36C26119B0030-014.pdf

Last updated March 2016

Safety & Infection Control Handbook

For

Contractors

VA SIERRA NEVADA HEALTH CARE SYSTEM

(VASNHCS)

RENO, NEVADA

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Important Emergency Phone Numbers:

To report a FIRE (CODE RED): Activate nearest Manual Pull Station.

To report a MEDICAL EMERGENCY (CODE BLUE): Announce 3 times to ensure timely response.

To request the POLICE: VA Extension 1234 (Internal Phone) or dial (775) 328-1234 for emergencies and non-emergencies.

Chief, Facilities Management Service: (775) 789-6668

Safety & Occupational Health Manager: (775) 784-3962

Construction Safety Specialist: (775) 786-7200 ext. 5850

Industrial Hygienist: (775) 784-3961

Contracting Officer’s Representative: (COR)

COR’s can be contacted by dialing the extension (last four numbers) on any hospital facility phone.

COR Names and Phone Numbers:

Phil Feiler, Chief, Projects Section ........................................................................................ (775) 326-5789

VACANT, General Engineer ................................................................................................. (775) 789-6680

Michael Grayson, General Engineer ................................................................................... (775) 789-6676

VACANT, Electrical Engineer ................................................................................................ (775) 326-5788

Jonathon Emis, Electrical Engineer ...................................................................................... (775) 789-6685

Kevin Brun, Engineering Technician .................................................................................... (775) 789-6670

VACANT, Engineering Technician ...................................................................................... (775) 326-5787

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Safety & Infection Control

Handbook for Contractors

T H E R O L E O F T H E C O N T R A C T O R

Contract workers are an important part of our healthcare system. They provide services in virtually all areas of the healthcare system from time to time. Some contract workers work in direct contact with patients; others work in office areas without direct contact.

Regardless of where they work, their activities support the healthcare and environment of our patients.

It is critically important to know about the healthcare system, its patients, its rules and regulations, and ways in which your safety and that of our valuable patients and employees can be ensured.

Please take a moment to review this handbook with all of your employees and make sure everyone is familiar with the safety and infection control requirements. If you have any questions, please feel free to contact the VA COR that is overseeing your project.

Construction Safety

The management, patients, and employees of this healthcare system appreciate your efforts to help us improve our facility and service to our Veterans; however, safety must be stressed at all times.

The VA has a requirement that all general and sub-contractors must complete the

OSHA 10-Hour Construction Safety Training and be currently certified; the prime contractor’s supervisor must complete the 30-Hour Construction Safety Training and be currently certified. Failure to have the proper certification will require that the contractor’s employee not be allowed back on the VA job until the training is complete and has been certified.

The Contracting Officer has designated the Contracting Officer Representative (COR) as the

Construction Safety Officer (CSO) for all construction projects under the authority contained in

VAAR 852.236-87, “Accident Prevention (SEP 1993) .” This authorizes the CSO, in connection with this contract, to monitor and enforce compliance of contract clause, FAR 52.236-13, “Accident Prevention (NOV 1991).”

The VASNHCS Construction Safety Committee will be conducting a periodic walk-through of the construction area. Any safety issues will be documented, and the

Contractor will have to immediately resolve the issue(s) and provide a written response on how the issue was resolved and what will be done in the future to prevent reoccurrence of the safety violation.

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Security and Identification

Security is a cooperative effort. VA Police enforce federal and local regulations to protect patients, contract workers, volunteers, staff, and visitors. They also protect government and private property and preserve a peaceful and secure environment at the healthcare system 24 hours a day.

All contract workers are required to obey traffic, parking, and security regulations. It is also necessary for everyone to use common sense, cooperate with the VA Police and, of course, keep personal possessions in a safe and secure place.

All contractors are required to obtain and wear a VASNHCS identification badge. The identification badge must be visibly displayed on a shirt or jacket at all times while working at this healthcare system.

All construction areas will be secured and locked at all times when entrances and gates are not actively being used. The contractor will provide a key or combination to the COR for access by the VA. All exterior construction areas will be fenced. Temporary fencing and signage will be secured in such a manner that it cannot be easily moved or lifted or blown over by wind.

The healthcare system’s buildings and its surrounding grounds are federal property.

The following items are forbidden under 38CFR1.218(b) in the healthcare system’s buildings or on the grounds and may result in fines or court appearances:

Alcoholic Beverages

Entering the premises under the influence of alcoholic beverages, marijuana, etc. - $200

Unauthorized use on property of alcoholic beverages, narcotics, marijuana, etc. - $300

Unauthorized introduction on VA controlled (including leased) property of alcoholic beverages, narcotics, etc. – Mandatory court appearance.

Firearms

Possession of firearms, carried either openly or concealed, whether loaded or unloaded (Law

Enforcement excepted) – Mandatory Court Appearance

Fireworks/Explosives

Introduction or possession of explosives, or explosive devices which fire a projectile, ammunition, or combustibles. (Powder actuated tools and ammunition are authorized, see note in “Basic Safety” section later in this document).

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Knives with blades over three (3) inches*

Possession of knives which exceed a blade length of 3 inches; switch blade knives; any of the variety of hatchets, clubs, and hand-held weapons; or brass knuckles. – Mandatory court appearance.

* excludes any tools of the trade

Liquid/Gas Emitting Weapons

The unauthorized possession of any of the variety of incapacitating liquid or gas-emitting weapons (e.g. pepper spray) - $200

Breach of Building Security

The unauthorized possession, manufacture, or use of keys or barrier card-type keys to rooms or areas of the property. - $200

The surreptitious opening, or attempted opening, of locks or card-operated barriers mechanisms on property. - $500*

*Note – this would include propping or other means of disabling a locking mechanism (e.g. tape) in order to readily gain access to doors that would otherwise be secure.

Fire Safety

Our healthcare system uses the local Fire Department. If you happen to be where a fire breaks out, pull the nearest fire alarm box. The fire alarm is located near the exits.

FIRE PROCEDURES:

Make sure you look for and become familiar with the locations of the area where you are working and always maintain a clear exit path.

In order to maintain a safe and healthy environment, smoking is prohibited in the facility’s buildings, entrances/exits, stairwells, attics, roofs, closets, offices, etc. Should you choose to smoke, you may smoke only in designated areas. This includes E-cigarettes and

Vaporizers.

If you hear the fire alarm system message in the area you are working, and the message directs you to evacuate, stay calm and evacuate the building, closing all doors behind you. Contract

Supervisors should account for all their employees during a fire emergency. If anyone is not accounted for, notify the Fire Department.

Adhere to all safe welding and burning precautions. Notify the COR to obtain a Hot Work Permit prior to welding, burning, grinding, or utilizing a metal chop saw.

The contract employees need to know where exits and extinguishers are located.

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CODE RED FIRE PROCEDURES:

R – Rescue all people from immediate danger

A – Alarm, Pull alarm box, or call VA Extension 7777

C – Confine the fire; close all doors

E – Extinguish/Evacuate the building

FIRE EXTINGUISHER USE:

P – Pull the pin on the extinguisher

A – Aim the nozzle at the base of the fire

S – Squeeze the handle

S – Sweep the nozzle from side to side across the base of the fire

Contractors must report all discharges of VA fire extinguishers to the COR.

Unless otherwise directed, all penetrations through fire or smoke partitions created by the

Contractor will be sealed with red colored fire caulk, fire pillows, or appropriate intumescent material.

Contractor Notification of the Permit Required Confined Space Entry Program

The healthcare system has many confined spaces throughout the campus. This includes, but is not limited to, manholes, boilers, connecting tunnels, ductwork, interstitial spaces, and crawl spaces.

Entry by Contractors into any confined space will require the Contractor to have an OSHA compliant Permit Required Confined Space Entry Program (29 CFR 1910.146). This includes, but is not limited to entry permits, required training, personal protective equipment, and other safety requirements.

The Contractor will demonstrate to the satisfaction of the VA that an OSHA compliant Permit

Required Confined Space Entry Program is in place. All confined spaces are considered

“permit-required” for contractor entry, but Contractors can “reclassify” confined spaces based on the hazards and work to be conducted, as outlined in the OSHA standard. The VA will communicate to the Contractor the known hazards contained in VA confined space.

Contractors shall check with the COR prior to entry into any permit-required space. The

Contractor will provide the COR with the confined space entry plan, and the COR will coordinate

7 | P a g e entry with the VA Safety & Occupational Health Office. The COR will provide the VA Safety &

Occupational Health Office with copies of all entry permits. The COR will brief the Contractor as to the recognized hazards of the space, as well as any safety issues that need to be addressed prior to entry, including safety issues that will be created by the Contractor as a result of the work being performed. Prior to entry into any confined space and upon completion of the entry, the COR shall be notified.

The VASNHCS will NOT be responsible for providing on-site rescue services. When required, the Contractor must arrange rescue services as outlined in the Approved Contractor’s Safety

Plan.

In those rare occasions that healthcare system employees must enter confined spaces controlled by the Contractor, the VA Safety & Occupational Health Office will be contacted to coordinate any

VA entry with the Contractor. The Contractor has primary control and VA employees will comply with the Contractor’s plan.

The Contractor is responsible for meeting all requirements of the applicable OSHA regulations and any other requirements as set forth by this healthcare system.

Trench and Excavation Safety Requirements

The walls and faces of trenches five (5) feet or more deep, and all excavations in which employees are exposed to changes from moving ground or cave-in, shall be guarded by a shoring system, sloping of the ground, or by providing proper shielding.

The portable trench shields may be used for the protection of personnel in lieu of shoring system or sloping.

The portable trench shield should be designed for type “C” soil and be maintained in a manner which will provide protection equal to or greater than the sheeting or shoring required for the trench.

Trenches four (4) feet or more deep shall have an adequate means of exit such as ladders, steps, or ramps located so as to require no more than 25 feet of lateral travel. Ladders must be secured and must extend 36 inches above the landing.

In excavations which employees may be required to enter, excavated or other material shall be effectively stored and retained at least two (2) feet or more from the edge of the excavations.

Employees shall be protected with personal protective equipment for the protection of the head, eyes, respiratory tract, feet, and other body parts as required. Hard hats will be required for all employees working in the area.

Unattended excavations or trenches will be effectively guarded against unauthorized entry by

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Prior to opening an excavation, steps will be taken to determine whether underground utilities, i.e., sewer, telephone, water, fuel, electrical line, etc., will be encountered.

Contractor shall provide appropriate traffic control, fencing or barricades, and signage which will be approved by the COR prior to commencement of work.

Working in Patient Areas

Information concerning patients and their records should be considered

CONFIDENTIAL.

Speak softly while on the units, in the hospital corridors, and in any other areas where people are working or patients are resting.

If patients ask you for help or advice, refer them to a VA employee for assistance.

Do not sit on any patient beds or handle any medical or patient equipment unless you are specifically assigned to do so as a contract worker. Also, do not use the nursing counters.

Do not leave any tools or electrical cords unattended.

Contract workers shall not enter a patient room that is posted with a STOP sign or a red or yellow card, unless asked to do so by your supervisor. If your supervisor has asked you to enter, confer with the Nurse Manager in charge of the floor or area before entering. She/he will give you instructions to protect yourself and our patients.

For all “CODES” or emergencies, stand clear of the hallways so that emergency personnel and equipment can move freely.

Do not move or touch a patient. Inform the nursing staff of all patient requests.

Infection Prevention and Control

Construction personnel will use a designated entry and exit site.

Only authorized personnel should enter the construction area.

Doorways and walkways must be kept free of debris.

The construction permit and construction class* will be posted at the site until completion of the project:

* Class 1 includes inspection and non-invasive activities, e.g., minor trim work.

* Class 2 includes small scale, short duration activities that create minimal dust, e.g.

installation of telephone or computer cables.

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* Class 3 includes any work which generates a moderate to high level of dust or requires demolition or removal of any fixed components or assemblies, e.g., removal of floor coverings.

* Class 4 includes major demolition and construction projects.

Blood borne pathogen training for contractors will be completed prior to start of work in areas identified as having potential for blood borne pathogen exposure to the construction workers.

In addition to the minimum personal protective equipment noted in the Basic Safety section below, appropriate infection control equipment, such as goggles for eye protection, face mask or shield, shoe covers, and clean gown issued by VASNHCS, will be worn upon entering protected environments such as Sterile Processing, Operating Rooms, and other clean areas.

All personal protective equipment must be removed at the site of exit to prevent carrying dust to other areas within the facility. Clothes and shoes should be free of loose sand or debris once personal protective equipment has been removed.

Walk-off mats must be placed at any entry/exit and must be changed frequently (checked at least twice daily) to prevent tracking of dust/debris into clean areas.

Contractors are responsible for keeping the construction entrance/exit zones clean. This may include wet mopping and/or vacuuming with a HEPA filtered vacuum.

The Infection Preventionist will make periodic unannounced compliance rounds. Issues needing attention will be discussed and corrected as soon as possible.

It is highly recommended that food or beverages are not consumed within the immediate area while construction activities are occurring. Covered drink containers are allowable at all times.

During demolition, dust will be vented to the outside of the building or personnel must use a

HEPA-equipped air filtration unit 24 hours/day.

Proper containment of construction waste, i.e., using a tightly covered container, is mandatory.

The shortest exit route to the outside should be taken when construction waste is being transported, unless otherwise approved by the facility.

Appropriate barrier systems for dust control must be in place before any construction starts.

It may be necessary to isolate the HVAC system in the area where work is being done to prevent contamination of the duct systems. This must be coordinated through the COR.

Once the project has been completed, the Infection Preventionist must do a walk-through inspection to ensure cleanliness in the area.

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If the tuberculosis (TB) preconstruction risk assessment found on the ICRA form determines that the construction worker(s) is at risk for exposure to TB, then:

The Contractor must provide written certification 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 be with negative screening reactions. This can be the Centers for Disease Control and Prevention

(CDC) two-step skin testing or a Food and Drug Administration (FDA) –approved blood test.

Contract employee manifesting positive screening reactions to the tuberculin must be examined according to current CDC guidelines prior to working on VA property.

Subsequently, if the employee is found without evidence of active (infectious) pulmonary TB, a statement documenting examination by a physician must be on file with the employee (construction contractor), noting that the employee with a positive tuberculin screening test is without evidence of active (infectious) pulmonary TB.

If the employee is found with evidence of active (infectious) pulmonary TB, the employee would require appropriate TB treatment and physician documentation that the construction worker is free from active TB disease before being allowed to return to work on VA property.

The Infection Preventionist is available Monday-Friday (except holidays), 7 a.m. to 3:30 p.m. for consultation at (775) 785-7292.

Basic Safety

Minimum personal protective equipment is defined as Hard Hat, Eye Protection, Safety Vest, and

Safety Shoes/Boots, and will be worn at all times on the job site unless a hazard analysis is reviewed and approved by the Safety & Occupational Health Office to a specific reduced level.

If you see a spill and you do not know what it is, notify your Supervisor or a VA employee nearby.

Do not clean it up yourself.

If you see any safety hazards, report them to the COR overseeing your project.

Be aware of patient and wheelchair traffic. Use caution and pull carts, as opposed to pushing carts, around a blind corner.

Do not open any windows without approval from the COR.

All supplies and other deliveries must be stored in a predetermined location, not left on the floor, and not left unattended.

Do not block hallways, passageways, or exits.

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Clean up your work area. Dispose of all debris in a contractor supplied waste container on a daily basis in accordance with all applicable laws and regulations including Environmental

Protection Agency (EPA), etc.

Do not leave the construction area unattended at any time unless the area is secure and locked. Exterior doors shall not be propped open, even if they are within a locked construction yard. Open exterior doors and windows provide ingress to the hospital for insects and pigeons.

In performing work, if any Contractor encounters what is believed to be Asbestos Containing

Materials, they are to stop and notify their supervisor and the COR overseeing the project.

Use only grounded UL-listed extension/flexible cords. Do not allow extension cords to cross a walkway or corridor, creating a trip hazard. Cords shall not be run through walls, ceilings, or floors, through doorways, or concealed behind doors, ceilings, floors, etc. Cords should be used in continuous lengths without splicing or tape and be visually checked prior to each use.

All cord and plug connect equipment, e.g., sump pumps, hand-held motor operated tools, and appliances used outside that operate on greater than or equal to 120 volts, or likely to be used in a wet environment, shall be grounded and equipped with a Ground Fault Interrupter (GFI).

Listed or labeled portable tools and appliances, protected by an approved UL system of double insulation or its equivalent, need to be grounded; however, GFI protection must still be used.

All energized parts of more than 24 volts must be guarded against accidental exposure. These may be guarded by a locked room accessible only to qualified persons, elevation to a height of over 10 feet above the floor, or by guards/cabinets that are inaccessible to unqualified workers, staff, patients, etc.

All energized parts should be de-energized prior to work being performed on the part or in the near vicinity of that part according to OSHA regulation 29 CFR 1926.417, Control of Hazardous

Energy Sources Lockout/Tagout.

Do not leave any power tools or equipment unattended (responsible worker no more than 25 feet away). Do not leave any tools unattended outside the construction area.

Powder actuated tools and ammunition will be in a locked case, gang box, or truck box when not in active use. This is in addition to OSHA rules for powder actuated tools.

Fall protection must be provided and utilized per OSHA regulation 29 CFR 1926.500 Subpart

M, Fall Protection, when applicable.

Scaffolding shall be erected in accordance with OSHA regulation 29 CFR 1926.451. Employees who erect, disassemble, move, operate, repair, maintain, or inspect a scaffold shall be trained by a competent person. Each employee who performs work on a scaffold shall be trained by a person qualified to recognize the hazards associated with the type of scaffold used and to understand the procedures to control or minimize these hazards. Ramps and walkways six (6) feet or more above lower levels shall have guardrail systems which comply with Subpart M of this part, Fall Protection.

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Contractor will notify the COR before bringing onsite or using any LASER/ionizing/non-ionizing radiation emitting devices (laser levels, x-ray devices, SONAR devices, etc.). This will allow the

COR to seek input and approval from the appropriate VA specialists such as the Radiation Safety

Officer.

Be careful and observe your surroundings while walking and working.

If you see a “Wet Floor” sign, do not walk in the area until the sign is removed.

If you spill something, clean it up immediately. Caution others to stay clear of the area until it is cleaned up. Notify the COR.

Parking for contractor personnel is limited to the streets around the hospital campus.

There is no contractor parking onsite or in the parking garage.

Environmental Rules and Regulations

Department of Veterans Affairs, Veterans Health Administration, Washington, DC 20420 VHA Directive 2011-036, Safety and Health During Construction, September 22, 2011.

Guidelines for the Design and Construction of Health Care Facilities, Facility Guidelines Institute, 2014.

Department of Health and Mental Hygiene, November 2008:

http://www.nyc.gov/html/doh/downloads/pdf/epi/epi-mold-guidelines.pdf.

Wayne Hansen, Editor, Opus Communications, 2002.

http://www.osha.gov/pls/oshaweb/owasrch.search_form?p_doc_type=STANDARDS&p_toc_lev el=1&p_keyvalue=Construction ntal Protection Agency Regulations, available at:

http://www.epa.gov/lawsregs/bizsector/construction.html

National Historic Preservation Act (NHPA), 1966

National Environmental Protection Act (NEPA), 1969 or 1970

Clean Air Act (CAA), 1970 and 1190

Federal Insecticide, Fungicide and Rodenticide Act (FIFRA), 1972

The VA complies with all federal and state environmental regulations. As such, all contractors working on VA property are expected to comply with all applicable environmental regulations.

These include, but are not limited to:

http://www.nyc.gov/html/doh/downloads/pdf/epi/epi-mold-guidelines.pdf http://www.osha.gov/pls/oshaweb/owasrch.search_form?p_doc_type=STANDARDS&p_toc_level=1&p_keyvalue=Construction http://www.osha.gov/pls/oshaweb/owasrch.search_form?p_doc_type=STANDARDS&p_toc_level=1&p_keyvalue=Construction http://www.epa.gov/lawsregs/bizsector/construction.html

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Endangered Species Act (ESA), 1973

Safe Drinking Water Act (SDWA), 1974

Resource Conservation and Recovery Act (RCRA), 1976

Toxic Substances Control Act (TSCA), 1976

Clean Water Act (CWA), 1977

Comprehensive Environmental Response, Compensation, and Liability Act

(CERCLA/Superfund), 1980

Pollution Prevention Act, 1990

Federal Facilities Compliance Act, 1992

Contractors must abide by all VASNHCS environmental permit requirements.

Any spills or environmental contamination must be immediately cleaned up by the Contractor in a manner appropriate for the nature of the chemical spilled. All environmental incidents must be reported immediately to the COR who will notify the Industrial Hygienist.

Questions regarding environmental issues are to be directed to the COR. The Industrial

Hygienist will make periodic unannounced compliance rounds. Issues needing attention will be discussed and corrected as soon as possible.