580-22-111 ICRA.pdf

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Infection Control Risk Assessment 2.0

Matrix of Precautions for Construction, Renovation and Operations

Step One: BIGO heat exchangers and pressure reduction station repairs Using Table 1, identify the Construction Project Activity Type (A-D).

Table I - Construction Project Activity Type: D

Inspection and non-invasive activities.

Includes but is not limited to:

• Removal of ceiling tile for visual inspection-limited to 1 tile per 50 square feet with Type A limited exposure time.

• Limited building system maintenance (e.g., pneumatic tube station, HVAC system, fire suppression system, electrical and carpentry work to include painting without sanding) that does not create dust or debris.

• Clean plumbing activity limited in nature.

Small-scale, short duration activities that create minimal dust and debris.

Type B • Work conducted above the ceiling (e.g., prolonged inspection or repair of firewalls and barriers, installation of conduit and/or cabling, and access to mechanical and/or electrical chase spaces).

• Fan shutdown/startup.

• Installation of electrical devices or new flooring that produces minimal dust and debris.

• The removal of drywall where minimal dust and debris is created.

• Controlled sanding activities (e.g., wet or dry sanding) that produce minimal dust and debris.

Large-scale, longer duration activities that create a moderate amount of dust and debris.

• Removal of preexisting floor covering, walls, casework or other building components.

Type C • New drywall placement.

• Renovation work in a single room.

• Non-existing cable pathway or invasive electrical work above ceilings.

• The removal of drywall where a moderate amount of dust and debris is created.

• Dry sanding where a moderate amount of dust and debris is created.

• Work creating significant vibration and/or noise.

• Any activity that cannot be completed in a single work shift.

Major demolition and construction activities.

Type D • Removal or replacement of building system component(s).

• Removal/installation of drywall partitions.

• Invasive large-scale new building construction.

• Renovation work in two or more rooms.

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Matrix of Precautions for Construction, Renovation and Operations

Step Two:

Using Table 2, identify the Patient Risk Group(s) that will be affected. If more than one risk group will be affected, select the higher risk group.

Table 2 - Patient Risk Group: Low

Low Risk

Non-patient care areas such as:

Medium Risk

Patient care support areas such as:

High Risk

Patient care areas such as:

Highest Risk

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

• Public hallways and • Waiting areas. • Patient care rooms • All transplant and intensive gathering areas not • Clinical engineering, and areas care units.

on clinical units. • Materials • All acute care units • All oncology units.

• Office areas not on management. • Emergency • OR theaters and restricted clinical units. • Sterile processing department areas.

• Breakrooms not on department - dirty • Employee health • Procedural suites.

clinical units. side. • Pharmacy - general • Pharmacy compounding.

• Bathrooms or locker • Kitchen, cafeteria, gift work zone • Sterile processing department rooms not on clinical shop, coffee shop, • Medication rooms and - clean side.

units. and food kiosks. clean utility rooms • Transfusion services.

• Mechanical rooms

• Imaging suites: • Dedicated isolation not on clinical units.

diagnostic imaging wards/units.

• EVS closets not on

• Laboratory. • Imaging suites: invasive clinical units.

imaging.

Step Three:

Match the Patient Risk Group (Low, Medium, High, Highest) from Step Two with the planned Construction Activity Project Type (A, B, C, D) from Step One using Table 3 to find the Class of Precautions (I, II, III, IV or \/) or level of infection control activities required. The activities are listed in Table 5 - Minimum Required Infection Control Precautions by Class.

Table 3 - Class of Precautions: lii

Construction Project Type Patient Risk Group TYPE A TYPE B TYPE C TYPE D

LOW Risk Group II Ii Ill

MEDIUMRiskGroup Ill IV _II

HIGH Risk Group Ill IV .,.

HIGHEST Risk Group _Ill _IV

Infection control permit and approval will be required when Class of Precautions Ill (Type C) and all Class of Precautions IV or V are necessary.

Environmental conditions that could affect human health, such as sewage, mold, asbestos, gray water and black water will require Class of Precautions IV for LOW and MEDIUM Risk Groups and Class of Precautions V for HIGH and HIGHEST Risk Groups.

©2021 American Society for Health Care Engineering of the American Hospital Association

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Matrix of Precautions for Construction, Renovation and Operations

Step Four:

Assess potential risk to areas surrounding the project. Using Table 4, identify the surrounding areas that will be affected and the type of impact that will occur. If more than one risk group will be affected, select the higher risk group using Table 2 - Patient Risk Group.

Table 4 - Surrounding Area Assessment

Unit Below: NA Unit Above: Unit Lateral: Hallway Unit Behind: Unit in Front: Loading

Optometry

Mechanical room dock Risk Group: Risk Group: High Risk Group: Low Risk Group: Low Risk Group: Low Contact: Contact: Salve Contact: FMS Contact: EMS Contact: FMS

Tecson

Phone: Phone:x-24405 Phone: x-20722 Phone:x-20722 Phone:x-20722 Additional Controls: Additional Controls: Additional Controls: Additional Controls: Additional Controls:

O Noise x Noise 0 Noise D Noise El Noise O Vibration x Vibration El Vibration El Vibration 0 Vibration O Dust control 0 Dust control El Dust control 0 Dust control 0 Dust control 0 Ventilation El Ventilation 0 Ventilation 0 Ventilation 0 Ventilation O Pressurization 0 Pressurization El Pressurization El Pressurization 0 Pressurization O Impact to other El Impact to other 0 Impact to other 0 Impact to other 0 Impact to other systems, such as: systems, such as: systems, such as: systems, such as: systems, such as:

O Data El Data 0 Data El Data 0 Data El Mechanical 0 Mechanical El Mechanical El Mechanical 0 Mechanical 0 Med Gases 0 Med Gases El Med Gases 0 Med Gases 0 Med Gases

Noise & Vibration Mitigation Strategies

O Use diamond drills instead of powder-actuated fasteners.

X Schedule noise-making periods with adjacent spaces.

El Use beam clamps instead of shot.

0 Prefab where possible.

El Use tin snips to cut metal studs instead of using a chop saw.

0 Install metal decking with vent tabs, then use cellular floor deck hangers.

O Consider pro-press instead of soldering, brazing or welding.

El Wet core drill instead of dry core or percussion.

0 Instead of jackhammering concrete, use wet diamond saws.

El Use HEPA vacuums instead of standard wet/dry vacuums.

El Use mechanical joining system sprinkler fittings instead of threaded.

O Where fumes are tolerated, use chemical adhesive remover (flooring glue) instead of mechanical.

El To remove flooring, shot blast instead of using a floor scraper.

O Use electric sheers instead of reciprocating saw for ductwork cutting.

X Install man/material lifts.

Ventilation & Pressurization Mitigation Strategies

0 HEPA to exterior.

El Install temporary ductwork.

0 Utilize temporary HVAC equipment.

El Vacate the area.

El Install temporary partitions.

El Use carbon filtration to filter odors.

Impact to Other Systems Mitigation Strategies

X Schedule outages.

El Provide temporary systems.

El Back-feed electricity or medical gases.

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Matrix of Precautions for Construction, Renovation and Operations

Table 5 - Minimum Required Infection Control Precautions by Class I Before and During Work Activity

Class of Mitigation Activities Precautions (Performed Before and During Work Activity) Class I 1. Perform noninvasive work activity as to not block or interrupt patient care.

2. Perform noninvasive work activities in areas that are not directly occupied with patients.

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

4. Immediately replace any displaced ceiling tile before leaving the area and/or at end of noninvasive work activity.

Class II 1. Perform only limited dust work and/or activities designed for basic facilities and engineering work.

2. Perform limited dust and invasive work following standing precautions procedures approved by the organization.

3. This Class of Precautions must never be used for construction or renovation activities.

Class III 1. Provide active means to prevent airborne dust dispersion into the occupied areas.

2. Means for controlling minimal dust dispersion may include hand-held HEPA vacuum devices, polyethylene plastic containment, or isolation of work area by closing room door.

3. Remove or isolate return air diffusers to avoid dust from entering the HVAC system.

4. Remove or isolate the supply air diffusers to avoid positive pressurization of the space,

5. If work area is contained, then it must be neutrally to negatively pressurized at all times.

6. Seal all doors with tape that will not leave residue.

7. Contain all trash and debris in the work area.

8. Nonporous/smooth and cleanable containers (with a hard lid) must be used to transport trash and debris from the construction areas. These containers must be damp-wiped cleaned and free of visible dust/debris before leaving the contained work area.

9. Install a sticky (dust collection) mat at entrance of contained work area based on facility policy.

Sticky mats must be changed routinely and when visibly soiled.

10. Maintain clean surroundings when area is not contained by damp mopping or HEPA vacuuming surfaces.

Class IV 1. 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.

2. All (plastic or hard) barrier construction activities must be completed in a manner that prevents dust release. Plastic barriers must be effectively affixed to ground and ceiling and secure from movement or damage. Apply tape that will not leave a residue to seal gaps between barriers, ceiling or floor.

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

4. Containment units or environmental containment units (ECUs) approved for Class IV precautions in small areas totally contained by the unit and that has HEPA-filtered exhaust air.

s. Remove or isolate return air diffusers to avoid dust entering the HVAC system.

6. Remove or isolate the supply air diffusers to avoid positive pressurization of the space.

7. Negative airflow pattern must be maintained from the entry point to the anteroom and into the construction area. The airflow must cascade from outside to inside the construction area. The entire construction area must remain negatively pressurized.

8. Maintain negative pressurization of the entire workspace by use of HEPA exhaust air systems directed outdoors. Exhaust discharged directly to the outdoors that is 25 feet or greater from entrances, air intakes and windows does not require HEPA-filtered air.

9. If exhaust is directed indoors, then the system must be HEPA filtered. Prior to start of work, HEPA filtration must be verified by particulate measurement as no less than 99.97% efficiency and must not alter or change airflow/pressure relationships in other areas.

10. Exhaust into shared or recirculating HVAC systems, or other shared exhaust systems (e.g., bathroom exhaust) is not acceptable.

11. Install device (e.g., magnehelic, manometer, or digital monitoring) on exterior of work containment to continually monitor negative pressurization. The "ball in the wall" or similar apparatus are not acceptable.

@2021 American Society for Health Care Engineering of the American Hospital Association

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Matrix of Precautions for Construction, Renovation and Operations

12. Contain all trash and debris in the work area.

13. Nonporous/smooth and cleanable containers (with a hard lid) must be used to transport trash and debris from the construction areas. These containers must be damp-wiped cleaned and free of visible dust/debris before leaving the contained work area.

14. Worker clothing must be clean and free of visible dust before leaving the work area. HEPA vacuuming of clothing or use of cover suites is acceptable.

15. Workers must wear shoe covers prior to entry into the work area. Shoe covers must be changed prior to exiting the anteroom to the occupied space (non-work area). Damaged shoe covers must be immediately changed.

16. Install a sticky (dust collection) mat at entrance of contained work area based on facility policy.

Sticky mats must be changed routinely and when visibly soiled.

17. Consider collection of particulate data during work to monitor and ensure that contaminates do not enter the occupied spaces. Routine collection of particulate samples may be used to verify HEPA filtration efficiencies.

Class V 1. 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.

2. All (plastic or hard) barrier construction activities must be completed in a manner that prevents dust release. Plastic barriers must be effectively affixed to ground and ceiling and secure from movement or damage. Apply tape that will not leave a residue to seal gaps between barriers, ceiling or floor.

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

4. Construct anteroom large enough for equipment staging, cart cleaning, workers. The anteroom must be constructed adjacent to entrance of construction work area.

5. Personnel will be required to wear coveralls at all times during Class V work activities.

Coveralls must be removed before leaving the anteroom.

6. Remove or isolate return air diffusers to avoid dust entering the HVAC system.

7. Remove or isolate the supply air diffusers to avoid positive pressurization of the space.

8. Negative airflow pattern must be maintained from the entry point to the anteroom and into the construction area. The airflow must cascade from outside to inside the construction area. The entire construction area must remain negatively pressurized.

9. Maintain negative pressurization of the entire workspace using HEPA exhaust air systems directed outdoors. Exhaust discharged directly to the outdoors that is 25 feet or greater from entrances, air intakes and windows does not require HEPA-filtered air.

10. If exhaust is directed indoors, then the system must be HEPA filtered. Prior to start of work, HEPA filtration must be verified by particulate measurement as no less than 99.97% efficiency and must not alter or change airflow/pressure relationships in other areas.

11. Exhaust into shared or recirculating HVAC systems, or other shared exhaust systems

(bathroom exhaust) is not acceptable.

12. Install device (e.g., magnehelic, manometer, or digital monitoring) on exterior of work containment to continually monitor negative pressurization. The ball in the wall" or similar apparatus are not acceptable.

13. Contain all trash and debris in the work area.

14. Nonporous/smooth and cleanable containers (with a hard lid) must be used to transport trash and debris from the construction areas. These containers must be damp-wiped cleaned and free of visible dust/debris before leaving the contained work area.

15. Worker clothing must be clean and free of visible dust before leaving the work area anteroom.

16. Workers must wear shoe covers prior to entry into the work area. Shoe covers must be changed prior to exiting the anteroom to the occupied space (non-work area). Damaged shoe covers must be immediately changed.

17. Install a sticky (dust collection) mat at entrance of contained work area based on facility policy.

Sticky mats must be changed routinely and when visibly soiled.

18. Consider collection of particulate data during work to monitor and ensure that contaminates do not enter the occupied spaces. Routine collection of particulate samples may be used to verify

HEPA filtration efficiencies.

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Infection Control Risk Assessment 2.0 Matrix of Precautions for Construction, Renovation and Operations

Table 6 - Minimum Required Infection Control Precautions I Upon Completion of Work Activity

Class of Mitigation Activities Precautions (Performed upon Completion of Work Activity) Classes I, II Cleaning:

and III 1 Clean work areas including all environmental surfaces, high horizontal surfaces and flooring materials.

2. Check all supply and return air registers for dust accumulation on upper surfaces as well as air diffuser surfaces.

HVAC Systems:

1. Remove isolation of HVAC system in areas where work is being performed. Verify that

HVAC systems are clean and operational.

2. Verify the HVAC systems meet oriainal airflow and air exchange design specifications.

Classes Ill, Class Ill (Type C Activities only), IV, and V precautions require inspection and documentation for IV and V downgraded ICRA precautions.

Construction areas must be inspected by an infection preventionist or designee and engineering representative for discontinuation or downgrading of ICRA precautions.

Work Area Cleaning:

1. Clean work areas including all environmental surfaces, high horizontal surfaces and flooring materials.

2. Check all supply and return air registers for dust accumulation on upper surfaces as well as air diffuser surfaces.

Removal of Critical Barriers:

1. 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.

2. 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:

i. Carefully remove screws and painter tape.

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

iii. Drywall cutting is prohibited during removal process.

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

V. Use a plastic barrier to enclose area if dust could be generated.

Negative Air Requirements:

1. The use of negative air must be designed to remove contaminates from the work area.

2. Negative air devices must remain operational at all times 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.

HVAC systems:

1. Upon removal of critical barriers, remove isolation of HVAC system in areas where work is being performed.

2. Verify that HVAC systems are clean and operational.

3. Verify the HVAC systems meets original airflow and air exchange design specifications.