Infection Control Risk Assessment Process

Transcription

1 Direction: Planning for health care facilities shall include, in addition to space and operational needs, provisions for infection control and protection of patients during any renovations or new construction. During the programming phase of a construction project, the owner shall provide an Infection Control Risk Assessment (ICRA). Infection Control During Construction: A Guide to Prevention and JCAHO Compliance; Chapter 5, Section 5.1 Definition: An ICRA is a documented process that focuses on reduction of risk from infection, permitting the organization to anticipate potential impacts. The AIA Guidelines, Chapter 1.5, divides the ICRA elements into three process areas: 1. Design 2. Construction 3. Mitigation Design - The design area requires "long-range planning" for new or renovated buildings. Considerations include: Number, Location, and Type of Isolation Rooms Location of Special Ventilation and Filtration Systems Air Handling Needs in Surgical Areas, Isolation Rooms, Laboratories, Exhaust Hoods for Hazardous Materials, Etc Water Systems and Treatments to Limit Legionella and Other Waterborne Pathogens Finishes and Surfaces to Prevent Mold & Bacteria Growth 1

2 Construction - The areas anticipated to be affected by construction shall receive consideration of the following: Impact of Disrupting Essential Services to Patients and Employees Determination of the Specific Hazards and Associated Protection Levels for Each Location of Patients and Definition of Risks to Each Impact of Planned and Unplanned Outages or Emergencies, Traffic flow, Cleanup, and Testing Location of Known Hazards Mitigation - The mitigation recommendations in the ICRA shall address the following: Patient Placement and Relocation Standards for Barriers Standards for Negative Pressure Provisions for Modification of Mechanical, Electrical, and Plumbing Systems Protection from Demolition Training of Hospital Staff, Visitors and Construction Personnel 2

3 Copy of Hospital Infection Control Policy ICRA: REQUIRED PREPARATORY ITEMS Available From Facility Infection Preventionist or Owner Representative Plan Review Review at Site Determine Risk Level Create Project Phasing Plans Identify Project Boundaries in Various Phases Determine Project Impacts to Mechanical, Electrical, and Plumbing Systems Anticipate Underslab Activities and Other Work Areas Outside of the Construction Space Determine Project Impacts to Life Safety Systems Create Detailed Schedule Including System Shutdowns Identify Adjacent Spaces and Patient Sensitivities, Include Potentially Affected Units Above, Below, Lateral Verify Locations for Temporary Barriers Verify Above Ceiling Conditions Verify Locations of Control Valves and HVAC Dampers Verify Phasing Perimeters and Required Wall / Barrier Ratings Types of Patients Are Materials For Patient Care Stored In The Area Are Patients Boarded In The Space Are Patient Procedures Performed In The Space What Is The Sensitivity Level Of The Patients In The Space Intensity of Project What is the Anticipated Amount Of Dust / Noise / Vibration What is the Duration of the Project What is the Potential for Moisture Damage or Exposure to Hazardous Materials 3

4 Types Of Patients: Group 1 No Clinical Activities Performed in This Area, No Clinical Equipment or Supplies, Area Completely Isolated from Patients Group 2 Patients Or Patient Care Workers Pass Through This Area Group 3 Patients Are Examined / Treated - Non-Invasive Procedures In This Area Group 4 Patients Are Boarded In This Location / Food Is Prepared In This Area / Clean Utility Storage Areas Group 5 Patients Undergo Invasive Procedures In This Location / Sterile Storage Areas / Patients with Potentially Compromised Immune Systems or Compromised Skin Are Boarded In This Area Types Of Activities: Limited Non-dust and non-vapor generating activities. Inspection activities that pose little to no risk of liberating molds or bacteria. The entire is away from patient, staff and public areas Minimal The activity has a very small potential to generate dust or vapors. No reasonable anticipation for accessing potentially water damage materials or liberating mold or bacteria. Non-dust generating above ceiling activities. No demolition. Small The activity includes the potential for a minor, controllable amount of dust and vapors. Small scale sanding, minor cutting of walls, minimal storage of material or chemicals, limited demolition. Moderate The project includes a higher amount of dust and vapors, demolition of fixed components, sanding, removal of finishes and dust generating above ceiling work. Major The project includes a large amount of dust and vapor potential, major demolition or renovation. 4

5 ICRA Risk Class Matrix Group 1 Group 2 Group 3 Group 4 Group 5 Limited I I II II II Minimal I I II III III Small II II III III IV Moderate III III III III IV Major III III III IV IV CLASS I PROJECT CONTROLS 1. Appropriate signage in place 2. Vacuum work area at end of work day 3. Remove trash daily in covered / sealed containers 4. Keep Unused Doors Closed 5. Do not liberate Asbestos or Lead containing substances. CLASS II PROJECT CONTROLS 1. Appropriate signage in place. 2. Vacuum work area at end of work day. 3. Keep all doors or barriers to work area closed. 4. Remove trash daily in covered / sealed containers. 5. Non-HEPA vacuums prohibited. 6. HEPA vacuum or damp mop outside of work areas daily. 7. Prevent dust migration via shoe tracking. 8. Mist surfaces while cutting, carpet prior to removal. 9. Flush water lines prior to reuse for projects > 48hrs. 10. Maintain as dry an environment as possible. Report any water leaks that occur to walls or structure. 11. Protect HVAC from construction dust. 12. Clean / disinfect surfaces following work. 13. Do not liberate Asbestos or Lead containing substances. 5

6 CLASS III PROJECT CONTROLS ( In Addition to Class II Controls) 1. Review procedures with Infection Prevention and Control. Documented exceptions permitted. Infection Control signature required. 2. Seal all penetrations to prevent dust migration, including openings in wall cavities and air gaps at base of existing walls. 3. Airtight barriers required. Poly barriers, > 6 mil, fire retardant permitted for projects < 5 days. Rigid barriers for projects > 5 days or in high traffic areas. Mobile containment units permitted. 4. Negatively pressurize work area. HEPA filters required for exhaust within 25 feet of patients or staff. 5. Isolate HVAC System in work area. 6. ICRA measures to remain in place until all dust generating activities are complete and work areas cleaned and disinfected. 7. Provide daily documented inspection for ICRA Compliance. CLASS IV PROJECT CONTROLS ( In Addition to Class II and III Controls) 1. All workers required to wear CLEAN protective coveralls, shoe covers and surgical caps when traversing occupied areas. 2. Utilize anteroom for donning /doffing required PPE, where feasible. 3. No exceptions to negative pressure requirement. 4. No exception to HEPA filtered exhaust. 5. Tape and seal any trash bin covers prior to transport across occupied areas. 6. Wipe with disinfectant all tools, equipment; including, trash bin exteriors, prior to transport across occupied areas. 6