L. IP Construction Guideline 6-22 Final.pdf

INFECTION PREVENTION GUIDELINE

TITLE: INFECTION PREVENTION IN MAINTENANCE, RENOVATION AND CONSTRUCTION

Reviewed/Revised and Approved by Infection Prevention and Control Committee- June 2022

I. PURPOSE

To establish a policy for maintaining a safe and healthy environment for patients, employees, visitors, and contractors during maintenance, renovation, and construction activities which may pose a risk of infection, especially to those who are immunocompromised. All maintenance, construction, and renovation projects should be planned and implemented in a manner to reduce infection risks. The goal of this policy is to provide the occupants of all buildings with an environment that is safe from potential infection hazards during all phases of maintenance, renovation, or construction.

Plans for renovation and construction of facilities must be reviewed by the Infection Prevention Lead (IP Lead), or designee, under the authority of the Infection Prevention and Control Committee at the design phase to remain in compliance with Infection Prevention Guidelines, VA Directives, and applicable local, state, and federal regulations. The project manager (FMS, MIT, FIT) shall provide the IP Lead, or designee with adequate notification (72 hours or more) for design/pre-construction risk assessment meetings. Infection Prevention Guidelines, VA Directives, and applicable local, state and federal regulations.

II. POLICY

To protect patients, staff, visitors, and contractors from safety and health hazards associated with construction and renovation activities on VA Loma Linda Healthcare System (VALLHCS) properties. It is VALLHCS policy that the following procedures be followed for control of these hazards when in-house or contracted maintenance, renovation, or construction projects occur.

III. RESPONSIBILITIES

A. Infection Prevention and Control Lead (IP Lead), or designee: The Infection Prevention and Control Lead, or their designee is responsible to participate in the pre-construction Infection Control Risk Assessment (ICRA) process and in the Construction Safety Committee including multidisciplinary rounds for maintenance, renovation, and construction projects at VALLHCS as scheduled.

B. Construction Safety Committee/Facility Safety Chief, or designee: The Construction Safety Committee is under the direction of the Facility Safety Chief, or designee and is responsible for oversight of the Construction Safety Program and to ensure that the goals of this guideline and VHA directive 7715, Safety and Health During Construction are met.

C. FMS Chief of Projects, M & O Supervisor (MIT team), Interior Design Supervisor (FIT team): FMS, MIT and FIT project managers have the overall responsibility for the day-to-day planning and oversight of their ongoing maintenance, renovation and construction projects including communication with contractors and ensuring that surveillance findings are resolved in a timely manner. They are responsible for notifying the IP Lead, or designee of all pre-construction meetings, any changes related to a project that may impact infection control, and coordinate a final inspection and clearance, if required. FMS, MIT and FIT staff may have additional responsibilities as listed in HCS policy 00-45, Safety and Health During Construction Activities.

IV. PROCEDURES

A. The Infection Prevention and Control Lead (IP Lead), or designee will:

1. Complete the initial VHA or OSHA 10-hour Construction Safety Course and 10-hour refresher every two years, as required.

2. Be an active member of the Construction Safety Committee and participate in the scheduled multidisciplinary rounds and committee meetings.

3. Inform the Construction Safety Committee of any new vaccination requirements (e.g., influenza/COVID-19/mandatory masking) that may apply to contractors.

a. If applicable, the project manager will inform the contracting department and individual contractors of vaccination requirements and will track contractor vaccination status in accordance with current VA directives.

4. Participate in the pre-construction Infection Control Risk Assessment (ICRA) meetings, project design/implementation meetings, and advise and/or provide recommendations on exposure mitigation and the prevention of facility associated infections in patients, staff, and visitors. The pre-construction Infection Control Risk Assessment meeting should be scheduled by the project manager (FMS, MIT, FIT) prior to the notice to proceed. This will assist in accommodating any additional costs that may be incurred in the project and is accomplished through the risk assessment process. The project manager is responsible for ensuring that the contractor is informed of the ICRA expectations after determination of risk group, construction class, and precautions is complete.

a. The Construction Safety Committee/Facility Safety Chief, or designee will be responsible to review air quality, utilities, noise, vibration, life safety and other hazards included in the pre-construction Infection Control Risk Assessment (ICRA) (Appendix A).

5. Provide educational material to VA staff, contractors, and subcontractors regarding the ICRA and the implications pertaining to infection prevention and control, as needed.

6. As part of the pre-construction ICRA process, assist with determination of the risk of transmission of Mycobacterium tuberculosis (MTB) infection to the construction worker during construction (Appendix A).

a. The Loma Linda VAMC is considered a low-risk facility for the transmission of Tuberculosis. However, contract employees working in an area where there is known, or suspected MTB case will be required to provide proof of MTB testing in accordance with VHA directive 7715. The contractor then must provide written certification to the Contracting Officer (CO) and project manager that all contract employees assigned to the work site have had an MTB screening test within 90 days prior to assignment to the worksite and been found to be negative. NOTE: This can be the Center for Disease Control (CDC) two-step skin testing, or a Food and Drug Administration (FDA)-approved blood test.

I. Any roof work must be preceded by project manager and IP verification of proximity to exhaust from the room currently occupied by a known or suspected MTB case.

II. Contractors will be required to show documentation of negative

MTB screening reactions for any additional workers who are added after the 90-day requirement before they will be allowed to work on the work site.

III. Contract employees with a positive MTB screening test must be examined by a physician and provide written certification from that physician that the contractor does not have active (infectious) MTB as described by the current CDC guidelines prior to working on VHA property.

IV. If the contract employee with a positive screen is determined, through examination by a physician, to not show evidence of active (infectious) MTB, a statement documenting this condition must be on file with the employer (contractor).

V. If the contract employee with positive screen is determined, through examination by a physician, to have active (infectious) MTB, the employee must complete a course of treatment to resolve the condition. A subsequent statement from a physician documenting that the worker is non-infectious must be on file before the contract employee may return to work on VHA property.

7. Provide the project manager a copy of the Infection Prevention Construction Permit (required for Class III-V projects) after completion of the ICRA showing the designated risk category for the project and associated infection control requirements. This should be posted at the construction site (usually at the main egress for construction workers) or be always readily available at the site.

A copy of the ICRA and Infection Prevention Construction Permit will be also kept by the Infection Prevention and Control section (Appendix A, B).

8. Participate in reassessing and downgrading the Infection Prevention Construction Permit requirements in conjunction with the project manager (FMS, MIT, FIT) and Facility Safety Chief, or designee. Downgrading of projects should be documented on the Infection Prevention Construction Permit with the date and signature/initials of certifying staff.

9. Participate in scheduled multidisciplinary Construction Safety rounds to assess compliance with ICRA/Permit requirements (Appendix D). Deficiencies from these rounds should be documented and sent to the project manager and their supervisor by the individual leading the rounds, usually the Facility Safety Chief or designee.

a. Correction of deficiencies should be tracked and monitored by the Construction Safety Committee/Facility Safety Chief, or designee.

Committee reports are forwarded to the Environment of Care (EOC) Committee.

b. If there is an immediate risk to patients, visitors, or employees, the project manager or Construction Safety Committee/Facility Safety Chief, or designee should notify the contractor or subcontractor to “Stop Work” until the safety concerns are addressed to their satisfaction.

c. Infection Prevention will present their construction-related findings and rounds participation to the Infection Prevention and Control Committee. Construction safety related to infection control is reviewed annually as part of the facility Infection Prevention Risk Assessment process.

10. Provide input in the design and planning phase of construction and renovation projects including but not limited to:

a. Number and placement of isolation rooms and anterooms.

b. Number and location of fixed sharps containers and glove dispensers.

c. Number and placement of sinks and dispensers for hand hygiene products including types of faucets (e.g., hand control vs foot control).

d. Appropriate location and type of ice machines.

e. Water supply and plumbing.

f. Number and location of adequate clean supply storage and supply areas, clean and dirty linen areas, soiled utility rooms, biohazardous waste and decontamination rooms, and housekeeping aide closets.

g. Medicine preparation areas and placement (e.g., > 3 feet from sink).

h. Types of surface finishes that are easily cleaned and maintained (e.g., porous vs non-porous).

i. Appropriate flooring, wall, and window coverings.

j. Air handling systems engineered for optimal performance, ease of maintenance and repair.

k. Staff, patient, and visitor traffic for the duration of the project.

l. Relocation decisions regarding patient care areas, storage areas, etc.

m. Construction waste containment, transport, and disposal.

11. Share the following general infection control precautions with the Construction Safety Committee/Facility Safety Chief, or designee, and project managers (FMS, MIT, FIT). These precautions should be followed for all maintenance, renovation, and construction projects (Class I-V) and are in addition to any ICRA/Permit requirements. The project manager should ensure that the general infection control precautions are reviewed by in-house staff and contractors and are followed during the duration of the project.

a. Biomedical Waste

I. FMS, MIT, or FIT project managers should coordinate with EMS to have all waste, including sharps containers, removed from areas to be renovated, altered, demolished, or constructed PRIOR to the start of the project.

II. The Facility Safety Chief, or designee should be notified immediately if unexpected biomedical waste is encountered by construction workers to coordinate safe removal and follow-up.

b. Barrier Walls

I. Rigid construction may be required as critical barriers for projects with a duration of >1 week.

c. Coordination I. Project managers should notify and coordinate with the Nurse

Manager, or designee if performing maintenance activities in or around patient care areas.

d. Environmental Control

I. Cover or remove all patient care items and equipment prior to beginning dust-producing activities.

II. Negative air pressure, when required, should be maintained at -0.03 around the clock (24/7) within the construction zone with no disruption of the air systems of the adjacent areas. Approval for a lower negative air requirement of -0.01 may be approved for certain projects with agreement of the project manager, Infection Prevention Lead and Facility Safety Chief, or designees.

III. The contractor or project manager should document verification of negative air (or actions taken) on a daily log (Appendix C). These logs should be stored with necessary project documents at the conclusion of the project.

IV. Construction debris should be removed from the construction area in tightly covered and dust-free carts using specified traffic patterns daily as established prior to the beginning of construction.

The least intrusive traffic plan will be followed.

V. Exterior window seals must be assured to minimize infiltration of outside excavation debris. Windows will remain closed during outside excavation, renovation, construction, alteration, or demolition.

VI. When using demolition chutes, the chute opening must be sealed when not in use. The chute and damper must be sprayed with water, as necessary, to maintain dust control.

VII. Control, collection, and disposal must be provided for any draining liquid or sludge encountered when demolishing plumbing.

e. Traffic Control

a. Designated entry and exit procedures will be defined (in conjunction with any necessary Interim Life Safety Measures) for each construction project.

b. All egress pathways should remain free of debris.

c. Unauthorized personnel should not be allowed to enter the construction zone. The doors should be labeled identifying construction zone as a restricted area/hard hat area and should remain locked when construction personnel are not present.

d. Only designated elevators should be used for construction activities during scheduled times.

f. Cleaning

a. The construction zone and adjacent entry area should be maintained in a clean and sanitary manner (incl. sweeping/wet mopping) daily or more frequently if needed to minimize dust during construction. The contractor will also be responsible for performing an initial clean of the construction zone and adjacent area before Infection Prevention Construction Permit downgrades will be considered.

g. Personnel Requirements

a. Clothing should be free of loose soil and debris upon exiting the construction zone.

b. Personnel protection equipment, including face shields, gloves, and N95 respirators will be utilized as appropriate for the task at hand. The contractor will provide these items.

c. Personnel entering sterile/invasive procedure areas will be provided with a disposable jump suit, head covering, and shoe covering by the contractor. These must be removed prior to exiting the work area. This is determined in the pre-construction Infection Control Risk Assessment process and will be noted on the Permit.

d. Tools and equipment must be damp wiped prior to entry and exit from sterile and invasive procedure areas.

e. Hospital-approved germicides will be used to clean tools and equipment that may be soiled with blood and body fluids.

a. Activation/Completion Phase Activities

a. After completion of construction, ventilation must meet specifications as mandated by regulatory bodies.

b. The area must be thoroughly cleaned and disinfected by EMS before being placed into service.

c. Water supply lines should be flushed before placing newly renovated, altered, demolished, or constructed areas into service.

d. During Activation, the Activation Manager should coordinate with FMS to complete environmental monitoring prior to the opening of any new construction area. This may include air testing, environmental testing or legionella testing for the project, as recommended by FMS, the Facility Safety Chief or designee, and/or the IP Lead, or designee.

e. The Activation manager shall notify the IP Lead, or designee at least 72 hours before project completion to schedule a walk through. A Pre-occupancy Check list (Appendix E) can be used and provided to the Activation or project manager (FMS, MIT, FIT) to address any items that require follow-up prior to the area being placed into service.

V. APPENDIX

A. Infection Control Risk Assessment (adapted and revised from ASHE ICRA 2.0)

B. Infection Prevention Construction Permit

C. Daily Negative Air Pressure Verification Log

D. Infection Prevention Surveillance Rounds Worksheet

E. Pre-Occupancy Checklist

VI. COLLABORATION:

Construction Safety Committee, Facility Safety section, FMS section, M&O section (MIT), Interior Design section (FIT), and Infection Prevention and Control section

VII. REFERENCES:

1. Association of Professional Infection Control (APIC) Text of Infection Control and

Epidemiology, Chapter 117: Water System Issues and Prevention of Waterborne Infectious Diseases in Healthcare Facilities and Chapter 118: Construction and

Renovation, available at http://text.apic.org/. Last revision 5/28/19. Last accessed 5/18/22.

http://text.apic.org/

2. Guidelines for Design and Construction of Hospital and Outpatient Facilities 2018 Edition, Facility Guidelines Institute, available at https://fgiguidelines.org/guidelines/2018-fgi-guidelines/. Last accessed 5/18/22.

3. OSHA Safety and Health Regulations for Construction, 29 CFR 1926, available at:

https://www.osha.gov/pls/oshaweb/owastand.display_standard_group

?p_toc_level=1&p_part_number=1926. Last accessed 5/18/22.

4. VA Loma Linda Healthcare System MCP 00-45, Safety and Health During

Construction Activities, available at Policies - 00-45 Safety and Health During Construction Activities.pdf - All Documents (sharepoint.com) .

Last accessed 5/18/22.

5. VHA Directive 7715, Safety and Health During Construction, available at https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=5380. Last accessed 5/18/22.

6. American Society of Healthcare Engineering (ASHE) Infection Control Risk Assessment

2.0 (ICRA 2.0), available at https://www.ashe.org/icra2 . Last accessed 5/18/22.

NOTE: Current National Fire Protection Association (NFPA) Standards are available at facility and/or Veterans Integrated Service Network (VISN) Safety and Engineering and/or Facilities Management Offices.

IX. RESPONSIBILITY AND REVIEW DATE: This Infection Prevention Guideline will be reviewed biennially by the Infection Prevention and Control Committee and reissued by June 2024.

https://fgiguidelines.org/guidelines/2018-fgi-guidelines/ https://www.osha.gov/pls/oshaweb/owastand.display_standard_group?p_toc_level=1&p_part_number=1926 https://www.osha.gov/pls/oshaweb/owastand.display_standard_group?p_toc_level=1&p_part_number=1926 https://dvagov.sharepoint.com/sites/VHALOM/policies_sop/HCS%20Policies/Forms/AllItems.aspx?q=construction&id=%2Fsites%2FVHALOM%2Fpolicies%5Fsop%2FHCS%20Policies%2FDirector%27s%20Office%20%2800%29%2F00%2D45%20Safety%20and%20Health%20During%20Construction%20Activities%2Epdf&parent=%2Fsites%2FVHALOM%2Fpolicies%5Fsop%2FHCS%20Policies&parentview=7 https://dvagov.sharepoint.com/sites/VHALOM/policies_sop/HCS%20Policies/Forms/AllItems.aspx?q=construction&id=%2Fsites%2FVHALOM%2Fpolicies%5Fsop%2FHCS%20Policies%2FDirector%27s%20Office%20%2800%29%2F00%2D45%20Safety%20and%20Health%20During%20Construction%20Activities%2Epdf&parent=%2Fsites%2FVHALOM%2Fpolicies%5Fsop%2FHCS%20Policies&parentview=7 https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=5380 https://www.ashe.org/icra2

APPENDIX A: Infection Control Risk Assessment (adapted/revised from ASHE ICRA 2.0)

Step One:

Using Table 1, identify the Construction Project Activity Type (A-D).

Table 1 - Construction Project Activity Type:

Type A

Inspection and non-invasive activities.

Includes but is not limited to:

• Removal of ceiling tile for visual inspection-limited to 1 tile per 50 square feet with limited exposure time.

• Limited building system maintenance (e.g., pneumatic tube station, HVAC system, fire suppression system, electrical and carpentry work to include painting without sanding) that does not create dust or debris.

• Clean plumbing activity limited in nature.

Type B

Small-scale, short duration activities that create minimal dust and debris.

Includes but is not limited to:

• Work conducted above the ceiling (e.g., prolonged inspection or repair of firewalls and barriers, installation of conduit and/or cabling, and access to mechanical and/or electrical chase spaces).

• Fan shutdown/startup.

• Installation of electrical devices or new flooring that produces minimal dust and debris.

• The removal of drywall where minimal dust and debris is created.

• Controlled sanding activities (e.g., wet or dry sanding) that produce minimal dust and debris.

Type C

Large-scale, longer duration activities that create a moderate amount of dust and debris.

Includes but is not limited to:

• Removal of preexisting floor covering, walls, casework, or other building components.

• New drywall placement.

• Renovation work in a single room.

• Non-existing cable pathway or invasive electrical work above ceilings.

• The removal of drywall where a moderate amount of dust and debris is created.

• Dry sanding where a moderate amount of dust and debris is created.

• Work creating significant vibration and/or noise.

• Any activity that cannot be completed in a single work shift.

Type D

Major demolition and construction activities.

Includes but is not limited to:

• Removal or replacement of building system component(s).

• Removal/installation of drywall partitions.

• Invasive large-scale new building construction.

• Renovation work in two or more rooms.

Step Two:

Using Table 2, identify the Patient Risk Group(s) that will be affected. If more than one risk group will be affected, select the higher risk group.

Table 2 - Patient Risk

Group:

Low Risk

Non-patient care areas such as:

Medium Risk

Patient care support areas such as:

High Risk

Patient care areas such as:

Highest Risk

Procedural, invasive, sterile support and highly compromised patient care areas such as:

• Public hallways and gathering areas not on clinical units.

• Office areas not on clinical units.

• Breakrooms not on clinical units.

• Bathrooms or locker rooms not on clinical units.

• Mechanical rooms not on clinical units.

• EVS closets not on clinical units.

• Waiting areas.

• Clinical engineering.

• Materials management.

• Sterile processing department - dirty side.

• Kitchen, cafeteria, gift shop, coffee shop, and food kiosks.

• Patient care rooms and areas

• All acute care units

• Emergency department

• Employee health

• Pharmacy -general work zone

• Medication rooms and clean utility rooms

• Imaging suites:

diagnostic imaging

• Laboratory.

• All transplant and intensive care units.

• All oncology units.

• OR theaters and restricted areas.

• Procedural suites.

• Pharmacy compounding.

• Sterile processing department - clean side.

• Transfusion services.

• Dedicated isolation wards/units.

• Imaging suites: invasive imaging.

Step Three:

Match the Patient Risk Group (Low, Medium, High, Highest) from Step Two with the planned

Construction Activity Project Type (A, B, C, D) from Step One using Table 3 to find the Class of

Precautions (I, II, III, IV or V) or level of infection control activities required. The activities are listed in Table 5 – Minimum Required Infection Control Precautions by Class.

Table 3 - Class of

Precautions:

Construction Project Type

Patient Risk Group TYPE A TYPE B TYPE C TYPE D

LOW RISK GROUP I II II III*

MEDIUM RISK GROUP I II III* IV

HIGH RISK GROUP I III IV V

HIGHEST RISK GROUP III IV V V

Infection Prevention Construction Permit and approval will be required when Class of Precautions

III, IV or V are necessary. Although, the Infection Prevention Construction Permit and FMS, Safety and IP approvals are not required for Class I & II maintenance activities, in-house and contracted staff are to follow the standard precautions & mitigation measures before, during, and after maintenance activities as listed in the Infection Prevention in Maintenance, Renovation and

Construction guideline, including Appendix A.

Environmental conditions that could affect human health, such as sewage, mold, asbestos, gray water, and black water will be elevated to Class of Precautions IV for LOW and MEDIUM Risk

Groups and Class of Precautions V for HIGH and HIGHEST Risk Groups.

*Negative pressure may be considered as an additional requirement.

Step Four:

Assess potential risk to areas surrounding the project. Using Table 4, identify the surrounding areas that will be affected and the type of impact that will occur. If more than one risk group will be affected, select the higher risk group using Table 2 - Patient Risk Group.

Table 4 - Surrounding Area Assessment

Unit Below: Unit Above: Unit Lateral: Unit Behind: Unit in Front:

Risk Group: Risk Group: Risk Group: Risk Group: Risk Group:

Contact: Contact: Contact: Contact: Contact:

Phone: Phone: Phone: Phone: Phone:

Additional Controls:

Noise

Vibration

Dust control

Ventilation

Pressurization Impact to other systems, such as:

Data

Mechanical

Med Gases

Water Systems

Additional Controls:

Noise

Vibration

Dust control

Ventilation

Pressurization Impact to other systems, such as:

Data

Mechanical

Med Gases

Water Systems

Additional Controls:

Noise

Vibration

Dust control

Ventilation

Pressurization Impact to other systems, such as:

Data

Mechanical

Med Gases

Water Systems

Additional Controls:

Noise

Vibration

Dust control

Ventilation

Pressurization Impact to other systems, such as:

Data

Mechanical

Med Gases

Water Systems

Additional Controls:

Noise

Vibration

Dust control

Ventilation

Pressurization Impact to other systems, such as:

Data

Mechanical

Med Gases

Water Systems

Noise & Vibration Mitigation Strategies

Use diamond drills instead of powder-actuated fasteners.

Schedule noise-making periods with adjacent spaces.

Use beam clamps instead of shot.

Prefab where possible.

Use tin snips to cut metal studs instead of using a chop saw.

Install metal decking with vent tabs, then use cellular floor deck hangers.

Consider pro-press instead of soldering, brazing, or welding.

Wet core drill instead of dry core or percussion.

Instead of jackhammering concrete, use wet diamond saws.

Use HEPA vacuums instead of standard wet/dry vacuums.

Use mechanical joining system sprinkler fittings instead of threaded.

Where fumes are tolerated, use chemical adhesive remover (flooring glue) instead of mechanical.

To remove flooring, shot blast instead of using a floor scraper.

Use electric sheers instead of reciprocating saw for ductwork cutting.

Install exterior man/material lifts.

Ventilation & Pressurization Mitigation Strategies

HEPA–99.97% to exterior.

Install temporary ductwork.

Utilize temporary HVAC equipment.

Vacate the area.

Install temporary partitions.

Use carbon filtration to filter odors.

Impact to Other Systems Mitigation Strategies

Schedule outages.

Provide temporary systems Back-feed electricity or medical gases.

Flushing and testing of building water systems.

Table 5 - Minimum Required Infection Control Precautions by Class | Before and During Work Activity

Class of Precautions

Infection Control Precautions- Performed Before and During Work Activity- Class I and II Maintenance Activities

(Infection Control Construction Permit Not Required)

Class I 1. Perform noninvasive work activity as to not block or interrupt patient care.

2. Perform noninvasive work activities in areas that are not directly occupied with patients.

3. Perform noninvasive work activity in a manner that does not create dust.

4. Immediately replace any displaced ceiling tile before leaving the area and/or at end of noninvasive work activity.

Class II 1. Perform only limited dust work and/or activities designed for basic facilities and engineering work.

2. Execute work by methods to minimize raising dust from maintenance activities.

3. This Class of Precautions must never be used for construction or renovation activities.

Class of Precautions

Infection Control Precautions- Performed Before and During Work Activity- Class III-V Renovation and Construction Activities (Infection Control Construction Permit Required)

Class III

1. Provide active means to prevent airborne dust dispersion into the occupied areas.

(Means for controlling minimal dust dispersion may include hand-held HEPA vacuum devices, polyethylene plastic containment, isolation of work area by closing room door, and/or water misting surfaces to control dust).

2. If the work area is contained, it should be neutral to negative pressured at all times.

3. Remove or isolate return air diffusers to avoid dust from entering the HVAC system.

4. Remove or isolate the supply air diffusers to avoid positive pressurization of the space,

5. Seal all doors with tape that will not leave residue

6. Contain all trash and debris in the work area.

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

8. Install a sticky (dust collection) mat at entrance of contained work area. Sticky mats must be changed routinely and when visibly soiled.

9. Maintain clean surroundings by damp mopping or HEPA vacuuming surfaces daily, and more often as needed.

Class IV

All requirements listed in Class III plus the following:

10. Construct and complete critical barriers meeting NFPA 241 requirements. Barriers must extend to the ceiling or if ceiling tile is removed, to the deck above.

11. All (plastic or hard) barrier construction activities must be completed in a manner that prevents dust release. Plastic barriers must be effectively affixed to ground and ceiling and secure from movement or damage. Apply tape that will not leave a residue to seal gaps between barriers, ceiling, or floor.

12. Seal all penetrations in containment barriers, including floors and ceiling, using approved materials (UL schedule firestop if applicable for barrier type).

13. Containment units or environmental containment units (ECUs) are approved for Class IV precautions in small areas that are totally contained by the unit. The unit must have HEPA-filtered exhaust air.

14. Negative airflow pattern must be maintained from the entry point to the anteroom and into the construction area. The airflow must cascade from outside to inside the construction area. The entire construction area must remain negatively pressurized.

15. Maintain negative pressurization of the entire workspace by use of HEPA exhaust air systems directed outdoors. Exhaust discharged directly to the outdoors that is 25 feet or greater from entrances, air intakes and windows does not require HEPA-filtered air.

16. If exhaust is directed indoors, then the system must be HEPA filtered. Prior to start of work, HEPA filtration must be verified by particulate measurement as no less than 99.97% efficiency and must not alter or change airflow/pressure relationships in other areas.

17. Exhaust into shared or recirculating HVAC systems, or other shared exhaust systems (e.g., bathroom exhaust) is not acceptable.

18. Install device (e.g., magnehelic, manometer, or digital monitoring) on exterior of work containment to continually monitor negative pressurization. The “ball in the wall” or similar apparatus is not acceptable.

19. Workers must wear shoe covers prior to entry into the work area. Shoe covers must be changed prior to exiting the anteroom to the occupied space (non-work area).

Damaged shoe covers must be immediately changed.

20. Worker clothing must be clean and free of visible dust before leaving the work area.

HEPA vacuuming of clothing or use of cover suites is acceptable.

Class V All requirements listed in Class III and IV plus the following:

21. Construct anteroom large enough for equipment staging, cart cleaning, workers. The anteroom must be constructed adjacent to entrance of construction work area.

22. Personnel will be required to wear coveralls at all times during Class V work activities.

Coveralls must be removed before leaving the anteroom.

Table 6 - Minimum Required Infection Control Precautions | Upon Completion of Work Activity

Class of Precautions

Mitigation Activities (Performed upon Completion of Work Activity)

Classes I, II and III

Cleaning:

1. Clean work areas including all environmental surfaces, high horizontal surfaces and flooring materials.

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.

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

Classes III, IV and V

Class III, IV, and V precautions require inspection and approval for downgraded ICRA precautions.

Construction areas must be inspected by an infection preventionist or facility safety staff, and the project manager for downgrading ICRA precautions.

Work Area Cleaning:

1. Clean work areas including all environmental surfaces, high horizontal surfaces and flooring materials.

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

Removal of Critical Barriers:

1. Critical barriers must remain in place during all work involving drywall removal, creation of dust and activities beyond simple touch-up work. The barrier may NOT be removed until an initial work area cleaning has been performed.

2. All (plastic or hard) barrier removal activities must be completed in a manner that prevents dust release. Use the following precautions when removing hard barriers:

i. Carefully remove screws and painter tape.

ii. If dust will be generated during screw removal, use hand-held HEPA vacuum.

iii. Drywall cutting is prohibited during removal process.

iv. Clean all stud tracks with HEPA vacuum before removing outer hard barrier.

v. Use a plastic barrier to enclose area if dust could be generated.

Negative Air Requirements:

1. The use of negative air must be designed to remove contaminates from the work area.

2. Negative air devices must remain operational at all times (24/7) and in place for 24 hours after completion of dust creating activities to remove contaminants from the work area and before removal of critical barriers.

HVAC systems:

1. Upon removal of critical barriers, remove isolation of HVAC system in areas where work is being performed.

2. Verify that HVAC systems are clean and operational.

3. Verify the HVAC systems meets original airflow and air exchange design specifications.

Appendix B: Infection Prevention Construction Permit

INFECTION PREVENTION CONSTRUCTION PERMIT

Project Name/Number: Location:

Project Start Date: Est. Duration: Permit Expiration:

Contractor: Phone #:

Project Manager: Phone #:

Infection Preventionist: Phone #:

Facility Safety Representative: Phone #:

TB screening required: Yes_____ No _____

YES NO CONSTRUCTION ACTIVITY YES NO

INFECTION CONTROL

RISK GROUP

TYPE A: Inspection, non-invasive activities. GROUP 1: Low-Risk

TYPE B: Small scale, short duration activities that create minimal dust and debris GROUP 2: Medium-Risk

TYPE C: Large scale, longer duration activities that create moderate dust/debris GROUP 3: High-Risk

TYPE D: Major demolition and construction activities GROUP 4: Highest-Risk

Date Phase Begins/Ends

& Staff Initials MITIGATION ACTIVITIES BEFORE AND DURING WORK ACTIVITY

CLASS I & II

Infection Prevention Construction Permit/Approvals are not required for Class I & II maintenance activities. In-house and contracted staff are to follow the standard precautions and mitigation measures before, during, and after maintenance activities as listed in the Infection Prevention in Maintenance, Renovation and Construction guideline, including Appendix A.

CLASS III

Begins____________

Ends _____________

PM______________

IP/Safety__________

1. Provide active means to prevent airborne dust dispersion into the occupied areas. (Means for controlling minimal dust dispersion may include hand-held HEPA vacuum devices, polyethylene plastic containment, or isolation of work area by closing room door).

2. If the work area is contained, it should be neutral to negative pressured at all times.

3. Remove or isolate return air diffusers to avoid dust from entering the HVAC system.

4. Remove or isolate the supply air diffusers to avoid positive pressurization of the space,

5. Seal all doors with tape that will not leave residue

6. Contain all trash and debris in the work area.

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

8. Install a sticky (dust collection) mat at entrance of contained work area. Sticky mats must be changed routinely and when visibly soiled.

9. Maintain clean surroundings when area is not contained by damp mopping or HEPA vacuuming surfaces.

Additional Requirements:

CLASS IV

Ends _____________

All requirements listed in Class III plus the following:

10. Construct and complete critical barriers meeting NFPA 241 requirements. Barriers must extend to the ceiling or if ceiling tile is removed, to the deck above.

11. All (plastic or hard) barrier construction activities must be completed in a manner that prevents dust release. Plastic barriers must be effectively affixed to ground and ceiling and secure from movement or damage. Apply tape that will not leave a residue to seal gaps between barriers, ceiling, or floor.

12. Seal all penetrations in containment barriers, including floors and ceiling, using approved materials (UL schedule firestop if applicable for barrier type).

13. Containment units or environmental containment units (ECUs) are approved for Class IV precautions in small areas that are totally contained by the unit. The unit must have HEPA-filtered exhaust air.

14. Negative airflow pattern must be maintained from the entry point to the anteroom and into the construction area. The airflow must cascade from outside to inside the construction area. The entire construction area must remain negatively pressurized.

15. Maintain negative pressurization of the entire workspace by use of HEPA exhaust air systems directed outdoors. Exhaust discharged directly to the outdoors that is 25 feet or greater from entrances, air intakes and windows does not require HEPA-filtered air.

16. If exhaust is directed indoors, then the system must be HEPA filtered. Prior to start of work, HEPA filtration must be verified by particulate measurement as no less than 99.97% efficiency and must not alter or change airflow/pressure relationships in other areas.

17. Exhaust into shared or recirculating HVAC systems, or other shared exhaust systems (e.g., bathroom exhaust) is not acceptable.

18. Install device (e.g., magnehelic, manometer, or digital monitoring) on exterior of work containment to continually monitor negative pressurization. The “ball in the wall” or similar apparatus is not acceptable.

19. Workers must wear shoe covers prior to entry into the work area. Shoe covers must be changed prior to exiting the anteroom to the occupied space (non-work area). Damaged shoe covers must be immediately changed.

20. Worker clothing must be clean and free of visible dust before leaving the work area. HEPA vacuuming of clothing or use of cover suites is acceptable.

Additional Requirements:

CLASS V

Begins____________

Ends _____________

All requirements listed in Class III and IV plus the following:

21. Construct anteroom large enough for equipment staging, cart cleaning, workers. The anteroom must be constructed adjacent to entrance of construction work area.

22. Personnel will be required to wear coveralls at all times during Class V work activities. Coveralls must be removed before leaving the anteroom.

Date Phase Begins/Ends

& Initials of Certifying

Staff

MITIGATION ACTIVITIES PERFORMED IN COMPLETION PHASE OF WORK ACTIVITY

CLASS I and II Infection Prevention Construction Permit/Approvals are not required for Class I & II maintenance activities. In-house and contracted staff are to follow the standard precautions and mitigation measures before, during, and after maintenance activities as listed in the Infection Prevention in Maintenance, Renovation and Construction guideline, including Appendix A.

CLASS III, IV, V

Ends _____________

Class III, IV, and V precautions require inspection and approval for downgraded ICRA precautions.

Construction areas must be inspected by an infection preventionist or facility safety staff, and the project manager for downgrading ICRA precautions.

Work Area Cleaning:

1. Clean work areas including all environmental surfaces, high horizontal surfaces, and flooring materials.

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

Removal of Critical Barriers:

1. Critical barriers must remain in place during all work involving drywall removal, creation of dust and activities beyond simple touch-up work. The barrier may NOT be removed until an initial work area cleaning has been performed.

2. All (plastic or hard) barrier removal activities must be completed in a manner that prevents dust release. Use the following precautions when removing hard barriers:

i. Carefully remove screws and painter tape.

ii. If dust will be generated during screw removal, use hand-held HEPA vacuum.

iii. Drywall cutting is prohibited during removal process.

iv. Clean all stud tracks with HEPA vacuum before removing outer hard barrier.

v. Use a plastic barrier to enclose area if dust could be generated.

Negative Air Requirements:

1. The use of negative air must be designed to remove contaminates from the work area.

2. Negative air devices must remain operational at all times (24/7) and in place for 24 hours after completion of dust creating activities to remove contaminants from the work area and before removal of critical barriers.

HVAC systems:

1. Upon removal of critical barriers, remove isolation of HVAC system in areas where work is being performed.

2. Verify that HVAC systems are clean and operational.

3. Verify the HVAC systems meets original airflow and air exchange design specifications.

Notes:

Appendix C: Daily Negative Air Pressure Verification Log

DAILY NEGATIVE AIR PRESSURE VERIFICATION LOG

Date Time Measurement Signature If modifications or repairs were necessary, record the action taken.

The project manager is responsible to have the completed logs retrieved from the work zones and filed in the project file. The chart should be indicating negative pressure of at least -0.030 W.C. in reference to the surrounding location, unless otherwise approved by project manager, Infection Prevention Lead and Facility Safety Chief, or designees.

Appendix D: Infection Prevention Surveillance Rounds Worksheet

Infection Prevention and Control Construction Surveillance Rounds

Project Name/Location: ___________________ Surveillance Date: __________

Comments:_________________________________________________________

Yes No N/A Notes

Current Permit posted:

Patient care equipment removed from construction area or properly covered.

Exterior windows inside of barriers remain closed.

Barriers are intact and sealed.

Zipper closed if plastic barrier used.

Negative pressure machines running and properly exhausted.

Construction entry and adjacent areas free of dust and debris

Walk off mats clean & adequate to contain construction dust

Within the facility, construction carts covered during transport of materials.

Ceiling tile outside of barriers replaced when not being accessed.

When project finished, was IC called for clearance and inspection?

Other

Appendix E: Pre-Occupancy Checklist

PRE-OCCUPANCY CHECKLIST

Project: _______________________________ Date: ____________________

Yes No N/A Comments

Finishes as designed

Washable surfaces

Ceiling tiles or solid ceiling

Walls sealed

Floors appropriate

Dispensers

Soap dispensers/paper towels in place

Hand sanitizer in place

Sharps containers in place

HVAC

Parameters (ACH, direction) as designed

Air balancing complete

Air filters changed

Evaporator pans checked

Plumbing/ Water System

Fixtures as designed

Plumbing fixtures operate

All outlets flushed

Hyper-chlorination

Thermal eradication

Tested for legionella/ coliforms

Legionella/coliforms results negative

Cleaning

Clean and remove dust barriers

Area wiped down

Routine terminal cleaning