S02_ICRA_with_permit.pdf

Steps 1-3 Adapted with permission V Kennedy, B Barnard, St Luke Episcopal Hospital, Houston TX; C Fine CA Steps 4-14 Adapted with permission Fairview University Medical Center Minneapolis MN Forms modified /updated; provided courtesy of Judene Bartley, ECSI Inc. Beverly Hills MI 2002. Jbartley@ameritech.net Updated, 2009.

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 only, e.g., limited to 1 tile per 50 square feet

• painting (but not sanding)

• wallcovering, 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 floorcoverings, ceiling tiles and casework

• new wall construction

• minor duct work or electrical work above ceilings

• major cabling activities

• any activity which cannot be completed within a single workshift.

TYPE D

Major demolition and construction projects Includes, but is not limited to:

• activities which require consecutive work shifts

• requires heavy demolition or removal of a complete cabling system

• new construction.

Step 1:

mailto:Jbartley@ameritech.net

Steps 1-3 Adapted with permission V Kennedy, B Barnard, St Luke Episcopal Hospital, Houston TX; C Fine CA Steps 4-14 Adapted with permission Fairview University Medical Center Minneapolis MN Forms modified /updated; provided courtesy of Judene Bartley, ECSI Inc. Beverly Hills MI 2002. Jbartley@ameritech.net Updated, 2009.

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

• Cardiology

• Echocardiography

• Endoscopy

• Nuclear Medicine

• Physical Therapy

• Radiology/MRI

• Respiratory

Therapy

• CCU

• Emergency Room

• Labor & Delivery

• Laboratories

(specimen)

• Medical Units

• Newborn Nursery

• Outpatient Surgery

• Pediatrics

• Pharmacy

• Post Anesthesia Care

Unit

• Surgical Units

• Any area caring for immunocompromised patients

• Burn Unit

• Cardiac Cath Lab

• Central Sterile Supply

• Intensive Care Units

• Negative pressure isolation rooms

• Oncology

• Operating rooms including C-section rooms

Step 2 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.

Step 3

Steps 1-3 Adapted with permission V Kennedy, B Barnard, St Luke Episcopal Hospital, Houston TX; C Fine CA Steps 4-14 Adapted with permission Fairview University Medical Center Minneapolis MN Forms modified /updated; provided courtesy of Judene Bartley, ECSI Inc. Beverly Hills MI 2002. Jbartley@ameritech.net Updated, 2009.

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

1. Clean work area upon completion of task.

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 cleaner/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. Upon completion, restore HVAC system where work was performed.

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 owner’s Safety Department and Infection Prevention & Control Department and thoroughly cleaned by the owner’s Environmental Services Department.

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 cleaner/disinfectant.

5. Upon completion, restore HVAC system

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.

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 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

1. Do not remove barriers from work area until completed project is inspected by the owner’s Safety Department and Infection Prevention & Control Department and thoroughly cleaned by the owner’s Environmental Services Dept.

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

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

4. Cover transport receptacles or carts. Tape covering unless solid lid.

5. Vacuum work area with HEPA filtered vacuums.

6. Wet mop area with cleaner/disinfectant.

7. Upon completion, restore HVAC system

Steps 1-3 Adapted with permission V Kennedy, B Barnard, St Luke Episcopal Hospital, Houston TX; C Fine CA Steps 4-14 Adapted with permission Fairview University Medical Center Minneapolis MN Forms modified /updated; provided courtesy of Judene Bartley, ECSI Inc. Beverly Hills MI 2002. Jbartley@ameritech.net Updated, 2009.

Step 4. Identify the areas surrounding the project area, assessing potential impact

Unit Below Unit Above Lateral Lateral Behind Front

Risk Group Risk Group Risk Group Risk Group Risk Group Risk Group

Step 5. Identify specific site of activity e.g., patient rooms, medication room, etc.

Step 6. Identify issues related to: ventilation, plumbing, electrical in terms of the occurrence of probable outages.

Step 7. Identify containment measures, using prior assessment. What types of barriers?

(E.g., solids wall barriers); Will HEPA filtration be required?

(Note: Renovation/construction area shall be isolated from the occupied areas during construction and shall be negative with respect to surrounding areas)

Step 8. Consider potential risk of water damage. Is there a risk due to compromising structural integrity? (e.g., wall, ceiling, roof)

Step 9. Work hours: Can or will the work be done during non-patient care hours?

Step 10. Do plans allow for adequate number of isolation/negative airflow rooms?

Step 11. Do the plans allow for the required number & type of handwashing sinks?

Step 12. Does the infection prevention & control staff agree with the minimum number of sinks for this project? (Verify against FGI Design and Construction Guidelines for types and area)

Step 13. Does the infection prevention & control staff agree with the plans relative to clean and soiled utility rooms?

Step 14. Plan to discuss the following containment issues with the project team.

E.g., traffic flow, housekeeping, debris removal (how and when), Appendix: Identify and communicate the responsibility for project monitoring that includes infection prevention & control concerns and risks. The ICRA may be modified throughout the project.

Revisions must be communicated to the Project Manager.

Steps 1-3 Adapted with permission V Kennedy, B Barnard, St Luke Episcopal Hospital, Houston TX; C Fine CA Steps 4-14 Adapted with permission Fairview University Medical Center Minneapolis MN Forms modified /updated; provided courtesy of Judene Bartley, ECSI Inc. Beverly Hills MI 2002. Jbartley@ameritech.net Updated, 2009.

Infection Control Construction Permit 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 INFECTION 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 6. Contain construction waste before transport in tightly dispersing 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 cleaner/disinfectant. 9. Isolate HVAC system in areas where work is being performed; restore when work completed.

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 cleaner/disinfectant prevent contamination of the duct system. 8. Remove barrier materials carefully to minimize

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

9. Contain construction waste before transport in

4. Maintain negative air pressure within work site utilizing tightly 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 11. Upon completion, restore HVAC system where work project is checked by Infection Prevention & Control and was performed.

thoroughly cleaned by Environmental Services.

Date

Initial

CLASS IV

1. Obtain infection control permit before construction begins. 8. Do not remove barriers from work area until completed

2. Isolate HVAC system in area where work is being done to project is checked by Infection Prevention & Control prevent contamination of duct system. and thoroughly cleaned by Environmental. Services.

3. Complete all critical barriers or implement control cube 9. Vacuum work area with HEPA filtered vacuums.

method before construction begins. 10. Wet mop with disinfectant.

4. Maintain negative air pressure within work site utilizing 11. Remove barrier materials carefully to minimize

HEPA equipped air filtration units. spreading of dirt and debris associated with

5. Seal holes, pipes, conduits, and punctures appropriately. 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. Upon completion, restore HVAC system where work leave the work site. was performed.

7. All personnel entering work site are required to wear shoe covers

Date

Initial

Additional Requirements:

Date Initials Exceptions/Additions to this permit

Date Initials are noted by attached memoranda Permit Request By: Permit Authorized By:

Date: Date: