Performing restoration activities in a healthcare facility is unique from other settings. Understanding the challenges of working in healthcare, including the legal and code requirements, combined with incorporating procedures necessary to protect immunocompromised individuals and prevent the transfer of infection, is key to the success of the project and protecting patient health.
Restoration professionals may not be fully aware of the direct impact they can have on patients, staff, and the indoor environment when working in healthcare facilities. In particular, in regard to healthcare associated infections (HAI), in which a patient acquires a secondary infection in the healthcare facility. According to the CDC, “each day, approximately one in 31 U.S. patients and 1 in 43 nursing home residents contract at least one infection in association with their healthcare.” Roughly 5% of HAIs can be directly related to construction-related activities which can cause dust migrations and changes in airflow that carry pathogens to secure areas of the facility.
Therefore, understanding the risks associated with the restoration project and how those risks can be mitigated, before the project begins, is essential. It is the responsibility of the healthcare facility to complete a Pre-Construction Risk Assessment (PCRA), which includes seven main components:
- Fire Prevention and the Life Safety Code,
- Infection Control Risk Assessment (ICRA),
- Utility Interruptions and Impacts,
- Noise,
- Vibration,
- Environmental Services, and
- Other Safety Hazards.
These components are assessed by a multidisciplinary team consisting of project managers, engineering representatives, safety office representatives, infection preventionists, environmental services and contractor representatives. While outside contractors are not directly responsible for completing the PCRA, their input is essential.
A key component of the PCRA, the Infection Control Risk Assessments (ICRA), operates as a blueprint to ensure all those involved are working towards to same goal and in the same manner with infection prevention in mind. Required for construction, renovation, and maintenance activities that could increase the infection risk, the ICRA evaluates, the type of work activity to be performed, the extent of the activity’s disturbance, the patient risk group, and the potential impact on surrounding areas, in order to determine the class of precautions that must be taken by the contractors to make the work safe for patients and visitors. The greater the risk, the higher the level of precaution.
The ICRA, in addition to determining the risks and mitigation strategies prior to project commencement, plays a vital role throughout the project. Utilized as a roadmap, the ICRA will delineate appropriate dust control procedures, including worker decontamination, maintenance of critical barriers, and the required negative pressure. These procedures should be continually monitored during the project and documented accordingly.
Proper education and training in infection control is a vital component of preventing HAIs. Contractors can inadvertently introduce or spread infectious agents if they are not trained in proper infection control practices. By equipping your response team with the knowledge and skills needed to maintain a safe and hygienic environment, you can play a direct role in protecting patients and saving lives.
Author: Shari L. Solomon, Esq.
