(See endnotes 9, 14, 16, 18)

Building Construction or Renovation

Many billions of dollars are being spent annually to renovate and upgrade existing hospital and other healthcare facilities and also to construct new ones. Many of the facilities in the United States were built in the 1950s and 1960s and no longer can provide efficient and safe healthcare delivery or utilize rapidly emerging technologies. Healthcare-associated infections and injuries can increase as a result of the close proximity of renovation areas and the work being done to patient care areas. The activities of construction increase the potential for airborne, waterborne, and contact infections by simply disturbing the existing facilities as repair or remediation occurs. There have been in the past outbreaks of disease when construction has caused microorganisms to become airborne or waterborne. This problem is especially a concern in high-risk patient areas.

However, healthcare-associated injuries and healthcare-associated infections can be reduced by following the evidence-based standards and recommendations established by The Joint Commission for the six phases of the building process including: planning; schematic design of the project including preliminary room layout, structure, and scope; design and development including all details; construction documents requiring a template using which contractors can make bids and also understand all the details of the construction; the actual construction phase of the building which can create numerous hazards to the contractors and existing patients and staff in renovated areas; and the commissioning of the building when actual ownership is taken after all specifications have been met as determined by inspection by the proper authorities in each area. The planning, construction, and design of these facilities impact the health and safety of employees, patients, visitors, and contractors.

There are numerous problems in facilities that need to be addressed. They are: traffic flow in highly sensitive areas including where high-risk patients are being treated; improper spatial separation of patients, especially where potential spread of healthcare-associated infection may occur; inadequate numbers and types of isolation rooms; inadequate access to hand-washing facilities; use of carpets and other types of materials which are difficult to clean in patient treatment and care areas; inadequate, poorly maintained, or inappropriate ventilation for isolation rooms, operating rooms, intensive care units, cancer care units, special nurseries including neonatal intensive care, emergency departments, care areas for other highly susceptible patients; exposure to fungi, dust, asbestos, etc. during renovation projects; inadequate or inappropriate water supplies for critical areas; etc.

Besides the normal hazards associated with renovation and construction, the contractors, staff, and patients are also exposed to numerous hazardous drugs and chemicals which may have a profound health effect on the individuals. Cleaning agents may also result in potentially hazardous situations and affect all individuals who are present.

Best Practices for Building Construction or Renovation (See endnote 7)

  • • Include environmental and infection control personnel in the team that prepares necessary plans and evaluates all healthcare facility demolition, construction, and renovation.
  • • Evaluate all potential hazards through a risk assessment process for demolition and construction activities prior to construction or renovation and determine how best to prevent or control these hazards to prevent accidents and resulting injuries and avoid environmentally created disease or healthcare-associated infections.
  • • Determine if construction will create water leaks, loss of negative air pressure or positive air pressure as needed in sensitive areas, barriers, and their types that need to either come down or be erected before construction, potential utility failures, fires, or other emergencies, potential spread of healthcare-associated infection, or interference with ingress or egress of staff, and make necessary plans for correction prior to construction.
  • • Observe all National Fire Protection Association standards and American National Standards Institute standards for construction, personal protective equipment, and construction practices.
  • • Monitor and then record and make necessary corrections on a daily basis of any adverse air flow in isolation rooms and reverse isolation rooms where immunocompromised patients receive care and treatment during all types of renovation and construction.
  • • Minimize all unnecessary stresses such as noise, vibration, dust, mold, etc.
  • • Ensure that all exits are unobstructed, all construction areas are secured, and that there is immediate entrance for emergency services including fire, police, and medical personnel in the event of an accident.
  • • Ensure that all alarm, detection, and suppression systems for fires are in working order.
  • • Ensure that all temporary partitions used in construction are smoke tight and non-combustible.
  • • Provide specialized training for all personnel in firefighting and give them additional firefighting equipment as needed.
  • • Prohibit all smoking within the premises.
  • • Determine appropriate storage, housekeeping, and debris removal and enforce it rigorously.
  • • Conduct fire and disaster drills on a routine basis.
  • • Work with a buddy system in dangerous areas such as the cleaning of large tanks.
  • • Control traffic flow during all construction and renovation areas to reduce dust levels and do not allow unauthorized people to enter construction sites.
  • • Create appropriate traffic flow in a new or renovated facility to avoid access problems for people coming into critical areas.
  • • Evaluate all proposed flooring materials for use of sealants, adhesives, maintenance, and treatment products needed, durability, safety and potential traction and prevention of falls, glare avoidance, acoustic properties, wear ability, and time needed for cleaning and maintenance, and utilize those products which are best able to protect the health and safety of all people while being cost-effective.
  • • Establish special separate rooms for infected individuals, highly infected individuals such as Ebola patients, immunocompromised patients, and special needs patients.
  • • Quickly respond to problems of water damage and determine if the wet material can be dried successfully without growth of mold or whether it needs to be removed and replaced immediately.
  • • Locate sinks and hand-washing dispensers in appropriate and convenient locations for employee use.
  • • Locate sharps containers in convenient places.
  • • Physically separate dirty work areas from clean work areas.
  • • Clean all work zones daily by using wet wiping techniques and cover all debris before removing from the work zone.
  • • Flush the water system to clear any sediment which is in the pipes to prevent growth of waterborne microorganisms.
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