S02 - Attachment 14 Infection Control Center Memo 11B-17-05 (11 pages).pdf

VA CARIBBEAN HEALTHCARE SYSTEM CENTER MEMORANDUM NO. 11B-17-05

SAN JUAN, PUERTO RICO AUGUST 2017

INFECTION CONTROL GUIDELINES ON CONSTRUCTION AND RENOVATION

I. PURPOSE: Planning for facility renovation and construction at the VA Caribbean Healthcare System includes early consultation with infection control program to ensure that:

A. The design of treatment areas and other structures will facilitate desired infection control practices.

B. Dust and other microbial contamination are minimized during the work phase of construction/renovation projects.

II. POLICY:

A. All renovation or construction projects will be reviewed with infection control during the planning phases.

B. All construction workers, including sub-contractors, and Facility Management employees, must follow the infection control procedures as described in this guideline.

C. All construction and renovation activities shall be designed and managed, in such a way that occupants’ exposure to dust moisture and hazards is limited. This will protect our staff, visitors, as well as sensitive procedures and equipment from possible ill effects.

III. RESPONSIBILITIES:

A. The Director is responsible for the overall implementation of this policy.

B. The Chief of Staff, Associate Director and Associate Director for Patient Care Services are responsible for ensuring the participation of all clinical services involved staff under his/her responsibility in supporting efforts for compliance with the requirements established in this center memorandum.

C. The Infection Control Program will be responsible to:

1. Identify and mitigate risks from infection that could occur during construction activities.

2. Determine whether construction poses sufficient increased risk to require/recommend that patients be moved to an area of the hospital where construction is not occurring.

3. Inspect areas where construction occurred as part of the construction rounds.

4. Conduct environmental investigation when a culture of a patient with infections potentially related to construction/renovation is identified.

D. The Chief Facility Management Service is responsible for informing all construction workers, including subcontractors and Facility Management employees of this policy and assures that they follow the infection control procedures described in this guideline.

The Chief Facility Management Service or designee will notify infection control of any proposed plan for construction and renovation projects.

E. Environmental Management Section is responsible to work with Facility Management to identify areas that need to be cleaned.

F. Project Engineer is responsible to:

1. Coordinate infection control training to be provided to the constructors.

2. Assure that the infection control construction permit can be found in the project file and at the construction area.

3. Assure constructors follow infection control procedures described in this policy.

G. Supervisor Contracting Officer is responsible for informing all possible contractors of this policy.

H. Service Chief where construction/renovation will take place is responsible to:

1. Help identify high risk patients.

2. Relocate high risk patients to unaffected areas before construction/ renovation work is initiated.

I. Safety Officer / Industrial Hygienist / Infection Control are responsible for conducting periodic inspection of areas under construction for compliance with infection control, safety measures, and for assisting in the assessment of other environmental conditions that may affect patients, visitors and staff.

IV. PROCEDURES:

A. Planning Phase

1. Infection control program must be informed of any projected plan of renovation or construction project.

2. Infection control program staff and project engineer will identify the type of construction project activity (Type A-D); the patient risk group (Group 1-4); and the classification of precautions (Class I-IV) using the Infection Control Risk Assessment Matrix of Precautions for Construction and Renovation, and sign the infection control construction permit. Refer to Attachments A, B and C.

3. Infection control will be involved in the planning phases for all renovation and new construction projects specific to the following major components (schematic design):

a. Number and placement of isolation rooms.

b. Air handling systems.

c. Number and placement of hand-washing facilities.

d. Staff and patient traffic patterns for the duration of the project.

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

f. Water supply and plumbing.

g. Construction waste containment, transport and disposal.

h. Selection and installation of medical equipment as it relates to infection control.

i. Selection of finishes and surfaces that can be effectively cleaned.

j. Assure accommodation of personal protective equipment (PPE) accessibility, security, sanitation, etc.)

k. Storage of equipment and supplies and disposal of regulated medical waste and any other hazards.

l. Education and training on the infection preventive measures of all personnel involved in construction or renovation activity.

B. Operational Phase

1. Medical waste

a. Hospital staff should remove all medical waste, including sharps containers, from areas to be renovated or constructed PRIOR to the start of the project.

b. Environmental Management Section and Infection Control Program should be notified immediately if unexpected medical waste is encountered.

2. Barrier products – Construction or renovation sites must be separated from patient-care areas and critical areas by physical barriers that keep the dirt and dust inside the work-site.

a. The integrity of the barriers must assure a complete tight seal of the construction areas from adjacent areas.

b. Rigid construction of fire-rated plastic sheeting (4 or 6 mil thickness) is used, depending on the location of the project, adjacent uses, and the duration of the project.

c. Contractor or shop must control that no dust particles are carried out from work area by providing the necessary material for its prevention.

3. Environmental control

a. If the infection control risk assessment (ICRA) classification requires negative air pressure, it will be maintained within the construction zone with no disruption of the air systems of the adjacent areas depending on project location. A HEPA (High Efficiency Particulate Accumulator) filter vacuum system rated at 99.97% capture of 0.3 microns (effective for pollen, mold spores, and dust particles) should be installed to ensure continuous negative air pressures within the work area. There should be no re-circulation of air, and ventilation filters will be changed as needed.

b. Demolition debris will be removed daily from the construction area in tightly fitted covered carts using specified traffic patterns.

c. Exterior window seals must be assured to minimize infiltration of outside excavation debris. Windows will remain closed at all times.

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

e. Seal all penetrations at existing perimeter wall.

4. Traffic control

a. Designated entry and exit procedures will be defined (in conjunction with any necessary interim life safety measures) for each construction project, where applicable.

b. All egress pathways will be free of debris.

c. Unauthorized personnel will not be allowed to enter the construction zone.

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

5. Cleaning

a. The contractor will be responsible to keep the construction area as clean as possible and upon completion of project for final cleaning of the construction area.

b. Acoustic ceiling tiles and other porous material used for fireproofing and filter which become wet after water breaks or flooding must be removed and replaced as quickly as possible.

c. Environmental Management Section will be responsible for the routine cleaning of adjacent areas prior to the opening of the newly renovated or constructed area. Specific responsibility will be defined in the construction contracts.

C. Completion phase

1. The area will be thoroughly cleaned before being placed into service.

2. Water supply lines will be flushed before placing newly renovated or constructed areas into service.

D. Compliance monitoring

1. The VA Caribbean Healthcare staff (project engineer, safety officer, industrial hygienist, infection control) and the contractor will conduct compliance monitoring as necessary and during weekly construction rounds. The following parameters will be monitored:

a. Air handling units

b. Integrity of barrier walls

c. Dress code

d. Environmental control

e. Noise

f. Traffic control

g. Personal protective equipment (PPE)

h. Water supply

V. REFERENCES:

A. The Joint Commission Accreditation Manuals 2017

B. APIC Infection Control Tool Kit Series: “Construction and Renovation”

C. VHA Directive 2011-036 “Safety and Health during Construction”

D. Centers for Disease Control and Prevention, Healthcare Infection Control Practices Advisory Committee (HIPAC), Guidelines for Environmental Control in Healthcare Facilities, 2003

E. Kennedy, V., Barnard, B., St. Luke Episcopal Hospital Houston, TX, ECSI, ASHE PDC 2001

F. APIC State of the Art Report: “The Role of Infection Control during Construction in the Health Care Facilities, AJIC 2000

VI. RESCISSIONS: Center Memorandum No. 11B-14-05, dated July 2014

VII. EXPIRATION DATE: August 2020

VIII. FOLLOW-UP AND RESPONSIBILITIES: Infection Control Coordinator

Antonio Sánchez, MD, MHSA, FAPA, FACHE Acting Medical Center Director

ATTACHMENT A

Infection Control Risk Assessment

Matrix of Precautions for Construction & Renovation

Step One: Using the following table, identify the Type of Construction Project Activity (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.

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 that 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.

ATTACHMENT A

Step Two: Using the following table, identify the Patient Risk Groups 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

Hallways

FMS/EMS

areas

Cardiology Echocardiography GI Endoscopy Nuclear Medicine Physical Therapy Radiology Respiratory

Therapy Laboratory Dietary Laundry Physical/

Occupational therapy

CBOCs Outpatient Clinics

Emergency Room Outpatient Surgery Pharmacy Post Anesthesia Care

Unit Surgical Units Nursing Home Urology Wards Dialysis Phlebotomy Area

Any area caring for immunocompromised patients

Cardiac Cath Lab Central Sterile Supply Intensive Care Units Oncology Operating rooms Invasive Radiology Radiation Therapy Pharmacy Admixture

Step Three: Match the _____________________________________

Patient Risk Group (Low, Medium, High, Highest) with the planned … Construction Project Type (A, B, C, D) on the following matrix, to find the … Class of Precautions (I, II, III or IV) or level of infection control activities required.

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

IC Matrix - Class of Precautions: Construction Project by Patient Risk

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.

Adapted with permission V Kennedy, B Barnard, St Luke Episcopal Hospital, Houston TX ECSI ASHE PDC 2001

ATTACHMENT B

Description of Required Infection Control Precautions by Class

During Construction Project Upon Completion of Project

C L

A

SS

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

2. Immediately replace a ceiling tile displaced for visual inspection

L

A

SS

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.

2. Contain construction waste before transport in tightly covered containers.

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

4. Remove isolation of HVAC system in areas where work is being performed.

C L

A

SS

II

I

1. Remove or Isolate HVAC system in area where work is being done to prevent contamination of duct system.

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 the Safety Officer and Infection Control Practitioner and thoroughly cleaned by the contractor.

2. Remove barrier materials carefully to minimize spreading of dirt and debris associated with construction.

3. Vacuum work area with HEPA filtered vacuums.

4. Wet mop area with disinfectant.

5. Remove isolation of HVAC system in areas where work is being performed.

ATTACHMENT B

L

A

SS

IV

1. Isolate HVAC system in area where work is being done to prevent contamination of duct system.

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

5. Construct anteroom and require all personnel to pass through this room so they can be vacuumed using a HEPA vacuum cleaner before leaving work site or they can wear cloth or paper coveralls that are removed each time they leave the work site.

6. All personnel entering work site 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 Safety Officer and Infection Control Practitioner and thoroughly cleaned by the contractor.

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.

5. Wet mop area with disinfectant.

6. Remove isolation of HVAC system in areas where work is being performed.

Adapted with permission V Kennedy, B Barnard, St Luke Episcopal Hospital, Houston TX ECSI

ASHE PDC 2001

ATTACHMENT C

Infection Control Construction Permit

Project Title: Permit No:

Location of Construction: Project Start Date:

Project Coordinator: Estimated Duration:

Contractor Performing Work: Permit Expiration Date:

Supervisor: Telephone:

YES NO CONSTRUCTION ACTIVITY YES NO INFECTON CONTROL RISK GROUP

TYPE A: Inspection, non-invasive activity GROUP 1: Low 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 1 work shift for completion GROUP 3: Medium/High risk

TYPE D: Major duration and construction activities requiring consecutive work shifts.

GROUP 4: Highest risk

CLASS I 1. Execute work by methods to minimize raising dust from 3. Minor demolition for remodeling.

construction operations.

2. Immediately replace any ceiling tile displaced for visual inspection

CLASS II 1. Provides active means to prevent air-borne dust from dispersing 6. Contain construction waste before transport in tightly into atmosphere. covered containers.

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

3. Seal unused doors with duct tape. before leaving work area.

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

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

CLASS III 1. Obtain infection control permit before construction begins. 6. Vacuum work with HEPA filtered vacuums.

2. Isolate HVAC system in area where work is being done to 7. Wet mop with disinfectant.

prevent contamination of the duct system. 8. Remove barrier materials carefully to minimize spreading

3. Complete all critical barriers or implement control cube of dirt and debris associated with construction.

Method before construction begins. 9. Contain construction waste before transport in tightly

4. Maintain negative air pressure within work site utilizing covered containers.

HEPA equipped air filtration units. 10. Cover transport receptacles or carts. Tape covering.

5. Do not remove barriers from work area until complete project 11. Remove or isolate HVAC system in areas where work is thoroughly cleaned by the contractor. is being performed.

Initials 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. Do not remove barriers from work area until completed

3. Complete all critical barriers or implement control cube project is thoroughly cleaned by the contractor.

method before construction begins. 9. Vacuum work area with HEPA filtered vacuums.

4. Maintain negative air pressure within work site utilizing HEPA 10. Wet mop with disinfectant.

equipped air filtration unit. 11. Remove barrier materials carefully to minimize spreading

5. Seal holes, pipes, conduits, and punctures appropriately. of dirt and debris associated with construction.

6. Construct anteroom and require all personnel to pass 12. Contain construction waste before transport in tightly through this room so they can be vacuumed using a HEPA covered containers.

vacuum cleaner before leaving work site or they can wear 13. Cover transport receptacles or carts. Tape covering.

cloth or paper coveralls that are removed each time they 14. Remove or isolate HVAC system in areas where leave the work site. construction is being done.

Initials Risk for the transmission of Tuberculosis (TB) to the contracted construction workers based upon the construction site location, patient population, hospital layout and the defined risk as outlined in CDC Guidelines. o Low o Medium o High Additional requirements:

Date/Initials _______________Exceptions/Additions to this permit

Date/Initials

Permit request by:

Date:

Permit authorized by:

Date: