Attachment 2 EHRM ICRA Form - Ft. Wayne.pdf

Combined Pre-Construction and Infection Control Risk Assessment Matrix of Precautions for Construction Projects

Project Description:

PART 1: INFECTION CONTROL RISK ASSESSMENT

Type Construction Project Activity

Type A☐

Inspection and Non-Invasive Activities.

Include, but are not limited to:

☐ Removal of ceiling tiles for visual inspection limited to 1 tile per 50 square feet

☐ Painting (sanding limited to <10% of area).

☐ Wall covering, electrical trim work, minor plumbing, and activities that do not generate dust or require cutting of walls or access to ceilings other than for visual inspection.

Type B ☐

Small scale, short duration activities that create minimal dust.

Include, but are not limited to:

☐ Installation of telephone and computer cabling.

☐ Access to chase spaces using doors or hatches (not cutting).

☐ Sanding of walls for painting or wall covering (minor repairs – not sanding for drywall finishing)

Type C ☐

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 (>50% of surface area – drywall finishing).

☐ Cutting of walls or ceilings.

☐ Removal of floor coverings, ceiling tiles, and casework. (>50% of surface area)

☐ New wall construction.

☐ Minor duct work or electrical work above ceilings.

☐ Major cabling activities.

☐ Any activity that cannot be completed within a single work shift.

Type D ☐

Major demolition and construction projects.

Includes, but is not limited to:

☐ Activities that require consecutive work shifts.

☐ Requires heavy demolition or removal of a complete cabling system.

☐ New construction.

☐ Low Risk ☐ Medium Risk ☐ High Risk ☐ Highest Risk

☐ Office areas

☐ Out Doors

☐ Electrical or Mechanical Rooms

☐ Social Work

☐ Retail Store

☐ Stairwells

☐ Conference Rooms

☐ Hallways

☐ EMS Areas

☐ Physical and Occupational Therapy

☐ Outpatient Areas

☐ Waiting Rooms

☐ Sleep Lab

☐ Mental Health (outpatient only)

☐ Prosthetics / Orthotics

☐ Domiciliary

☐ Primary Care Clinics

☐ CBOCs

☐ Urgent Care

☐ Kitchen or Food Preparation / Dining / Canteen

☐ Echocardiography

☐ Radiology/MRI/CT

☐ Respiratory Therapy

☐ Nuclear Medicine

☐ Senior Mental Health (In Patient or Senior)

☐ Community Living Center (CLC)

☐ Clean Supply

☐ Cardiac Cath, EP Lab or Cardiology

☐ Sterile Processing Service (SPS)

☐ All inpatient medical or surgical units

☐ Care Units: PACU, MICU, SICU, TCU

☐ Spinal Cord Injury

(SCI)

☐ Negative pressure isolation rooms

☐ Outpatient chemotherapy or Oncology areas

☐ Operating Rooms/Surgery Area

☐ Endoscopy

☐ Dialysis

☐ Bronchoscopy

☐ Pharmacy

☐ Clinical Laboratories ☐ Treatment /Procedure Rooms

IC Matrix Class of Precautions: Construction Project by Patient Risk Group and Construction Project Type

Patient Risk Group / Activity Type ☐ TYPE A ☐ TYPE B ☐ TYPE C ☐ TYPE D

☐ LOW Risk Group ☐ I (green) ☐ II (yellow) ☐ II (yellow) ☐ III/IV (pink)

☐ MEDIUM Risk Group ☐ I (green) ☐ II (yellow) ☐ III (pink) ☐ IV (red)

☐ HIGH Risk Group ☐ I (green) ☐ II (yellow) ☐ III/IV (pink) ☐ IV (red)

☐ HIGHEST Risk Group ☐ II (yellow) ☐ III/IV (pink) ☐ III/IV (pink) ☐ IV (red) Note: Infection Control approval is required for ALL construction or renovation activities.

Step 3: __☐Class I ☐Class II ☐Class III ☐Class IV

Do construction documents include all infection control requirements?

☐Yes ☐No ☐N/A

CL

AS

S During construction project, the following must be performed daily: Upon completion of the phased work in any room, the following must be performed per room:

CL

AS

S I

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

2. For visual inspection only, dampen ceiling tile with water spray before removing. Replace a ceiling tile immediately after inspection; do not leave unattended.

Clean up ceiling tile and flooring surfaces below with HEPA filtered vacuum or damp mop.

CL

AS

S

II

As above and:

1. Provide active means to prevent dust from dispersing. Dust left on the floors, clothing and/or body is not allowed in order to prevent spreading and tracking. “Active means” are:

a. Vacuum attachments on tools with HEPA vacuum when generating dust, or

b. HEPA vacuuming immediately as the dust is generated.

c. Remove or isolate HVAC system in areas where work is being performed.

d. Water mist work surfaces to control dust while cutting.

e. Seal unused doors with duct tape.

f. Block off and seal all HVAC air vents.

g. Place +tacky mat at inside of entrance of work area and change frequently or when ineffective.

h. Wet mop and/or vacuum with +HEPA-filtered vacuum the work area before leaving the site. Brooming is not sufficient.

2. Whenever transporting outside of construction site, wipe materials, equipment and work surfaces with EPA registered, unscented +disinfectant, which has manufacturer’s labeling as a bactericide, tuberculocide, virucide, and fungicide.

3. There shall be no standing, uncovered water during construction. This includes water in equipment drip pans and open containers within the construction areas. All accidental spills must be cleaned up and dried within 12 hours. Remove and dispose of porous materials that remain damp for more than 72 hours.

As above and:

1. Wet mop and/or vacuum with

HEPA-filtered vacuum before leaving work area and wipe work surfaces with disinfectant.

2. Contain construction waste before transport in tightly covered containers. Tape may be used to ensure a tight cover.

3. Remove isolation of HVAC system in areas when work and area cleanup has been completed.

CL

AS

S

III

As above and:

1. Complete all critical barriers, i.e., +sheetrock, +plywood, +plastic, to seal area from non-work area or implement +control cube method before construction begins.

2. Maintain Negative Pressure Ventilation +(NPV) at 0.01" Water Column (WC) within the work site utilizing NPV machine.

3. NPV monitoring devices should be visible from outside the worksite and readings shall be documented daily or more often as needed. Keep +trackin monitoring device and +tracking log at outside of entrance at the site.

4. Contain construction waste before transport in tightly covered containers. Tape covering, unless using form-fitting solid lid.

5. Seal holes, pipes, conduits, and punctures etc. appropriately during construction.

As above and:

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

2. Do not remove barriers from work area until completed project is thoroughly and inspected by COR, Safety and Infection Control.

CL

AS

S

IV

As above and:

1. +Seal holes, pipes, conduits, and punctures.

2. Construct anteroom and require all personnel to pass through this room to 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.

3. All personnel entering work site are required to wear shoe covers. Shoe covers must be changed each time the worker exits the work area.

As above

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

Unit Below Unit Above East West North South

Risk Group Risk Group Risk Group Risk Group Risk Group Risk Group

Identify the impact and any precautions necessary to minimize disruptions to surrounding areas:

Identify specific site of activity, e.g., patient rooms, medication room, etc:

Identify containment measures using prior assessment. What types of barriers such as solid wall barriers?

Will barrier entry ways require doors or zipper flaps? Will HEPA filtration be required?

Note: Renovation/construction area shall be isolated from the occupied areas during construction and shall be negative with respect to surrounding areas.

Consider potential risk of water damage. Is there a risk due to compromising structural integrity (e.g., wall, ceiling, roof)?

☐ Yes ☐ No

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

Do plans allow for adequate number of isolation/negative airflow rooms due to those taken out of service during construction?

☐ Yes ☐ No ☐ N/A

Do the plans allow for the required number and type of hand washing sinks due to those taken out of service during construction?

☐ Yes ☐ No ☐ N/A

Does the infection control staff agree with the minimum number of sinks due to those taken out of service during construction for this project? (Verify against the American Institute of Architects Guidelines for types and area.)

☐ Yes ☐ No ☐ N/A

Does the infection control staff agree with the plans relative to clean and soiled utility rooms in lieu of those taken under construction?

☐ Yes ☐ No ☐ N/A

Tuberculosis Risk Assessment. A risk assessment must be conducted for the transmission of TB to the contracted construction workers based upon the construction site location, patient population, hospital layout, and the defined risk as outlined in the “CDC Guidelines for preventing the transmission of Mycobacterium Tuberculosis in Health-Care Setting, 2005.”

☐ Construction project is high risk for TB transmission. Detail safety measures. Requires contractor pre-testing.

☐ Construction project is low risk for TB transmission. No pre-contract testing required.

Who is responsible for daily cleaning inside work area?

Is terminal cleaning required at the end of each work day?

☐ Yes ☐ No

If yes, who is responsible for coordinating the terminal cleaning?

Are there any special needs required for terminal cleaning at the end of the project?

☐ Yes ☐ No

If yes, list special needs.

Do construction drawings show locations and details of construction barriers?

☐ Yes ☐ No ☐ N/A

Do construction drawings show necessary modifications to the HVAC system needed to meet NPV requirements?

☐ Yes ☐ No ☐ N/A

Do construction documents require the contractor to provide a pressure indicator?

☐ Yes ☐ No ☐ N/A

Do the construction drawings show the general location of waste dumpster(s) or bins?

☐ Yes ☐ No ☐ N/A

Do the construction documents require the contractor to submit detailed safety and infection control plans for VA approval (i.e. location and types of barriers)?

☐ Yes ☐ No ☐ N/A

PART 2: PRE-CONSTRUCTION RISK ASSESSMENT

Utility Interruptions and/or impact:

During the course of the project are any of the following likely to be interrupted or impacted in any area of the facility?

Yes No ☐ ☐ Water Supply (Including shutting off any valves) ☐ ☐ Sewer Service ☐ ☐ Roof/Storm Drainage ☐ ☐ Normal Power ☐ ☐ Emergency Power ☐ ☐ Ventilation Systems ☐ ☐ Oxygen ☐ ☐ Medical Air ☐ ☐ Medical Vacuum ☐ ☐ Other Medical Gases:

☐ ☐ HVAC

☐ ☐ Sprinkler System

For any systems where interruptions are foreseen, describe the steps to be taken to mitigate the impacts:

To be completed if the water supply will be interrupted or impacted in any way: ☐N/A Domestic Water Outage YES NO

Will valves be shut off longer than 48 hours?

Required Actions if YES:

Minor Domestic Water System Modifications and Repairs YES NO Will the project modify any valves in the existing plumbing system?

Will the project modify existing plumbing lines less than or equal to 18 feet?

Required Actions if YES to either or both:

Major Domestic Water System Modifications and Installations YES NO Will the project modify install any new plumbing lines?

Will the project modify existing plumbing lines greater than 18 feet?

Required Actions if YES to either or both:

Describe preventative measures that will be taken to insure that an unplanned interruption will not occur:

Do construction documents show any additional work related to water safety, including but not limited to:

AWWA requirements, responsibility of contractor for flushing and disinfecting, etc.

☐Yes ☐No ☐N/A

Noise and Vibration Assessment:

List any activities that will generate noise and/or vibration likely to be disruptive.

Activity:

Time & Duration:

Mitigation Strategies:

Activity:

Time & Duration:

Mitigation Strategies:

Safety Hazards:

List any hazardous materials to be used or stored within the project area:

☐ Yes ☐ No If yes, what steps will be taken to minimize impact:

Are there any known or suspected contaminants?

☐ Asbestos ☐ Lead ☐ Mold ☐ No known or suspected contaminants List steps to be taken to minimize impact:

Does the planned work include any of the following?

☐ Confined space entry ☐ Excavation requiring protection ☐ Work requiring fall protection ☐ Lock Out Tag Out ☐ Cranes or hoisting equipment ☐ Live electrical work ☐ Scaffolding ☐ Interruption of normal pedestrian or vehicular traffic ☐ N/A List steps to reduce/mitigate risk of any items checked:

☐ Yes ☐ No If yes, a hot work permit will be required.

Will the project move, change access to, or hinder the use of an eyewash and/or shower station?

☐ Yes ☐ No If yes, describe plan to mitigate risk.

Will there be hot work done on this project?

Is the work likely to generate any noxious or unusual odors?

PART 3: INTERIM LIFE SAFETY MEASURES (ILSM)

Project Evaluation Review the project/repair using the following criteria and indicate whether each item is applicable by marking the appropriate box. For any “YES” responses, coordinate with the Safety Office to review the required actions for appropriate interim life safety measures. In the Interim Life Safety Summary Sheet (PART II) at the bottom of this document, list specifically how the required interim life safety measures will be implemented for this project/repair impacting Life Safety. For the INTERIM LIFE SAFETY MEASURES Daily Inspection sheet (PART III), copy the measures from PART II into PART III, and issue PART III only to the Contractor for daily ILSM inspections.

A. EXITS YES NO

1. Does the project/repair have the potential of affecting an exit or other means of egress?

2. Will the affected exit be used by other than the contractor’s/maintenance personnel?

Required Actions: If a means of egress is obstructed, an alternate must be designated and training is required for those persons affected. Safety office will conduct/coordinate training. Means of exiting construction/repair areas must be inspected on a daily basis to prevent blockages due to debris. This needs to be documented and can be done by the contractor/shop foreman or shop designee.

B. EMERGENCY ACCESS YES NO

1. Does the project/repair have the potential to obstruct access to the emergency department?

2. Does the project/repair have the potential of obstructing access for fire department connections, hydrants, or fire lanes?

Required Actions: If an emergency access is obstructed, an alternate means of access must be designated and the Columbus Fire Department and VA Police must be notified by the Safety Office of the alternative.

C. FIRE PROTECTION YES NO

1. Does the project have the potential of impairing existing fire alarm, detection, or suppression systems?

2. Will temporary fire protection systems be required as part this project/repair?

Required Actions: If a fire protection or alarm system is to be rendered non-operational for more than 4 hours out of a 24-hour period, either a substitute system or a fire watch must be initiated. If neither of these methods can be implemented, the area must be closed down and evacuated. All of these measures must be coordinated with the Safety Office, VA Police, and the affected staff.

D. TEMPORARY PARTITIONS YES NO

1. Will construction compromise any fire or smoke partitions or barriers?

Required Actions: If construction/repair involves major breaches in fire or smoke barriers, the contractor must erect temporary walls around the construction area equal to the barrier that has been compromised.

E. ADDITIONAL FIRE FIGHTING EQUIPMENT AND TRAINING YES NO

1. Does the area affected by the project warrant placement of additional fire protection equipment?

2. Will additional firefighting training be required by affected personal?

Required Actions: If the fire load of a particular area is significantly increased over normal due to construction, additional firefighting equipment (such as fire extinguishers) will be required. If any of this additional firefighting equipment is of a different type than that already available in the affected area, training in the use of this equipment for staff or contractor personnel is required.

F. SMOKING POLICY YES NO

1. Will variance to existing medical center smoking policy be permitted?

Required Actions: If designated smoking areas are impacted or closed due to construction, temporary areas may need to be established.

G. COMBUSTIBLE LOAD LEVELS YES NO

1. Does the project involve the storage of flammable or combustible materials?

2. Does the project have the potential for creating flammable or combustible debris?

Required Actions: Surveillance of construction sites will need to be increased to prevent the accumulation of excess flammable or combustible debris. The fire load of the construction area must be kept to a minimum.

H. FIRE DRILLS YES NO

1. Does the project warrant additional fire drills within the affected areas?

Required Actions: If the life safety features of a particular area are adversely impacted by construction, then the frequency of fire drills must be increased to two per shift per quarter for healthcare/lodger occupancies. Adverse impacts would include blocked fire exits, impaired fire alarm or sprinkler systems, or major compromises in fire or smoke barriers or compartments.

I. HAZARD SURVEILLANCE YES NO

1. Does the project present additional hazards, such as excavations, construction storage or field offices, crane work, high voltage, confined spaces, scaffolding, etc., which warrant increased hazard surveillance?

Required Actions: If yes, then additional project surveillance is warranted to identify potential life safety issues.

J. OCCUPATIONAL HEALTH ISSUES YES NO

1. Do construction workers need to be restricted to dedicated corridors, elevators, or exits?

2. Is special ventilation required for the area during construction?

3. Will any disruptions of the water/plumbing system affect the purity of potable water?

4. Will the construction activities be hazardous to immune-compromised patients?

Required Actions: Any construction activities that adversely affect occupational health issues must be reviewed to minimize the effects. If negative pressurization is required for “special ventilation”, then include a daily reporting of the pressure measurement as part of the the daily ILSM log.

K. ADDITIONAL PERSONNEL TRAINING YES NO

1. Does the project have the potential of affecting structural features of the fire safety systems?

2. Does the project have the potential of affecting compartmentalization features of the fire safety systems?

3. Does the project have the potential for negatively affecting infection control procedures?

Required Actions: Affected personnel must be notified when fire safety systems or infection control procedures are compromised and trained in temporary changes in procedures to compensate for the impaired systems. Examples are the need for alternate fire exits, alarm or sprinkler systems or to evacuate behind secondary fire barriers or compartments due to fire or smoke partition compromises.

L. FACILITY-WIDE TRAINING YES NO

1. Does the project present life safety code deficiencies or construction hazards which warrant facility-wide education of personnel concerning the interim life safety measures?

2. Does the project present occupational health deficiencies which warrant facility-wide education of personnel concerning those procedures?

Required Actions: Training must be provided facility wide to educate staff, patients and visitors to any life safety system that is impaired throughout the entire building. In addition, the Fort Wayne or Marion Fire Department and VA Police will be notified.

Part 4: APPROVALS:

Contracting Officer’s Representative (COR):

Safety:

Infection Control:

Patient Safety:

Asst. Chief Engineer (Projects):