36E77618R0097-017.docx

INFECTION CONTROL RISK ASSESSMENT (ICRA)

Step 1: Construction Activity Type. Use the following descriptions to identify the type of construction to be performed.

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 not sanding).

· Wall covering, electrical trim work, minor plumbing, and activities that do not generate dust or require cutting of wall or access to ceilings for other than 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 of walls or ceiling where dust migration can be controlled.

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 of walls for painting or wall covering.

· Removal of floor coverings, ceiling tiles and casework.

· New wall construction.

· Minor ductwork 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.

Step 2: Patient Risk Group. Use the following lists to identify the group or area that will be affected. If more than one risk group will be affected, select the higher risk group.

· Clinic areas

· Cystology

· Echocardiography

· Endoscopy

· Food Services

· Nuclear Medicine

· Physical/Occupational Therapy

· Radiology/MRI

· Respiratory Therapy

· Ambulatory Surgery

· Dialysis

· Laboratories (specimens)

· Patient Care Units

· Post-Anesthesia Care

· Urgent Care

· Pharmacy

· Cardiac Cath Lab

· Central Sterile Supply

· Intensive Care Units

· Negative Pressure Isolation Rooms

· Oncology

· Operating Rooms

· Any area caring for immunocompromised patients

Step 3: Class of Precautions. Use the following table to match the Patient Risk Group with the planned Construction Activity Type. The Class of Precautions reflects the level of Infection Control activities required.

Note: Infection Control approval is required when the Construction Activity and Risk Level indicates that Class III or Class IV control procedures are necessary. See the Infection Control Construction Permit for requirements.

Description of Required Infection Control Precautions by Class of Construction Activity

2. Immediately replace a ceiling tile displaced for visual inspection.

1. Clean work area upon completion of task.

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

3. Seal unused doors with duct tape.

4. Block off and seal air vents.

5. Place dust mat at entrance and exit of work area.

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

1. Wipe work surfaces with disinfectant.

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

3. Wet mop and/or vacuum with HEPA filtered vacuum before leaving work area.

4. Remove isolation of HVAC system in areas where work is being performed.

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.

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

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

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

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

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

3. Vacuum work area with HEPA filtered vacuums.

4. Wet mop area with disinfectant.

5. Remove isolation of HVAC system in areas where work is being performed.

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.

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

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

5. 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 cloth or paper coveralls that are removed each time they leave the work site.

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

7. Do not remove barriers from work area until completed project is inspected by the Safety Department and Infection Control Department and thoroughly cleaned by the Environmental Services Department.

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

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

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

4. Vacuum work area with HEPA filtered vacuums.

5. Wet mop area with disinfectant.

6. Remove isolation of HVAC system in areas where work is being performed.

Step 4. Identify the areas surrounding the project area, assessing potential impact.

Step 5. Identify specific site of activity eg, patient rooms, medication room, etc.

Step 6. Identify issues related to ventilation, plumbing, electrical in terms of the occurrence of probable outages. ___________________________________________________________________________

Step 7. Identify containment measures, using prior assessment. What types of barrier?

(eg, solid wall barriers); 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)

Step 8. Consider potential risk of water damage. Is there risk due to compromising structural integrity?

(eg, wall, ceiling, roof)

Step 9. Work hours: Can or will work be done during non-patient care hours?

Step 10. Do plans allow for adequate number of isolation/negative airflow rooms?

Step 11. Do the plans allow for the required number and type of handwashing sinks?

Step 12. Does the infection control staff agree with the minimum number of sinks for this project? NA (Verify against AIA Guidelines for type and area)

Step 13. Does the infection control staff agree with the plans relative to clean and soiled utility room?

Step 14. Plan to discuss the following containment issues with the project team.

(eg. Traffic flow, housekeeping, and debris removal of how and when), Step 15. ____YES _____NO 2-step tuberculosis skin testing (TST) documentation is required for this project involving occupied rooms.

� ____YES _____NO N-95 respirator fit-testing documentation is required for projects involving occupied airborne isolation rooms.

TB risk assessment: Per CDC criteria, Charlie Norwood VAMC is a low risk facility for TB; however, contract employees working in an area where there is known TB, or those working on local exhaust ventilation (or within 25 feet of a labeled biohazard exhaust vent), airborne isolation room, ED, OR or patient treatment room will be required to provide proof ot TB testing in accordance of VHA Directive 2011-036. While it isn’t required for all construction workers, they are encouraged to have 2-step tuberculosis skin testing (TST).

INFECTION CONTROL CONSTRUCTION PERMIT

Location of Construction: __________________________ Start date: _________________ Project Coordinator: ______________________________ Duration: __________________ Contractor Performing Work: _______________________ Permit expires: _____________ Supervisor: _____________________________________ Phone: ____________________

TYPE A: Inspection, non-invasive activity

LOW Risk:

TYPE B: Small scale, short duration, minimum dust

MEDIUM Risk:

TYPE C: Generates moderate to high levels of dust, requires greater than 1 work shift to complete

HIGH Risk:

TYPE D: Major demolition and construction projects

HIGHEST Risk

2. Immediately replace ceiling tiles.

3. Vacuum work area upon completion

Class II

1. Provide active means to prevent air-borne dust from dispensing into atmosphere.

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

3. Seal unused doors with duct tape.

4. Block off and seal air vents.

5. Wipe surfaces with disinfectant

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

7. Wet mop and/or vacuum with HEPA filtered vacuum before leaving the work area. Do not dry sweep work area.

8. Place dust mat at entrance and exit of work area.

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

Class III

Contractor:

Date/Initials

Adhere to all of the above as well as items listed below.

1. Obtain Infection Control Permit before construction begins.

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

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

4. Do not remove barriers from work area until thoroughly cleaned by Environmental Services.

5. Vacuum work area with HEPA filtered vacuum cleaner. Wet mop with disinfectant.

6. Remove barrier materials carefully to minimize spreading of dust and dirt.

Class IV

Contractor:

Date/Initials

Adhere to all of the above as well as items listed below.

1. Obtain Infection Control Permit before construction begins.

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

3. Construct anteroom if space allows 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.

4. All personnel are required to wear shoe covers when entering work area and remove when leaving work area.

Additional Requirements:

Construction material brought in via: ____________ Waste/Debris removed via: ____________

Date

Initials

_____ Exceptions/Additions to this permit are noted by attached memoranda

Permit Requested By: _______________________________________ Date:__________ Permit Authorized By: _______________________________________ Date:__________