CSA Z Infection Control during Construction, Renovation and Maintenance of Health Care Facilities Overview and Case Studies

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1 CSA Z Infection Control during Construction, Renovation and Maintenance of Health Care Facilities Overview and Case Studies Grant Rogers, BSc. Principal 1

2 North West Environmental Group Industrial Hygiene Hazardous Materials Infection Control Construction Safety Environmental Management ESA I & II Land Management/ Planning

3 North West Environmental Group 13 full time staff Area BC NWT Alberta Yukon Ontario Scientists Industrial hygienists Engineers Technicians 3

4 What is Industrial Hygiene Definition: The science and art of anticipating, recognizing, preventing and controlling environmental factors in the workplace that could lead to sickness, impaired health, and well being.

5 WHAT IS INFECTION CONTROL ANYWAY? Prevention of illness in patients, staff and visitors in a health care facility Wide and varied field of study IC in construction is a minor component Illness: Infections Allergic reactions

6 WHY CONSTRUCTION? AIRBORNE DUST... NOT STERILE Cutting, grinding, materials handling, tracking Vibration WATER CONTAMINATION (Legionella) BACTERIA, FUNGI (moulds) OTHER FACTORS Chemical vapours, allergens

7 WHO CAN BE AFFECTED? PATIENTS - Increased susceptibility to infection Immunosuppression Drugs (cancer treatment, transplant, steroids) Chronic illness (HIV, hepatitis, Very young, Very Old Trauma/operation (unhealed wounds Invasive procedures (dialysis, endoscopy, injections) Affects can be life-threatening Many documented fatalities linked to construction dust

8 Who Else? STAFF (Doctors, nurses, housekeeping, food service) Handling sterile supplies Preparation and handling of food Susceptible to infections, allergic responses...iaq Issues VISITORS Contact with patients Susceptible to infections, allergic responses

9 How do we control the risk? Multi-disciplinary approach Design team Users Project Management Industrial Hygienist Establishment of Precautionary Measures RISK ASSESSMENT How much contamination will be created and of what type? Who will be affected? PREVENTIVE MEASURES ANALYSIS

10 PREVENTIVE MEASURES ANALYSIS Construction Activity Type Type Description Example A B C D Inspection and noninvasive. No dust Small scale, short duration. Minimal dust. Generate moderate to high dust. Removal of fixed facility component Generate high levels of dust. Single controlled opening to wall or ceiling (ceiling tile or access panel, painting (no sanding), electrical trim work, minor plumbing, other activities Access to and use of chases, cutting small openings in a small space where dust can be controlled, minor cabling repair, sanding of small areas of a wall, minor plumbing work (<30 mins) to one or more patient care areas Sanding a wall, removal of floor coverings, ceiling tiles, casework; new wall construction, electrical above ceilings, minor ductwork, major cabling, plumbing (0.5 hr < 1hr) to one or more patient care areas Soil excavation, new construction over consecutive shifts, heavy demolition, removal of a complete cabling system, plumbing ( > 1hr) more than one patient care areas

11 PREVENTIVE MEASURES ANALYSIS Population Risk Group Risk Group Description 1 Lowest Offices, public areas, workshops, housekeeping rooms, unoccupied wards 2 Medium Patient care areas (unless RG 3 or 4), outpatient clinics, admission and discharge, waiting rooms, autopsy, Occupational therapy. 3 Medium to High Emergency (non-trauma), imaging, Lab & Del, nurseries, laboratory, food prep, & handling, respiratory, geriatric, pediatric, long term care, patient wards, clean linen. 4 High Risk ICUs, Ors, Oncology & Transplant outpatient clinics, dialysis, critical care, diagnostic imaging, endoscopy, clean/sterile storage, trauma rooms, dental procedure rooms, in patient and outpatient clinics for Immunodeficiency diseases (e.g. HIV)

12 Preventive Measures Matrix

13 Preventive Measures I coordination and good housekeeping, moving of sensitive materials and supplies, patients, use of HEPA vaccum. II active dust control, containment (closure of window and doors, dust barriers, protection of systems (ventilation), III complete enclosures, negative pressure, anterooms, removable outerwear, walk off mats, Multidisciplinary Team, quality assurance (milestone inspections) IV anterooms where no direct exterior access exists

14 Work in Existing Issues are complex and full Risk Assessment Required. Examples...

15 Mental Health Unit Rental Suite approx 10,000 sf in strip mall Open concept 80 % offices & support with 20% client consult. Clients present multitude of complex health issues from depression and addiction to chronic illness, all ambulatory Minor reno moving walls with minor plumbing. Insulation of consult room walls with FG Site fully operational throughout work.

16 PMA First phase Client consult room insulation Drop ceiling re/re Addition of blow fibreglass Shares recirculated air with offices 10 rooms in 800 sf zone. Group 2/Type C: Level III Negative pressure, complete hoarding system Done over the weekend Worker coveralls HEPA vacuums Original plan: insulate during working hours and try and clean up later.

17 PMA second phase Wall demo/reconstruction Work in open area amongst health care workers Shares recirculated air with client consult rooms Group 1/Type D: Level III Negative pressure, complete hoarding system To be done during normal working hours Worker coveralls HEPA vacuums Original plan: No hoardings, hanging poly for visual effect, staff would pass through work areas under construction.

18 Open concept

19 Client Consult Rooms

20 Dialysis Clinic small reno Rental Suite approx 5000 sf in strip mall Open concept dialysis room with offices & support rooms. Clients have renal failure and procedures are invasive. Minor reno adding a separation wall in a storage room off the main dialysis area. Site fully operational throughout work.

21 PMA Minor demo and wall construction, some electrical 10 rooms in 800 sf zone. Group 4/Type D: Level IV Negative pressure, complete hoarding system Anterooms Worker coveralls HEPA vacuums Night work (2200 hrs 0600 hrs)

22 Entry to Enclosure

23 Inside Enclosure

24 Adjacent Supplies

25 Inside Anteroom

26 Acute Care Hospital Running of Services thru Central Sterilization Central sterilization and processing Processes all sterile supplies/instruments for OR, endoscopy etc. Directly connected to OR suite by dumb by elevator Re & re of ceiling tiles for running of conduit, fire main, potable water and medical gas Adjacent areas operational hrs.

27 PMA Minor demo and wall construction, some electrical Area: 12 x 24 Group 4/Type D: Level IV Negative pressure, complete hoarding system Anterooms Worker coveralls + scrubs outside work area HEPA vacuums Particle counting before, during and prior to nightly teardown. Night work (2200 hrs 0600 hrs)

28 Inside enclosure (entrance)

29 Inside enclosure (pass thru)

30 Hoarding

31 Sterile Supplies Behind Barrier

32 Sterile Supplies

33 Complex Care Facility Adjacent to Existing 20,000 sf facility added on to existing site Full excavation and new construction Buildings connected during final phases Concerns re: dust ingress, noise, vibration, vehicles (exhaust), traffic

34 PMA Group 1/Type D: Level III Negative pressure only upon opening of connection Anterooms not required...exterior access Worker coveralls not required (exterior access) HEPA vacuums in final clean only Complete interior clean of each phase: Wall closures, above ceiling, final clean

35 Dust on Ductwork

36 Acute Care Hospital OR Air Handler Maintenance and Duct Cleaning Corrosion observed in air handler servicing OR suites (12 ORs active 24 hrs per day) Need to sand corrosion and repaint inside air handlers including down stream of filters Air samples collected in OR showed presence of rust. Clean ductwork

37 PMA Group 4/Type C: Level IV Shut down of air handlers, system put on emergency by pass Interior of air handlers sealed downstream. Particle counts taken downstream in air handler and in Ors before during and after work. Negtive pressure enclosures at each diffuser (cleaning point)

38 Interior of Duct

39 Portable Enclosure

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