Transcript New 2015 ICRA Safety Management

ICRA
It’s Not Only About Compliance
FFEF
Patrick Lorimer
Eatontown NJ Office
Mario Santos
Regional Safety Director
Monmouth Medical Center
What Are Our Customers Reading?
LEGIONELLA?
INFANT
ABDUCTION?
WORKPLACE
VIOLENCE?
EBOLA
ASPERGILLUS
What Are Healthcare Consumers Reading…..
What Are Healthcare Consumers Reading…..
Adoption of Facility Guidelines Institute (FGI)
Effective January 1, 2011 TJC Updated
EC.02.06.05 and adopted the 2010 Guidelines
for Design and Construction of Health Care
Facilities.
The Joint Commission
The Hospital manages its environment during demolition,
renovation or new construction to reduce risk to those in
the organization
EC.02.06.05
1. When planning for a new, altered, or renovated space,
the hospital uses state rules or regulations or
Guidelines for Design and Construction of Health Care
Facilities (2010)
2. When planning for demolition, construction or
renovation, the hospital conducts a preconstruction
risk assessment (PCRA) for air quality requirements,
infection control, utility requirements, noise, vibration
and other hazards that affect care, treatment and
services
What is a PCRA
• PCRA is a Joint Commission
P
C
Standard that requires hospitals to
assess and mitigate risks associated
with any construction, renovation or
maintenance project.
• PCRA is the umbrella that includes
ICRA, ILSM and a risk assessment
program!
R A
Risk Elements-PCRA
For construction projects, including renovation and
demo activities, TJC identified 6 risk elements as
part of a PCRA:
1. Air Quality
2. Infection Control
3. Utility Systems
4. Noise Vibration
5. Other Hazards
PCRA also requires an assessment of the impact of
construction on the fire protection features LSC 101
Facility Guideline Institute 2010 Guidelines
• PCRA Team is required
• PCRA performed during planning and
continued through construction-Functional
Program! Stressed in 2014 edition
• Owner performs monitoring of risk mitigation
measures for the duration of the project
Multi-Disciplinary Team Approach
• Multiple Experts help to:
– Identify Risks
– Assign Risk Mitigation Measures
– Determine Methods to Evaluate Effectiveness
• Who Are the Experts?
– Infection Prevention
– EH&S/IH
– Facilities/Plant Ops
– Construction Project Manager
– Architects
– Subcontractors/Trades
– Clinical Staff/Nurse Managers
– Environmental Services
Multi-Disciplinary Team Approach
What do these experts know?
• Building Systems-MEP
• Project Scope/Design
• Mold Issues
• Noise
• IAQ
• Data Interpretation
• Clinical Impacts
Multi-Disciplinary Team Approach
SWISS CHEESE MODEL
Consider the holes to be opportunities for a process to fail while
each of the slices is a “defensive layer” in the process. An error
may allow a problem to pass through a hole in one layer, but in
the next layer the holes are in different places, and the problem
should be caught.
Roles and Responsibilities
Infection Prevention
• ID Risk Groups (ICRA Form)
• Help evaluate patient impact
• Establish contractor work practices
EH&S
• Issues related to containment, engineering controls, work
practices, etc.
• Regulatory requirements, asbestos, LSC, OSHA, etc.
• Aware of other hazards, chemical biological, asbestos issues
• Communication to staff on Hazards and EH&S issues
• Bridge issues between clinical and construction
Roles and Responsibilities
Facilities/Plant Operations
• Understanding of utility systems-Critical
• Vibration Impact
• Policies and procedures for maintenance and shut offs
• Understanding of the scope of the work and impact to the systems
on the owner side
Architects
• Scope and Phasing
• Knowledge of impacts to departments
• Advanced warning of impact to utilities and above the ceiling work
Subcontractors
• Understanding of containment requirements
• Chemicals being used
• Vibration Issues
• Exhaust issues in the work area
Roles and Responsibilities
Medical/Clinical Staff
• Patient Acuity
• Assist with assigning risk groups
• Input on impacts with noise and vibration
• Hand washing locations and air flow issues
• Staff education
EVS
• Pre-cleaning
• Guidance on cleaning agents
• Location of Sharps Containers, waste collection
process, and routing waste
Benefits of a Multi-Disciplinary Team
• Meet the TJC standards
• Better management of risks
• Early planning leads to better mitigation
– Avoids department complaints/issues
– Avoids clinical disruptions
– Avoids project interruptions
– Minimizes impact to the EC
– Reduce Costs!!
Pre-Planning-Design Phase
• Ensure your thought leaders are brought
together at the design stages of renovation or
construction
• Consider the issue associated with the
Environment of Care to include items beyond
IC
• Design is something you live with for years!
Legionella Prevention
• Design water systems to reduce risk
–Scale system for actual needs (don’t over build), leads to
decreased circulation around water circuits
–Limit dead legs and areas of stagnation
• Assess need for filtration in high risk areas
–Legionella in the incoming water, high risk patients, amount
of water use in the area
Sinks
• Hands free
–
Wrist blades, knee control, electronic eye
– Avoid aerators as these promote water dispersal
• Electronic eye
–
Save water, are popular with patients
– May be more prone to legionella contamination
– Must consider wiring to emergency power
.
Ice and Water
• Cold water is less likely to harbor legionella
• Assure cleaning and maintenance plan is in
place
• Assure people are trained to change filters
and clean/disinfect various components of
machines
• Trouble spots are anywhere that water sits
for prolonged periods
• Prevent contamination of ice by providing
place outside of ice for the scoop
Flood Damage Prevention
Raise Sheetrock off floor during construction
Patient Handling and Movement
Assessment (PHAMA)
• Needs assessment to identify appropriate
equipment for the service area
• Definition of space, structural, and other
design requirements to accommodate this
equipment
–Prevent hallway clutter
–Adequate outlets
–Assure safe patient handling
Carpeting
• Pleasant, inviting appearance
• Comfort and warmth underfoot
• Sound deadening properties
• No solid evidence that carpeting is linked
to increased risk of hospital acquired
infections under normal circumstances
• Wet carpet is a risk for Aspergillus
Finishes
• Easily cleanable with hospital
disinfectants
• Not prone to soiling with extensive use
(e.g. vinyl upholstery vs. cloth)
• Skid-resistant
• No crevices for dust
• Bed Bug resistant?
Fixtures
Antimicrobial Surfaces
• Copper Surfaces
– Passive continuous activity; need info on exact alloys and
application method; long term efficacy
• Curtains
– Become contaminated again shortly after cleaning (within 1
week)
– Antimicrobial curtains may delay contamination (to 2 weeks in
recent study)
– May be more effective vs certain pathogens
– Consider alternatives (e.g. smartglass)
PCRA Forms-Impact of Construction
Noise
Vibration
Other-EM
Utility Systems
PCRA Forms
ILSM
Air Quality and IC
Forms
ICRA Matrix
Important Aspects of ICRA
• Before a project gets under way, perform an
ICRA to define the scope of the activity and
the need for barrier measures
• Determine if immuno-compromised patients
maybe at risk for exposure to fungal spores for
dust generated during the project
• Develop a contingency plan to prevent such
exposures
• Who signs the forms? IP? Contractor? Both?
ICRA Assessment
ICRA Assessment
Barrier For Dust Control
Door Closed
Tight to ceiling and walls
Barrier For Dust Control
Zipper closed
Sticky mat
Tight to ceiling and walls
Creating Negative Pressure
Exhausting HEPA filtered air
Checking HEPA Air Scrubbers
Air Flow Indicator
Sticky Mats
Use Of Coveralls
During Demolition
Debris Removal
Sealed Air Ducts
Other Hazards
•
•
•
•
Always hardest to predict
Look at any historical issues
Murphy’s Law!
Are we prepared……
Case Study St. Joseph’s Regional Medical Center
• St. Joseph’s Regional Medical Center –
Master Plan Implementation Project
• City of Paterson, Passaic County, New Jersey
St. Joseph’s Regional Medical Center –
Master Plan Implementation Project
City of Paterson, Passaic County, New Jersey
ICRA Planning - The Team
• With 3 years of campus demolition and construction activity, vigorous
planning in the conceptual phase critical to ascertain potential risks
• Well before breaking ground, ICRA team formed. First meetings
paralleled Design Development and Budget Determination Phase.
• Team consisted of:
–
–
–
–
–
–
–
–
–
–
Hospital Administration
Clinicians
Infection Control
Safety Officers
Facility Managers
Architects
MEP Engineering Consultants
Environmental Consultants
Construction Manager
Program Manager
SBL
Program Manager
F.C.
SJHC
Architect/Project
Manager
Clinicians/Infection
Control Team
Partner
MEP & Env. Cons.
SJHS
Admin
SJHC
F.M.
Safety
ICRA Plan - Monitoring Strategy
• Selection of most critical systems and strategic air
sampling monitoring locations
• Critical Areas:
–
–
–
–
–
–
Emergency Department
Main Building Entrance
Surgical Suite
ICU/CCU
Cath Lab Suite
Ancillary Patient Entries
ICRA Plan -Putting the Plan into Action
• Environmental Monitoring: Establishing a Baseline
– Initial task: Conduct 8-hour, on-site fugitive nuisance
dust air monitoring using real time particulate sampling
device as well as CO, CO2, RH, temperature and VOC’s
• Areas to be monitored:
–
–
–
–
Inside facility adjacent to the construction area
Inside the facility-away from construction
Construction area
Ambient outside away from construction
Data was used to prepare a “Dust Control Plan”
ICRA Plan - Protecting Patients Prior to Work
• Sealing locked/screwed shut exterior
windows with silicone on critically
exposed building facades
• Inspecting & correcting air-handling
unit pre-filter assemblies for tightness
• Changing pre-filters as needed
• Installing pre-filters on fresh
air intakes (F.A.I.)
in vicinity of construction
ICRA Plan - Protecting Patients During the Work
• Plan, Do, Check, Act (PDCA)!
• Installation of pressure gauges
through window framing at
selected corridors for positive
pressure indication over time
• At stairwell doorways above
grade, install alarms &
warning signage to prevent
use of fire stairwells for
normal employee traffic
• Extension of HVAC F.A.I. air
intake ductwork above
ground level construction
← Peak of Exterior
Construction
AREAS
S.o.N.
Demo
ICRA Plan - When Things Don’t Go as Planned
• During demolition of School
of Nursing, unexpected
building collapse
– High level of dust &
debris
• Measures in place protected
against potential infiltration
to hospital
• Underscores importance of
ICRA program in
Construction Project Risk
Management
Keys to Success
Planning Stage
• Begin PCRA early and call in your experts
• Effectively evaluate construction isolation
practices and containment strategies
• Define meetings and walk-through schedules
• Design construction entryways, egress paths,
work flow patterns early
Keys to Success
Execution
• Implement routine construction site inspectionsDaily!
• Make them multi-disciplinary
• Use a checklist
• Contractor report cards?- use the results of your
inspections to grade your contractors.
• Consider a risk rating to findings to prevent
significant events
• Repeat violations of Priority III issues result in
being removed as a preferred vendor.
Keys to Success
Training
• Contractors
• Staff
Keys to Success
Pre-Occupancy Checklist and Walk Through
• Not only punch list items but focus on
cleanliness and readiness to re-occupy
• Review and Benchmarking
• How did we do?
• Evaluate data on deficiencies, workplace
injuries, life safety code/fire marshal
evaluations.
Summary
• Attention to detail at all levels
• ICRA is not just a permit for dust control
during construction
• Design is something you will live with for years
So Why Do We Do What We Do?
Because…
•
•
•
•
TJC tells us to...
We have a policy that has to be followed…
To Reduce Liability…
Because Infection rates and data is viewable
by EVERYONE now…
• But what is the MAIN reason why we do what
we do?
We Do It For The Patient
You Do It For The Family
You Do It Because What You Do Matters
ICRA - PCRA
It’s really not about
COMPLIANCE,
is it?
Questions?