Attachment H Contruction Safety Infection Prevention and Control Risk Assessment.pdf

6/24/19

Department of Veterans Affairs Medical Center West Palm Beach

CONSTRUCTION SAFETY, INFECTION PREVENTION AND CONTROL

RISK ASSESSMENT

Project Name and Number or Workorder Number:

Location:

Supervisor/COR/Contractor: Current with OSHA Trg? Y N

Start Date: Target Completion Date:

Date Reviewed with Risk Assessment Team:

Scope of Work:(Include details of work to be accomplished under the scope of this risk assessment.)

Identify staging area/materials storage areas:

Medical Center equipment/supplies/furnishings are removed or protected from dust, debris, possible damage?

Inspection Schedule:

Reassessment Required: Y N

Reassessment to be initiated by:

Signature of Review:

PART 1: CONSTRUCTION SAFETY RISK ASSESSMENT

Yes No NA Comments

GENERAL SAFETY

Completed By:_______________________Date:____________

1. Does the work include above ceiling work? (If yes, an

Above Ceiling Permit is required. See also Fire Safety/ILSM Section, Item 2.)

2. Will the scope of work require shutdown of any utility system?

If YES, see Utility Shutdown Request Form (FMS SOP 1.11)

3. Does the work involve lockout-tagout?

a. Single staff

b. Multiple staff

c. VAMC and contractor staff

4.. Does the work involve working on exposed energized parts?

5. Does the work involve trenching, excavation, shoring?

6. Does the work require personal fall protection or a fall prevention plan?

7. Does the work involve cranes, man-lifts, etc.?

8. Does the work require use of scaffolds? (OSHA Scaffold

Certification is required.)

a. Contractor to inspect

b. VAMC user to inspect

9. Does the work require cutting of concrete, concrete block, generation of nuisance dust?

10. Are negative pressure and exhaust compliant with CDC guidelines? If exhaust is to the return, is the system CDC compliant and all patient/staff safety concerns addressed?

11. Does the work involve entry into a confined space or permit required confined space?

Identify VAMC and contractor POC for permit required space.

12. Does the work involve the obstruction of a road way or access to the Medical Center?

13. Does the work involve the use of a man lift/aerial platform/scissor lift?

14. Does the nature or scope of the project impact potential safety risks for patients, visitors or staff?

15. Are appropriate barriers/signs/warnings planned and/or installed?

16. Does the project create a risk for patients or their environment of care specific to unique characteristics of the patient? (i.e., age, cognitive ability, mobility challenges, sensory impairments)

17. Does the nature or scope of the project indicate staff in the area needs additional training, protective measures or monitoring?

18. Does the scope or nature of the project create noise or vibration hazards for the surrounding environment of care?

19. Does the work involve the addition, deletion, removal or

‘out of service’ of an emergency eyewash and/or shower?

IF YES: Tag as out of service, update SDS/SharePoint listing, complete risk assessment, implement interim measures, document staff training.)

20. Will the area have emergency powered lighting?

21. Are public address system emergency announcements audible? (COR workorder)

22. Does the work involve open or creating a dead-leg in the water distribution system? Does the work impact the Legionella remediation program? Do staff in the area need additional training?

Corrective Actions/Comments:

FIRE SAFETY (See also – ILSM Evaluation)

Completed By:________________________Date:___________

1. Is a hot-work permit required?

2. Will work above the ceiling require sprinkler heads to be re-oriented? (See General Safety Item #1 and Above Ceiling Permit)

3. Does the work involve a change in space utilization/occupancy addressed by NFPA 101?

4. Will the scope of work change the life safety drawings?

(Report requirement to Life Safety Committee. Track completion of updates to drawings.)

5. Will the scope of work change fire detection, signaling, or extinguishment device inventory?

6. Will the scope of work change a fire/smoke barrier wall/ door or power assisted door?

7. Does the nature or scope of the project require collaboration with local fire department?

8. Will access to any building access point (including emergency department), hydrant or sprinkler connection become blocked or obstructed?

IF YES: Document notification to fire department.

9. Will travel distances to pull stations, fire extinguishers, and exits remain unchanged?

10. Will protection of hazardous areas remain unchanged?

11. Will annual/quarterly testing and preventive maintenance of the fire detection, alarm, or extinguishment systems be impacted?

12. Have life safety drawings been updated as needed?

HAZ MAT/IH/GEMS

Completed By:_______________________Date:___________

1. Will the renovation project involve the disruption of 260 sq ft of surfacing material or 260 linear feet of material on pipes?

(If YES, materials must be tested to determine if asbestos containing materials are present. Test results must be reviewed prior to start of work.)

2. Are hazardous materials involved?

3. Are the Contractor’s chemical inventory and SDS available?

4. What types of waste streams are generated?

a. Wood

b. Concrete

c. Sheetrock

d. Metals

e. Cardboard

f. Plastic

g. Hazardous

h. Electronics

i. Other

5. Rate of waste generation – Is contractor providing construction waste recycling report?

6. Are reused materials and equipment involved?

7. Is water management provided for?

a. Storm water

b. Wastewater treatment

c. Anti-siphon and backflow prevention

8. Are the equipment or processes used during construction activities creating noise levels above 85 decibels?

9. Will staff in or adjacent to the project require personal monitoring or additional hazard communication training?

10. Are special equipment or monitoring devices needed, PM’ed and available?

11. Will the project impact Medical Center hazardous waste disposal practices?

12. Will hazardous materials used in the project impact Medical

Center compliance with Clean Water, Clean Air, ECRA, SARA

Title III, or GEMS requirements?

The following are considered for NEPA:

13. Repair, replacement and new installation of primary or secondary electrical distribution systems?

14. Repair, replacement, and new installation of components such as windows, doors, roofs; and site elements such as sidewalks, patios, fences, retaining walls, curbs, water distribution lines, and sewer lines which involve work totally within VAMC property boundaries?

15. Routine medical center grounds and facility maintenance activities?

16. Procurement activities for goods and services for routine facility operations maintenance and support?

17. Interior construction or renovation?

18. New construction of 75,000 gross square feet or less?

19. Development of acquired land or 5 acres or less?

20. Actions which involve support or ancillary appurtenances for normal operations?

21. Leases, licenses, permits, and easements?

EMERGENCY MANAGEMENT

Completed By: _________________________Date:________

1. Will the nature or scope of the project impact Medical Center Emergency Operations Plan?

2. Will the nature or scope of the project impact use of any emergency notification procedures?

3. Will the nature or scope of the project impact communications or other interactions with local community emergency management?

4. Will the nature or scope of the project impact the Medical

Center’s ability to evacuate or receive patients?

5. Will the nature/scope of the project affect continuity of operations and if so, is there a need for an Incident

Management Team to provide focus, direction, support, coordination to affected Services/Units?

Would an IMT ensure recovery requirements for affected operations are met while minimizing confusion and duplication of effort? (If yes, an IMT scaled for the event should be activated at the beginning of planning.)

Corrective Action/Comments:

Other forms completed and attached: (check all that apply)

ILSM Evaluation and Plan

Utility Shutdown Request Form

Above Ceiling Permit HEPA Filter Change Worksheet

Hot Work Permit

Part 2: INFECTION PREVENTION AND CONTROL RISK ASSESSMENT

Completed By: ______________________________________________ Date: __________________

Are constructions workers at risk of transmission of TB to them related to this construction/renovation project? ___Yes ___No

✓ CONSTRUCTION ACTIVITY ✓ INFECTION CONTROL RISK GROUP

Type A: Inspection Non-invasive, minor Low Risk

Type B: Small, short duration, moderate levels Medium Risk

Type C: Moderate to high-level, generates moderate to high levels of dust.

High Risk

Type D: Major demolition Highest Risk

Matrix of Precautions for Construction & Renovation

Step One:

Using the following table, identify the Type of Construction Project Activity (Type A-D)

Type A Inspection and Non-Invasive Activities. Includes, but is not limited to:

• Removal of ceiling tiles for visual inspection limited to 20 Ln Ft tile per 160 sq. ft. Space.

• Painting (but not sanding).

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

• Patching walls – not exceeding 8 sq. ft.

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.

• Patching walls – exceeding 8 sq. ft.

Type C Work that generates a moderate to high level of dust or requires demolition or removal of any fixed building components and assemblies or new construction.

Includes, but is not limited to:

• Sanding of walls for painting or wall covering exceeding 32 sq. ft.

• Removal of floor coverings, ceiling tiles and casework

• New wall construction

• Uncontained duct, HVAC or electrical work above ceilings

• Major cabling activities

• Any other project where high levels of dust are generated.

Type D M 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 Two:

Using the following table, identify the Patient Risk Groups that will be affected.

If more than one risk group will be affected, select the higher risk group:

Low Risk Medium Risk High Risk Highest Risk

• Administrative Offices

• Public Corridors

• Elevators

• Day Rooms

• Canteen Retail Store

• Outpatient, Urgent Care and Primary Care

Clinics

• Laboratory

• Cardiology

• Echocardiography

• Endoscopy

• Food Services

• Interim Care and

Medical Units

• Nuclear Medicine

• Pharmacy

• Physical Therapy

• Radiology and Nuclear Medicine

• Respiratory Therapy

• CCU

• Emergency Room

• Laboratory

• Outpatient

Surgery

• Pharmacy

• Post

Anesthesia Care Unit

• Surgical Units

• Any area caring for immuno-compromised patients

• SPD Storage/Sterilization

• Intensive Care Units

• TB Negative Pressure

Isolation Rooms

• Operating Room

Step Three: Match the Patient Risk Group (Low, Medium, High, Highest) with the planned Construction Project Type (A, B, C, D) on the following matrix, to find the Class of Precautions (I, II, III or IV) or level of infection control activities required. Class I-IV Precautions are delineated as follows:

Infection Control Matrix

Class of Precautions: Construction Project by Patient Risk Group

Project Type

Patient Risk Group TYPE A TYPE B TYPE C TYPE D

LOW Risk Group I II II III/IV

MEDIUM Risk Group I II III IV

HIGH Risk Group I II III/IV IV

HIGHEST Risk Group

II III/IV III/IV IV

Note: Infection control approval will be required when the Construction Activity and Risk

Level indicate that Class III or Class IV or control procedures are necessary.

Description of Required Infection Control Precautions by Class

During Construction Project Upon Completion of Project

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

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

Class

II

1. Provide active means to prevent airborne 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. Place dust mat at entrance and exit of work area.

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. Wipe work surfaces with disinfectant, wet mop and/or vacuum with HEPA vacuum before leaving work area.

Remove isolation of HVAC.

Class

III

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

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.

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

Environmental Health and Safety and Infection

Control and thoroughly cleaned by Environmental

Sanitation Section.

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.

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

Class

IV

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.

1. Do not remove barriers from work area until completed project is thoroughly cleaned by Environmental

Management.

2. Vacuum work area with HEPA filtered vacuums.

3. Wet mop with disinfectant.

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

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

6. Cover transport receptacles or carts. Tape covering.

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

Exceptions to the permit:

(END)