New construction and renovation in hospitals and other healthcare settings can pose an infectious threat to patients via dust and contaminated water, but infection preventionists may not be called into a project until its final stages.
“A lot of what we hear and see is that infection control only gets involved in the end, specifically to approve dust barriers,” says Richard A. Vogel, MS, CIC, the author and editor of new APIC guidelines on the issue and an Infection Control Specialist at New York Presbyterian Hospital. “Actually, their input is needed right from [the beginning of] the design and throughout construction. That’s where the shortcomings are – getting them involved early.”
APIC created the Infection Prevention Manual for Construction & Renovation to help IPs protect patients during the seemingly endless process of renovation and new construction in healthcare settings.
“Hospitals are aging, there is new technology, there is the wish for a higher level of amenities for the patients, and required support services [for those amenities],” Vogel says. “It’s a never-ending cycle of making things better, and there is a lot of competition, so people want the best and the newest.”
The IP should be included in all phases of construction project planning to ensure that such items as sinks, soiled and clean utility rooms, and airborne isolation rooms are properly laid out to meet the needs of the space, the manual states. This should include meeting regularly with facility and project managers to discuss upcoming renovations.
“The IP should be involved in projects from the initial planning stages through completion,” the APIC manual states. “A common challenge is lack of engagement from administration and getting support for infection control programs.”
One way to get support is to demonstrate the need for an infection control during construction and the importance of input from IPs. Factors to highlight include the following:
- the need to comply with regulatory agencies, including state regulations, Facility Guidelines Institute, and Joint Commission requirements;
- the need to demonstrate to administration the value of the program;
- the need to demonstrate how input from IPs results in an enhanced outcome and/or where the lack of input resulted in an adverse outcome.
“The main risk from construction renovation is the dust that could contain aspergillus spores - and other fungal infections are also possible,” Vogel says. “Water can be a problem also during construction because often the water flow to a certain area is shut down, which gives you a nice environment for Legionella to grow.”
The manual provides policies and procedures, resources, models, examples, and educational material. This material can be used by new and experienced IPs and for facilities of different sizes and patient populations, both as examples of how other facilities have developed their infection control during construction programs, and as templates to adapt for their own facilities.
For example, the manual includes in-depth explanations about infection control risk assessment (ICRA) requirements, timing, and who should be included on the team. Based on the results of the ICRA, the design of the space should be accommodated to meet the requirements. These include issues such as patient placement and relocation, standards for barriers, phasing, protection from demolition, training, impact of utility outages, removal and movement of debris, and use of bathrooms and food areas for construction contractors.
A notification process should be implemented so that the project manager alerts the IP of upcoming projects. This will allow an ICRA to be completed before construction begins. If a training program is required for contractors, it is important to add that into the policy, the manual recommends. An example policy included in the manual outlines the following key points for the ICRA:
- An ICRA is developed for all projects that may affect the health of patients.
- The ICRA is multidisciplinary, documented assessment process intended to proactively identify and mitigate risks from infection that could occur during construction activities.
- The process must take into account the patient population at risk, the nature and scope of the project, and the functional program of the healthcare facility.
- The ICRA determines the potential risk of transmission of various air- and waterborne biological contaminants in the facility.
- The ICRA should be a part of integrated facility planning, design, construction, and commissioning activities.
Editor’s note: More information on the APIC construction manual including details for purchase are available at: bit.ly/1K98Tfs.
