Infectious control Construction Guideline 9-18.pdf

A

INFECTION PREVENTION GUIDELINE

TITLE: INFECTION PREVENTION IN CONSTRUCTION AND RENOVATION

Reviewed/Revised and Approved by Infection Prevention and Control Committee- September 2018.

I. PURPOSE

To establish the infection prevention policy for applicants for employment, employed personnel, and volunteers to prevent and control the spread of infectious/communicable diseases.

To establish a policy for maintaining a safe and healthy environment for patients, employees, visitors, and contractors during construction activities. The process of demolition, remodeling and construction may pose a risk of infection, especially those who are immunocompromised. All construction and renovation projects are planned and implemented in a manner to reduce infection prevention risks. The goal of this policy is to provide the occupants of all buildings with an environment that is safe from potential infection hazards during all phases of renovation or construction.

Plans for major renovations and construction of facilities must be reviewed by the Infection Prevention and Control Section, under the authority of the Infection Prevention and Control Committee (IPCC) at the design phase. This is done for compliance with Infection Prevention Guidelines, VA Directives and applicable local, state and federal regulations.

II. POLICY

To protect patients, staff, visitors, and contractors from safety and health hazards associated with construction activities on Department of Veterans Affairs Loma Linda Healthcare System (VALLHCS) properties and leased properties, it is VALLHCS policy that procedures be followed for control of these hazards when VA funded projects occur.

Construction activities include projects performed by employees or contractors managed by VALLHCS.

III. RESPONSIBILITIES

A. Infection Prevention and Control Coordinator: The Infection Prevention and Control Coordinator or their designee is responsible to participate in the project design and implementation of construction and remodeling projects at VALLHCS. The Infection Prevention and Control Coordinator also works closely with and assists the contractors and engineers to maintain a safe and healthy environment for patients, employees, visitors, and contractors during construction activities.

B. Construction Safety Committee: The Construction Safety Committee is responsible for oversight of the Construction Safety Program and ensure that the goals of VHA directive 7715, Safety and Health During Construction, are met.

C. Facilities Management Service (FMS) (Chief of Projects/CO/COR/CSO/PE/PM): FMS staff have the overall responsibility for the day to day planning and oversight of ongoing construction projects including communication with contractors and ensuring that surveillance findings are resolved in a timely manner. They are responsible for notifying the IPCC or their designee of all pre-construction meetings, any changes related to a project that may impact infection control, and coordinate a final inspection and clearance so that the pre-occupancy checklist can be completed by the IPCC. FMS staff have additional responsibilities as listed in HCS policy 00-45, Safety and Health During Construction Activities.

IV. PROCEDURES

A. The Infection Prevention and Control Coordinator or their designee will:

1. Complete the VHA or OSHA 10-hour Construction Safety Course and subsequently complete 10 hours of Construction Safety Training, as required.

2. Be an active member of the Construction Safety Committee and participate in the scheduled multidisciplinary rounds and committee meetings.

3. Participate in the Pre-Construction Risk Assessment, project design and implementation meetings using the current 2014 FGI Guidelines and VHA DIRECTIVE 7715 Safety and Health During Construction (April 6, 2017).

4. Advise and/or provide recommendations on exposure mitigation and the prevention of facility associated infections in patients, staff, and visitors.

5. Conduct and document a Pre-Construction Infection Control Risk Assessment (PICRA) in conjunction with the multidisciplinary team and the contractor as part of the Pre-Construction Risk Assessment process. The determination of risk group, construction class, and precautions that will be required by the contractor as well as the risk of transmission of Mycobacterium tuberculosis (MTB) infection to the construction worker during construction will be addressed (see Appendix A).

a. The risk of acquiring MTB will be based upon the construction site location (including adjacent areas above and lateral to the construction site), patient population, hospital layout, and the latest Center for Disease Control (CDC) defined risk.

i. If the contracted construction worker(s) are determined to be at risk for transmission of TB (based on the risk assessment), the following actions are required:

a. The contractor must provide written certification to the Contracting Officer (CO) and Contracting Officer’s Representative (COR) or Project Engineer (PE) that all contract employees assigned to the work site have had a pre-placement tuberculin screening within 90 days prior to assignment to the worksite and been found to have negative TB screening reactions. Contractors will be required to show documentation of negative TB screening reactions for any additional workers who are added after the 90-day requirement before they will be allowed to work on the work site. NOTE: This can be the Center for Disease Control (CDC) two-step skin testing, or a Food and Drug Administration (FDA)-approved blood test.

b. Contract employees manifesting positive screening reactions to the tuberculin must be examined by a physician and certified in writing that the contractor does not have active infectious tuberculosis as described by the current CDC guidelines prior to working on VHA property.

i. If the contract employee with a positive screen is determined, through examination by a physician, to not show evidence of active (infectious) pulmonary TB, a statement documenting this condition must be on file with the employer (construction contractor).

ii. If the contract employee with positive screen is determined, through examination by a physician, to have active (infectious) pulmonary TB, the employee must complete a course of treatment to resolve the condition. A subsequent statement from a physician documenting a non-infectious condition must be on file before the contract employee may return to work on VHA property.

b. Provide educational material to VA staff, contractors, and subcontractors regarding the PICRA process and the implications pertaining to infection prevention and control, as needed.

c. Communicate the expectations for infection prevention and control to the FMS department prior to the notice to proceed. This will assist in accommodating any additional costs that may be incurred in the project and is accomplished through the risk assessment process. FMS is responsible for ensuring that the contractor is informed of the expectations.

d. The Safety office and FMS will be responsible to review air quality, utilities, noise, vibration, life safety and other hazards included in the Pre- Construction Risk Assessment process.

e. The risk assessment categories will be available on SharePoint and a copy of the Infection Prevention and Control Permit with the designated risk category for the project will be kept in the coordinator’s office. A copy of the permit must be posted at the construction site (see Appendix B).

f. Reassess the PICRA and adjust Infection Prevention and Control Permit as needed to ensure compliance with necessary changes in the project.

6. Conduct periodic job-site inspections to ensure compliance with the items on the posted permit and report any deficiencies to the Construction Safety Officer

(CSO).

a. The CSO will ensure that identified deficiencies are corrected by the contractor and include the Infection Prevention and Control Coordinator or their designee on this correspondence.

b. Recommend to temporarily halt construction or remodeling if, during an inspection, it is noted that there is an immediate risk to patients or employees. This is done under the authority of the Chief, Infectious Disease Section and the Chief of Staff, and there will be immediate communication to the Chief of Projects.

c. Summaries of the inspections by the Infection Prevention and Control department will be presented to the Construction Safety and Infection Prevention and Control Committees.

B. The Infection Prevention and Control Staff participation in the design and planning phase should include but is not limited to:

1. Number and placement of isolation rooms and anterooms.

2. Number and location of fixed sharps containers and glove dispensers.

3. Number and placement of sinks and dispensers for hand hygiene products.

4. Types of faucets (e.g., aerated vs non-aerated; hand control vs foot control).

5. Appropriate location and type of ice machines.

6. Water supply and plumbing.

7. Number and location of adequate clean supply storage and supply areas, clean and dirty linen areas, soiled utility rooms, biohazardous waste and decontamination rooms, and housekeeping aide closets.

8. Medicine preparation areas and placement (e.g., > 3 feet from sink).

9. Types of surface finishes that are easily cleaned and maintained (e.g., porous vs non-porous).

10. Appropriate flooring, wall and window coverings.

11. Air handling systems engineered for optimal performance, ease of maintenance and repair.

12. Staff, patient, and visitor traffic for the duration of the project.

13. Relocation decisions regarding patient care areas, storage areas, etc.

14. Construction waste containment, transport, and disposal.

C. Additional specific construction processes for consideration:

1. Biomedical Waste

a. All waste, including sharps containers, from areas to be renovated, altered, demolished, or constructed shall be removed PRIOR to the start of the project.

b. Infection Prevention and Control staff shall be notified immediately if unexpected biomedical waste is encountered by construction workers.

2. Barrier Walls

a. Construction sites must be separated from patient care areas and critical areas by barriers that keep the dirt and dust inside worksites.

b. The integrity of the barrier walls must assure a complete seal of the construction area from adjacent areas.

c. Rigid construction Mc Cain wall system shall be used for all barriers.

Walls will be dust proof with airtight seals maintained at the full perimeter of the walls, as well as all penetrations.

3. Environmental Control

a. Negative air pressure of at least -0.03 W.C. will be maintained at all times within the construction zone for Class III and IV projects (with no disruption of the air systems of the adjacent areas, depending on project location).

i. A HEPA (High Efficiency Particulate Accumulator) filter vacuum system rated at 95% capture of 0.3 microns (effective for pollens, mold spores, and dust particles) shall be installed to ensure continuous negative air pressures within the work area.

ii. There will be no re-circulation of air, and ventilation filters will be changed when dirty or covered in dust.

iii. Contractor to complete daily negative air pressure verification log which will be posted at site next to manometer.

b. Construction debris will be removed from the construction area in tightly fitted covered carts using specified traffic patterns daily as established prior to the beginning of construction. The least intrusive traffic plan will be followed. Exterior of the carts shall be free of excessive dust.

c. Tacky/walk-off mats shall be utilized immediately outside the construction zone to remove dust and soil from shoes, cartwheels, etc., as personnel exit the area. The tacky mat must be large enough to cover the entire exit and changed daily and whenever it becomes visibly covered with dust and debris.

d. Exterior window seals must be assured to minimize infiltration of outside excavation debris. Windows will remain closed during outside excavation, renovation, construction, alteration, or demolition.

e. When using demolition chutes, the chute opening must be sealed when not in use. The chute and damper must be sprayed with water, as necessary, to maintain dust control.

f. Control, collection, and disposal must be provided for any draining liquid or sludge encountered when demolishing plumbing.

4. Traffic Control

a. Designated entry and exit procedures will be defined (in conjunction with any necessary Interim Life Safety Measures) for each construction project.

b. All egress pathways will remain free of debris always.

c. Unauthorized personnel will not be allowed to enter the construction zone and the doors will remain locked. The doors will be labeled with warning signs stating “Danger Hard Hat Area” and “Construction Area Authorized Personnel Only.”

d. Only designated elevators will be used for construction activities during scheduled times.

5. Cleaning

a. The construction zone and adjacent entry area shall be maintained in a clean and sanitary manner by the contractor and will be swept and mopped daily or more frequently, if needed, to minimize dust.

b. FMS will be responsible for the routine cleaning of adjacent areas and for the final terminal cleaning of the construction zone prior to the opening of the newly constructed areas. Specific responsibility will be defined in the construction contracts.

6. Personnel Requirements

a. Clothing shall be free of loose soil and debris upon exiting the construction zone.

b. Personnel protection equipment, including face shields, gloves, and N95 respirators will be utilized as appropriate for the task at hand.

The contractor will provide these items.

c. Personnel entering sterile/invasive procedure areas will be provided with a disposable jump suit, head covering, and shoe covering by the contractor. These must be removed prior to exiting the work area. This is determined in the PICRA process and will be noted on the permit.

d. Tools and equipment must be damp-wiped prior to entry and exit from sterile and invasive procedure areas.

e. Hospital-approved germicides will be used to clean tools and equipment that may be soiled with blood and body fluids.

f. All contractors, subcontractors, Safety Management and FMS employees shall receive infection control training as it relates to construction.

7. Environmental Monitoring

a. Safety Management and FMS employees, in conjunction with

Infection Prevention and Control will plan for environmental monitoring prior to the opening of any new construction area. This may include air testing, environmental testing or legionella testing for the project, as appropriate.

8. Compliance Monitoring

a. A multidisciplinary team from the Construction Safety committee will conduct compliance monitoring rounds per VHA Directive 7715, Safety and Health During Construction.

1. Infection Prevention and Control nurses will participate in the compliance monitoring rounds with the multidisciplinary team, as scheduled.

2. Infection Prevention and Control nurses will perform additional periodic construction surveillance rounds as time permits.

b. The following parameters will be monitored by the multidisciplinary team members:

i. Air handling

ii. Integrity of barrier walls

iii. Dress code

iv. Environmental control

v. Noise

vi. Traffic Control

vii. Personal protective equipment

viii. Water supply

ix. Fire and general safety

x. Interim life safety measures (ILSM)

d. Infection Prevention and Control construction surveillance findings are provided to the FMS-Chief of Projects or other designated lead for the multidisciplinary rounds who will forward them to the appropriate project contact (COR/CO/PM) for follow-up.

9. Completion Phase

a. After completion of construction, ventilation must meet specifications as mandated by regulatory bodies.

b. The area must be thoroughly cleaned and disinfected before being placed into service.

c. Water supply lines will be flushed before placing newly renovated, altered, demolished, or constructed areas into service.

d. Legionella / coliform testing will be completed and negative results received prior to occupation of new construction as determined by Water Safety Committee.

e. COR or PE/PM shall ensure that the contractor provides for independent third-party testing of the water supply where affected by modification work.

f. The COR or PE/PM will notify the Infection Prevention and Control

Coordiantor or their designee at least 72 hours before project completion to schedule a walk through. The Pre-occupancy check list (See Appendix E) will be completed and submitted to the COR or PE/PM who will address any items that require follow-up.

COLLABORATION: Construction Safety Committee, Safety officer and FMS.

REFERENCES:

NOTE: Current National Fire Protection Association (NFPA) Standards are available at facility and/or Veterans Integrated Service Network (VISN) Safety and Engineering and/or Facilities Management Offices.

1. Association of Professional Infection Control (APIC) Text of Infection Control and Epidemiology, Chapter 115: Water System Issues and Prevention of Waterborne Infectious Diseases in Healthcare Facilities and Chapter 116: Construction and Renovation, available at http://text.apic.org/

2. Guidelines for Design and Construction of Hospital and Outpatient Facilities 2014 Edition, Facility Guidelines Institute, available at https://www.fgiguidelines.org/guidelines/2014-hospital-outpatient/read-only-copy/

3. OSHA Safety and Health Regulations for Construction, 29 CFR 1926, available at:

https://www.osha.gov/pls/oshaweb/owastand.display_standard_group?p _toc_level=1&p_part_number=1926

4. VA Loma Linda Healthcare System, Healthcare System (HCS) Policy 00-45, Safety and Health During Construction Activities, available at http://sharepoint.lom.med.va.gov/policies_sop/HCS%20Policies/Director's

%20Office%20(00)/00-45%20Construction%20Safety%20Policy.doc

5. VHA Directive 7715, Safety and Health During Construction, available at https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=5380

RECISSION:

RESPONSIBILITY AND REVIEW DATE: This memorandum will be reviewed biennially by the Infection Control Committee and reissued by March 2020.

http://text.apic.org/ https://www.fgiguidelines.org/guidelines/2014-hospital-outpatient/read-only-copy/ https://www.fgiguidelines.org/guidelines/2014-hospital-outpatient/read-only-copy/ https://www.osha.gov/pls/oshaweb/owastand.display_standard_group?p_toc_level=1&p_part_number=1926 https://www.osha.gov/pls/oshaweb/owastand.display_standard_group?p_toc_level=1&p_part_number=1926 http://sharepoint.lom.med.va.gov/policies_sop/HCS%20Policies/Director's%20Office%20(00)/00-45%20Construction%20Safety%20Policy.doc http://sharepoint.lom.med.va.gov/policies_sop/HCS%20Policies/Director's%20Office%20(00)/00-45%20Construction%20Safety%20Policy.doc https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=5380

Appendix A: Pre-Construction Infection Prevention and Control Risk Assessment (PICRA) Matrix of Precautions and Additional Considerations for Construction, Renovation and Maintenance Projects

1. PURPOSE: To establish procedures and criteria for precautions in construction and renovation involving Infection Control risks such as high levels of dust or demolition or removal of any fixed building components or assemblies.

2. POLICY: Construction Safety Committee will provide strategies to ensure infection risk to patients resulting from construction and renovation is abated or minimized through assessment and engineering controls. The following three step process and tools will be utilized.

STEP ONE:

Using the following table, identify the Type of Construction Project Activity (Type A-D) and the Patient Risk Group that will be affected. If more than one risk group will be affected, select the higher risk group.

Activities Examples

Type A

Type A

Inspection and Non-Invasive Activities. Includes, but is not limited to: removal of ceiling tiles for visual inspection (limited to 1 tile per 50 square feet; painting but NO SANDING; wall covering;

electrical trim work; minor plumbing; and activities which do not generate dust or require cutting into walls or access to ceilings other than for visual inspection.

Type B

Small scale, short duration activities, which create minimal dust. Includes, but is not limited to:

installation of telephone and computer cabling; access to chase spaces; cutting into walls or ceiling where dust migration can be controlled using dustless tools, tools with dust control guards and/or dust control systems.

Type C

Any work that generates a moderate to high level of dust. Includes but is not limited to:

demolition or removal of any fixed building components or assemblies; sanding walls for painting or wall covering; removal of floor coverings, ceiling tiles and chase work; new wall construction;

window installations; minor duct work or above-ceiling electrical work; major cabling activities, and any activity which cannot be completed within a single work shift.

Type D

Major demolition and construction projects. Includes, but is not limited to: activities which require consecutive work shifts; heavy demolition; removal of complete cabling systems; and new construction.

Risk Group

G1

Low Risk: Office areas, Non-patient care support areas (e.g. EMS, Biomed), lobbies, warehouse, meeting rooms, classrooms, halls and corridors, elevators- unless adjacent to a higher risk area-must check with Infection control.

G2

Medium Risk: Canteen & CLC dining room, retail store, waiting rooms.

G3

High Risk: Ambulatory care clinics, CBOCs, BHOST, outpatient pharmacy/ non-compounding areas, radiology/MRI, cardiology, nuclear medicine, pulmonary, pain clinic, GI lab, modules inpatient mental health (2NE), 3NE, laundry, PM&R, MRI, laundry, exam rooms, and modules, Kitchen

G4

Highest Risk: Any area caring for immuno-compromised patients, Emergency Department, SICU/MICU/CCU, 3SE, 4SW, 4NW, CLC, dental operatories, infusion clinic, dialysis, cardiac cath lab, interventional radiology, Pre-op/SSU/OR/PACU, SPS, lab, and inpatient pharmacy/ IV & compounding areas.

STEP TWO:

Match the Construction Project Type (A, B, C, D) with the Patient Risk Group (Low, Medium, High, Highest) on the construction activity matrix to determine the class of precautions. Infection Control procedures are described in the table following the matrix.

Construction Activity Matrix: Class of Precautions for Construction Projects by Patient Risk

Class Matrix Risk Group

G1 G2 G3 G4

Activity Type A I II II III/IV

B I II III IV

C I II III/IV IV

D II III/IV III/IV IV

Description of Required Infection Control Precautions by Class

CLASS I

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

• Replace any ceiling tile displaced for visual inspection as soon as possible

• Ensure that work area is left clean and dust-free upon project completion.

CLASS II

*All requirements listed in Class I apply.

• Remove or isolate HVAC system in area where work is being done to prevent contamination of the duct system.

• Place tacky/walk-off mat at the exit of work area. The mat must be large enough to cover the entire exit and changed daily and whenever it becomes visibly covered with dust and debris.

• Provide active means to prevent air-borne dust from dispersing into atmosphere.

• Water mist work surface to control dust while cutting.

• Seal unused doors with duct tape.

• Block off and seal duct vents.

• Contain construction waste before transport in tightly covered containers.

• Vacuum with HEPA filtered vacuum and wet mop before leaving work area daily, and more often as needed.

• Wipe casework and horizontal surfaces with disinfectant upon completion of project.

• Remove isolation of HVAC system in areas where work has been performed upon completion of project.

CLASS III

listed in Class I and II apply.

• Cover up or remove all supplies and equipment that could potentially come in contact with construction dust/dirt/debris.

• Complete all critical barriers or implement control cube method before construction begins.

• Maintain negative air pressure (minimum -0.03 column inches of water pressure differential by manometric measurement) within work site at all times, utilizing HEPA filtered ventilation units. Complete daily negative air pressure verification log and post at site next to manometer.

• Use additional HEPA equipped air scrubbers within project containment area to minimize spreading and aerosolization of dirt and dust. The number of units used must be sufficient to adequately filter the air given the size of the containment area.

• Do not remove barriers from work area until complete project is thoroughly cleaned.

• Remove barrier materials carefully to minimize spreading of dirt and debris associated with construction.

• After barrier materials are removed, ensure that the area is thoroughly cleaned again by EMS before it is released to the end user(s).

CLASS IV

listed in Class I-III apply.

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

• 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.

• All personnel entering work site are required to wear shoe covers.

STEP THREE: Additional considerations to be discussed and reviewed with team in Pre- Construction meeting are listed below. Applicable items should be listed on the Infection Prevention and Control Risk Assessment & Permit under “Additional Requirements.”

*Note: “TB screening required” section must have a response denoted.

• When determining the identification of the infection control risk group, consider the areas surrounding the project for any potential impacts and include the need for the contractor to have a TB screening, if applicable.

• Identify issues related to ventilation, plumbing, electrical in terms of possible outages.

• Identify specific containment measures to be used (e.g. plastic vs. solid walls).

• Identify potential risk of water intrusions or aerosolization. Is there a risk due to compromising structural integrity (e.g. wall, ceiling, roof)?

• Identify work hours: Can or will the work be done during non-patient care hours?

• Identify any infection prevention-related design issues (e.g. adequate number/location of hand washing sinks, isolation/negative airflow rooms, clean and soiled utility rooms).

• Identify other containment issues (e.g. traffic flow, debris removal pathway).

• Water safety considerations:

➢ Legionella: Will project disturb or break water systems, or result in water system stagnation greater than 7 days? If Yes: All Hot and cold-water systems will be flushed until flowing clear and without air in the system. NOT LESS THAN 10 MINUTES. All faucets and showerheads will be removed and cleaned.

➢ Temperatures will be taken to insure hot water is within limits identified by the Facility Management Service (FMS).

➢ Water samples will be taken to verify chlorine levels, temperature and freedom from Legionella as determined by the Water Safety Committee.

Appendix B: Infection Prevention and Control Risk Assessment (ICRA) & Permit for Construction, Renovation and Maintenance Projects

INFECTION PREVENION AND CONTROL PERMIT

*Permit must be obtained prior to start of construction and posted for project duration. Call Infection Prevention and Control at x2942 upon project completion to schedule pre-occupancy evaluation.

Project Name/Number: Location:

Project Start Date: Est. Duration: Permit Expiration:

Project Manager (COR): Phone #:

Contractor: Phone #:

TB screening required: Yes No

The Loma Linda VAMC is considered a low-risk facility for the transmission of Tuberculosis. However, contract employees working in an area where there is known or suspected TB case (any roof work must be preceded by COTR and IPC verification of proximity to exhaust from room currently occupied by a known or suspected TB case) will be required to provide proof of TB testing in accordance with VHA directive 7715.

YES NO CONSTRUCTION ACTIVITY* YES NO INFECTION CONTROL RISK

GROUP*

TYPE A: Inspection, non-invasive activity. GROUP 1: Low-Risk

TYPE B: Small scale, short duration activities, which create minimal dust.

GROUP 2: Medium-Risk

TYPE C: Activity generates moderate to high levels of dust, requires > 1 work shift for completion.

GROUP 3: High-Risk

TYPE D: Major demolition and construction activities, requiring consecutive work shifts.

GROUP 4: Highest-Risk

*Instructions, detailed keys (Construction activity and Infection control risk groups) and Class determination grid can be found in the guideline for Infection Control in Construction and Renovation (Appendix A).

CLASS I

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

• Replace any ceiling tile displaced for visual inspection as soon as possible.

• Ensure that work area is left clean and dust-free upon project completion.

CLASS II

All requirements listed in Class I are required plus the following:

• Remove or isolate HVAC system in area where work is being done to prevent contamination of the duct system.

• Place dust-mat at entrance and exit of work area and replace or clean when no longer effective.

• Provide active means to prevent air-borne dust from dispersing into atmosphere.

• Water mist work surface to control dust while cutting.

• Seal unused doors with duct tape.

• Block off and seal duct vents.

• Contain construction waste before transport in tightly covered containers.

• Vacuum with HEPA filtered vacuum and wet mop before leaving work area daily, and more often as needed.

• Wipe casework and horizontal surfaces with disinfectant upon completion of project.

CLASS III

All requirements listed in Class I and II are required plus the following:

• Cover up or remove all supplies and equipment that could potentially encounter dust/dirt/debris.

• Complete all critical barriers or implement control cube method before construction begins.

• Maintain negative air pressure (minimum -0.03 column inches of water pressure differential by manometric measurement) within work site utilizing HEPA filtered ventilation units. Complete daily negative air pressure verification log and post at site next to manometer.

• Use additional HEPA equipped air scrubbers within project containment area to minimize spreading and aerosolization of dirt and dust. The number of units used must be sufficient to adequately filter the air given the size of the area.

• Do not remove barriers from work area until complete project is thoroughly cleaned.

• Remove barrier materials carefully to minimize spreading of dirt and debris associated with construction

• After barrier materials are removed, ensure that area is thoroughly cleaned again by EMS before released to end user(s).

CLASS IV

• All requirements listed in Class I, II, and III plus the following:

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

• Construct anteroom; 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 exit the work site.

• All personnel entering work site are required to wear shoe covers.

Additional Requirements:

Permit requested by: Date: Permit authorized by: Ext. Date:

Appendix C: Example Daily Negative Air Pressure Verification Log for Construction, Renovation and Maintenance Projects Class III or IV.

DAILY NEGATIVE AIR PRESSURE VERIFICATION LOG

Date Time Measurement Signature of persons who verified the work zone was under negative pressure

(minimum -0.03).

If repairs were necessary, record the action taken.

The CO/COR/PE is responsible to have the completed logs retrieved from the work zones and filed in the project file. The chart should be indicating negative pressure of at least -0.030 W.C.

in reference to the surrounding location.

Appendix D: Infection Prevention and Control Surveillance Rounds Worksheet for Construction, Renovation and Maintenance Projects.

Infection Prevention and Control Construction Surveillance Rounds

Project Name/Location: ___________________ Surveillance Date: __________

Comments:_________________________________________________________

Infection Prevention and Control Nurse Reviewer:

Yes No N/A Notes

Current Permit posted:

Patient care equipment removed from construction area or properly covered.

Exterior windows inside of barriers remain closed.

Barriers are intact and sealed.

Zipper closed if plastic barrier used.

Negative pressure machines running and properly exhausted.

Construction entry and adjacent areas free of dust and debris

Walk off mats clean & adequate to contain construction dust

Within the facility, construction carts covered during transport of materials.

Ceiling tile outside of barriers replaced when not being accessed.

When project finished, was IC called for clearance and inspection?

Other

Appendix E: Infection Prevention and Control Pre-Occupancy Checklist for Construction, Renovation and Maintenance Projects.

PRE-OCCUPANCY CHECKLIST

Project: _______________________________ Date: ____________________

Yes No N/A Comments

Finishes as designed

Washable surfaces

Ceiling tiles or solid ceiling

Walls sealed

Floors appropriate

Dispensers

Soap dispensers/paper towels in place

Hand sanitizer in place

Sharps containers in place

HVAC

Parameters (ACH, direction) as designed

Air balancing complete

Air filters changed

Evaporator pans checked

Plumbing/ Water System

Fixtures as designed

Plumbing fixtures operate

All outlets flushed

Hyper-chlorination

Thermal eradication

Tested for legionella/ coliforms

Legionella/coliforms results negative

Cleaning

Clean and remove dust barriers

Area wiped down

Routine terminal cleaning