Environmental Infection Control
Download
Report
Transcript Environmental Infection Control
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
Dust
Microbials
Gases/Fumes/Odors
Waterborne Contaminants
Misc. Nuisances
Noise/Vibration
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
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
Welding/Soldering
Cutting/Grinding
VOCs- off-gassing of new products, adhesives, etc.
Chemicals/Cleaners
Environmental Infection Control > Contaminants
Misc. Issues
Not necessarily environmental contaminants, but
potentially disruptive
Increased foot and vehicle traffic
Alternate routes of building exit/entry
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
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.)
Major Air Quality Issues (cont.)
Removal of flooring
Removal of windows and doors
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
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:
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)
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
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
Floor to floor construction
Seal and tape all joints, edges, holes, etc.
Environmental Infection Control > Engineering Controls
Consider Outside Influences
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
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:
Changing attitudes toward construction and maintenance
Use proper techniques even if not the Easiest/cheapest
Planning ahead
QUESTIONS AND ANSWERS
?