Exhibit C_ICRA Wipeable_2023v1.1.pdf

VA St. Louis Medical Center Infection Control Risk Assessment Class: I / II Project Location: FES Signature:

SUMMARY OF PROJECT:

Step 1: Project Type Activity Type A

Inspection and/or facility upkeep generally defined as follows:

• Work can be completed in a single shift, not to exceed 10 hours.

• Patients and/or employees may be in the area depending on the activity & location, excluding patient care rooms.

• Work that does not create dust or debris.

• Removal of ceiling tile or access to mechanical or electrical chase for visual inspection limited to 1 tile per 50 square feet with limited exposure time (not to exceed an hour foreach tile) within the shift.

• Minor interior updates (e.g., replacing up to 2 floor or ceiling tiles, carpentry work to include hanging signage, and painting without sanding) that do not create dust or debris.

• Limited building system maintenance such as plumbing on potable systems limited to faucet replacement etc. and electrical work such as replacement of bulbs, receptacles,or switches.

Type B

General Maintenance and repair work generally defined as follows:

• Prolonged inspection and work that may take longer than a single shift but not exceeding a week.

• Patients and employees are not to be in the area until activity is completed.

• Work that creates minimal dust and debris.

• Interior finish or surface repairs, updates, or modifications such as repair of firewalls and barriers, and new flooring that produces minimal dust and debris. Controlled sanding activities (e.g., wet or HEPA vacuum dry sanding) that produce minimal dust and debris.

• Access to chase spaces using doors and hatches (not cutting).

• Plumbing work such as installation or replacement of a single fixture or piping for a single fixture. Any work on sanitary plumbing including snaking of drains.

• Electrical work such as installation of cabling/wiring/conduit for a single device, installation of new device such as a light fixture that produces minimal dust and debris.

• Air Handler and/or fan shutdown/startup and HVAC work such as replacement of a single diffuser, single terminal unit or a single device that produces minimal dust and debris.

Type C

Small-scale construction, renovation, or maintenance generally defined as follows:

• Patients and employees are not to be in the area until activity is completed.

• Demolition/removal of preexisting floor covering, casework, lay-in ceiling, or other architectural elements.

• Demolition/removal of drywall/framing, hard ceilings, and doors/framing and minimal infrastructure such as electrical circuits and branch piping.

• Installation of new walls, ceilings and doors including framing, drywall/plaster, and associated work.

• Plumbing work such as the installation of new sinks, showers and toilets and associated plumbing.

• Shut down of sections of potable water systems.

• Electrical work such as installation of conduit and wire for lighting, receptacles and switches for an area, the installation of conduit and wire for new devices such as terminal units, fans etc.

• Non-existing (new) cable pathway or invasive (new runs) electrical work above ceilings.

• Modification of existing fire alarm and suppression systems.

• Mechanical work such as the installation of ductwork, diffusers, and terminal units for an area.

Step 2: Patient Risk Group Low Risk Non-patient care areas

Public hallways and gathering areas Not on clinical units, Office/Breakrooms /Bathrooms not on clinical units, Mechanical rooms Not on clinical units, Social Work, Stairwells, Theater, Conf. Rooms, EMS closets not on clinical units

Medium Risk Patient care support

Out Pt Mental Health, PT/OT, Waiting areas, SPS-dirty side, gift shop, Prosthetics/Orthotics, Domiciliary, Sleep Lab

High Risk Patient care areas

Patient care rooms and areas, All acute care units, All outpatient units and clinics, ED, Employee health, Pharmacy general, medication rooms, clean supply/utility rooms, radiology, MRI, Nuclear Med, General Pharmacy, In Pt Mental Health, CLC, Laboratory, Kitchen, Cafeteria, Materials management/logistics

Highest Risk Procedural, invasive, sterile, ICU, PCU, SCI, Oncology Unit, OR/PACU/Restricted Areas, Procedural Suites, Cardiac Cath, Pharmacy Compounding, SPS–clean side, Transfusion services, Negative Pressure Isolation Rooms, Invasive Imaging, Dialysis, Bronchoscopy, Out Pt Chemo

ICRA Wipeable 2023v1.1

Step 3: Class of Precautions Type A Type B Type C Type D

Low Risk Group I II II III/IV – Requires IP Approval

Medium Risk Group I II III – Requires IP Approval IV – Requires IP Approval

High Risk Group I II III/IV – Requires IP Approval IV – Requires IP Approval

Highest Risk Group II III/IV – Requires IP Approval III/IV – Requires IP Approval IV – Requires IP Approval

Step 4: Infection Control Precautions Required Infection Control Precautions Upon Completion of Work Activity

Class I 1. Do not block or interrupt patient care.

2. Do not create dust.

3. Any materials and equipment being brought into the facility must be free of contaminants and loose material.

4. Immediately replace ceiling tile after visual inspection.

Cleaning:

1. Clean surfaces and floor after work is completed with hospital approved cleaner.

Class II All control measures in Level I and the following:

1. Immediately close access panels upon completion of work.

2. Dust control is required and may include:

3. HEPA vacuum tool attachments, HEPA vacuum while creating dust, if not possible HEPA Vacuum immediately after dust creation.

4. Plastic barriers (Type C Work) or close room door

5. Water mist while cutting

6. Tacky mat inside at entrance to work area and changed when ineffective and at least 2 times per shift.

7. HEPA cart

8. Ensure worker clothing is clean and free of visible dust before leaving the work area.

9. Remove or isolate air diffusers (supply and return) and FCUs to protect the HVAC system from dust and reduce air turbulence. Rebalance system to address diffuser isolation.

10. When the work involves or impacts potable water systems including stagnation due to reduced usage, the piping shall be flushed twice a week or isolated from the main system.

11. Seal doors to prevent dust migration.

12. Contain all trash and debris in the work area. Perform daily cleaning and disposal of trash (covered) from work area using an identified exit route.

13. Any equipment, tools, or materials removed from the work area must be in sealed containers and/or cleaned of dust and debris prior to removal from the area.

14. Nonporous/smooth and cleanable containers (with a hard lid) must be used to transport trash and debris from the construction areas. These containers, including the wheels, must be damp-wiped cleaned and free of visible dust/debris before leaving the contained work area.

15. Install a sticky (dust collection) mat at entrance of contained work area based on facility policy. Sticky mats must be changed routinely when ineffective.

16. Maintain clean surroundings when area is not contained by damp mopping or HEPA vacuuming surfaces as needed and at least daily.

No visible footprints or wheel marks outside of work area.

17. No standing water, all spills/leaks cleaned and dried immediately.

Remove porous materials that remain above 17% moisture when tested with moisture meter at 72 hours after start of leak.

Cleaning:

1. Clean work areas including all environmental surfaces, all horizontal surfaces and flooring materials with hospital approved cleaner.

2. Check all supply and return air registers for dust accumulation on upper surfaces as well as air diffuser surfaces.

HVAC Systems:

1. Remove isolation of HVAC system in areas where work is being performed. Verify that HVAC systems are clean and operational.

HEPA vac diffusers as needed.

2. Verify the HVAC systems meet original airflow and air exchange design specifications.

Water systems:

1. Until the potable water system is activated and in use, flushing shall continue at least twice per week in accordance with VHA Directive 1061..

ICRA Wipeable 2023v1.1