be installed either on or in the intake grid of the unit and held in place with a special housing or clamps.

F.

Negative Air Machine Safety and Warning Devices: An electrical/ mechanical lockout must be provide to prevent the fan from being operated without a HEPA filter. Units must be equipped with an automatic shutdown device to stop the fan in the event of a rupture in the HEPA filter or blockage in the discharge of the fan. Warning lights are required to indicate normal operation; too high a pressure drop across filters; or too low of a pressure drop across filters.

G.

Negative Air Machine Electrical: All electrical components shall be approved by the National Electrical Manufacturer's Association (NEMA) and Underwriter's Laboratories (UL). Each unit must be provided with overload protection and the motor, fan, fan housing, and cabinet must be grounded.

2.1.5 PRESSURE DIFFERENTIAL

The fully operational negative air system within the regulated area shall continuously maintain a pressure differential of -0.02" water column. Before any disturbance of any material or building system, this shall be demonstrated to the VA by use of a pressure differential meter/manometer as required by OSHA 29 CFR 1926.1101(e)(5)(i). The Competent Person shall be responsible for providing and maintaining the negative pressure and air changes as required by OSHA and this specification.

2.1.6 TESTING THE SYSTEM

The negative pressure system must be tested before any disturbedance. After the regulated area has been completely prepared, the decontamination units set up, and the negative air machines installed, start the units up one at a time. Demonstrate and document the operation and testing of the negative pressure system to the VA using smoke tubes and a negative pressure gauge. Testing must also be done at the start of each work shift.

2.1.7 DEMONSTRATION OF THE NEGATIVE AIR PRESSURE SYSTEM

The demonstration of the operation of the negative pressure system to the VA shall include, but not be limited to, the following:

A.

Contractor to install Triatek (Web site www.Ttk.com) negative air isolation monitoring stations at the sites access doors or at opposite sides of the construction area check with COTR for number of units and location.

B.

Curtains of the decontamination units move in toward regulated area.

D. Use smoke tubes to demonstrate air is moving air across all areas in which work is to be done.

E. Plastic barriers and sheeting move lightly in toward the regulated area.

2.1.8 USE OF SYSTEM DURING construction OPERATIONS

A.

Start units before beginning any disturbance occurs. After work begins, the units shall run continuously, maintaining 4 actual air changes per hour at a negative pressure differential of 5.0 Pa (-0.02") water column, for the duration of the work until a final visual clearance and final air clearance has been completed.

B.

The negative air machines shall not be shut down for the duration of the project unless authorized by the VA, in writing.

C.

Construction work shall begin at a location closest from the units and proceed away from them. If an electric failure occurs, the Competent Person shall stop all work and not resume until power is restored and all units necessary are operating properly again.

D. The negative air machines shall continue to run after all work is completed and until a final visual clearance and a final air, clearance has been completed for that regulated area.

2.2 CONTAINMENT BARRIERS AND COVERINGS IN THE REGULATED AREA

2.2.1 GENERAL

A.

Seal off the perimeter to the regulated area to completely isolate the regulated area from adjacent spaces. All surfaces in the regulated area must be covered to prevent contamination and to facilitate clean-up. Should adjacent areas become contaminated, immediately stop work and clean up the contamination at no additional cost to the Government.

2.2.3 CONTROLLING ACCESS TO THE REGULATED AREA

A.

Access to the regulated area is allowed only through the personnel decontamination facility (PDF). All other means of access shall be eliminated and OSHA warning signs posted as required by OSHA. If the regulated area is adjacent to or within view of an occupied area, provide a visual barrier of opaque fire retardant poly sheeting at least 4 mils thick to prevent building occupant observation. If the adjacent area is accessible to the public, the barrier must be solid and capable of withstanding the negative pressure.

2.2.4 CRITICAL BARRIERS

A. Completely separate the regulated area from adjacent areas using fire retardant poly at least 6 mils thick and duct tape. Individually seal with two layers of 6 mil poly and duct tape all HVAC openings, cap off exhaust into the regulated area. Individually seal all lighting fixtures, clocks, doors, windows, convectors, speakers, or any other objects in the regulated area. Use care with hot/warm surfaces see fig 1.

2.2.5 PRIMARY BARRIERS

A.

Temporary Construction Partitions:

1. Install and maintain temporary construction partitions to provide separations between construction areas and adjoining areas. Construct partitions of gypsum board or treated plywood (flame spread rating of 25 or less in accordance with ASTM E84) on one side of wood or metal steel studs. Seal with one layers of 6 mil poly for a vapor barrier under gypsum or plywood. Extend the Poly through suspended ceilings to floor slab or roof. Seal penetrations at door openings, install tight-fitting yellow construction doors with self-closing devices see fig. 2 for barrier construction. Contractor to provide the construction(s) door for the project.

2.2.6

CONTRACTOR SPILL RESPONSE KIT

A.

The kit should include the following:

1. Shop Vacuum.

2. Multi-Purpose Spill Control Sorbents to absorb nonaggesive liquids up to 30 gallons.

3. Sorbents pillows.

4. Pipe leak clamps for copper & steel pipe in sufficient size range and quantity base on project piping scope.

5. Bucket & mop and water resistant duct tape.

Figure 1

Figure 2

Figure 3

01 01 10 IC-1

_1386744301.dwg

_1359284198.dwg