Exhibit_F_Infection_Control_Guidelines_W911RX_18_T_CCTV_IACH.pdf

DEPARTMENT OF THE ARMY

IRWIN ARMY COMMUNITY HOSPITAL

FORT RILEY, KANSAS 66442-5037

INFECTION CONTROL SOP 15 January 2007

NO. 27

INFECTION CONTROL CONSTRUCTION AND RENOVATION GUIDELINES

1. HISTORY. This is the first printing of this SOP.

2. PURPOSE. This policy describes basic procedures for construction and renovation in Irwin Army Community Hospital (IACH) and outlying areas. This policy is to be used only as a guideline and may be modified at the direction of the Infection Control Officer and/or the Facilities Manager or Project Manager.

3. APPLICABILITY. This SOP applies to all IACH outpatient and inpatient activities.

4. REFERENCES:

a. Joint Commission Standards, current edition.

b. APIC Text of Infection Control and Epidemiology, Construction and Renovation Chapter 108, 2005 edition.

c. Guidelines for Environmental Infection Control in Health-Care Facilities:

Recommendations of CDC and HICPAC, U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, 2003.

d. Ready Reference to the APIC Text, 2005.

e. Infection Control Compliance Guide, G. Bennett, 2004.

f. FR MEDDAC Regulation 40-123, Infection Prevention and Control Program, 21 December 2006.

g. Construction-related Nosocomial Infections in Patients in Health Care Facilities:

Decreasing the Risk of Aspergillus, Legionella and other Infections, Canada Communicable Disease Report, Volume 2752, July 2001.

h. Infection Control Issues in the Environment of Care: Improving Health Care Quality and Safety, Joint Commission Resources, 2005.

i. Hospital Epidemiology and Infection Control, Mayhall, Glen, Third Ed., Lipincott, 2004.

Exhibit F INFECTION CONTROL CONSTRUCTION AND RENOVATION GUIDELINES

INFECTION CONTROL SOP# 27

5. BACKGROUND. This SOP was developed from the Infection Control and Disease Surveillance Manual (FR MEDDAC Regulation 401-123, dated 20 April 2004), chapter 30.

6. DEFINITIONS OF CONSTRUCTION ACTIVITY TYPES: Construction activity types are defined by the amount of dust which is generated, the duration of the activity, and the amount of shared Heating, Ventilation, and Air Conditioning (HVAC) systems.

NOTE: Contact IACH Infection Control Officer, Facilities Management Branch, or Preventive Medicine Service if any activity is questionable under these guidelines.

a. Type A: Inspections and Non-Invasive Activities. Includes, but is not limited to, removal of ceiling tiles for visual inspection , 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.

b. 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, minor ductwork or electrical work within the Integrated Building Systems (IBS) or ceiling where dust migration can be controlled.

c. 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 wall for painting or wall covering, removal of floor coverings, ceiling tiles and casework, new wall construction, minor ductwork or electrical work within the work space area, major cabling activities, and any activity which cannot be completed within a single work shift.

d. Type D: Major demolition and construction projects. Includes, but is not limited to, activities which require consecutive work shifts, require heavy demolition or removal of a complete ceiling system, major plumbing, and new construction.

7. DEFINITIONS OF INFECTION CONTROL RISK GROUPS:

See table on following page:

GROUP I

LOWEST

GROUP 2

MEDIUM

GROUP 3

MEDIUM HIGH

GROUP 4

HIGHEST

Office areas

All patient care units not specified in groups 3 or 4

1) Emergency Room

2) Radiology/MRI

3) Post-anesthesia Care units, Ambulatory Surgery Center

4) Special Care Unit

5) Admission/Discharge area

6) Physical therapy

7) Dining Hall

8) Laboratories

9) Outpatient areas

1) Operating Rooms; Sterile Processing

2) Anesthesia areas

3) All Endoscopy areas

4) Pharmacy

8. CONSTRUCTION ACTIVITY/INFECTION CONTROL MATRIX:

If not shown on the drawing, determine the level of infection control classification necessary for the work by matching the construction activity with the designated risk group in the Matrix below. Provide the associated infection control procedures.

CONSTRUCTION

ACTIVITY

TYPE

“A”

“B”

“C”

“D”

RISK LEVEL

Group 1 I II II III/IV Group 2 I II III IV Group 3 I III III/IV IV Group 4 III III/IV III/IV IV

9. INFECTION CONTROL PERMIT:

An Infection Control Construction Notice to Proceed is required for Class III or higher procedures and any activity in Group IV. Refer to shaded area on Construction Activity/Infection Control Matrix.

When required, contractor obtains Infection Control Construction Notice to Proceed from IACH Infection Control Officer before beginning any demolition or construction work.(see Appendix A). The Facility Management Branch will maintain the notice with a copy provided to the contractor.

10. PERFORMANCE REQUIREMENTS:

Infection control is critical in all areas of all facilities. Construction activities causing disturbance of existing dust, or creating new dust, must be conducted in tight enclosures cutting off any flow of particles into patient areas (Risk Levels III and IV).

IACH requires any subcontractor, sub-subcontractors, material suppliers, vendors, employees, or agents to be bound by these same requirements.

Negative air machines equipped with HEPA filters shall provide air flow into the construction area and exchange the air approximately four times per hour. There may be variation dependent on the nature of the construction/renovation and the area. This is determined on a case-by-case basis.

IACH Infection Control Officer, Facilities Management Branch, or Preventive

Medicine Service may modify performance requirements for certain activities. Any modifications made by IACH personnel do not relieve the contractor of compliance with proper infection control procedures.

11. SUBMITTALS:

Submit a plan to comply with these guidelines to the Project Manager that includes infection control procedures, barrier installation, negative air, interim life safety, and worker/material/debris routes.

Submit the Material Safety Data Sheets (MSDS) for chemicals that will be brought into IACH facilities to the Project Manager.

Construction/renovation will not begin until submittals have been approved and the approval returned to the contractor. The submittal approval must be signed by Facilities Management Branch and will be maintained by the Project Manager.

12. QUALITY CONTROL:

All work shall be stopped on the project whenever a hazardous infection control deficiency exists.

Contractor shall take immediate action to correct all deficiencies.

13. PRODUCTS AND MATERIALS:

Sheet Plastic: Plastic sheeting, 6-mil thickness

Barrier Doors: Fixed doors, when necessary, will be wood solid core in metal frames and will be painted.

Air Filtration Machines: Negative Air Machines equipped with HEPA filters.

Typically, these will displace 1-2000 cfm.

Exhaust Ducts: Flexible steel reinforced; blower hose or equivalent.

Adhesive Walk-Off Mats: Minimum size mats of 24 inches x 36 inches. (Note: In

Class I, II, and III activities, a damp towel is sufficient.)

Disinfectant: IACH approved disinfectant or one as approved with the submittals.

14. BARRIERS:

Closed door with a flapped plastic sheeting over the door and connected to the doorframe is acceptable for projects which can be contained.

Construction, demolition, or renovation not capable of containment within a single room (or suite) must have the following barriers erected, as appropriate, and as determined on a case- by-case basis. The following guidance is provided and will be applied as appropriate:

Airtight plastic barrier will be erected that extends from the floor to ceiling. The seams must be sealed with duct tape to prevent dust and debris from escaping.

The bottom must fit tight against the floor.

Drywall barriers will be erected with joints covered or sealed to prevent dust and debris from escaping as appropriate.

All penetrations will be sealed and airtight.

When practical, critical barriers will be installed at all penetration of ceiling envelopes, chases, and ceiling spaces. These barriers must prohibit the movement of air from one area to another.

Anterooms or double entrances will be installed that will allow workers to vacuum off existing clothing.

General entrances will be double flapped with “Z” or “I” openings.

When barriers are erected that block means of egress, interim life safety measures must be instituted, to include training of employees of alternate routes. The IACH Safety Officer will provide the training and ensure appropriate safety measures are implemented.

15. INFECTION CONTROL PROCEDURES:

General.

Maintain manpower and equipment, including dust mops, wet mops, brooms, buckets, and clean wiping rags for cleaning fine dust with approved disinfectant from floors in adjacent occupied areas.

Contain work areas outside of construction barriers, including spaces above ceilings, with full height polyethylene sheet barrier, tightly taped.

Clean up dust tracked outside of construction area immediately with approved disinfectant by housekeeping.

Implementation.

Temporary construction barriers and closures above ceilings shall be dust tight when practical.

Removal of debris shall be in tightly covered containers as much as practical.

Adhesive mats or damp towels at barrier entrances and in the anteroom shall be kept clean and changed daily, or as necessary, to prevent accumulation of dust.

Any dust tracked outside of barrier shall be removed immediately. Cleaning outside barrier to be by HEPA filtered vacuum or damp mop with approved disinfectant.

Any ceiling access panels opened for investigation beyond sealed areas shall be replaced immediately when unattended.

Block off all existing ventilation ducts within the construction area. Method of capping ducts shall be dust tight and withstand airflow.

When openings are made into existing ceilings, use an enclosure or provide a plastic sheeting enclosure around ladder sealing off opening, fitted tight to ceiling and floor. Provide thorough cleaning of existing surfaces which become exposed to dust.

The top of ceiling tiles in patient care areas shall be misted with a 1:10 sodium hypochlorite solution (bleach).

Removal of construction barriers and ceiling protection shall be done carefully, outside of normal work hours whenever possible. Vacuum and clean all surfaces free of dust after the removal.

When access panels are opened in occupied areas for work above ceilings, use mini-enclosures or plastic sheeting around ladders and extending from the floor to the ceiling opening.

All vacuuming outside areas not under negative pressure to be with an industrial

HEPA filter equipped vacuum.

Construct anteroom to maintain negative airflow from clean area through anteroom and into work area.

Responsibilities (General and by Activity Class):

Contractor is responsible for obtaining the Infection Control Construction Notice to Proceed from IACH Infection Control Officer prior to commencing construction.

Medicine Service will evaluate every work order involving construction and/or renovation. They reserve the right to add requirements to a project on an individual basis.

Facilities Management Branch is the overall coordinator for construction/renovation within IACH facilities and will ensure coordination concerning infection control and employee and patient safety.

Medicine Service will make periodic visits to work site to ensure compliance of policy.

Class I:

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

Immediately replace any ceiling tile displaced for visual inspection.

Class II:

Provide active means to prevent air-borne dust from dispersing into atmosphere.

Water mist work surfaces to control dust while cutting.

Seal unused doors with masking tape.

Block off and seal air vents by installing critical barriers.

Wipe work surfaces with disinfectant after completion by housekeeping.

Class III:

Contractor obtains Infection Control Construction Notice to Proceed from

IACH Infection Control Officer before construction begins.

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

Complete all critical barriers before construction begins or use mini-enclosures.

Maintain negative air pressure within work site utilizing HEPA equipped air filtration units as directed by IACH Infection Control Officer and Industrial Hygienist.

Contain construction waste before transport in tightly covered containers or wrapped if emitting dust.

Cover transport receptacles or carts.

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

Place dust mat at entrance and exit of work area.

Remove isolation of HVAC system barriers after completion of work and final clean up.

Seal unused doors with masking tape.

Class IV:

Contractor obtains Infection Control Construction Notice to Proceed from

IACH Infection Control Officer before construction begins.

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

Complete all critical barriers or install a mini-enclosure before construction begins.

Maintain negative air pressure within work site utilizing negative air machines as directed.

Seal holes, pipes, conduits, and punctures appropriately.

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

Provide adhesive walk-off mats at entrance to anteroom from the work area.

Replace used mats with new mats in accordance with manufacturer’s recommendations.

Do not remove barriers from work area until completed project is inspected by

Medicine Service.

Vacuum work area with a HEPA filtered vacuum cleaner.

Wet mop area with disinfectant used by housekeeping.

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

Contain construction waste before transport in tightly covered containers or wrapped if emitting dust.

Cover transport receptacle or cart.

Remove isolation of HVAC system barriers in areas where work has been completed and completion inspections accomplished per paragraph 13.c.(3).

Environmental Monitoring.

Contractor is responsible for maintaining equipment and replacement of HEPA and other filters in accordance with manufacturer’s recommendations.

Medicine Service will perform field inspections.

Preventive Medicine Service will confirm specified air movement when barriers are erected or modified.

IACH Preventive Medicine Service will monitor air quality throughout the project as needed.

Enforcement.

For breach of this infection control policy, IACH Project Manager will be notified and work will be stopped. This action will be in accordance with the specifications in the contract.

Medicine Service issuing the stop work order will record the following:

Document each violation with photographs, if time exists.

Specifically record the violations with date and time.

Notify Project Manager immediately.

Violations of infection control policies may affect status as a responsible contractor for bidding future work.

APPENDIX A: Infection Control Construction Notice to Proceed Permit No:

Location of Construction: Project Start Date:

Project Manager: Estimated Duration Contractor Performing Work:

Supervisor: Telephone:

YES NO CONSTRUCTION ACTIVITY YES NO INFECTION CONTROL RISK GROUP

TYPE A: Inspection, non-invasive activity GROUP 1: Least 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 construction operations.

2. Immediately replace any ceiling tile displaced for visual inspection.

3. Minor Demolition for Remodeling

CLASS II

1. Provides active means to prevent air-borne dust from dispersing into atmosphere

2. Water mist work surfaces to control dust while cutting.

3. Seal unused doors with masking tape.

4. Block off and seal air vents.

5. Wipe surfaces with disinfectant.

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

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

8. Place dust mat at entrance and exit of work area.

9. Remove or isolate HVAC system in areas where work is being performed.

CLASS III

1. Obtain infection control permit before construction begins.

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

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

6. Vacuum work with HEPA filtered vacuum.

7. Wet mop with disinfectant

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

9. Contain construction waste before transport in

Date

4. Maintain negative air pressure within work site utilizing HEPA equipped air filtration units.

5. Do not remove barriers from work area until complete project is thoroughly cleaned by Housekeeping Services.

tightly covered containers.

10. Cover transport receptacles or carts. Tape covering.

Initial

CLASS IV

Date

1. 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 cleaner 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. Do not remove barriers from work area until completed project is thoroughly cleaned by the Housekeeping Service.

9. Vacuum work area with HEPA filtered vacuum.

10. Wet mop with disinfectant.

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

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

13. Cover transport receptacles or carts. Tape covering.

Initial

Additional Requirements:

Date Initials

_______ Exceptions/additions to this permit Date

Initial are noted by attached memorandum

___________ Exceptions/additions to this permit Date Initials are noted by attached memorandum

Permit Requested By: Infection Control Officer: Permit Authorized By:

Date: Date: Date: