VA244-17-R-1057-007.pdf

Pie-Construction Risk Assessment

Infection Control/Safety Construction Permit

Location of Construction: Floor Replacement Phase 1 Project Start Date: TBD Project Coordinator: Thomas Bucci Estimated Duration: 180 days Contractor Performing Work: TBD Permit Expiration Date: TBD Supervisor Nick Girken Telephone: 610-384-7711 x3218

Description of project:: Remove carpeting and tile floor in pre-selected areas in buildings 1, 3, 5, 6, 38, and 39. Prepare sub-base and sub-floor as necessary. Install new interlocking luxury vinyl planking IAW manufacturers' specifications. Replace cove base.

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 5 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 light 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.

Yes No X Will there be noise generated that will impact a department adjacent to above or below the construction area?

X a. If so, these departments must be notified. Adjacent floor will be notified personally.

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

Noise ind ri 'entexi in the space when ti ,trippirig maclline is removing the floor and the sr ihtyr,r, 1,,rrr, , orar hr, ^WI l \ IA .9;111 ,,onfrarq,,I) to, Yes No X Will there be vibration generated that will impact a department adjacent to, above, or below the construction area? —

X 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?

Yes No NA 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 ol.an for tinPynPr.ted ntitpnes

Environment Yes No Are any of the following environmental hazards present?

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

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

X Is asbestos abatement required on this iob? 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 assianed to each area while the hot work is beina 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

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 • Electrical X • Domestic water X • Oxygen

X • Sewage

X • HVAC

Yes No X 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, 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 Yes No

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

X Will project affect traffic patterns in area?

\Iteinates routes al e easily designated Areas can be narrowed to allow access. F Liu Blocking of access will only cx;cur alter hours and li

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 Preventinnist if any activity is airestinnahle tinder these di lidelines Yes No

X 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 VVIL BE IN PLACED AND MAINTAINED FOR THE DURATION OF THE PROJECT

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

DEBRIS CARTS AND DUMPSTERS WILL BE USED AND COVERED

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

NA 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? ' , lracent ti _

NA VVil 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 _ Yes No

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

,X Electrical trim work. Describe: Install 18 LED 2'x4' troffer lights X Minor plumbing. Describe:

Type B Small scale, short duration activities that create minimal dust Yes No

X Installation of telephone and computer cabling X Access to chase spaces X

Cutting of walls or ceiling where dust migration can be controlled.

GROUP I

LOWEST

GROUP

MEDIUM

GROUP 3

HIGH

GROUP 4

HIGHEST

1) Blda. #69 Therapy areas

2) Respiratory Therapy/EKG

3) Outpatient Clinics

4) CBOC's

5) Mental Health Units

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

7) Dining areas (Canteen, 139)

1) Pharmacy Blda 2

2) Radiology/ CT Scanner Blda 3

3) Urgent Care Bldg 3

4) Laboratories Bldg 3

SPS. Blda 4 Respiratory Isolation Rooms — 1B Urgent Care Bldg 3

2) Hallways

3) Utility areas

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

X Sanding of walls for painting or wall covering X Removal of Dfloor coverings Oceiling tile Ocasework (>50% of surface area) Describe: Remove 17K so *ft of

I 'oor cfm, :: fn' trnIrIccniE:n1

_ )( New wall construction X Minor ductwork or electrical work above ceilings X Major cabling activities

X Activity cannot be completed within a single work shift

Type D Major demolition and construction projects.

Yes No

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

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 qroup

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

TYPE B: Small scale, short duration projects 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

"ID"

INFECTION CONTROL

RISK GROUP

Group I I II II III/1V Group 2 I II III IV Group 3 I II III/IV IV

Group 4 III III/IV III/IV IV

An Infecion 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 rasing dust fun rnrtstn irtion rner-Atinns

2. Irrrnediately replarP any ceiling tile displaced for visual insnerlim

CLASS II 1. PrcMde active means to prevent ar-borne dust fiuir dispersina into atmosphere

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

2. VV-ater 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. Wpe surfaces with disinfectant. 9. Remove or isolate HVAC system in areas where work is beinaPerform2d.

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 inA fter 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.

Class IV Obtain infection control permit before construction begins.

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

Prevent contamination of duct system.

3. Complete all critical barriers or implement control cube method before construction begins.

4. Maintain negative air pressure within work site utilizing

HEPA equipped air filtration units.

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

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

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

8 Contain construction waste before and during transport in tightly covered containers. Cover transport receptacles or carts. Tape covering.

9 Do not remove barriers from work area until completed project is inspected by Safety and Epidemiology Depts. and thoroughly cleaned.

After work is completed:

10. Vacuum work area with HEPA filtered vacuums.

11. Wet mop with disinfectant.

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

la 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 dean 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 C , GROUP 1 , CLASS ll

• 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, COR, POLICE AND SAFETY OFFICE IF A FEDERAL OR STATE

REGULATOR ARRIVE ONSITE TO INSPECT JOBSITE.

• TB risk assessment: for 2017 probability/severity is a ,which requires continuing evaluation including the annual risk assessment for Coatesville VMAC (CY 2017) places the facility in what the CDC defines a 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 Thomas Bucci

Date: 6/22/17

Safety Approval

Ki Thomas

Date: it)

Infection Preventionist Approval Jani e Myers ate: