Seven Keys to Infection Control When Remodeling

Successful infection control begins with the first meeting regarding the planning of a healthcare project. It’s that important. The following seven keys to infection control supplement recommendations in the American Institute of Architects (AIA) Guidelines for Design and Construction of Hospitals and Health Care Facilities and the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). Adhering to these requirements and recommendations leads to the development of well-designed facilities. The Seven Keys Obvious differences exist between infection-control measures for construction of a new facility vs. renovating or expanding an existing property. New construction provides a clean slate, and while infection-control measures are extensive, the interaction with patients, their families and staff obviously is not as involved. In either case, however, all team members should keep inflection control at the forefront. Outstanding design and proper infection control can go hand in hand, and will result in a project that meets all requirements. The seven keys to infection control include: Development of a multidisciplinary team Understanding of risk levels Communicating in all phases Scheduling carefully Placing patients thoughtfully Don’t build in problems Paying attention to the details Develop a Multidisciplinary Team Every project team should include professionals from a range of disciplines, including architecture, engineering, epidemiology, safety, housekeeping and facility operations. Each discipline has unique perspectives that add value in all planning and design decisions. This facilitates wide-ranging input regarding infection control, and helps to ensure that all areas and procedures receive the proper level of attention. All team members need to be involved throughout all project phases and review all appropriate documentation. The selection of the contractor and subcontractors adds more layers to the team and thus to the review process, which enhances the team’s ability to thoroughly assess all design decisions even more. Every contractor should understand the risk categories (to be discussed later), and the requirements and precautions for each. Contractors begin by understanding these issues in order to calculate the cost impact on their work. You do not want a contractor tempted to skimp on work if you won’t pay for extras. Second, understanding the risks and precautions helps inform and train their personnel. Two examples illustrate the importance of a multidisciplinary team: Hospital-acquired infections, which can be more prevalent if proper hand washing does not occur, can be a problem. The hospital staff on the team can be responsible for working with nursing administrators to ensure that sinks are provided in ample numbers and that they are properly situated throughout the facility. The second example involves the use of carpet versus hard flooring. Carpet is not applicable in many areas because the fibers trap minute particles that can result in poor infection control. Carpet is acceptable for use in lower-risk areas such as offices, but higher-risk areas such as surgical suites and the emergency rooms are not appropriate settings. Having many perspectives on the team helps ensure that use of any material is appropriate to its environment. Understand Risk Levels There are four risk levels associated with infection control: low, medium, high and highest. All project personnel need to be informed about the risk levels and the associated precautions required for each. There is minimal need to control dust and other particles raised from construction in low-risk situations because patients typically are not in these areas. Offices are one example of a low-risk area. A thorough cleaning that includes vacuuming and/or wet mopping when construction is complete usually is adequate to prepare the space for occupancy. It is necessary to mitigate the intrusion of airborne dust into medium-risk areas, including cardiology, nuclear medicine, physical therapy and imaging. Use water mist when cutting or drilling concrete, and seal unused doors with duct tape and/or duct mats. Isolate the ventilation system or shut it down to stop dust particles from moving throughout the system. Wet mop and vacuum with a high-efficiency particulate air (HEPA) vacuum when construction is complete. High-risk spaces, including critical care, emergency rooms, labor and delivery, newborn nurseries and pediatrics, require the same provisions as medium-risk areas but also may require construction of barriers with sheet rock or plastic. Using clean-air machines during construction also may be required. Contain construction waste safely before transport through the area, and clean following construction completion by vacuuming with a HEPA vacuum and mopping with disinfecting solution. Highest risk areas are those for patients with immune-deficiency concerns such as chemotherapy, burn or cardiac cath patients. In addition to the procedures mentioned previously, an anteroom should be constructed adjacent to the space, which all workers must pass through before entering the construction area. Shoe covers must be used and changed each time a worker passes in and out of the area and gowns also may be required. All cleaning procedures mentioned before must be used when construction is complete. Communicate in All Phases Regular communications regarding project progress and status are critical. All team members should be involved in any meeting where major decisions are addressed or when major project updates are given. All key personnel need to review the construction documentation to help make certain that no area is overlooked. Communication is especially important during utility shutdowns. Department meetings must be conducted with all staff well in advance and updates provided as the shutdown time becomes closer. Include information on when the shutdown will occur, for how long, when it is scheduled and provide information regarding contingency plans during this time. The staff should subsequently explain the potential impact, if any, to patients and their families. Schedule Carefully Schedule work so that as much as possible is done when it will be the least disruptive to patients and staff. If the area in question is in or near an outpatient area that is open from 8 a.m. to 5 p.m., try to perform construction during evening hours. In another example, do not shut off water at bath time, but do this, if possible, when usage is lower. Communicate with contractors the importance of sometimes working during off hours. They cannot fully appreciate the importance of this unless the associated benefits are explained fully. Patient Placement Move patients and departments to an area that will not be impacted by construction if at all possible. Temporary relocations may involve some extra work for departmental staff, but it will be better for everyone in the long run. Provide effective barriers if patients must remain in the area. These include plastic sheeting and sheet rock in some instances. Again, match the barriers and cleaning after construction is complete to the risk level. Don’t Build in Problems It is vital to not build in problems, and this is especially important when it comes to new facilities. The team should design to eliminate or reduce moisture problems, which can result in mold and mildew. The building envelope’s design, as one example, must match the climate. Brick and masonry can hold moisture in some instances, so use what is appropriate for the climate where the project is located. Vapor retarders such as foil-backed insulation, plastic or polyethylene sheeting can be used as appropriate to slow down vapor movement. Not matching the flow through the cooling coil to the size of the coil a sizing and velocity issue can result in condensate carryover. The placement and type of fans used for the heating and ventilation system also must be addressed. Do not stack coils without proper drain pans. Again, improper condensate drainage can lead to the development of mold and mildew inside the air handling unit and the spores can be spread into the occupied areas. Chilled-water systems also can present challenges. Insulate and use vapor barriers on pipes so that condensation won’t develop, and seal the ends of cold-water pipes with insulation. Pay Attention to the Details Finally, pay attention to all details, from large to small. Inspect, inspect and inspect some more. Make sure that any damage to pipes, walls and other building components and systems does not occur when one trade finishes work and another takes over. Inspect during and when each group is done. Using these seven keys to control infection can help ensure a successful facility. Bill Petersen can be reached by phone at (402) 399-1000 or via e-mail at William.Petersen@hdrinc.com.

NULL