Construction Drawings and Terminology for the Infection Prevention Professional. Objectives. Disclaimer

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1 Construction Drawings and Terminology for the Infection Prevention Professional APIC Greater St. Louis Chapter 073 October 2012 Objectives Define the terms and descriptions of airborne engineering controls Visualize what is occurring in each engineering control to better understand the applications Discuss proactive planning, design and construction of patient care environments with engineers, architects and contractors Review IP evaluation of construction projects, both large and small Disclaimer Drawings, figures, pictures and sketches and name usage are for illustrative and educational purposes only Use of these is should not be considered as endorsement, recommendation or support This program is for educational purposes only 1

2 Definitions Airborne Engineering Controls Negative Pressure Laminar Flow Positive Pressure HEPA CFM ACH Constant Volume VAV FCU Plenum HVAC AHU Other Good Terms to Know Chase RFI CCD MEPFP Riser Stack Ventilation Issues Airborne transmission of disease has been a problem since mankind has lived indoors. Sunlight (UV radiation) kills most microbes that cause disease in humans. Many respiratory pathogens have adapted to our comfortable indoor environments, escaping deadly sunlight. 2

3 The HVAC System Heating Ventilation and Air Conditioning Specialized field of engineering Healthcare facilities are environments of controlled hazards Ventilation, humidity, aerosolized pharmaceuticals, airborne contagions, chemical handling Airborne Engineering Controls Functions of the HVAC system Dilution ventilation Contaminant exhaust Directional airflow control Filtration Environmental temperature control Relative humidity control Airborne Engineering Controls Air pressure differential is a measurable quantity Airflow is measured in cubic feet per minute (CFM) CFM is a standard measure of airflow How many cubic feet pass a stationary point in one minute Higher CFM = more air 1 CFM approximately 2 liters per second 3

4 Negative Pressure Supply < exhaust Higher exhaust pulls air into room Air flow differential rate 100 CFM SUPPLY EXHAUST NEGATIVE PRESSURE (SUPPLY<EXHAUST) LOCAL EXHAUST SUPPLY EXHAUST NEGATIVE PRESSURE (SUPPLY<EXHAUST) LOCAL EXHAUST 4

5 Negative Pressure Room Identification 5

6 NEGATIVE PRESSURE Supply < exhaust Supply = 300 cfm Exhaust = 400 cfm Negative pressure Supply < Exhaust 300 CFM 400 CFM Laminar Air Flow Used in clean rooms Air makes single pass through room Air enters room through filter (HEPA) Exhausted through walls or floor Vertical Horizontal Requires higher airflow exchange rates than negative, positive or neutral pressure 6

7 Terminology HEPA High efficiency particulate air filter HEPA filters have minimum removal efficiencies of 99.97% or higher with particulates > 0.30 microns Filter bacteria, mold and viruses Viruses can be 0.01 microns usually attach to larger particles Average diameter, microns Kowalski et al. HPAC, July 1998, p 35. Vertical Laminar Air Flow Best control of clean working environment Supply through diffusers on ceiling Airborne contamination from personnel or procedure immediately exhausted out 7

8 SUPPLY HEPA FILTER EXHAUST EXHAUST Horizontal Laminar Air Flow Supply through wall on one side of room Exhaust through ceiling or wall on other side of room May have some downstream contamination in direction of air flow Equipment required (HEPA, ductwork, etc.) may result in cost savings SUPPLY HEPA FILTER EXHAUST 8

9 Positive Pressure Protective Environment Air flow goes from clean to dirty 95% Efficiency Filter Supply > exhaust Higher supply rate pushes air out Air flow differential rate 100 CFM SUPPLY WITH 95% FILTER EXHAUST POSITIVE PRESSURE (SUPPLY>EXHAUST) LOCAL EXHAUST Supply Air > exhaust Supply Air 500 CFM Exhaust 400 CFM Supply > exhaust by 100 CFM 9

10 Terminology ACH Air changes per hour Different rooms have different ACH requirements Operating rooms and delivery rooms require 25 ACH minimum Nurseries, ED triage and Airborne Infection Isolation rooms require 12 ACH minimum Patient rooms, physical therapy, laboratory require 6 ACH minimum (2003 ASHRAE HVAC Design Manual for Hospitals and Clinics; pp ) Terminology Air based HVAC (Heating, ventilation and airconditioning) have two basic categories, variable air volume (VAV) and constant volume Constant volume used when pressure differential required like in OR and lab VAV used when pressure differential doesn t need to be controlled like in hallways Terminology AHU / Air handling unit Part of the HVAC system Large metal box with blowers, heating and or cooling elements, filter racks etc Usually connects to ductwork to distribute air to building and return to AHU 10

11 Terminology FCU Fan coil unit Below window unit that moves room air Provides either heating or cooling May be located other than below window 11

12 Terminology Plenum space provided for air circulation for HVAC Typically above a suspended ceiling to structural deck above May also contain cables, pipes, etc Proper barriers are required in plenum to deck above 12

13 Terminology Chase - A vertical or horizontal shaft in a wall for mechanical, electrical, pipes, duct and conduit to pass through. Chases are usually fire rated Suitable barrier since penetrations are sealed Terminology RFI Request for information usually a clarification of something shown on the drawings ASI - Architect s supplemental instruction a response to the RFI CCD Construction change directive signed by the owner and architect, document becomes effective immediately MEPFP Mechanical, electrical, plumbing and fire protection 13

14 Terminology Stack vertical pipes for the plumbing waste system Three sections Soil stack carries waste from toilets Waste carries waste from all other fixtures Vent Provides air circulation throughout the waste system and allows release of sewer gas Risers pipes leading from the water supply to the fixtures PLUMBING STACKS Waste Stack Soil Stack Vent 14

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16 Construction Drawings 16

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19 Infection Prevention and Construction Planning Early involvement is key Recommended by American Institute of Architects (AIA), American Society of Heating, Refrigeration and Air-Conditioning (ASHRAE), APIC Input in initial planning Approval during design phase Walk through with contractor prior to work Infection Prevention and Construction Planning Patient risks Worker risks Intra-construction monitoring HEPAs Negative Pressure Walk off mats Debris removal Authority to close job down (check your policy) 19

20 Things To Look For 20

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24 Revised 10/07 Start Date: Project Name: Step 5 - Sign and authorize risk End Date: Project Location: Step 3 - Find Precaution Level: assessment below Step 1 - Choose Step 2 - Choose Step 4 - Color level of project: Step 6 - Return to Infection work area: type of work: Control - Addresses below 1 - Work Area 1 - Work Area 2 - Type of Work 3 - Infection Control Precautions 3 - Infection Control Precautions 1 4 A GREEN ORANGE Non-Physician Offices Endo / DDCC Non-invasive, inspection, wallcovering, 1A, 2A, 3A, 5A, 6A, 6B, 6C, 6D 4A, 3B, 2C, 5C 2 CSPD electrical trim, minor plumbing *Ceiling tile sprayed with bleach to GREEN and In addition cafeterias Pharmacy NO sanding, wall cutting or dust prior to displacing, replaced YELLOW precautions; Kitchens, Main CAM fl.1,6,10,11,12** AND all satellites generation at all immediately after visual inspection. *Infection Control consulted 4400, 7200 B * Visitor and patient traffic routes * Dust minimized - partitions 6300, 6400 Dialysis Small scale, short duration, minimal should avoid work area. erected to deck above. 7300, 7400, 7500 ALL ORs dust generation. Including but not * Clean supplies transported and * Optimal: Chute for debris removal, 10100, Perfusion, limited to; cables or wires above ceilings, stored away from contaminated with HEPA filter or see Card Cath 11100, All ICUs and CCUs accessing chase spaces, wall cutting, materials. YELLOW elevator guidelines , Chemo Center ceiling penetrations where dust can * Water interruption scheduled * Barriers - dampers closed, assure 12100, All nurseries be controlled during times of low activity. adjacent air filters functioning, 13100, , 5400 C YELLOW airtight plastic or drywall barriers 14400, Work that generates moderate to high 1B, 1C, 2B, 5B from floor to ceiling, seams sealed 15300, 15400, Radiation Oncology levels of dust, removal or demolition of In addition to GREEN precautions; with duct tape or ECUs - NOTE Gamma Knife fixed building components or * Mist work surfaces when cutting barriers must be removed carefully CAM fl. 4,7,8** assemblies, including but not *Air vents or returns blocked and to minimize dust generation. Barriers 3 limited to; Center, 3200, 5900 sanding walls, removing floorcovering, sealed - Facilities Engineering to be disposed of with other debris. Wound CDL Admitting, ED 6900, 7900 ceiling tiles and casework, new wall to evaluate - If air handler supplies *Negative pressure in const. area Pulmonary Rehab 8100, 9400 construction, minor duct or electrical construction area only, it should be with HEPA filters Resp Care, Lab 89ICU & PICRU work above ceilings, major cabling or shut down *Increase air filter changing. PACU, Shukar, SDSA Bronch, MPC wiring activities, or anything that cannot (monitor filters during contruction * Vents cleaned prior to occupancy All Radiology and CT 5 be completed within a single work and change if necessary) * Water lines at site and adjacent Physical Therapy near shift. *1 room areas to have walls areas flushed prior to occupancy Outside from floor CAM fl. 2,3,5,13,14** air intakes <75ft to ceiling, door closed, frame and *Outside demolition >75 feet from D 2100, 6200, construction. door duct taped. air intakes. Major demolition or 7100, 71OU away Including but not limited to; activities *Debris removed Outside from in covered, sealed RED Nuclear Medicine air intakes > 75 ft which require consecutive work shifts, or taped containers, use service 4B, 3C, 4C, 1D, 2D, 3D, 4D, 5D 9100, 9200 heavy demolition or removal of elevators or non patient elevator. In addition to GREEN, YELLOW and 10100, 10200, complete cabling or wiring systems, * Walk-off mats at entrance ORANGE precautions; 4900, 5200 new construction. *Penetrations in walls not open for *Infection Control consulted Ultrasound NOTE: DAMAGED STEP 5 > 4 hours. Cover w/ plastic and *Patients relocated to remote area ASBESTOS FOUND Date tape if more. away from construction. WILL BE ABATED Contractor *Ceiling tiles ** Listings for areas replaced ASAP, if not specifically OR ENCAPSULATED I am aware open >4 hours, must be covered. of and will enforce STEP 6 covered in work PER Infection Control precautions required to Infection areas Please send Control ENVIRONMENTAL for this project. Elevator(s) approved for debris removal Fax HEALTH AND mailstop SAFETY POLICY BJH/WUSM Project Manager After Hours/weekend pager A Good Idea! 24

25 INFECTION PREVENTION NOTES THIS PROJECT WILL REQUIRE G.C. TO FILL OUT DAILY (ILSM) INTERIM LIFE SAFETY MANAGEMENT SHEETS. ALL WORK AREAS UNDER CONSTRUCTION MUST BE SEALED OFF FROM ADJACENT AREAS. NEGATIVE PRESSURE MUST BE MAINTAINED AT ALL TIMES IN CONSTRUCTION AREAS. ALL DEBRIS LEAVING CONSTRUCTION AREAS FOR DUMPSTER MUST BE COVERED W/ DAMP COVER & CART WIPED DOWN PRIOR TO LEAVING. CONTRACTOR TO MAINTAIN WET MAT, WALK-OFF MAT, BARRIER, & DRY MAT AT ALL CONSTRUCTION ENTRANCES. WALK-OFF MATS TO BE CHANGED HOURLY MIN. OR AS NEEDED. REFER TO TYP. ROOM LAYOUT DETAIL 10/A7. G.C. TO INSTALL OWNER FURNISHED CONSTRUCTION PATIENT ROOM ENTRY DOORS. Summary Have a basic understanding of construction drawings Speak the same language Maintain visibility In house as well as outside contractors Don t be afraid to ask questions Stay involved References 2003 ASHRAE HVAC Design Manual for Hospitals and Clinics AIA Guidelines for Design and Construction of Health Care Facilities Bartley JM. APIC State-of-the-Art Report: The role of infection control during construction in health care facilities. AJIC; April 2000 :

26 Loie Ruhl, RN, BS, CIC Barnes-Jewish Hospital 4901 Forest Park Avenue Mailstop St. Louis, Missouri Questions???? 26

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