PCRA Form Bldg 58 A and B Renovation 8-2023 signed (002).pdf

Pre-Construction Risk Assessment

Infection Control / Safety Construction Permit

Location of Construction: Bldg. # 58 1ST & 2ND FLOOR Project Start Date: TBD

Project Coordinator: Michael Dusablon Estimated Duration: TBD

Contractor Performing Work: N/A Permit Expiration Date:TBD

Supervisor: Scott Carter Telephone: 610-384-7711 Ext. 3517

Description of project: Complete renovation of the first and second floor of building 58. The two floors will be un-occupied during the entire demolition and construction phases of the project. The ground floor will remain occupied during the entire length of the project. ICRA barriers will be put in place to block all airborne dust and debris from entering the ground floor area.

All ceiling work performed on the ground floor required for new first floor plumbing work will be phased in areas that can be sealed off to other ground floor areas.

Construction Activities

The following projects do not require completion of the Pre-Construction Risk Assessment form:

1. Paint and wallpaper in business offices and non-patient areas.

2. Paint in patient room if closed for painting and less than 3 sq. ft. of wall needs patched. Filter for room unit changed after painting.

3. Installation of soap dispenser/needle box/paper towel holder in patient room

4. Repair of window blind.

5. Ceiling tile replacement for areas less than 50% of the total square footage of the room, if not in business offices and non-patient areas.

6. Ceiling tile replacement for area less than Five 2 X 2 tiles in a patient area if patient is out of the immediate area and clean up can be accomplished before patient returns.

7. Minimum repair of nurse call system/TV/Bed/Telephone.

8. Check or replace electric outlet.

9. Replace l ight bulb.

10. Unstop sink/commode with no water on floor.

11. Unstop commode when water on floor requires maintenance to have Housekeeping clean area immediately.

12. Repair medical gas outlet. (Front Body)

13. Air balance readings.

14. Check air-conditioning. Yes No

X Will there be noise generated that will impact a department adjacent to, above, or below the construction area?

a. If so, these departments must be notified.

b. How are you going to reduce the noise to an acceptable level?

SHORT DURATION AND INTERMITEN NOISE ACTIVITIES.

Yes No

X Will there be vibration generated that will impact a department adjacent to, above, or below the construction area?

a. If so, these departments must be notified each time this type of work will be performed.

b. How are you going to reduce the vibration to an acceptable level? SHORT DURATION AND INTERMITEN

VIBRATION ACTIVITIES.

X

Are Emergency Procedures in place and posted on each job for accidental events that could greatly impact Patient Care or Life Safety to the facility? Included in these procedures are such things as:

• Emergency telephone numbers of key departments.

• A plan that describes where main valves, switches, and controls are for the area in case of an emergency.

• A plan for unexpected outages.

Environment

Yes No Are any of the following environmental hazards present?

Will hazardous chemicals be used on this project? How will fumes and odors be controlled? SDS Sheets are required.

IF YES SUBMITLIST OF CHEMICALS. FUMES WILL BE EXHAUSTED TO THE OUTSIDE.

X Is asbestos abatement required on this job? If so, notify Safety and FES at the activation.

X Will there be hot work done on this project? If there are, then a hot work permit must be posted on the job site. All hot work must have a fire watch assigned to each area while the hot work is being performed.

X Will there be a Confined Space Entry required on this project? If so, the Medical Center’s confined space entry program must be followed. X Utility Failures

Yes No Will any of the following systems be out of service at any time during the project?

X • Fire alarm (If out for more than 4 hours, Interim Life Safety Measures must be implemented.)

X • Sprinkler (If out for more than 4 hours, Interim Life Safety Measures must be implemented.)

X • Elec t r i ca l X • Domestic water X • O x y g e n X • S e w a g e X • H V A C

Will there be any work that will require activation of the Interim Life Safety Measures during this project? Some things that trigger ILSM's to be implemented are but not limited to:

• Any construction that impacts an EXIT or stairs,

• Any construction that impacts major breaches in a fire or smoke wall,

• Taking the main fire protection system out of service (sprinkler),

• Taking the main fire alarm system out of service,

• Taking the "area" fire or fire alarm systems out of service for more than 4 hours within a 24-hour period.

Implementation of the ILSM requires a fire watch and the ILSM forms to be completed (forms are to be obtained from the Medical Center Fire Department)

Additional Safety Concerns

X Will construction affect exit routes from occupied areas adjacent to construction site?

X Will project affect traffic patterns in area?

The following must be completed prior to any construction activities.

• Separation wall must be constructed prior to project beginning.

• Fire protection systems must remain intact.

• Provide extra fire extinguishers in work areas.

• Maintain exit lights in work area.

• Maintain negative air in construction area (24/7) through duration of project.

• There cannot be any return air from within the construction area to the rest of the building.

• Redirect exiting not to go through construction area.

• Put signs on doors into construction area "Construction Area – Do Not Enter".

• Maintain daily logs and keep a current Hot Work Permit.

• Place tacky mats at doors interior and exterior exiting construction area.

• All debris removal must be by covered cart.

• Maintain clean and orderly work area.

• How will this project affect the departments above, below and adjacent to this project?

Air Quality and Infection Control

The construction activity types are defined by the amount of dust that is generated, the duration of the activity, and the amount of shared HVAC systems. Contact CVAMC's Safety Office and Infection Preventionist if any activity is questionable under these guidelines.

Will dust be generated during this project?

If yes, explain location of and plan for interim dust barriers or attach floor plan with barriers clearly marked.

DUST BARRIERS, ICRA WALLS WILL BE IN PLACEAND MAINTAINED FOR THE DURATION OF THE PROJECT

Will debris removal be necessary? If yes, explain plan for debris removal and control.

DEBRIS CARTS AND DUMPSTERS WILL BE USED AND COVERED

X Negative airflow ventilation and filtration in place and assessed for effectiveness.

Exhaust fans in place and functioning.

X Is supply duct to area closed and HEPA filtration unit in place and functioning in adjacent patient care area?

Will work be done in a sterile area? If so, how are you going to maintain sterile atmosphere in work area and access to and from work area?

Type A Inspections and Non-Invasive Activities or Small scale, Short duration Activities

Removal of ceiling tiles for visual inspection (e.g 1 tile per 50 square feet) Painting (but not sanding) Wall covering—Describe work to be done:

Electrical trim work. Describe:

Minor plumbing. Describe:

Type B Small scale, short duration activities that create minimal dust.

Yes No

Installation of telephone and computer cabling

Access to chase spaces Cutting of walls or ceiling where dust migration can be controlled.

Type C Any work that generates a moderate to high level of dust or requires demolition or removal of any fixed building components or assemblies.

Yes No

Sanding of walls for painting or wall covering

Removal of x❑floor coverings ❑ceiling tile ❑casework (>50% of surface area) Describe:

% Describe:

New wall construction Minor ductwork or electrical work above ceilings Major cabling activities Activity cannot be completed within a single work shift

Type D Major demolition and construction projects.

X Will require heavy demolition or removal of a complete ceiling system New construction X Activities which require consecutive work shifts

GROUP I

LOWEST

GROUP

MEDIUM

GROUP 3

HIGH

GROUP 4

HIGHEST

1) Office areas 1

) Bldg. #69 Therapy areas

1) Pharmacy Bldg 2 1

SPS, Bldg 4

2) Hallways 2

) Respiratory Therapy/EKG

2) Radiology/ CT Scanner Bldg 3 2

Respiratory Isolation Rooms – 1B

3) Utility areas util

) Outpatient Clinics 3) Urgent Care Bldg. 3 Urgent Care Bldg. 3

) CBOC’s 4) Laboratories Bldg. 3

) Mental Health Units

6) CLCs(1B, 59B, 138A, 138B, 138E/H)

7) Dining areas (Canteen, 139)

Contact the Infection Preventionist or Safety Office for risk assessment of any area not listed above.

CONSTRUCTION ACTIVITY (from previous page) Check type of activity

INFECTION CONTROL RISK GROUP (see above) Check risk group

TYPE A: Inspection, non-invasive activity GROUP 1: Lowest Risk

TYPE B: Small scale, short duration projects X GROUP 2: Medium Risk

TYPE C: Activity generates moderate to high levels of dust, requiring >1 work shift for completion

GROUP 3: High Risk

TYPE D: Major duration and construction activities Requiring consecutive work shifts

GROUP 4: Highest Risk

CLASSIFICATION OF REQUIRED PREVENTIVE MEASURES

CONSTRUCTION ACTIVITY-

TYPE

"A"

TYPE

"B"

TYPE

"C"

TYPE

"D"

INFECTION CONTROL

RISK GROUP

Group I I II II III/IV

Group 2 I II III IV

Group 3 I II III/IV IV

Group 4 III III/IV III/IV IV

An Infection Control—Safety Construction Permit is required for Class III or higher projects. Refer to Construction Activity/Risk Group Matrix (above).

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

2. Immediately replace any ceiling tile displaced for visual inspection.

CLASS II 1. Provide active means to prevent air-borne dust from dispersing into atmosphere

6. Contain construction waste before and during transport in tightly covered containers.

2. Water mist work surfaces to control dust while cutting. 7. Wet mop and/or vacuum with HEPA filtered vacuum before

3. Seal unused doors with duct tape. Leaving work area.

4. Block off and seal air vents. 8. Place dust mat at entrance and exit of work area as needed.

5. Wipe surfaces with disinfectant. 9. Remove or isolate HVAC system in areas where work is being performed.

CLASS III

1. Obtain infection control permit before construction begins. 7. Place dust mat at entrance and exit of work area. Replace as

2. Isolate HVAC system in area where work is being done to needed.

Prevent contamination of the duct system. 8. Do not remove barriers from work area until completed project is

3. Complete all critical barriers before construction begins. inspected by Safety and thoroughly cleaned.

4. Maintain negative air pressure within work site utilizing

HEPA equipped air filtration units.

5. Contain construction waste before and during transport inAfter work is completed:

Tightly covered containers. 9. Remove barrier materials carefully to minimize spreading of dirt

6. Seal holes, pipes, conduits, etc. appropriately. and debris associated with construction.

10. Remove isolation of HVAC system.

Class IV

1. Obtain infection control permit before construction begins. 7. All personnel entering work site are required to wear shoe

2. Isolate HVAC system in area where work is being done to covers

Prevent contamination of duct system. 8. Contain construction waste before and during transport in tightly

3. Complete all critical barriers or implement control cube covered containers. Cover transport receptacles or carts. Tape method before construction begins. covering.

4. Maintain negative air pressure within work site utilizing 9. Do not remove barriers from work area until completed project is

HEPA equipped air filtration units. inspected by Safety and Epidemiology Depts. and thoroughly

5. Seal holes, pipes, conduits, and punctures appropriately. cleaned.

6. Construct anteroom and require all personnel to pass through this room so they can be vacuumed using a HEPA After work is completed:

vacuum cleaner before leaving work site or they can wear 10. Vacuum work area with HEPA filtered vacuums.

cloth or paper coveralls that are removed each time they 11. Wet mop with disinfectant.

leave the work site. 12. Remove barrier materials carefully to minimize spreading of dirt and debris associated with construction.

13. Remove isolation of HVAC system.

Additional concerns for all classes:

1. SIGNITURE OF RECORD ALL ONSITE CONSTRUCTION WORKERS FOR REVIEW OF FIRE AND LIFE SAFETY

PROCEDURES AT COATESVILLE VAMC.

2. REVIEW OF INFECTION PREVENTION TRAINING AND CONSTRUCTION SAFETY CHECK LIST.

3. Maintain manpower and equipment including dust mops, wet mops, brooms, buckets, and clean wiping rags for cleaning fine dust from floors within the work area (when appropriate) and adjacent occupied areas.

4. Contain work areas outside of construction barriers, including spaces above ceilings, with full height polyethylene sheet barrier that will be extended to the deck of the space and will be tightly taped.

5. Clean up dust tracked outside of construction area immediately.

6. Temporary construction barriers and closures above ceiling must be sealed as described in #4 above.

7. Removal of debris must be in covered containers.

8. Intermediate jobs that create a moderate amount of dust inside room and is made negative by use of HEPA-equipped unit with minimum 10 ACH, and all air discharged outside, HEPA unit must run 2 hours after completion of job and Housekeeping must clean room before unit is removed from room. All work and use of HEPA unit must be documented and Copy forward to Infection Prevention and Control and Safety. NOTE: all duct vents and Fan Coil Units to be sealed off during construction.

9. All water lines inactivated for greater than 72 hours must be thoroughly flushed. New piping will be flushed and disinfected prior to use.

Additional Requirements or Concerns:

• THIS PROJECT IS TYPE__D__, GROUP__2__, CLASS_IV___

• SUBMITT EMERGENCY PROCEDURES TO BE POSTED

• POST PCRA AND APPROPRIATE CONSTRUCTION SIGNAGE FOR LIMITED ACCESS AND PROPER PPE IN WORK AREA

• CONTRACTOR TO NOTIFY COATESVILLE VAMC CO, COTR, POLICE AND SAFETY OFFICE IF A FEDERAL OR STATE

REGULATOR ARRIVE ONSITE TO INSPECT JOBSITE.

• TB risk assessment: for 2023 probability/severity is a 2, which requires continuing evaluation including the annual risk assessment for Coatesville VMAC (CY 2023) places the facility in what the CDC defines as low risk.. Based on the number of infectious TB patients hospitalized in the last year (<6) and TST/QuantiFeron conversion data among healthcare workers the risk is low for transmission. The risk of tuberculosis transmission within the facility will be assessed annually and as needed. Contract employees working in an area where there is known TB or those working on local exhaust ventilation (or within 25 feet of labeled biohazard exhaust vent) airborne isolation in Urgent Care or on 1B will be required to provide proof of TB testing in accordance with VHA Directive 2011-036.

• Dumpsters to have 6’ high chain link enclosures.

• No eating, drinking or smoking on the jobsite.

Permit Request By Michael Dusablon

Safety Approval

Infection Preventionist Approval

Date: Date: Date: