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The Challenge Hospital-associated infections (HAIs) like MRSA continue to be a problem in health care facilities It is estimated that each year in the US: 1.7 million patients acquire HAIs 99,000 patients die from these infections 5,000 HAI deaths result from construction-related activities Studies indicate invasive aspergillosis can occur during construction and renovation

3 The Situation  Feedback from our contractors indicated a growing concern from health care customers over increased patient infections due to cross-contamination from renovations and additions  Health care organizations are in need of construction professionals with the skills to properly contain infectious agents on a job site  Specialized training – focusing on the health care environment – is needed in order for health care organizations to renovate, alter, or expand facilities with confidence

Best Practices in Healthcare Construction Training Best Practices in Healthcare Construction Training  Developed to train crews to minimize risk of hospital acquired infections related to construction activities  Training teaches the best way to protect the facility, workers, staff and most importantly – the patients  Goal is to create the most optimal flooring installation conditions as possible so that the floor does not fail and contaminants are contained

5 87% of work is done without properly trained labor* Improperly-installed floors lead to unsafe conditions for the staff and patients, which causes...  Disruption to building operations  Expensive repairs  Loss of facility use  Unsafe conditions Flooring & Healthcare Facilities *Bureau of Labor Statistics

6  Moisture and/or alkalinity in the substrate  Improper use of patch or leveling compound  Installation of flooring and adhesive over poorly prepared subfloor  Improper training for floor installer in a healthcare environment Main Failure Areas

7 Moisture and Alkalinity Awareness Moisture, and its rate of movement through a substrate, is a critical factor in the success or failure a flooring project.

8 One obvious result of excessive moisture is the failure of an adhesive to bond the flooring to the substrate. Moisture and Alkalinity Awareness

9 When excess moisture migrates through the slab, it can carry excess salts to the surface. Excess alkalinity can crystallize creating an extreme bond breaker. Moisture and Alkalinity Awareness

10 Mold and bacteria issues can arise from excessive moisture. Moisture and Alkalinity Awareness

11  Inadequate drying time allotted  Applied too thick  Wrong primer for type of substrate  Gypsum product used on or below grade Improper Patch or Leveling

12  Low spots filled with adhesive, causing flooring to indent  Patch is used instead of underlayment board  Flatness tolerance is not achieved prior to floor installation  Substrate is not checked for flatness  Installed failed to detect surface imperfections prior to installing floor covering Improper Floor Preparation

13 85% of all healthcare flooring installations fail due to improper subfloor preparation Why Do Floors Fail?

14 Jobsite Preparation Substrate is examined for high spots or low areas

15 Considerations:  Floor should be smooth, clean, dry  Floor should be free of ALL contaminants  Examine for construction joints or saw cuts  Check expansion joints  Achieve flatness tolerance levels  Use proper leveling products Concrete Subfloor Prep

16  Wood underlayments are used when the condition of the substrate is not acceptable  It is used to provide a dimensionally stable, smooth surface to receive the new floor covering Failures arise from:  Wood not structurally sound  Inadequate fastening of wooden subfloor  Use of poor quality lauan resulting in staining Wood Underlayments

17 Conditions Impacting Adhesion and Contributing to Contaminant Transference: Dusting…Scaling…Flaking…Pop-outs...Delamination…Cracking…and of course: Moisture & Alkalinity Determine Appropriate Preparation Methods & Equipment Abrasive-blasting…Scarifying…Bush-hammering…Hydro-blasting Substrate Assessment for Healthcare Recognize Presence of Contaminants Dust…Cure & Seal…Acid…Machine Oil…Micro-fractures

18 Deliver a workforce of floor covering professionals who understand how to protect the patients and staff during a building project, while not disturbing daily activities. One Goal

19 A Reliable Contractor Should…  Be dependable  Perform quality work in a timely fashion  Posses proper bonding and insurance  Control their own workforce  Have access to continuing education for their crews  Have access to healthcare-specific training for their crew  Fulfill specification parameters:

20 Specification It does matter who installs your floors. Use this language to ensure a quality installation: General Quality Assurance Installers: Skilled trades people enrolled in a state-approved apprenticeship program, or certified by a program equal to the INSTALL program, which includes all of the following: Four-year apprenticeship program at 160 hours per year Career-long training opportunities Manufacturer-endorsed training Fundamental journeymen skills certification This specification can be placed in these sections of Division 09: Flooring Flooring Treatment Specialty Flooring Wood Flooring Resilient Flooring Fluid-Applied Flooring Carpeting

21 Healthcare facility managers who understand the procedures involved in construction-related infection control can help to reduce the risks… Architects who understand the specific risks involved can help communicate the facility’s needs to the contractor…. Contractors and workers who understand the issues involved when working in a healthcare facility help to add value, safety and professionalism to healthcare construction projects. Communication is key! Working Together

22 Questions?