wyoming infection control ellwood - university of … once the nature and scope of the construction...
TRANSCRIPT
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A short workshop on preparing and implementing the ICRA
Cynthia Ellwood, Ph.D., CIH, Content developed with cooperation from Saunders Construction, Inc., Exempla Healthcare and Children’s Hospital Colorado
Objectives
Understand that the ICRA matrix is a guideline to assist in the infection control risk assessment.
Understand how to gather information from the contractor in order to accurately determine the type of construction work.
Understand how to adapt the Class I, II, III, and IV controls to fit your unique construction activities.
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Objectives
Understand how to assist the contractor in implementing infection controls.
Understand how to build your infection control inspection forms and conduct the inspection.
Be able to apply ICRA principles in participant's facility
What do the guidelines say about construction?
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Air contaminants generated during construction projects
Inorganic particles – Aerosols General construction dusts (sheet rock, fiberglass,
wood dust, concrete dust)
Metal fumes and metal dusts
Vapors – adhesives, paints, solvents
Organic particles – Bioaerosols Fungi – Aspergillus sp., Fusarium sp., Rhizopus sp.
Bacteria – water systems
Air contaminant sources within the hospital infrastructure
Upper surface of ceiling tiles
Within wall cavities
Within electrical boxes & med gas panels
Within light fixtures
Carpet
Water features
Cleaning activities
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What is Infection Control?
Systematic process that reduces the risk of infection to patients during construction projects1. Infection Control Risk Assessment (ICRA)
2. Infection Control Construction Permita. Identifies the infection control risk mitigation
recommendations (ICRMRs)
3. Infection Control Plana. Details on how contractor will achieve the ICRMRs
Infection Control Risk Assessment
Multidisciplinary, documented process
Intention Identify & mitigate risks from infections during
construction
Considerations Population at risk Nature of construction project Scope of construction project
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Completing the ICRA
Completing the ICRA
End product of the ICRA is the identification of control classificationsClass 1Class 2Class 3Class 4
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Infection Control Risk Mitigation Recommendations (ICRMRs)
Written plans
Describe specific methods to control contaminants During construction
During commissioning
Typical ICRMRs
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Costs and the Blame Game
Best Position - Address infection control during the bidding process Identify costs related to infection control
compliance
Include infection control requirements in construction specifications ICRA
ICRMRs
Construction interpretation of ICRMR ≠ IP expectations
Activity – above ceiling investigation in OR corridors
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Class 2 Controls
What are the IP expectations?
Clean equipment Clean personnel
clothing Bunny suit ensemble Containment cube HEPA filtered equip
Vacuum Negative air machine
No patients in ORs Task conducted after
hours
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What do these expectations mean to the contractor?
Clean equipment = purchase disinfectant + time
Clean personnel clothing = vacuum clothing + time
Bunny suit ensemble = purchase
What do these expectations mean to the contractor?
Containment cube = purchase + maintenance
HEPA filtered vacuum = purchase + maintenance
HEPA filtered negative air machine = purchase + maintenance
No patients in ORs = overtime (labor costs)
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What do these expectations mean to the contractor?
An increase in costs Labor
Materials
Grumpy guys that take shortcuts to save time and money
Shortcuts!
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The Nuts and Bolts of Infection Control
What are we really doing?
• Identifying conditions and factors related to the transmission of infectious disease agents that can be released during construction
• Designing and implementing contaminant transmission controls
• Continuously evaluating the effectiveness of controls
How We Design an Infection Control Plan?
SOURCE PATHWAY PATIENT
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Interrupt the Pathways
SOURCE PATHWAY PATIENT
The Nuts and Bolts of Infection Control
Let’s Focus On:
• Identifying conditions and factors related to the transmission of infectious disease agents that can be released during construction
Transmission: the movement of contaminant from source to patient
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The Nuts and Bolts of Infection Control
Let’s Focus On:
• Identifying conditions and factors related to the transmission of infectious disease agents that can be released during construction
Conditions and Factors:Identified once the nature and scope of the construction project is understood
Example: Above ceiling investigation in OR corridor
Investigation Location is OR corridors
Remove ceiling tiles
Poke head above ceiling and look around
Nature Scope
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Conditions and Factors of Contaminant Transmission
Contaminant Source
Transmission Pathway to patient
Personnel clothing Fall off walking through corridors
Airborne and re-entrainmentShared traffic route
Equipment (ladder) Fall off during movement Airborne and re-entrainmentShared traffic route
Ceiling tiles Damage during removal and placement
Airborne and re-entrainmentShared traffic route
Ceiling cavity Pressurized cavity Airborne (small particle diameter)
Dust in the ceiling cavity
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Contaminant Transmission Controls
Contaminant Source
Transmission Controls
Personnel clothing Fall off walking through corridors
Vacuum clothingBunny suit ensembleNight/weekend
Equipment (ladder) Fall off during movement Vacuum and then wipe clean with disinfectantNight/weekend
Ceiling tiles Damage during removal and placement
Containment cube with HEPA filtered negative air machine
Example: Cutting in an outlet box
Nature Small scale, short
duration, cutting drywall
Scope Corridor wall shared
with isolation room Cut drywall, box
installed, cover plate installed
Waste materials generated
Wires pulled later
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Conditions and Factors of Contaminant Transmission
Contaminant Source
Transmission Pathway to patient
Personnel clothing Fall off walking through corridor
Airborne and re-entrainmentShared traffic route
Equipment (drywall saw)
Fall off during movement Airborne and re-entrainmentShared traffic route
Drywall dust & waste
Generated during cutting and removal
AirborneDirect proximity to patients and staff
Wall cavity Depressurized cavity Airborne (small particle diameter)
The Cutout Box
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Contaminant Transmission Controls
Contaminant Source
Transmission Controls
Personnel clothing Fall off walking through corridors
Vacuum clothing
Equipment (drywall saw)
Fall off during movement Vacuum and then wipe clean with disinfectant
Drywall dust Generated during cutting and removal
Containment – cutout box, poly walls, filtered directional airflow
Waste materials Generated during movement
Tight and clean waste container
Gathering information from the contractor
Nature – big picture information How long is task? Hours, days, weeks, months
How invasive? Investigation only Above ceiling cable pulls Install card readers Drywall cutting Remove carpet / vinyl flooring Patch and paintMajor demolition and build-back
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Hidden cavities
Cavities revealed!
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Gathering information from the contractor
Scope – getting the details! Exact location of work – floor plans are needed Characterize the work location Pressurized or depressurized to adjacent/adjoining
rooms Ventilation in work area
Ducted supply and return air Plenum return air Exhaust present
Occupants in or near the area Hospital materials moving through the area
Gathering information from the contractor – Scope details cont.
Will wall and/or ceiling cavities be opened?
What tools will be used? Hand tools – drywall saws, sand paper block,
hammer
Power tools – tin cutters, hammer drill, finishing sander
Is HVAC system part of the scope? What downstream rooms will be affected?
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Gathering information from the contractor – Scope details cont.
Will air handling unit (AHU) be turned off? What areas will be affected?
For above ceiling work, determine if ceiling cavity is pressurized.
What building materials will be transferred to the work location?
What equipment will be transferred to the work location?
Gathering information from the contractor – Scope details cont.
What waste materials will be generated? Where will recycle dumpster be located?
Where will waste dumpster be located?
Can waste be removed through window chute?
What noise levels will be generated and when?
Will vibration be generated and when?
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Gathering information from the contractor – Scope details cont.
Will there be disruptions to: Med gases
Electrical power
Fire detection / suppression
Water supply
Emergency exit routes
Will there be core drilling through floors?
Does the scope include new domestic plumbing?
Break for lunch
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Interrupt the Pathways
SOURCE PATHWAY PATIENT
A quick review of controls – in pictures
Demolition Bunny suit ensemble
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Control transmission along the traffic route
Wiped clean Covered and wipe wheels
Control transmission along the traffic route
Waste from demolition zoneMove container to pre-clean station
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Control transmission along the traffic route
Clean waste cart prior to entry into anteroom Clean personnel in anteroom
Control transmission along the traffic route
Clean cart moves through hospital
Cart cleaned again after dumpster
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Control transmission along the traffic route
Staging large materials Tacky mats
Frequent mopping or vacuuming traffic route
Control construction traffic flow
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The bootie dilemma
Wear booties in the work area only
OR
Wear booties outside of the work area (walking through hospital)
OR
Wear booties in both locations, changing each time worker exits work area
Summary: Controls along the traffic route
Designated traffic routes– patients, staff & construction crew
Contractor or EVS mops traffic routes
Movement of construction materials Clean carts / covered materials
Removal of waste materials Clean carts out of work zone & into facility
Bunny suits and shoe covers
Vacuum personnel clothing
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Patient control systems
Patient relocation Unit closures Day-time or night-time
hours when construction work is conducted
Workers do not ride in elevators with patients
Separate patients and construction area by • Distance• Time
Source controls: Containment barriers – 3 main types
Environmental containment unit (ECU)
Non-rigid containment barrier
Rigid containment barrier
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Containment Layout• Directional
airflow
• Pressure differential
• Entry & exit procedures
• Adhesive mats
• Dust suppression
• HEPA filtered equipment
Dirty Area Buffer Zone
Buffer Zone
Anteroom
• Dirrectional airflow
• Pressure differential
• Entry & exit procedures
• Adhesive mats
• Dust suppression
• HEPA filtered equipment
Containment Layout
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• Directional airflow
• Pressure differential
• Entry & exit procedures
• Adhesive mats
• Dust suppression
• HEPA filtered equipment
Containment Layout
Manometer
Work area is depressurized relative to adjacent critical areas by at least -0.03 inch w.g. (ANSI/ASHRAE/ASHE Standard 170-2008, Ventilation of Health Care Facilities)
Corridor
PatientArea
Work Area
Anteroom
Work Area is NegativePressure to Patient
Areas
Negative Air Machine
Temp Duct to Exterior
Anteroom Overview
Manometer
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Manometer
Manometer – Visual display of airflow
Tape Shows Alarm Condition
Connect manometer to autodialer – call out to pager or cell phone at pre-selected alarm level
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• Directional airflow
• Pressure differential
• Entry & exit procedures
• Adhesive mats
• Dust suppression
• HEPA filtered equipment
Entry and Exit Procedures
• Vacuum work clothing
• Wear appropriate clean clothing
• Clean equipment
• Cover equipment
• Walk over tacky mats
The Infection Control Plan
Generated by the IP and contractor Details on how infection control compliance will
be achieved
Facility IP approval of infection control materials Disinfectant
Barrier building materials
Protective clothing
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Infection Control Plan
• Written procedures that detail the infection controls for the project• Floor plans• List of emergency personnel• Required signage• Waste removal requirements• Cleaning requirements• Clothing requirements• Other infection control
procedures
Other IC Procedures
Manometer documentation and calibration
Auto-dialer installation and contact list
Response to manometer alarms
Clean-duct protocols
ECU use
Construction cleaning requirements
Infection control inspections and corrective actions
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Case Study - Handouts
Understand scope of construction work
ICRA matrix
Develop ICRMRs
InspectionsVisual validation of infection controls
Clean clothing -vacuuming
Controlled traffic patterns Wet-wiping carts Waste removal Adhesive floor mats Dust suppression
methods No access to elevators
with patients Daily, weekly and
monthly inspections
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Inspections: Quantified validation of infection controls
Directional airflow
Pressure differentials
Environmental monitoring Particles
Bioaerosols – fungi
Write down this information – keep in a safe and secure location and easily retrievable
Inspections – simple form
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Case Study - Handouts
Developing inspection forms
Returning the space back to the facility - Two levels of cleaning
Construction cleaning before barrier removal Facility Terminal Clean
Remove all dust and debris Surfaces will be visibly clean
Disinfect all surfaces
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Thank you
Cynthia Ellwood, PhD, CIH
Associates in Occupational + Environmental Health, LLC
303-582-3020