ENVIRONMENTAL INFECTION CONTROL
DURING CONSTRUCTION AND RENOVATION
Presented By: Doug Marshall
Environmental Infection Control
WHAT IS IT?


Identifying hazards that could potentially compromise
patient care
Implementing proper controls to reduce risk and
minimize the impact of hazards created by demolition,
renovation, and/or new construction activities
Environmental Infection Control
What is it? (cont.)
Impacts may include those on air or water quality,
infection control, utility and equipment requirements,
noise and vibration, emergency procedures, etc.
Environmental Infection Control
Why the concern?
 Sensitive patients, physically and/or mentally
 Compromised immune systems (illness or medication)
 Critical medical procedures
 Critical services, utilities, and equipment that cannot be
damaged or disrupted
 Need for stable indoor environment
Environmental Infection Control
Contaminants of Concern

Air- Particulates
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Dust

Microbials
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Gases/Fumes/Odors
Waterborne Contaminants
 Misc. Nuisances
 Noise/Vibration
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Environmental Infection Control > Contaminants
DUST PARTICULATES

General Dust

Demolition/Dismantling

Sanding/Cutting
Environmental Infection Control > Contaminants
Microbial Particulates

Microbial “reservoirs” in flooring, wall cavities, HVAC
systems, materials affected by water damage or high
humidity, or spores brought in from outdoors
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May include molds that are pathogenic, toxic, and/or
allergenic (especially Aspergillus)

May include bacterial growth
Environmental Infection Control > Contaminants
Other Contaminants

Gases/Fumes/Odors
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Welding/Soldering

Cutting/Grinding

VOCs- off-gassing of new products, adhesives, etc.

Chemicals/Cleaners
Environmental Infection Control > Contaminants
Misc. Issues
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Not necessarily environmental contaminants, but
potentially disruptive

Increased foot and vehicle traffic
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Alternate routes of building exit/entry
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Alternate emergency/fire evacuation routes and
procedures
Abnormal “loads” on utilities or equipment
Environmental Infection Control
Noise & Vibration
May affect patients and/or employees

premature neonates

recent ICH or stroke

neurological/psychiatric disorders
May affect critical procedures/testing

EEG or EKG

hearing assessments

neurological studies

fine motor skill procedures

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certain laboratory procedures
sleep studies, etc.
Environmental Infection Control
Current Regulations & Guidelines


The Joint Commission (TJC)
AIA Guidelines for the Design and Construction of Hospital
and Health Care Facilities (mandated by state law)

CDC Guidelines on Environmental Infection Control

State Licensure (depending upon state)
Environmental Infection Control > Regulations & Guidelines
TJC Environment of Care Std.

EC.8.30

Demolition, Construction or Renovation, and Maintenance

Proactive risk assessment

Identify hazards that could potentially compromise patient
care

Address impact on requirements/procedures
Environmental Infection Control > Regulations & Guidelines
EC8.30 CONSTRUCTION, DEMOLITION, AND
MAINTENANCE/REPAIR


Infection Control Risk Assessment
(Multi-disciplinary team approach to project review for prevention of
airborne & waterborne nosocomial disease.)

design and function of new area

At risk patients

dust and moisture containment

Noise/vibration

What contingency plans are in place for unexpected outages
Environmental Infection Control > Regulations & Guidelines
CDC GUIDELINES FOR EIC


Construction, Renovation, Remediation, Repair and
Demolition
ICRA (Infection Control Risk Assessment)

Multi-disciplinary team

Risk assessment of project

P&P to protect patients

Procedures to correct problems rapidly
Environmental Infection Control > Regulations & Guidelines
CDC GUIDELINES FOR EIC

CDC Guidelines- Major Air Quality Issues

Air Sampling

External and Internal demolition- Are Barriers Required?
 Working with plumbing in sensitive areas
 Exposure of ceiling spaces
 Crawling into ceiling spaces
 Work on elevator shafts
 Demo of wallboard, plaster, ceramic tile, ceiling tile
Environmental Infection Control > Regulations & Guidelines
CDC GUIDELINES FOR EIC (CONT.)
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Major Air Quality Issues (cont.)
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Removal of flooring

Removal of windows and doors
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Removal of casework

HVAC systems design and filtration

HVAC maintenance and repair
 duct cleaning
 system shutdown
 moisture in system
 backup emergency power
Environmental Infection Control > Regulations & Guidelines
AIA GUIDELINES (CHAPTER 5)

For all new construction and renovation


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Consultation from infection control professionals, and safety
professionals
Development of an ICRA
Initiated in planning and design and continued through
construction/renovation

Performed by multi-disciplinary panel

Documented!!
Environmental Infection Control > Regulations & Guidelines
CHAPTER 5 ICRA- BASIC ELEMENTS
Impact of disrupting essential services
 Patient placement and relocation
 Placement of barriers
 Evaluation of ventilation needs
 Number of AII and PE rooms
 Patient protection from:


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Demolition
Un-planned outages
Movement of debris
Patient flow through building
Environmental Infection Control > Risk Assessment
ICRA MATRIX


Aids in determining proper work practices and types of
engineering controls, and monitoring required.
Assesses risk based upon the patient risk group and types
of activities performed
Environmental Infection Control > Risk Assessment
ICRA Matrix (cont.)


Type A- (Inspection and Non-invasive)
 removing ceiling tile for inspection
 painting without sanding
 wall-covering
 electrical trim
 minor plumbing
Type B (Work Activities)
 Small scale/ short duration
 Minimal dust created
Environmental Infection Control > Risk Assessment
ICRA Matrix (cont.)
Type C (Work Activities)
 Demolition/removal of fixed building parts
 Moderate-high dust, including sanding, flooring removal, ceiling
tiles & casework, major cabling,
 Can’t be done in 1 shift
Type D (Work Activities)
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
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Major demolition/construction
High dust created, including heavy demo, removal of walls, new
construction
Required consecutive work shifts
Environmental Infection Control > Engineering Controls
Engineering Controls
Containment of Dust and Debris

Controlling construction related activities

Envelope penetrations

Building shafts, chutes, stairwells and elevators

Removal of materials from building
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Electrical and water system shutdowns

HVAC system shutdowns, potential for passive ventilation
Environmental Infection Control > Engineering Controls
Common Controls

Defining contractor points of entry/exit

Use of tacky mats and disposable suits

General containment barriers

Control cubes for point of entry

Negative pressure requirements

HVAC system protection and isolation
Environmental Infection Control > Engineering Controls
Types of Barriers
Short-duration

Fire-resistant plastic

Airtight with Negative Pressure
Long Duration

Install plastic barrier while building rigid barrier

Drywall on metal studs
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Floor to floor construction

Seal and tape all joints, edges, holes, etc.
Environmental Infection Control > Engineering Controls
Consider Outside Influences

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Protect building ventilation systems (i.e. freshair intakes)
Control building entrances
Window/door infiltration
Access to construction zones
Building tie-ins
Street cleaning
Emergency response
Environmental Infection Control
Monitoring


Establish background bio-aerosol levels prior to
construction
Compare levels during and after construction to these
baselines

Include viable and non-viable particles

Monitor ventilation (air changes, filtration, pressure)
Environmental Infection Control > Monitoring
When Should You Sample?
Baseline and before occupancy (“Commissioning”)

Insure proper ventilation and cleanliness

Provides comparison data for later if necessary
Ongoing Surveillance
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Pressure differentials

Air Exchanges

Particle count for filtration efficiency
Environmental Infection Control
Understand Air Flow in the Building

Positive vs. Negative Pressure

Air Flow Velocities

Affects of doors and window

Elevator shafts
Environmental Infection Control
OVERALL GOALS:

Save Lives through:
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Changing attitudes toward construction and maintenance

Use proper techniques even if not the Easiest/cheapest

Planning ahead
QUESTIONS AND ANSWERS
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