ICRA MPD Nurse Call Replacement_ complete.pdf

VHAInfectionControlRiskAssessment(ICRA) forConstruction,RenovationandMaintenance

6/8//2023

Instructions:

ThisICRAtemplatepertainsspecificallytoinfectionprevention.Itmustbeusedinconjunctionwiththerequired Pre-ConstructionRiskAssessment(PCRA)fortheactivitywhichaddressesotheractivity-relatedsafetyconcerns (e.g.,vibration,noise)outsidethescopeoftheICRA

InfectionPreventionandControlConstruction/Renovation/MaintenancePermit(lastpage)shouldbepostedatthe entranceoftheproject.Pleasecompletethisform,attachthescopeofworkdocumentandsubmitthisformtothe InfectionPreventionandControlcontactasfollows:

PAD-LauraMarkmanRN(x64168)orJayasreeSureshkumarRN(x64849)orMaribelMarronRN(x67533) MenloPark—JackieDugyon-EscalanteRN(52-22999) Livermore-MaricarTelmoRN(53-32260)

Tocompletethetemplate:

•Table1((ProjectManagertocomplete)toidentifythecategoryoftheconstruction,renovationand/or maintenanceactivity.

•Table2(ProjectManagertocomplete)toidentifytheareasaffectedbytheactivity.

•Table3(InfectionPrevention&Controltocomplete)toidentifytheoverallpatientriskcategorythatwill beaffectedbytheactivity.

•Table4(InfectionPrevention&Controltocomplete)todeterminethelevelofinfectionpreventionand controlprecautionsneededfortheactivity.

•Onceall4stepsabovearecompleted:RefertoTable5fortheminimumrequiredcontrolmeasuresfor thelevelofinfectionpreventionandcontrolprecautionsneededfortheactivity.RefertoTable6forthe minimuminfectionpreventionandcontrolmeasuresrequiredoncompletionoftheactivity.

Project#:640A0-22-103

ProjectTitle:ReplaceNurseCallSystem___________________________________

ProjectLocation:MPDB331andB360_________________________________

ProjectStartDate:_101112023_______EstimatedDuration:6months_______

COR(print):_DominicRamos______________Phone:510-449-8753

Table1:(ProjectManagertocomplete)Construction,Renovation,and/orMaintenance ActivityCategory

NOTE:Ifanyofthebulletedcriteriainahigheractivitycategorypertainstotheworkthatwillbedone (eveniftheothercriteriaareinalowercategory),usethehigheractivitycategoryfortheVHAICRA.

ActivityCategorydeterminedfromTable1(A,B,C,orD):B

Inspectionandlorfacilityupkeepgenerallydefinedasfollows:

.Workcanbecompletedinasingleshift,nottoexceed10hours.

•Patientsand/oremployeesmaybeintheareadependingontheactivity.

Category•Workthatdoesnotcreatedustordebris.

•Removalofceilingtileoraccesstomechanicalorelectricalchaseforvisualinspection limitedto1tileper50squarefeetwithlimitedexposuretime(nottoexceedanhourfor eachtile)withintheshift.

•Minorinteriorupdates(e.g.,replacingfloororceilingtiles,carpentryworktoinclude hanging_signage,_and_painting_without_sanding)_that_do_not_create_dust_or_debris.

VHA-ICRA-2023-1.0Page1of7

6/8//2023

•Limitedbuildingsystemmaintenancesuchasplumbingonpotablesystemslimitedto faucetreplacementetc.andelectricalworksuchasreplacementofbulbs,receptacles, orswitches.

Generalmaintenanceandrepairworkgenerallydefinedasfollows:

Category•Prolongedinspectionandworkthatmaytakelongerthanasingleshiftbutnot

Bexceedingaweek.

•Patientsandemployeesarenottobeintheareauntilactivityiscompleted.

•Workthatcreatesminimaldustanddebris.

•Interiorfinishorsurfacerepairs,updates,ormodificationssuchasrepairoffirewalls andbarriers,andnewflooringthatproducesminimaldustanddebris.Controlled sandingactivities(e.g.,wetordrysanding)thatproduceminimaldustanddebris.

•Plumbingworksuchasinstallationorreplacementofasinglefixtureorpipingfora singlefixture.Anyworkonsanitaryplumbingincludingsnakingofdrains.

•Electricalworksuchasinstallationofcabling/wiring/conduitforasingledevice, installationofnewdevicesuchasalightfixturethatproducesminimaldustanddebris.

•AirHandlerand/orfanshutdown/startupandHVACworksuchasreplacementofa singlediffuser,singleterminalunitorasingledevicethatproducesminimaldustand debris.

Small-scaleconstruction,renovation,ormaintenancegenerallydefinedasfollows:

•Workrequiringlongerthanasingleweektocompletebutnotexceeding6months.

•Patientsandemployeesarenottobeintheareauntilactivityiscompleted.

•Demolition/removalofpreexistingfloorcovering,casework,lay-inceiling,orother

Categoryarchitecturalelements.

C

•Demolition/removalofmorethan32ft2ofdrywall/framing,hardceilings,and doors/framingandminimalinfrastructuresuchaselectricalcircuitsandbranchpiping.

•Installationofnewwalls,ceilingsanddoorsincludingframing,drywall/plasterand associatedwork.

•Plumbingworksuchastheinstallationofnewsinks,showersandtoiletsand associatedplumbing.

•Shutdownofsectionsofpotablewatersystems.

•Electricalworksuchasinstallationofconduitandwireforlighting,receptaclesand switchesforanarea,theinstallationofconduitandwirefornewdevicessuchas terminalunits,fansetc.

•Modificationofexistingfirealarmandsuppressionsystems.

•Mechanicalworksuchastheinstallationofductwork,diffusers,andterminalunitsfor anarea.

Large-scaleconstruction,renovation,ormaintenancegenerallydefinedasfollows:

•Workexceeding6monthsinduration.

Category•Patientsandemployeesarenottobeintheareauntilactivityiscompleted.

D•Large-scaledemolitionofbuildingcomponentsandinfrastructureincludingremovalof multipledoors,walls,framing,ceilings,flooring,piping,electricalandHVAC.

•Theinstallationbuildingcomponentssuchasnewwalls,ceilingsanddoorsincluding framing,drywallandassociatedplasterwork.

VHA-ICRA-2023-1.0Page2of7

6/8//2023

•Plumbingworksuchastheinstallationof:

onewmedicalgassystems, osteam/heatinghotwater,condensatesystems, omultiplesinks,showersandtoiletsincludingassociatedplumbing.

•Shutdownofpotablewater,steam/heatinghotwater,condensate,andmedicalgas systems.

•Electricalworksuchasinstallationofelectricalfeeders,distributionpanels,conduitand wireforlighting,receptaclesandswitchesforanarea,theinstallationofconduitand wirefornewdevicessuchasterminalunits,fansetc.

•Installationoffirealarmandsuppressionsystems.

•Electricalshutdownofmultiplepanels.

•Mechanicalworksuchastheinstallationofairhandlingequipment,associated ductwork,diffusers,heatexchangers,terminalunitsandcontrols.

vHA-IcRA-2o23-1.oPage3of7

6/8//2023

Table2:(ProlectManagertocomplete)AffectedAreaAssessment

Identifytheareasandassociatedpatientsthatwillbeaffectedbythe construction/renovation/maintenanceactivity(seetheFigureforavisualrepresentationofadjacent affectedareas).

AREAABOVE

j

-$ADJACENTAREA2

I ATVITYLfi

Jr

AREABELOW]

Figure:Isometricdrawingofaffectedareaassessment

AreaService(s)/Type(s)ofArea(s)PointofContact(POC)POCContact (e.g.,OR,Unit/Ward,SterileInformation

Processing,_Administrative,_etc.)

ActivityArea**Bldg.331and360AnthonyLositoAnthonyLositova.gov

AreaAboveNone

AreaBelowNone

AdjacentArea1

AdjacentArea2

AdjacentArea3

AdjacentArea4

TheremaybemorethanoneService/typeofareaforeachrow.Listall.

Listthearea(s)inwhichtheconstruction/renovation/maintenanceactivitywilloccur.NOTE:WhentheActivity

CategoryisB,C,orD,thecontrolmeasuresaredeterminedbythePatientRiskintheadjacentaffected areas.

VHA-ICRA-2023-1.0Page4of7

6/8//2023

Table3InfectionPrevention&Control:PatientRiskCategory

UsingTable3,identifythepatientriskcategoryforeacharealistedinTable2.Ofthepatientrisk categoriesidentified,selecttheonewiththegreatestriskastheoverallPatientRiskCategoryforthe activity.

OverallPatientRiskCategorydeterminedfromTable3(Low,Medium,High,orHighest):High

LowRiskMediumRiskHighRiskHighestRisk

Non-patientcareareasPatientcaresupportPatientcareareassuchProcedural,invasive, suchas:areassuchas:as:sterilesupportandhighly compromisedpatientcare areassuchas:

Publichallwaysand•Waitingareas•Patientcarerooms•Allintensivecareunits gatheringareasnot•Clinicalandareas,including•Alloncologyunitsand inclinicalareas..spinalcordinjurychemotherapy/infusion engineering units •Officeareasnotin(biomedical)centers clinicalareas•Allacutecareunits, .Materials•ORtheatersand Breakroomsnotinmanagementincludingmentalrestrictedareas clinicalareashealth

.Sterile•Hemodialysisunits •Bathroomsorlockerprocessing

•Alloutpatientunits andclinics•Proceduralrooms* roomsnotinclinicaldepartment— areasdirtyside•Emergency•Pharmacy

•Mechanical/electrical•Kitchen,departmentcompoundingarea roomsnotinclinicalcafeteria,gift•CommunityLiving•Sterileprocessing areasshop,coffeeCenters,department—clean shop,andfooddomiciliaries,andside Outsidespaceskioskstransitional•Transfusionservices residences .Imagingsuites—

.Employeehealthinterventionalimaging •Pharmacy—general•Dedicatedisolation workzonewards/unitsfor .Medicationroomsinfectiousdiseases andcleanutility rooms

•Imagingsuites— diagnosticimaging

•Laboratory

ProceduralRoomsaredesignatedfortheperformanceofpatientcareactivitiesthatmayrequirehigh-level disinfectedorsterileinstrumentsandsomeenvironmentalcontrolsbutisnotrequiredtobeperformedwiththe environmentalcontrolsofanoperatingroom(OR).Theroomisintendedforproceduresthatareperformedinan asepticsurgicalfieldandpenetratestheprotectivesurfacesofapatient’sbody(e.g.,subcutaneoustissue, mucousmembranes,cornea)orentryintooropeningofasterilebodycavity.Examplesofthesespacesinclude CardiacCatheterizationSuites,ElectrophysiologySuites,Endovascular/GISuites,AngioSuitesandotherspaces whichmayhavehighriskpatientpopulations.

VHA-ICRA-2023-1.0Page5of7

6/8//2023

AdditionalRiskAssessment:

1.Iisruptionofessentialservices(e.g.,ventilation,water)topatients/employeesanticipated?

esNorzi

Comments:ectrica

2.Isrelocationofpatientstoalternateunitsrequired?Yes( Comments:

3.Willtheremovalofdebrispassthroughpatientcareareas?cNo Comments:

4,IsLegionellaandotherenvironmentwatertestingrequiredbeforeoccupancy?Yes

5.IstherepossibleexposuretoactiveTBintheconstructionarea?Yes

Ifyes,contractormustprovidedocumentationofTBscreeningresultofconstructionworkerswithin90 daysofworkcommencing.AnyonewithpositiveTBscreeningmustshowproofofstartingtreatment.

Table4(InfectionPrevention&Controltocomplete):LevelofInfectionPreventionand ControlPrecautions

MatchtheOverallPatientRiskCategory(Low,Medium,High,Highest)determinedfromTable3with theplannedConstruction/Renovation/MaintenanceActivityCategory(A,B,C,D)fromTableIto determinetheminimumLevelofInfectionPreventionandControlPrecautions(I,II,III,orIV)using Table4below.

LevelofPrecautionsdeterminedfromTable4(I,II,III,orIV):

PatientRiskActivityCategory Category

LowRisk

MediumRisk

HighRisk

HighestRisk

AninfectionpreventionandcontrolpermitisrequiredforLevelIIIandLevelIV.ICRAshouldbe completedforallprojectsregardlessofPrecautionLevel.

Table5RequiredInfectionPreventionandControlMeasures,byLevelofPrecautions

ControlsdefinedbelowfortheLevelofPrecautionsidentifiedfortheactivitymustbeinplacebeforethe activitybeginsandmaintaineduntilworkiscompletedandtheareaisactivated.Controlmeasuresfor eachPrecautionLevelmustalsoincludethecontrolmeasuresintheprecedingLevel(s).

VHA-ICRA-2023-1.0Page6of7

6/8//2023

Astheactivityprogresses,afullre-evaluationofremainingactivitytypeandpatientriskisrequiredprior todowngradingtheLevelofPrecautions.

LevelofControlMeasures Precautions LevelI1.Performworkactivityinamannerthatdoesnotcreatedust.

2.Immediatelyreplaceanyceilingtile,closeaccesspanels,etc.,uponcompletionof work.

3.Anymaterialsandequipmentbeingbroughtintothefacilitymustbefreeof contaminantsandloosematerial.

LevelIIAllcontrolmeasuresinLevelIandthefollowing:

1,Provideactivemeanstocontrolairbornedustfromdispersingintooccupiedareas and/orwatermistsurfacetocontroldust(e.g.,MobileDustContainmentCartor otherapproveddustcontainmentsystemorprocess).

2.Ensureworkerclothingiscleanandfreeofvisibledustbeforeleavingtheworkarea.

3.Removeorisolateairdiffusers(supplyandreturn)toprotecttheHVACsystemfrom dustandreduceairturbulence.Rebalancesystemtoaddressdiffuserisolation.

4.Whentheworkinvolvesorimpactspotablewatersystemsincludingstagnationdue toreducedusage,thepipingshallbeflushedtwiceaweekorisolatedfromthemain system.

5.Sealdoorstopreventdustmigration.

6.Containalltrashanddebrisintheworkarea.Performdailycleaninganddisposalof trash(covered)fromworkareausinganidentifiedexitroute.

7.Anyequipment,tools,ormaterialsremovedfromtheworkareamustbeinsealed containersand/orcleanedofdustanddebrispriortoremovalfromthearea.

8.Nonporous/smoothandcleanablecontainers(withahardlid)mustbeusedto transporttrashanddebrisfromtheconstructionareas.Thesecontainersmustbe damp-wipedcleanedandfreeofvisibledust/debrisbeforeleavingthecontained workarea.

9.Installasticky(dustcollection)matatentranceofcontainedworkarea.Stickymats mustbechangedroutinelyandwhenvisiblysoiled.

10.MaintaincleansurroundingswhenareaisnotcontainedbydampmoppingorHEPA vacuumingsurfacesatleastdaily.

LevelIllAllcontrolmeasuresinLevelsIandIIandthefollowing:

1.Ensureavailabilityofequipmentforcleaninghands.

2.ConstructandcompletecriticalbarriersmeetingNFPA241requirements.Barriers mustextendtotheceilingorifceilingtileisremoved,tothedeckabove.

3.All(plasticorhard)barrierconstructionactivitiesmustbecompletedinamanner thatpreventsdustrelease.Plasticbarriersmustbeeffectivelyaffixedtofloorand ceiling(orfloor/roofdeckabove)andsecurefrommovementordamage.

4.Sealallpenetrationsincontainmentbarriers,includingfloorsandceiling,using approvedmaterials(ULschedulefirestopifapplicableforbarriertype).

5.Maintain.01inches/watergaugenegativepressurizationoftheentireworkspaceby useofHEPAexhaustairsystemsdirectedoutdoors:thismustbemaintained continuously24/7forthedurationoftheproject.Exhaustdischargeddirectlytothe outdoorsthatis25feetorgreaterfromentrances,airintakesandwindowsisnot requiredtobeHEPA-filtered.Exhaustingdischargedairintosharedorrecirculating HVACsystems,orothersharedexhaustsystems(e.g.,bathroomexhaust)is prohibited.

VHA-ICRA-2023-1.0Page7of7

6.Installadifferentialpressuresensingdevice(e.g.,magnehelic,manometer,ordigital monitoring)onexteriorofworkcontainmenttocontinuallymonitoranddocument negativepressurization.The“ballinthewall”orsimilarapparatusare acceptable.

LevelIVAllcontrolmeasuresinLevelsI,IIandIIIandthefollowing:

1.Barriersmustbehardbarriersunlesstemporarytoinstallfinalbarrier.

2.Containmentmustincludeananteroomtoensurepressurecontrol.Anteroommust belargeenoughforequipmentstaging,cartcleaning,workers’PPEandcleaning.

3.Workerclothingand/orPPEmustberemovedorcleanandfreeofvisibledust beforeleavingtheworkareaanteroom.HEPAvacuumingofclothingoruseof coversuitsisacceptable.

4.Workersmustwearshoecoversorhaveamethodtocleanshoesinanteroom.

Shoecoversmustberemovedpriortoexitingtheanteroomtotheoccupiedspace (non-work_area)._Damaged_shoe_covers_must_be_changed_immediately.

Table6MinimumInfectionPreventionandControlMeasuresRequiredUpon CompletionoftheActivity

Controlsdefinedbelowshallbecompleteduponcompletionoftheactivityandinspectedpriorto terminatingmeasuresdefinedinTable5.

Constructionareasmustbeinspectedbyaninfectionpreventionistandengineering representative/COR(andothersasdeterminedbythefacility)forfinalactivity/projectcloseoutand removalofinfectionpreventionandcontrolmeasures.

LevelofMeasures Precautions

Cleaning:

LevelsI-Il1.Cleanworkareasincludingallenvironmentalsurfaces,highhorizontalsurfacesandflooring materials.

2.Checkallsupplyandreturnairregistersfordustaccumulationonuppersurfacesaswellasair diffusersurfaces.

HVACSystems:

1.RemoveisolationofHVACsysteminareaswhereworkisbeingperformed.VerifythatHVAC systemsarecleanandoperational.

2.VerifytheHVACsystemsmeetoriginalairflowandairexchangedesignspecifications.

Watersystems:

1.Untilthepotablewatersystemisactivatedandinuse,flushingshallcontinueatleasttwiceper weekinovernightstayareas.

WorkAreaCleaning:

LevelsIll-IV1.Cleanworkareasincludingallenvironmentalsurfaces,highhorizontalsurfacesandflooring materials.

2.Checkallsupplyandreturnairregistersfordustaccumulationonuppersurfacesaswellasair diffusersurfaces.

RemovalofCriticalBarriers:

1.Criticalbarriersmustremaininplaceduringallworkinvolvingdrywallremoval,creationofdust andactivitiesbeyondsimpletouch-upwork.ThebarriermayNOTberemoveduntilawork areacleaninghasbeenperformed.Additionalcleaningmaybeneededafterremovalofbarrier.

2.All(plasticorhard)barrierremovalactivitiesmustbecompletedinamannerthatpreventsdust release.Usethefollowingprecautionswhenremovinghardbarriers:

i.Carefullyremovescrewsandpaintertape.

ii.If_dust_will_be_generated_during_screw_removal,_use_hand-held_HEPA_vacuum.

6/87/2023

VHA-ICRA-2023-1.0Page8of7

6/8//2023 forConstruction,RenovationandMaintenance iii.Drywallcuttingisprohibitedduringremovalprocess.

iv.CleanallstudtrackswithHEPAvacuumbeforeremovingouterhardbarrier.

v.Useaplasticbarriertoencloseareaifdustcouldbegenerated.

NegativeAirRequirements:

1.Theuseofnegativeairmustbedesignedtoremovecontaminantsfromtheworkarea.

2.Negativeairdevices(fans,filters,monitoringanddocumentationequipment)mustremain operationalatalltimesandinplaceforaperiodaftercompletionofdustcreatingactivitiesto removecontaminantsfromtheworkareaandbeforeremovalofcriticalbarriers.

HVACsystems:

1.Uponremovalofcriticalbarriers,removeisolationofHVACsysteminareaswhereworkis beingperformed.

2.VerifythatHVACsystemsarecleanandoperational.

3.VerifyanddocumentthroughaTABtheHVACsystemsmeetsoriginalairflowandair exchangedesignspecifications.

Watersystems:

1.Untilthepotablewatersystemisactivatedandinuse,flushingshallcontinueatleasttwiceper weekinaccordancewithVHADirective1061

Additiona’requirements:

PkcLWl/iEW—,iz)iv7a’-xei-wher’?Z-‘17*fYfl7Jcd/Y?Ci1.

a4kIeOccjwaafa Reviewedby:ProjectManagername:InfectionPreventionfsfname:

ProjectManagersignatureDatei

InfectionPreventionistDate signature yzø&3

KeepthisICRAonfile Post

InfectionPreventionandControlConstructionlRenovation/MaintenancePermit AtWorkSite

VHA-ICRA-2023-1.0Page9of7

InfectionPreventionandControlConstructionlRenovationlMaintenancePermit ThispagemustbepostedattheentrancetotheprojectareaforLevelIllandLevelIVactivities.

LocationofMPDB331andB360 construction/renovation/maintenance ProjectmanagerIDominichamosProjectstartdate10/1/2023 Contactphonenumber51n-44q-R75Completiondate3/1/2024 ContractorIPermitexpirationdate

LevelofInfectionPreventionandControl .iig?iPrecautions(I,IlIIlorIV)1/

LevelofControlmeasurestobeinplaceforthedurationoftheactivity Precautions(Checktheboxfortheactivity’sLevelofPrecautionstoindicatetheControlMeasures) LevelI1.Performworkactivityinamannerthatdoesnotcreatedust.

j2.Immediatelyreplaceanyceilingtile,closeaccesspanels,etc.,uponcompletionofwork.

3.Anymaterialsandequipmentbeingbroughtintothefacilitymustbefreeofcontaminantsandloosematerial.

LevelIIAllcontrolmeasuresinLevelIandthefollowing:

1.Provideactivemeanstocontrolairbornedustfromdispersingintooccupiedareasand/orwatermistsurfacetocontroldust(e.g., /MobileDustcontainmentCartorsomeothersystem).

2.Ensureworkerclothingiscleanandfreeofvisibledustbeforeleavingtheworkarea.

3.Removeorisolateairdiffusers(supplyandretum)toprotecttheHVACsystemfromdustandreduceairturbulence.Rebalance systemtoaddressdiffuserisolation.

4.\Nhentheworkinvolvesorimpactspotablewatersystemsincludingstagnationduetoreducedusage,thepipingshallbeflushed twiceaweekorisolatedfromthemainsystem 5.Sealdoors,topreventdustmigration.

6.Containalltrashanddebrisintheworkarea.Performdailycleaninganddisposaloftrash(covered)fromworkareausingan identifiedexitroute.

7.Anyequipment,tools,ormaterialsremovedfromtheworkareamustbeinsealedcontainersand/orcleanedofdustanddebris priortoremovalfromthearea.

8.Nonporous/smoothandcleanablecontainers(withahardlid)mustbeusedtotransporttrashanddebrisfromtheconstruction areas.Thesecontainersmustbedamp-wipedcleanedandfreeofvisibledust/debrisbeforeleavingthecontainedworkarea.

9.Installasticky(dustcollection)matatentranceofcontainedworkareabasedonfacilitypolicy.Stickymatsmustbechanged routinelyandwhenvisiblysoiled.

10.MaintaincleansurroundingswhenareaisnotcontainedbydampmoppingorHEPAvacuumingsurfacesatleastdaily.

LevelIllAllcontrolmeasuresinLevelsIandIIandthefollowing:

1.Ensureavailabilityofequipmentforcleaninghands.

2.ConstructandcompletecriticalbarriersmeetingNFPA241requirements.Barriersmustextendtotheceilingorifceilingtileis removed,tothedeckabove.

3.All(plasticorhard)barrierconstructionactivitiesmustbecompletedinamannerthatpreventsdustrelease.Plasticbarriersmust beeffectivelyaffixedtofloorandceiling(orfloor/roofdeckabove)andsecurefrommovementordamage.

4.Sealallpenetrationsincontainmentbarriers,includingfloorsandceiling,usingapprovedmaterials(ULschedulefirestopif applicableforbarriertype).

5.Maintain.01inchesIwatergaugenegativepressurizationoftheentireworkspacebyuseofHEPAexhaustairsystemsdirected outdoors(unlessaworkspecificwaiverisapprovedbyVHA’sOfficeofHealthcareEngineering);thismustbemaintained continuously24/7forthedurationoftheproject.Exhaustdischargeddirectlytotheoutdoorsthatis25feetorgreaterfrom entrances,airintakesandwindowsisnotrequiredtobeHEPA-filtered.Exhaustingdischargedairintosharedorrecirculating HVACsystems,orothersharedexhaustsystems(e.g.,bathroomexhaust)isprohibited.

6.Installadifferentialpressuresensingdevice(e.g.,magnehelic,manometer,ordigitalmonitoring)onexteriorofworkcontainment tocontinuallymonitoranddocumentnegativepressurization.The“ballinthewall”orsimilarapparatusarenotacceptable.

LevelIVAllcontrolmeasuresinLevelsI.IIandliiandthefollowing:

1.Barriersmustbehardbarriersunlesstemporarytoinstallfinalbarrier.

j2.Containmentmustincludeananteroomtoensurepressurecontrol,Anteroommustbelargeenoughforequipmentstaging,cart cleaning,workers’PPEandcleaning.

3.Workerclothingand/orPPEmustberemovedorcleanandfreeofvisibledustbeforeleavingtheworkareaanteroom.HEPA vacuumingofclothingoruseofcoversuitsisacceptable.

4.WorkersmustwearshoecoversorhaveamethodtocleanshoesinanteroomShoecoversmustberemovedpriortoexitingthe anteroomtotheoccupiedspace(non-workarea).Damagedshoecoversmustbechangedimmediately.

.41• Additionalrequirements:[(e4$4’AdI-f’(CUUP’Oi’fle w1e,ft’c1ck-/4s

,,,n..,9.1INI

ProjectManagersignatureDate8/22/2023 — ePrevti05ti,Date

Uniquepermitnumber

ActivityCategoryOverallPatientRiskCategory (A,B,C,orD))(Low,Medium,High,orHighest)

VHA-ICRA-2023-1.0