Risk Assessment.pdf

Attachment A

Pre-Construction Risk Assessment Project Number and Title:

Project Location:

Project Coordinator:

Assessment Date: Planned Start Date (FY/QTR):

Pre-Construction Risk Assessment Y N Air Quality (also reference ICRA) Potential Mitigation

Will air handlers or other HVAC equipment be modified or replaced?

Are there potential impacts to air intakes or existing filters?

Will there be materials, installations, or equipment causing vapors/fumes?

Will there be any asbestos removal or hazardous material demolition?

Will there be dust generated during the project (interior or exterior)?

Y N Noise/Vibration Will there be rotary equipment such as motors or generators in use?

Will there be noise/vibration generated that will impact areas adjacent?

Will rotary drills, hammer drills, concrete vibration or similar tools be in use?

Y N Utility Interruptions/Impacts

Will there be any work on domestic water systems (ref. VHA Directive 1061)?

Will there be any utility shutdowns (IT, electrical, HVAC, steam, plumbing, medical gas, vacuum, water, fire alarm).

Y N Patient Safety

Will any patient safety systems such as wander guard, patient monitoring, nurse call, or code blue be out of service?

Will any medical equipment be placed out of service during construction?

Y N Other

Will construction compromise access or security?

Will there be any hot work required?

Will there be any confined space entry?

Will duress/panic alarms be placed out of service, moved, or added?

For CT, PET, or Nuclear Medicine Services: Prior to installation of new/replacement imaging equipment or room modification where ionizing radiation will be emitted or radioactive materials will be stored, a physicist must conduct a shield design and a survey prior to clinical use of the room.

Other?

Project COR/LP Signature: Construction Safety Subcommittee Review:

Attachment A

Additional Requirements and Comments:

Attachment B Infection Control Risk Assessment

(Match construction activity to patient risk group to determine project class)

CONSTRUCTION ACTIVITY TYPE PATIENT RISK GROUP

A: Inspection, non-invasive activity-includes, not limited to removal of ceiling tiles for inspection (1/50 sq ft), painting (not sanding), wall covering, electrical trim work, minor plumbing, activities which do not generate dust or require cutting of walls or access to ceilings other than for visual inspection.

Low Risk- (Office Areas)

B: Small scale, short duration, creating minimal dust-includes but not limited to installation of telephone/computer cabling, access to chase spaces, cutting of walls or ceiling where dust migration can be controlled.

Medium Risk- (Cardiology, ECHO, Endoscopy, Nuclear Medicine, Physical Therapy, Radiology/MRI, Respiratory Therapy)

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 not limited to sanding of walls for painting or wall covering; removal of floor coverings, ceiling tiles, and casework; new wall construction; minor duct work or electrical work above the ceilings; major cabling activity; any activity which cannot be completed in a single work shift.

High Risk- (CCU, ER, Laboratories (specimen), Outpatient Surgery, Pediatrics, Pharmacy, Post Anesthesia care, Surgical Units)

D: Major duration and construction activities-Includes, but not limited to:

activities that require consecutive work shifts; requires heavy demolition or removal of a complete cabling system; new construction.

Highest Risk- (Any area caring for Immunocompromised patients, Cardiac Cath Lab, Central Sterile Supply, ICU, Medical Unit, Negative pressure isolation rooms, Oncology, Operating rooms)

Project Class

Patient Risk Group TYPE A TYPE B TYPE C TYPE D LOW Risk I II II III/IV MEDIUM Risk I II III IV HIGH Risk I II III/IV IV HIGHEST Risk II III/IV III/IV IV

During Construction Project Upon Completion of Project CLASS I 1. Execute work by methods to minimize raising dust from construction operations.

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

1. Clean work area upon completion of task.

CLASS II

1. Include all items from Class I above

2. Provides active means to prevent air-borne dust from dispersing into atmosphere

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

4. Seal unused doors with duct tape (or similar method).

5. Block off and seal air vents.

6. Place dust mat at access points of work area.

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

8. Isolate HVAC system in areas where work is being performed to prevent contamination of duct system.

1. Wipe surfaces with cleaner/disinfectant.

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

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

CLASS III

1. Include all items from Class I/II above

2. Involve infection control in design/planning before construction begins.

3. 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.

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

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

1. Include all items from Class I/II above

2. Do not remove barriers from work area until completed project is thoroughly cleaned.

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

4. Vacuum work area with HEPA filtered vacuums.

5. Wet mop area with cleaner/disinfectant.

6. Coordinate with EMS for final cleaning prior to bring area back into service.

CLASS IV

1. Include all items from Class I/II/III above

2. Involve infection control in design/planning before construction begins.

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

4. 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 the work site.

5. Walk-off mats are recommended to minimize tracking of heavy dirt and dust from construction areas. Shoe covers may be considered in certain areas.

1. Include all items from Class I/II/III above

Is there a risk to the Contractor of T.B. exposure?

PROJECT CLASS: <SELECT>

YES NO

Infection Control Officer Signature: Infection Control Additional Requirements/Comments:

NOTES (Consider adjacencies - above, below, lateral, shared HVAC, etc.):

Clear Form

Attachment B

Infection Control Construction Permit Permit No:

Location of Construction: Project Start Date:

Project Coordinator: Estimated Duration:

Contractor Performing Work Permit Expiration Date:

Supervisor: Telephone:

YES NO CONSTRUCTION ACTIVITY YES NO INFECTION CONTROL RISK GROUP

TYPE A: Inspection, non-invasive activity GROUP 1: Low Risk TYPE B: Small scale, short duration, moderate to high levels GROUP 2: Medium Risk

TYPE C: Activity generates moderate to high levels of dust, requires greater 1 work shift for completion

GROUP 3: Medium/High Risk

TYPE D: Major duration and construction activities Requiring consecutive work shifts

GROUP 4: Highest Risk

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

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

3. Minor Demolition for Remodeling

CLASS II 1. Provides active means to prevent air-borne dust from dispersing 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 cleaner/disinfectant.

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

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

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

9. Isolate HVAC system in areas where work is being performed; restore when work completed.

CLASS III

Date

Initial

1. Obtain infection control permit before construction begins.

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

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

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

5. Do not remove barriers from work area until complete project is checked by Infection Prevention & Control and thoroughly cleaned by Environmental Services.

6. Vacuum work with HEPA filtered vacuums.

7. Wet mop with cleaner/disinfectant

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

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

10. Cover transport receptacles or carts. Tape covering.

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

CLASS IV

Date

Initial

1. Obtain infection control permit before construction begins.

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

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

4. Maintain negative air pressure within work site utilizing

HEPA equipped air filtration units.

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

6. 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 the work site.

7. All personnel entering work site are required to wear shoe covers.

8. Do not remove barriers from work area until completed project is checked by Infection Prevention & Control and thoroughly cleaned by Environmental. Services.

9. Vacuum work area with HEPA filtered vacuums.

10.

11.

Wet mop with disinfectant.

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

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

13. Cover transport receptacles or carts. Tape covering.

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

Additional Requirements:

Permit Authorized By (Infection Control): Permit Acknowledged By (Contractor):

Date: Date:

Permit Requested By (COR/LP):

Date:

Will there be any asbestos removal or hazardous material demolition?

Any currently identified asbestos will need to be abated, and any possible asbestos found shall be tested, and positive test results will require abatement.

Will there be dust generated during the project (interior or exterior)?

Most dust on this project will be in construction site only. Infectious control barriers shall be utilized as needed. Main locations will be the entry into the corridor from the lobby, and at the entrances to the lobby during the lobby portion of the construction.

Will there be rotary equipment such as motors or generators in use?

Air compressors may be used on this project. To mitigate any vibrations and noise caused by them the air compressors will be placed a sufficient distance away from the medical spaces, and hoses to the equipment will be ran to them. All hoses will remain in controlled spaces as to not cause a tripping hazard to patients or staff.

Will there be noise/vibration generated that will impact areas adjacent?

See above mitigation factors.