Healthcare workers are, like patients, subject to illness from a variety of airborne pathogens common to hospital settings. This risk increases during construction and renovation, as these endeavors release dust as well as disease-inducing microbes into the surrounding environment.
Hospitals are under competitive pressure to continually upgrade and expand their facilities. Aging infrastructure, new technologies, and the increasing demand for more patient-friendly facilities all generate a constant need for construction and repair. Any one of these activities has the potential to release dust, bacteria and mold-spores into the air.
The Centers for Disease Control (CDC) publishes guidelines designed to manage the potential health impact of construction activities. These guidelines include resources for understanding modes of disease transmission, ventilation, environmental monitoring and infection control. To manage these risks, one of our hospital clients has developed procedures for infection control during construction projects.
A Construction Management Team meets weekly to review current construction activities and communicate with staff. The committee includes representatives from the laboratory, engineering, environmental services, administration and risk management.
An Infection Control Risk Assessment (ICRA) is conducted for construction projects to determine the potential risk to patients and staff, as well as inform the appropriate regulatory agencies of ongoing activity.
Hospital staff, contractors and sub-contractors undergo training and are all required to be familiar with infection control procedures.
Environmental monitoring involves two types of activities: 1) daily physical monitoring of activities to make sure that building activities and ICRA barriers conform to infection control and safety standards, and 2) air quality testing to assess whether the ICRA barriers are preventing construction dust from entering the active areas of the hospital.
The construction management team meetings are used to keep the affected departments informed of ongoing construction activities. Information is then disseminated through a variety of means including departmental meetings, memos and email. There are also standard procedures for communication between the construction team and hospital administrators. For example, if a potential hazard is discovered, the director of facility design and construction is immediately involved. Additional steps may then be required to keep the staff informed.
In one instance, this hospital was converting an operating room into a new central sterilization suite. Workers had removed an autoclave, exposing the wall behind it. During a weekly air quality test, EES discovered large patches of mold on the wall.
We immediately informed the hospital’s director of facility design and management, who ordered a hold on construction. Based on our recommendation, he also had the area quarantined off and ordered that staff whose work areas were near the construction be relocated until we could determine if the mold was toxic.
Next, Environmental and Engineering Solutions took bulk samples to identify the type of mold and the extent of the contamination and determine if there was any danger to hospital staff or construction employees. The hospital’s management also informed the staff who worked in the area that they had found the mold.
Fortunately, the laboratory report came back negative for toxic mold, bacteria or harmful particulates. These results were made known to the staff at a special meeting. The employees were allowed to read a copy of the report to validate our findings. Using these results, we also made recommendations to the hospital regarding what remediation steps needed to be undertaken and what protective measures were required for the workers. We then conducted a visual inspection before giving the go-ahead for construction activities to resume.
By focusing on infection control, hospitals can avert potentially hazardous situations and reduce the risks to patients and staff. Communication, environmental monitoring and training, as well as adherence to strict infection control procedures are all essential steps in the process. With pre-planning, training and active communication, hospitals can manage the risks and maintain active construction schedules with confidence.
HE Number 11