SOW Attachment 02 - VA ICRA.pdf

VA Maine HCS Infection Control Risk Assessment for Construction and Renovation

Project Name: Work performed by:

Project Location (Building & Room#): Phone Number:

Project Reviewer(s): Expected start date:

Date reviewed: Expected end date:

Description of Work to be Performed:

Step 1: Using the following table identify the Type of Construction Project by checking the appropriate box

TYPE A

Inspection and Non-Invasive Activities. Includes but is not limited to:

• Removal of ceiling tiles for Visual Inspection Only (1 tile per 50 square feet for less than 1 hour).

• Painting & wall covering (No Sanding).

• Electrical trim work, minor plumbing and activities that do not generate dust or require cutting of walls or access to ceilings other than for visual inspection.

• Outdoor construction that does not involve major earth movement.

TYPE B

Small scale, short duration activities which create minimal dust. . Includes but is not limited to:

• Removal of ceiling tiles (> 1 tile per 50 square feet or > 1 hour).

• Installation of telephone and computer cables and security systems.

• Access to chase spaces.

• Cutting/Drilling into 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 walls for painting or removing wall coverings.

• Removing floor coverings, ceiling tiles and casework.

• New wall construction; minor ductwork 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:

• Heavy demolition or removal of a complete ceiling system.

• New construction.

• Activities that require consecutive work shifts.

Step 2: Using the following table, identify the Patient Risk Groups that will be affected by checking the appropriate box. If more than one risk group will be affected, select the higher risk group:

Infection Control Patient Risk Groups (including hallways adjacent to area indicated)

Group 1: Low Group 2: Medium Group 3: High Group 4: Highest

• Any building where patient care is NOT performed and does not have occupied offices.

• Outdoor areas with no regular foot traffic

• Admitting

• Outpatient Clinic

• Outpatient waiting areas/offices

• Cafeteria

• Laboratory

• Physical Therapy

• Occupied office space

• In-patient/Residential units

• Emergency room

• Radiology/Nuc.Med./MRI

• Echocardiography

• Dialysis

• Pharmacy

• Central Supply/WDU

• Dental

• Microbiology

• Women’s Health/clinical rooms

• OR Suites and Corridors

• Sterile Core and connecting rooms

• Day Surgery, Cystoscopy/GU/GI

• Pre/Post Op Holding (PACU/ASU)

• Cardiac Cath Lab

• Intensive Care Units

• Pharmacy admixture

• Oncology

• Interventional Radiology/INR

• Sterile Processing/Supply/Storage

• Pain Clinic Intervention Rooms

Step 3: Match the Patient Risk Group (Low, Medium, Medium High, and 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). Class I-IV Infection control precautions are delineated the following page.

(Check the appropriate box) Construction Type

Patient Risk Group TYPE A TYPE B TYPE C TYPE D

LOW (Risk Group 1) I II II III/IV

MEDIUM (Risk Group 2) I II III IV

High (Risk Group 3) I III III/IV IV

HIGHEST (Risk Group 4) III IV IV IV

Class I Class II Class III Class IV

402-23-003S Install Security upgrades 257-209-200 TBD

BLD 200 - Starbucks location FMS - Safety - and IP TBD include pulling cables above ceiling tiles

BLD 257, BLD 209 PIV Office

Install a combination of intrusion detection, motion detection, and PACS devices and hardware. This will

VA Maine HCS Infection Control Construction Permit

Location of Construction: Project no.

Dates of permit:

VAMEHCS COR: Alt. COR:

Contractor performing work: Supervisor:

Infection Control to review project and check all indicated measures. Permit to be posted at site.

Barriers / Containment Trash/Debris Removal Class I Contain construction waste in containers with sealed lids

Replace ceiling tiles within 1 hour Clean outside of waste containers each time brought out of site Execute work methods to minimize raising dust Designated times for debris removal Class II Window chute for trash

Complete all required barriers before construction begins. Designated route for debris removal Measures to contain airborne dust, like temporary plastic curtains Cleaning Seal unused doors with duct tape Wet mop/clean on regular basis, every Mist work surfaces while cutting & use air scrubber/Hepa unit Wet mop and/or vacuum before leaving work area.

Dust mats at entrances and exits of the work area/anteroom HEPA filter vacuum area. Maintain Clean Work Area Remove or isolate HVAC system in work area Wipe work surfaces with disinfectant.

Environmental Containment Unit (ECU) Construction /Maintenance Workers Class III - IV Education Construction workers: Handout Video

Complete all required barriers before construction begins. Protective Clothing required (e;g Bunny suit Booties) Dust mats at entrances and exits of the work area/anteroom Construction workers limited from hospital/cafeteria Plastic only, seal seams with duct tape (no above ceiling work) Designated toilets for construction workers:

Pre-fabricated hard wall system- floor to overhead with joints sealed

Re-routing / Relocation

Environmental Containment Unit Move or cover patient care equipment/supplies Anteroom for construction workers and/or equipment to enter and exit.

Signage to alert to risk in area

Remove or Isolate HVAC system in work area Relocate staff with offices in area or complete work when department is closed

Negative air pressure within work site Relocate patients Portable HEPA unit Designated pathway (attach spatial map) Seal unused doors with duct tape Reroute patients/visitor traffic (attach spatial map) post signage Seal holes, pipes, conduits and punctures appropriately. Notify Infection Control Immediately of:

Barrier curtains to contain dust during removal of rigid barriers Any water leaks/damage, or Mold Discovery Do not remove barriers from work area until area cleaned HVAC/Electrical,Water, Steam, System downtimes Increase frequency check/change air filters (e.g. earthwork near intakes)

Project completion (IC Inspection before occupancy) Changes in dates, scope and findings related to compliance

Evaluate air exchange rates (Engineering) Notes: (Additional measures or explanation of above):

Monitoring

Rounds by Project Coordinator and IC Visual monitoring negative air pressure Monitor differential negative pressures in Anteroom and Work area with Monometer Airborne particle sampling

Signatures Required:

VAMEHCS COR / Alt. COR Date Infection Control Date

Engineering Project Supervisor / Chief of M&O Date Safety Date

(10/23/2020) VAMEHCS

BLD 200 Starbucks, BLD 209 PIV office and 402-23-003S

2-21-23

Micheal O'Brion

TBD

Work in BLD 200 Starbucks must be performed after store closes. All items in area must be covered to insure no dust or debris from open ceiling tiles does not move onto food prep areas. Work with Unit Manager to ensure materials are covered or moved.

BLD 257

VIRGILEA HAMM Digitally signed by VIRGILEA HAMM Date: 2023.02.21 11:15:12 -05'00'