ICRA 660-CSI-115 DEXA Site Prep.pdf

Attachment B Infection Control Risk Assessment Matrix of Precautions for Construction Renovation

Project # / EWO #:

Start Date: Estimated Duration:

Contractor: TBD ICN:

Contractor Phone #: TBD ICN Phone #:

A)

(1) removal of ceiling tiles for visual inspection only, e.g., limited to 1 tile per 50 square

B)

Cardiac Cath/Angiography

Group 4

TYPE C

Sterile Processing

Highest Risk

All OR's

Low Risk

Group 3

Group 4

Group 2

ICN must be consulted when the assessment indicates that Class II, III, or IV precautions are required.

TYPE A TYPE BRisk Group TYPE D

Group 1

II

Ambulatory Medicine Unit (2 West)

Pharmacy IV Prep (Inpatient)

Dialysis Unit

Group 2 Group 3

Medium Risk

Nonmedical

All ICUs

Office Areas or

B.3 Inpatient Mental Health Ward

Out Patient Clinics

PT / OT

Pharmacy (In & Out Patient)

Canteen Kitchen

Cardiology

Pulmonary / Bronchoscopy

Telemetry

Imaging

Laundry

Nuclear Medicine

Patient Kitchen & Dining

Out Patient Surgery

801-582-1565 ex 4723

Joshua Keene

Bldg 1

DEXA Site Prep

STEP #2: Using the following table, identify the Risk Groups that will be affected. If more than one group will be affected, select the higher risk group.

STEP #1: Using the following table, identify the Type of Construction Project Activity (Type A-D)

Type C

CONSTRUCTION ACTIVITY TYPES:

Inspection and Non-Invasive Activities, includes but is not limited to one or more of the following:

(2) painting (but not sanding) (3) wallcovering (4) electrical trim work (5) minor plumbing,

(6) activities which do not generate dust or require cutting of walls or access to ceilings other than for visual inspection

Type A

Type B

Type D

Small scale, short duration activities which create minimal dust. Includes, but is not limited to one or more of the following:

(1) access to chase spaces (2) cutting of walls or ceilings where dust migration can be controlled (3) installation of telephone and computer cabling

Any work which 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 one or more of the following:

(1) sanding of walls for painting or wall covering (2) removal of floorcoverings (3) removal of ceiling tiles (4) casework (5) new wall construction (6) minor duct work

(7) electrical work above ceilings (8) major cabling activities (9) any activity which cannot be restored back to original state within a single workshift

Major demolition and construction projects. Includes, but is not limited to one or more of the following:

(1) requires heavy demolition (2) removal of a complete cabling system (3) new construction connected to occupied area

INFECTION CONTROL RISK GROUPS

associated space

Laboratories

3 West

Acute Medicine (2 East, 2 North)

B.2

High Risk

Emergency Room (ECU)

Post Antesthesia Care

Group 1

I

I

I

III/IV

II

II

II

III/IV

III/IV

III

II

IV

IV

IV

III/IV

Project Name / EWO Description:

Location of Activity:

Project Manager:

Project Manager Phone #: 801 582 1565

Elena Snelton

660-CSI-115

Construction Project Type

Decontamination

Dental

Distribution

G.I. Lab

Hoptel

Public Corridor (patient activity)

STEP 3: Determine Class of Precautions (I, II, III or IV) Using Matrix Below:

Attachment B Infection Control Risk Assessment Matrix of Precautions for Construction Renovation

During Construction Project Upon Completion of Project

1 Execute work by methods to minimize raising dust. 1 Clean work area upon completion of task.

2 Immediately replace a ceiling tile displaced for visual inspection

3 Contaminated materials kept away from patient transportation route and storage for clean supplies.

4 Worker traffic routes should minimize contact with patients.

In Addition to Class I Precautions:

1 Consult Infection Control Nurse prior to beginning work. 1 Wipe work surfaces with cleaner/disinfectant.

2 Educate VA staff regarding construction activity. 2 Contain construction waste before transport in tightly covered containers.

3 Block and seal air vents before starting. 3 Wet mop and/or vacuum with HEPA filtered vacuum before leaving work area.

4 Coordinate air filter maintenance with Operations. 4 Use only designated elevators (e.g. utility) for debris removal.

5 Seal unused doors with duct tape. 5 Remove and replace wet ceiling tiles.

6 No more than 2 ceiling tiles are to be removed at any time.

6 Place dust mat at entrance and exit of work area 7 Cover all kitchen equipment with platic before work starts, all surfaces should still be wiped clean with disinfectant after work ends.

8 All drilling should be coved by hepa vaccum during the drilling operation.

In Addition to Class I and II Precautions:

1 Consult Infection Control Nurse prior to beginning work. 1 Do not remove barriers from work area until completed project is inspected by the owner’s Safety Department and Infection Prevention & Control Department and thoroughly cleaned by the owner’s Environmental Services Department.

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.

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

3 Maintain negative air pressure within work site utilizing HEPA equipped air filtration units.

3 Vacuum work area with HEPA filtered vacuums.

4 Contain construction waste before transport in tightly covered containers.

4 Wet mop area with cleaner/disinfectant.

5 Cover transport receptacles or carts. Tape covering unless solid lid. 5 Upon completion, restore/clean HVAC system as needed where work was performed.

6 Water lines flushed at site and adjacent areas.

C L

A S

S

IV

In Addition to Class I and II and III Precautions:

1 Consult Infection Control Nurse prior to beginning work.

2 Relocate patients to area remote from construction area.

IP Signature:

Date Reviewed:

Physicial ICRA needs to be signed at work site.

C L

A S

S I

C L

A S

S

II

C L

A S

S

II

I

Infection Control Construction Precautions