01 35 33 Infection Control Requirements.pdf

VA 556-21-701 EHRM Infrastructure Upgrades

Captain James A. Lovell FHCC, North Chicago, IL

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Infection Control Requirements

SECTION 01 35 33

INFECTION CONTROL REQUIREMENTS

1.1 APPLICABLE PUBLICATIONS:

A. This Specification is edited from the VHA model specification for construction safety requirements developed by the VHA Center for

Occupational Safety and Health, which had included infection control.

Infection Control has been properly segregated to become Specification

01 35 33 Infection Control Requirements, using nomenclature and formatting propagated by Construction Specifications Institute. Both templates were then edited to optimally communicate the requirements of all projects at the facility. Both specifications are required to be included in all construction contracts by VHA Directive 7715 Safety and

Health During Construction (6APR17), which is available at:

https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=5380

B. Reference and include Specification 01 41 00 Regulatory Requirements in all contracts.

1.2 INFECTION CONTROL

1. Infection Control is critical in all medical center facilities.

Interior construction activities causing disturbance of existing dust, or creating new dust, must be conducted within ventilation-controlled areas that minimize the flow of airborne particles into patient areas.

Exterior construction activities causing disturbance of soil or creates dust in some other manner must also be controlled.

2. An Activity Hazard Analysis (AHA) associated with infection control will be performed by VA personnel in accordance with FGI Guidelines

(i.e. Infection Control Risk Assessment; ICRA). The ICRA procedure similar to the one found on the American Society for Healthcare

Engineering (ASHE) website will be utilized.

1) Risk classifications of Class I or Class II shall require approval by the Facility Safety Manager and Contracting Officer

Representative before beginning any construction work.

2) Risk classifications of Class III or Class IV shall require a permit before beginning any construction work. Infection Control permits will be issued by the Facility Safety Manager and Contracting

Officer Representative.

3. The Infection Control Permits shall be posted outside the appropriate construction area. More than one permit may be issued for a construction project if the work is located in multiple areas or for contiguous areas which are identified in planning as different Risk

Classes. However, work outside the primary project scope area may vary.

The required infection control precautions with each Class are as follows:

A. Class I requirements:

1) During construction work:

a. Notify the Contracting Officer Representative.

b. Execute work using methods to minimize raising dust from construction operations.

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c. Ceiling tiles: Immediately replace any ceiling tiles displaced for visual inspection.

2) Upon Completion:

a. Clean work area upon completion of task.

b. Notify the Contracting Officer Representative.

B. Class II requirements:

1) During construction work:

a. Notify the Contracting Officer Representative.

b. Provide active means to prevent airborne dust from dispersing into atmosphere such as wet methods or tool mounted dust collectors where possible.

c. Water mist work surfaces to control dust while cutting materials.

d. Seal unused doors with painters’ tape (unless you also intend to replace the door and frame, or sand it to bare metal and refinish it). Post signs on both sides of effected doors stating that the door has been tape-sealed.

e. Block off and seal air supply and return vents.

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

2) Upon completion (day, shift, final):

a. Wipe work surfaces with cleaner/disinfectant.

b. Contain construction waste before transport in tightly covered containers.

c. Damp (NOT Wet) mop and/or vacuum with HEPA-filtered vacuum before leaving work area.

d. Upon final completion, restore HVAC system where work was performed

e. Notify the Contracting Officer Representative.

C. Class III requirements:

1) During construction work:

a. Obtain permit from the Contracting Officer Representative.

b. Remove or Isolate HVAC system in area where work is being done to prevent contamination of duct system.

c. 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. Install construction barriers and ceiling protection carefully, outside of normal work hours.

d. Maintain negative air pressure, 0.01 inches of water gauge, within work site utilizing HEPA equipped air filtration units and continuously monitored with a digital display, recording and alarm instrument, which must be calibrated on

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01 35 33 -3 installation, maintained with periodic calibration and monitored by the contractor.

e. Contain construction waste before transport in tightly covered containers.

f. Cover transport receptacles or carts. Tape covering unless solid lid.

2) Upon completion:

a. Do not remove barriers from work area until completed project thoroughly cleaned, and is inspected by the Contracting

Officer Representative and by the VA Environmental Services

Department.

b. Remove construction barriers and ceiling protection carefully to minimize spreading of dirt and debris associated with construction, outside of normal work hours.

c. Vacuum work area with HEPA filtered vacuums.

d. Wet mop area with cleaner/disinfectant.

e. Upon completion, restore HVAC system where work was performed.

f. Return permit to the Contracting Officer Representative.

D. Class IV requirements:

1) During construction work:

a. Obtain permit from the Contracting Officer Representative

b. Isolate HVAC system in area where work is being done to prevent contamination of duct system.

c. 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. Install construction barriers and ceiling protection carefully, outside of normal work hours.

d. Maintain negative air pressure, 0.01 inches of water gauge, within work site utilizing HEPA equipped air filtration units and continuously monitored with a digital display, recording and alarm instrument, which must be calibrated on installation, maintained with periodic calibration and monitored by the contractor.

e. Seal holes, pipes, conduits, and punctures.

f. 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 work site.

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

2) Upon completion:

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a. Do not remove barriers from work area until completed project thoroughly cleaned, and is inspected by the

Contracting Officer Representative and by the VA

Environmental Services Department.

b. Remove construction barriers and ceiling protection carefully to minimize spreading of dirt and debris associated with construction, outside of normal work hours.

c. Contain construction waste before transport in tightly covered containers.

d. Cover transport receptacles or carts. Tape covering unless solid lid.

e. Vacuum work area with HEPA filtered vacuums.

f. Wet mop area with cleaner/disinfectant.

g. Upon completion, restore HVAC system where work was performed.

h. Return permit to the Contracting Officer Representative.

4. Barriers shall be erected as required based upon classification (Class

III & IV requires barriers) and shall be constructed as follows:

A. Class III and IV - closed door with painter’s tape applied over the frame and door gap is acceptable for projects that can be contained in a single room.

B. Construction, demolition or reconstruction not capable of containment within a single room must have the following barriers erected and made aesthetically presentable on the hospital-occupied

(public, not construction area) side:

1) Class III and IV (where dust control is the only hazard, and an agreement is reached with the Contracting Officer’s

Representative) - Airtight plastic barrier that extends from the floor to ceiling. Seams must be sealed with duct tape to prevent dust and debris from escaping.

2) Class III and IV - Drywall barrier erected with joints covered or sealed to prevent dust and debris from escaping.

3) Class III and IV - Seal all penetrations in existing barrier air-tight.

4) Class III and IV - Barriers at penetration of ceiling envelopes, chases, and ceiling spaces to stop air and debris movement.

5) Class III and IV - At elevators shafts or stairways within the field of construction, overlapping flap minimum of two feet wide of polyethylene enclosures for personnel access.

6) Class IV only – Ante room or double entrance openings that allow workers to remove protective clothing or vacuum off existing clothing.

5. Products and Materials:

A. Sheet Plastic: Fire retardant 6-mil thickness meeting all fire codes.

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B. Barrier Door Assemblies: Self-closing, self-latching, fire-rated, solid core steel, within steel frame, painted to match adjacent finishes.

C. Dust-proof, fire-rated drywall.

D. High Efficiency Particulate Air (HEPA)-Equipped filtration machine rated at 95% capture of 0.3 microns including pollen, mold spores and dust particles. HEPA filters should have ASHRAE 85 or other pre-filter to extend the useful life of the HEPA. Provide both primary and secondary filtrations units. Maintenance of equipment and replacement of the HEPA filters and other filters will be in accordance with manufacturer’s instructions.

E. Exhaust Hoses: Heavy duty, flexible steel reinforced; Ventilation

Blower Hose

F. Adhesive Walk-off Mats: Provide minimum size mats of 24 inches x 36 inches

G. Disinfectant: Hospital-approved disinfectant or equivalent product.

Provide a current Safety Data Sheet to the COR, and also store with the product.

H. Portable Ceiling Access Module

6. Before any construction on site begins, all contractor personnel involved in the construction or renovation activity shall be trained by the contractor in infection prevention measures established by the medical center, and a record of which shall be transmitted to the COR.

7. A dust control program will be established and maintained as part of the contractor’s infection preventive measures in accordance with the current edition of the FGI Guidelines for Design and Construction of

Hospitals (or Outpatient Clinics as applicable). Prior to start of work, prepare a plan detailing project-specific dust protection measures with associated product data, including periodic status reports, and submit to the COR for review for compliance with contract requirements in accordance with Section 01 33 23, SHOP DRAWINGS, PRODUCT DATA, AND SAMPLES.

8. Medical center Infection Control personnel will monitor for airborne disease (e.g. aspergillosis) during construction. A baseline of conditions will be established by the medical center prior to the start of work and periodically during the construction stage to determine impact of construction activities on indoor air quality with safe thresholds established.

9. In general, the following preventive measures shall be adopted during construction to keep down dust and prevent mold.

A. Contractor shall verify that construction exhaust to exterior is not reintroduced to the facility through intake vents, or building openings. HEPA filtration is required where the exhaust dust may re-enter the medical center.

B. Exhaust hoses shall be configured to ensure that dust is not reintroduced to the medical center.

C. Adhesive Walk-off or Carpet Walk-off mats shall be used at all interior transitions from the construction area to occupied medical center area. These mats shall be changed as often as required to

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01 35 33 -6 maintain clean work areas directly outside construction area at all times.

D. Vacuum and damp (not wet) mop all transition areas from construction to the occupied medical center at the end of each workday. Vacuum shall utilize HEPA filtration. Maintain surrounding area frequently. Remove debris as it is created. Transport these outside the construction area in containers with tightly fitting lids.

E. The contractor shall not transport debris through patient-care areas without prior approval of the COR and the Facility Safety Manager.

When, approved, debris shall be hauled in enclosed dust-proof containers or wrapped in plastic and sealed with duct tape. No sharp objects should be allowed to cut through the plastic. Wipe down the exterior of the containers with a damp rag to remove dust.

All equipment, tools, material, etc. transported through occupied areas shall be made free from dust and moisture by vacuuming and wipe down.

F. There shall be no standing 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 1 hour. Remove and dispose of porous materials that remain damp for more than 2 hours.

G. At completion, remove construction barriers and ceiling protection carefully, outside of normal work hours. Vacuum and clean all surfaces free of dust after the removal.

10. Final Cleanup:

A. Upon completion of project, or as work progresses, remove all construction debris from above ceiling, vertical shafts and utility chases that have been part of the construction.

B. Perform HEPA vacuum cleaning of all surfaces in the construction area. This includes walls, ceilings, cabinets, furniture (built-in or free standing), partitions, flooring, etc.

C. All new air ducts shall be cleaned prior to final inspection.

11. Exterior Construction

A. Infection control-related measures for prevention of fugitive dust are likely required also for OSHA-required respiratory health risk prevention, such as silicosis.

B. Contractor shall verify that dust will not be introduced into the medical center through intake vents or other building openings.

HEPA filtration on passive intake vents is required where dust may be introduced. Where powered vents occur, application of HEPA filters can result in motor failure or fire, therefore they cannot be used.

C. Dust created from disturbance of soil such as from excavation, stone placement, or vehicle movement shall be wetted with use of a water truck or misting system as necessary to prevent fugitive dust.

D. Absolute prevention of tracking soil onto paved areas outside construction boundaries is preventable with a little care and effort. Not doing so is illegal and will not be tolerated. It is

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01 35 33 -7 not only an environmental hazard to sewers, ditches, streams, rivers, and lakes, but people in and around construction sites.

E. All cutting, drilling, grinding, sanding, or disturbance of materials shall be accomplished with tools equipped with either local exhaust ventilation (i.e. vacuum systems) or wet suppression controls.

1.2 TUBERCULOSIS SCREENING

1. Contractor shall provide written certification that all contractor 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 have negative TB screening reactions. Contractors shall be required to show documentation of negative TB screening reactions for any additional workers who are added after the initial submission of documents before new workers will be allowed to work on the site.

NOTE: This can be the Center for Disease Control and Prevention (CDC) two-step skin testing or a Food and Drug Administration (FDA)-approved blood test.

A. Contract employees manifesting positive screening reactions to the tuberculin shall be examined according to current CDC guidelines prior to working on VHA property.

B. Subsequently, if the employee is found without evidence of active

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

TB.

C. If the employee is found with evidence of active (infectious) pulmonary TB, the employee shall require treatment with a subsequent statement to the fact on file with the employer before being allowed to return to work on VHA property.

1.3 OTHER CONTAGIOUS RISKS

1. The General Contractor is responsible for all actions or inactions of their staff, and those of their subcontractors at any tier, with regard to site safety and health, and how the actions or inactions of their personnel effect the safety and health of the general public, patients, and Government employees at the job site.

2. It is imperative, and therefore required, that the General Contractor ensure that their staff, and those of their subcontractors at any tier, conduct responsible screening of their employees prior to allowing them access to any job site, much less the clinical spaces of VA.

3. Conducting employee education, incenting desired behavior such as paid sick time, and providing on-site superintendents and safety officers basic diagnostic tools such as digital thermometers, and medical PPE

(gloves, masks, etc.) are only part of responsible planning.

4. If your employee is sick, please ensure that they stay home.

1.4 INFECTION CONTROL FOR STERILE ENVIRONMENTS

In addition to all requirements listed above, regardless of Risk Class:

1. All persons entering sterile environments shall comply with all requirements of the Infection Control Risk Assessment (ICRA) and Permit

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01 35 33 -8 without exception. Violators shall be escorted from the property, accompanied by the General Contractor’s Site Safety and Health Officer

(Competent Person), or if the offenders include the Competent Person, then the Superintendent shall also leave. Failure to promptly comply with this requirement will result in VA Police escorting offenders.

2. Never allow eating or drinking within a sterile environment.

3. Do not bring dirty work boots, ladders, tools, materials, and consumables into a sterile environment. Ensure that all such materials are “as-new” clean.

4. Prior to beginning work, erect a dust-tight enclosure around the work area and associated pathway to it from the entrance to the sterile environment. Plan and execute this activity using modular materials and systems specifically made for these purposes. Ensure that the size of the work area accommodates the number of workers planned, their tools, parts, and other necessities, as well as the equipment planned for removal or replacement, and sufficient quantities of HEPA filter units to maintain dust-free air. Ensure that any and all dust or other airborne particulates are contained within the enclosure, and filtered through a HEPA air purification system prior to opening the enclosure.

Uncontrolled releases will result in time and expense associated with very detailed cleaning of the effected space at the contractor’s expense.

5. Provide within the temporary enclosure a negative pressure environment which employs HEPA air filtration to isolate specific work areas from rest of the space, ensuring that no airborne particulates are released out of the enclosure.

6. Prior to removing equipment or tools from within the enclosure, wrapping them in plastic film is one of the effective ways of ensuring that dirty products are not allowed to contaminate clean areas outside the containment.

7. One the work is complete, and equipment and tools are methodically removed from the containment, the contractor shall use a HEPA-filtered commercial-grade shop vacuum to clean all surfaces within the enclosure prior to breaking it down for removal.

8. All workers shall utilize sterile environment PPE for the prevention of transmission of infection while working within all Surgical Service, Sterile (re)Processing Service, Isolation Treatment Rooms, and similar protective environments. For these activities, the contractor shall provide sufficient quantities of PPE for use by their employees and subcontractors without re-use after leaving the space. Employees are required to don new PPE when they re-enter the space.

9. PPE includes coveralls, boot covers, bouffant caps and surgical masks.

Below are explanatory notes and example manufacturers and model numbers. You are free to source the materials from any manufacturer, however, we require pre-submittal of the products you intend to purchase and use, as typical.

A. Lint free, sterile disposable Cleanroom Coveralls: Not plastic suits as one would for hazmat, or general-purpose suits one would use for painting. Examples: Kimberly Clark KIMTECH PURE A5 Sterile

Cleanroom Coverall Code 88803 (25/case), and DuPont IsoClean sterile cleanroom coveralls CRC-IC182-CS (25/case). Important performance factors include anti-static properties, lint production

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01 35 33 -9 prevention, elastic wrists and ankles. Hoods are not required, and are likely to impede donning of surgical mask and hair (and beard) covers.

B. Lint free disposable shoe/boot covers. Examples: Kimberly Clark

KIMTECH PURE A8 Code 3971 (300/case), CT International CSC-SCRXL200 or CSC-SCRX200-NS (anti-skid model) (400/case), Criti-Clean Blue

Polypropylene anti-skid CSC-P-300-XL or CSC-P-CON (with conductive strip) (300/case).

C. Lint free disposable Cleanroom Bouffant Caps. Single ply polypropylene. DuPont Model REG3274 (750/case), or Medline Model

CRI1003 or CRI1004 (500/case)

D. Lint free disposable surgical masks. Not dust masks used in construction. Pleated adjustment to cover mouth and nose even while talking, and elastic ear loops to secure it to user (vs. tying strings). Example: Kimberly Clark Professional Procedure Mask, Pleat-Style w/Ear Loops, Blue. Part No.: KCC47080 (50/box) or 3M

Catalog No. 1826 with similar specs.

10. Prior to commencement of the work, the Contractor shall don special sterile environment PPE defined in this Specification erect a temporary barrier system to contain dust along the route from the door to the work area, sizing the work area sufficiently enabling all planned work without having to modify or repair the wall system.

A. The wall system must be dust-tight, affecting a containment. Within the containment the Contractor shall operate and maintain multiple

HEPA filtration units to remove airborne particulates within the containment.

B. Sterile area personal protective equipment is required to be worn while erecting the containment. If the containment is properly constructed and maintained, the special PPE should no longer be required until removal of the containment begins.

C. To help ensure an effective and efficient plan, submit the containment wall system planned for use with this project, along with the HEPA filtration equipment, and a sketch reflecting proposed planning to the COR no less than 21 calendar days prior to commencement of work (and allowing time to procure materials and equipment needed).

D. Basis of specification for the system are:

Edge Guard (www.edge-guard.com)

Hepa Cart (www.hepacart.com)

Starc Systems (www.starcsystems.com)

Abatement Technologies (www.abatement.com)

E. Equipment and systems purchased, rented, or otherwise provided by the Contractor for this project must arrive in like-new (clean) state, and remain so for the duration of use. The equipment and systems shall not be stored at the facility while not in use. VA cannot be responsible for any loss or damage to Contractor property.

F. Prior to removal of the containment, first ensure that all work is complete, then thoroughly vacuum all surfaces using a commercial-grade HEPA filtered shop-type vacuum cleaner. Inspect for residual

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01 35 33 -10 dust. Vacuum all surfaces again. Inspect for residual dust. Being certain that there is no residual dust, don special PPE, and then begin methodically disassembling and removing the containment system.