S02_Attachment 03 (CSIC)_36C24123R0177.pdf

ATTACHMENT 03

Construction Specifications for Infection Control

7 pages

22 August 2023

Providence, Rhode Island VA Health Care System (650)

“Site Prep: Room 277”

Design-Build

ATTACHMENT B

INFECTION CONTROL PROCEDURES

PART 1 GENERAL

1.1 DEFINITIONS

Construction 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.

Construction Type B - Small scale, short duration activities that create minimal dust. Includes, but is not limited to: installation of telephone or computer cabling; access to pipe chase spaces; cutting of walls or ceilings where dust migration can be controlled.

Construction Type C - Any work, which 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 ductwork or electrical work above ceilings; major cabling activities; and any activity which cannot be completed within a single work shift.

Construction Type D - Major demolition and construction projects. Includes, but is not limited to:

activities that require consecutive work shifts; require heavy demolition or removal of a complete ceiling system; and new construction.

Group 1 Lowest Risk Patient Risk Group - Office areas

Group 2 Medium Risk Patient Risk Group - Cardiology, Echocardiography, Laboratories, Nuclear Medicine, Physical Therapy, Radiology/MRI, Respiratory Therapy

Group 3 Medium-High Risk Patient Risk Group - Emergency Room, Day Surgery, Pharmacy, Endoscopy

Group 4 Highest Risk Patient Risk Group - Dialysis Unit; Oncology Unit; Operating Rooms; Sterile Processing, Cardiac Catheterization & Angiography Areas, Intensive Care Unit(s); Medical/Surgical Nursing Units, Post-Anesthesia Care Units.

HEPA - High Efficiency Particulate Air

HEPA Filtered – Equipment that uses a HEPA filter that complies with MIL-STD-282 method

102.9.1 and captures a minimum of 99.97% of particulate matter that is 0.3 micron in diameter.

Level of Infection Control - Class I, II, III or IV, as determined from the Infection Control risk assessment matrix.

1.2 DESCRIPTION

The purpose of the infection control procedures are to minimize the risk of infection during construction by maintaining the integrity of the environment, and controlling the spread of dust.

The following Infection Control Matrix defines the matrix of precautions to be implemented for construction, demolition and renovation. Matching the planned construction type with the patient risk group on the matrix defines the minimum level of infection control required (Class I, II, III or IV).

Risk Level Construction Activity

Type A Type B Type C Type D Group 1 Lowest Risk Class I Class II Class II Class III/IV Group 2 Medium Risk Class I Class II Class III Class IV Group 3 High Risk Class II Class II Class III/IV Class IV Group 4 Highest Risk Class II Class III/IV Class III/IV Class IV

Class I:

1. Execute work by methods to minimize raising dust and fumes from interior and exterior construction operations.

2. Water mist work surfaces to control dust

3. Immediately replace a ceiling tile displaced for visual inspection

4. Use travel routes that minimize exposure of patients to construction workers, materials, tools, and equipment.

5. Schedule utility interruptions during periods of low hospital activity.

Class II: In addition to precautions for Class I:

1. Provide temporary ICRA barrier around construction area to prevent airborne dust from dispersing into atmosphere using fire resistive polyethylene secured by poles, clips and tape with zipper door access OR use approved self-contained ICRA cart with telescoping ICRA barrier at every opening in ceiling.

2. HEPA vacuum upper surfaces of ceiling tiles prior to removal, after removal of first tile.

3. Seal unused doors with tape OR cover doors with fire resistive polyethylene and seal all 4 edges.

4. Block off and seal air vents in work area, OR isolate HVAC system in areas where work is being performed to prevent contamination of ducted systems.

5. Place adhesive walk-off mats at entrance and exit of work areas.

6. Tightly cover waste containers before removing from the work area.

7. HEPA vacuum work surfaces and waste containers before removing from the work area.

8. HEPA vacuum worker clothing, tools, materials, and equipment before leaving the work area.

Class III: In addition to the precautions for Class I and II:

1. Maintain negative air pressure within work area 24 hours per day, 7 days per week by utilizing HEPA equipped air filtration units, preferably with exhaust to exterior via windows, and install manometer and record daily readings.

2. Seal holes, pipes, conduits, and punctures through walls and floors within the work area using fire-safe, impermeable materials. (Obtain Penetration Permit for any new penetrations involved in the work.)

3. Construct anteroom (Construction Vestibule) contiguous with work area and require all personnel to pass through this anteroom so they can be vacuumed using a HEPA vacuum cleaner before leaving work site.

4. Do not remove ICRA barriers from the work area until the completed project is thoroughly cleaned by the Contractor and the VA’s Environmental (Housekeeping) Services Department, and inspected by the VA Project Manager.

Class IV: In addition to precautions for Class I, II and III:

1. No work is permitted in areas occupied by patients.

2. All personnel entering work site are required to wear head covers, shoe covers and coveralls.

Head covers, shoe covers and coveralls must be changed within the anteroom (Construction Vestibule) each time the worker exits the work area.

3. Do not remove ICRA barriers from the work area until the completed project is thoroughly cleaned by the Contractor, the VA’s Environmental (Housekeeping) Services Department and inspected by the VA Project Manager.

Conduct work by implementing the appropriate level of infection control as required or as noted herein.

1.3 SUBMITTALS

Government approval is required for submittals with a "G" designation; submittals not having a "G" designation are for information only.

SD-06 Test and Inspection Reports

Air sampling results Infection Control Compliance Checklists Logs of negative pressure measurements for work site;

SD-07 Certificates

Employee training;

VAMC Infection Control Construction Permits; G

1.4 QUALITY ASSURANCE

1.4.1 Qualifications

All personnel are required to wear N95 respirators, disposable booties and coveralls when working inside the containment. These are to be removed when exiting the work area.

All personnel are to be trained on infection control procedures and these work procedures.

1.5 EQUIPMENT

Fire retardant polyethylene

HEPA filtered vacuum

HEPA filtered negative air machine

Duct tape

Framing and other materials necessary to isolate the work area

Power equipment that generates dust will have dust collection equipment attached.

1.6 PROJECT/SITE CONDITIONS

1.6.1 Existing Conditions

Perform work without damage or contamination of adjacent areas. Where existing work is damaged or contaminated, restore work to its original condition or better as determined by the Contracting Officer.

1.7 SEQUENCING AND SCHEDULING

All work will be coordinated with the hospital infection control office, facility director, safety department, security office and work will not commence until the Infection Control Construction Permit has been approved by VAMC for that specific work area, including designation of the pre-determined debris removal routes.

Any issue that could have impact on VAMC operations must be reported to the VAMC project representative before commencement. This would include containment breeching, loss of negative pressure, releases of dust/debris into uncontrolled interior building areas or other issues that could affect infection control procedures.

Work phasing and breakout of specific work areas shall be in coordination with the Contracting Officers needs and the General Contractor's schedule and not adversely affect the operations of the VAMC in any way.

PART 2 PRODUCTS

Not Used.

PART 3 EXECUTION

3.1 PREPARATION

Obtain an Infection Control Construction Permit prior to performing any work of construction types A through D as defined above. No work will be allowed to proceed until an Infection Control Construction Permit has been completed and signed and all protective measures required by the permit are in place.

All work shall be accomplished using the controls indicated in the specifications and on the Infection Control Construction Permit for the class of protection required for the work.

Removal of a single ceiling tile in a suspended acoustic ceiling for observation purposes only does not require an infection control construction permit.

Existing air handling ductwork, supply and return grills, and/or HVAC fresh air intakes shall be isolated using air tight seals.

Elevator use must be coordinated with facilities and must not impact VAMC operations. Time and dates of waste load must be identified each day.

3.2 ERECTION

Install impervious barriers from floor to ceiling and wall to wall to seal work areas from non-work areas. When work is in an area designated for Class IV protection, double impervious barriers shall be used.

Impervious barriers shall be constructed of non-combustible or fire retardant materials. Barriers shall be minimum one-hour rated construction. Fire retardant polyethylene may be used for impervious (dust) barriers that remain in place for not more than 72 hours. Construct all other barriers of gypsum board (flame spread rating of 25 or less in accordance with ASTM E84) on both sides of metal steel studs. Extend the partitions through suspended ceilings to floor slab deck or roof. Wood framing is not allowed. At door openings, use Class C ¾ hour fire/smoke rated doors and frames with closers.

Critical barriers are to be installed on all doors and windows and other entrances to the work area.

Seal all holes, chases, pipe cavities and other perforations before commencing work. Sealants shall be non-flammable material.

When required as an infection control measure, create a negative air pressure work area by installing HEPA filtered negative air machines within the work area to remove dust particles from the air and exhaust to the outside. Negative air pressure shall be maintained at all times, including non-work periods, for the duration of the work.

Maintain negative pressure of at least -0.02 inches water in all work areas and document compliance.

Construct an entry/exit chamber (construction vestibule) for decontaminating people and equipment leaving the work area. A HEPA vacuum is required to remove dust from equipment and people leaving the site. Disposable PPE shall be removed prior to exiting the entry/exit chamber.

For projects that require maintaining negative air pressure within the work area, provide an entry/exit chamber (construction vestibule) for delivering or removing materials and equipment at the worksite.

Delivery and remove of materials and equipment at the worksite must be completed in a manner that maintains the specified negative air pressure within the work area at all times.

Adhesive Step-off pads at least 24"x36" are to be located at the exit of the work area before entering the occupied areas of the VAMC.

Vacuum the top surfaces of ceiling tiles using a HEPA vacuum prior to removal of ceiling tiles.

Traffic shall be minimized to/from the work area.

Elevators or stairwells within the work area must be isolated with impervious barriers.

Activities such as cutting, demolishing, and other large dust generating activities shall have work surfaces water-misted prior to impact.

Where powered equipment that generates dust will be utilized, such equipment shall have dust collection equipment attached.

Provide active means to prevent airborne dust from dispersing into the atmosphere.

3.3 FIELD QUALITY CONTROL

3.3.1 Inspection

Conduct daily infection control inspections using the VAMC Infection Control Compliance Checklist on page 2 of the Infection Control Construction Permit. Daily inspections shall also be conducted on days when no construction activity is performed. Submit compliance checklist not more than 1 work day after completing an inspection.

Continuously monitor negative pressure levels. Document negative pressure levels at the start of work each day and at 2 hour maximum intervals during each work day. Maintain a written log of negative pressure levels measured to include date and time of the measurement. Submit written log of negative pressure levels weekly and not more than 1 work day after completing the last log entry using the VAMC Infection Control Compliance Checklist on page 2 of the Infection Control Construction Permit.

All barriers and HEPA filtered negative pressure are to remain in place until clearance has been obtained from VAMC representatives. This could include the IC Department, Safety Department, and Environmental Services Department.

3.3.2 Tests

VAMC representatives may conduct post abatement and during abatement sampling for dust, mold spores and surface contamination. Sampling may be conducted for dusts outside the work area to assess impact.

3.4 CLEANING AND DISPOSAL

The construction area and adjacent areas are to be kept in a clean and sanitary manner, using damp methods and HEPA filtered vacuuming.

Dry sweeping shall not be allowed.

Any dust tracked outside of the barriers must be removed immediately and as it accumulates.

Surfaces are to be cleaned daily or more frequently if needed with VAMC approved cleaning products.

There shall be no standing water in the work area. All accidental spills must be cleaned up immediately and wet porous material removed within one hour.

Any water damaged areas scheduled for impact/demolition shall be removed first, under HEPA filtered exhaust and containment, with the waste promptly bagged, to reduce aerosol of microbial agent/fungi/spore from potentially escaping out of the work space.

All barriers are to be removed carefully to minimize the spread of contaminants.

Where feasible, the optimal method for removal of debris is via an exterior type chute to closed top containers.

Where not feasible, waste is to be removed in clean air tight covered containers and transported from the work area by a pre-determined route during off-peak hours. Such designated debris removal routes shall be cleaned by damp-mop and/or HEPA filtered vacuuming prior to being returned to patient/staff use.

For work performed exterior to the building envelope, no debris/waste movement shall be allowed through the building interior spaces.