1. Presented By: Kary S. Amin Nova Environmental, Inc.
Michigan Association for the Healthcare Environment Infection Control During Construction & Renovation
Presented By:
Kary S. Amin
Nova Environmental, Inc.
Nova Environmental, Inc.

2. Infection Control During Construction & Renovation
Issues and Concerns
Preconstruction Planning
Contaminants Generated By Construction
Proper Containment and Isolation
Post-Construction & Clean-up
Development of Infection Control Policy
Nova Environmental, Inc.

3. Issues and Concerns Unique concerns in hospitals… Continual occupancy
Increased suseptability - Immune
Deficiency/HAI
(Hospital Acquired Infection)
Construction’s effect on
accessibility and impact
on emergency planning
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4. Issues and Concerns Unique concerns in hospitals
“Minor problems can be deadly”
Jackhammer could dislodge years of build-up in plumbing system, releasing bacteria into the water supply.
Dust from drywall demolition could enter the HVAC and disperse to operating areas.
Rain could blow into open windows, creating moisture intrusion that can lead to mold growth.
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5. Pre-Construction Planning
Complete an ICRA (infection control risk assessment)
Documented guideline.
Diverse group of employees involved, including infection control staff.
Begins early in design stage.
Intended to evaluate design and construction’s impact on occupants and the environment.
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6. Pre-Construction Planning Design
Design to support infection control and in compliance with relevant guidelines, standards, codes and regulations.
HVAC, recommended ventilation and filtration
Mechanical systems involving water supply and plumbing
Number and type of hand-washing fixtures, soap, paper towels, lotions
Sharps disposal unit placement
Accommodation for PPE
Type of surfaces, ceiling tiles, walls, counters, floor coverings, furniture, etc.
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7. Pre-Construction Planning Location of Construction
Proximity to high risk areas (Surgery, Mother/Baby, Intensive Care, Emergency Room, Oncology, etc.)
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8. Pre-Construction Planning Extent of Construction
Size of work area
Length of construction schedule
Scope and degree of activities
Number of workers
Contractor shifts
Accessibility, egress
External excavation/construction
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9. Pre-Construction Planning Type of Construction
Demolition of components
Pre-planning for asbestos, lead, mold, dust & debris generation
Evaluation of HVAC isolation
Shut off or reroute
Negative/postitive air pressure
Construction area air filtration and movement
Installation of new furnishings and building components
Odors (VOCs)
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10. Pre-Construction Planning Type of Containment
Intent is to ensure complete isolation of potential construction contaminants from building occupants and environment
Needs to be detailed and identified within construction documents
Coordination through construction managers or general contractors
Determination of standards for accountability
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11. Pre-Construction Planning Monitoring – Determine Cleanliness
Consider air monitoring, especially when construction is adjacent to high risk areas
Consider establishing criteria for level of cleanliness expected upon completion of construction work, (visual, clearance sampling)
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12. Contaminants Generated By Construction
Asbestos
Fibrous mineral that can be incorporated into any building component (inhalation hazard)
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13. Contaminants Generated By Construction
Lead
Element that has commonly been used in paint and incorporated into drywall used in X-Ray areas of hospitals (inhalation and ingestion hazard)
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14. Contaminants Generated By Construction
Mold
Fungi that can develop or grow on organic building components (inhalation and ingestion hazard)
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15. Contaminants Generated By Construction
Bacteria
Potentially hazardous microorganisms that have needs similar to mold, nutrients and moisture (various routes of entry)
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16. Contaminants Generated By Construction
Dust and Debris
Particulate (and potential fumes) common during construction and renovation (inhalation hazard)
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17. Proper Containment & Isolation
Isolation of construction zones from rest of building
Small short projects with minimal dust generation, fire rated polyethylene, sealed entryway
Larger projects require rigid dust-proof and fire rated barrier walls, (such as drywall) with caulked seams for tight seal
All stationary items seal with critical barriers
Barrier to extend above ceilings, below floors (tunnels) if applicable
Verify that everything is properly sealed
(Need to consider egress and accessibility issues)
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23. Proper Containment & Isolation
HVAC
Shut off or temporarily modify
Critical barriers over all vents/diffusers/ducts
Construction must be under negative pressure with respect to adjacent areas at all times, may need portable ventilation systems
Exhaust from construction should be exhausted directly outside if at all possible. If re-circulated, must be flowed through HEPA filtration system
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25. Proper Containment & Isolation
Decontamination
Ensuring workers and equipment coming out of construction zone don’t contaminate non-construction areas
Workers to HEPA vacuum dust/debris off cloths prior to exiting work area
Tacky mats and disposable boot coverings should be used
Equipment and supplies cleaned prior to exiting work area
Debris removed from construction sites in carts with tight- fitting covers
Designate elevators for construction traffic only
Adjacent areas mopped daily or as needed to control dust
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27. Post-Construction & Clean-Up
Plans should include vacuuming of construction areas and flushing debris from water systems before re-occupancy
Sufficient ventilation to vacate odors from new furnishings
All surfaces within construction zone should be dust-free
Visual inspection by hospital representatives a must
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28. Post Construction Sampling
Intended to document that renovated area is “safe” for re-occupancy.
After cleaning, prior to barriers being removed
Consider:
General particulate air sampling
Dust sampling for lead
TO sampling for VOCs
Nova Environmental, Inc.

29. Post Construction Cleanup
Clean during process of barrier dismantlement
Final cleaning of areas, including locations of barriers. This should be performed with HEPA vacuums, not brooms!
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30. Development of Renovation Construction Infection Control Policy
Written program with following components:
Infection Control Risk Assessment
Construction Design Phase
Requirements for containment & Isolation
Contaminant control methods
Post-construction cleanup and sampling
Clearance criteria
Nova Environmental, Inc.

31. Presentation Summary
Ensure that infection control staff are involved from initial stages of design;
Ensure that infection control procedures are taken seriously by all contractors and that there is accountability;
Ensure that post-construction cleanup is extremely thorough;
Consider third party clearance sampling to provide occupant documentation of cleanliness.
Nova Environmental, Inc.

32. Thank you for participating Nova Environmental, Inc
Thank you for participating Nova Environmental, Inc Plymouth Road Suite 210 Ann Arbor, MI (734)
Nova Environmental, Inc.