J-1502000-02(DHA)-02_Infection Control Risk Assessment.pdf

ICRA to be posted at work location Page 1 of 4

Naval Hospital Guantanamo Bay, Cuba, Infection Control Risk Assessment

Additional Requirements:

Step One:

Using the following table, identify the CONSTRUCTION ACTIVITY TYPE (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 1 tile per 50 square feet

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.

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

Project Title:

Todays Date:

BOMI Project Manager: Estimated Duration:

Company Name: Expiration Month / Year:

Contractor Project Manager:

Check Box that Applies

CONSTRUCTION ACTIVITY TYPE Check Box that Applies

INFECTION CONTROL

RISK GROUP

TYPE A: Inspection, non-invasive activity GROUP 1: Least 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 than 1 work shift for completion. GROUP 3:

Medium/High Risk

TYPE D: Major duration and construction activities Required consecutive work shifts GROUP 4: Highest Risk

Contractor Name / Date: Safety Signature / Date:

FEAD Approval / Date Infection Control Approval:

BOMI Approval:

Start Month / Year:

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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 duct work or electrical work above ceilings

Major cabling activities

Any activity which cannot be completed within a single work shift

TYPE D

Major demolition and construction projects

Includes, but is not limited to:

Activities which require consecutive work shifts

Requires heavy demolition or removal of a complete cabling system

New construction

Step Two:

Using the following table, identify the INFECTION CONTROL RISK GROUP 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

Office areas

Administration

Public areas

Cardiology

Echocardiography

Endoscopy

Nuclear Medicine

Physical Therapy

Diagnostic imaging

Echocardiography

Emergency Dept.

Kitchen

Labor & Delivery

Laboratories

Newborn Nursery

Nuclear Medicine

Outpatient Surgery

PACU

Pediatrics

Pharmacy

PT Tank areas

Radiology/MRI

Respiratory Therapy

Surgical Units

Any area caring for immuno-compromised patients (e.g., IDSI, Dialysis)

Cardiac Cath/Angio Lab & Recovery areas

Central Sterile Supply/SPD

Intensive Care Units

Medical Unit

Negative pressure isolation rooms

Oncology (including Outpatient Chemotherapy)

OR’s including C-section rooms

Pharmacy Admixture

Special procedures

Transplant Units

Step 3:

Match the CONSTRUCTION ACTIVITY TYPE with the INFECTION CONTROL RISK GROUP using the below Matrix to determine the INFECTION CONTROL CLASS.

Ken.O.Lanum Highlight

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CLASS I-IV or Color-Coded Precautions are delineated on the following page.

Construction 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 control procedures are necessary.

Description of Required Infection Control Precautions by CLASS

DURING AFTER

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

2. Immediately replace a ceiling tile displaced for visual inspection

1. Sweep, vacuum, and/or pick up any debris created by work.

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.

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

1. Wipe work surfaces with disinfectant.

Contain construction waste before transport in tightly covered containers.

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

3. Upon completion, restore HVAC system in areas where work was performed.

CLASS III 1. Remove or Isolate HVAC system in area where work is being done to prevent contamination of duct system. HVAC unit must be locked out and tagged out if possible.

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 FEAD, BOMI, and Infection Control Service and thoroughly cleaned by the contractor.

2. Vacuum work area with HEPA filtered vacuums.

3. Wet mop area with disinfectant.

4. Remove isolation of HVAC systems in areas where work was being performed.

CLASS IV 1. Isolate HVAC system in area where work is being done to prevent contamination of duct system. HVAC unit must be locked out and tagged out if possible.

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 a HEPA vacuum for vacuuming prior to exit) before construction begins.

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.

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

6. All personnel entering worksite 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 FEAD, BOMI and Infection control Department and thoroughly cleaned by the owners Environmental Services Department.

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

Unit Below Unit Above Lateral/North Lateral/South Behind/East Front/West

Risk Group- Risk Group- Risk Group- Risk Group- Risk Group- Risk Group-

1. Identify specific site of activity, e.g., patient rooms, medication room, etc. (Attach site plan)

2. Identify issues related to: ventilation, plumbing, electrical in terms of the occurrence of probable outages.

Identify containment measures, using prior assessment. What types of barriers, e.g., solid wall barriers? Will

HEPA filtration be required?

(Note: Renovation/construction area shall be isolated and under negative pressure with respect to surrounding areas)

3. Consider potential risk of water damage. Is there a risk due to compromising structural integrity, e.g., wall, ceiling, roof?

4. Work hours: can or will the work be done during non-patient care hours?

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

6. Do plans allow for the required number and type of hand washing sinks?

7. Does the Infection Control staff agree with the minimum number of sinks for this project? (Verify against AIA Guidelines for types and area)

8. Does the infection control staff agree with the plans relative to clean and soiled utility rooms?

9. Plan to discuss the following containment issues with the project team, e.g., traffic flow, housekeeping, debris removal (how and when).

NOTES:

NOTE: Identify and communicate the responsibility for project monitoring that includes infection control concerns and risks.

The ICRA may be modified throughout the project. Revisions must be communicated to the FEAD, BOMI and IC department.

Natalie.King Typewritten Text