Reduce dust and danger during construction

Collaboration leads to infection/construction matrix

To prevent potentially deadly dust-borne infections during hospital construction and renovation, infection control professionals in Houston have designed a risk matrix to ensure ongoing projects pose little risk to even the most vulnerable patients.

Hospital construction and renovation projects pose particular risks to immunocompromised patients who may inhale airborne dust particles that carry fungal spores that cause aspergillosis. Indeed, the Centers for Disease Control and Prevention warns that construction increases the risk of aspergillosis, and the agency recommends using special airflow and air filtration systems to keep fungal spores down in high-risk areas like bone marrow transplant patient rooms.1 In addition, ICPs have become increasingly involved in construction projects to ensure adequate controls are in place from the onset to prevent airborne outbreaks. (See related story in Hospital Infection Control October 1995, pp. 125-131.)

"I learned how to read blueprints," says Virginia Kennedy, RN, MS, CIC, an infection control professional at St. Luke’s Episcopal Hospital in Houston.

Learning each other’s language

Kennedy was the principal infection control representative on the hospital’s multidisciplinary team of architects, construction subcontractors, facility engineers, air-handling specialists, and safety personnel who developed the infection control/construction activity matrix. The group was formed to ensure the 26-story hospital could continue safe expansion and renovation, she notes.

"We knew that over the next several years, that hospital was going to be undertaking a great deal of renovation and construction projects," she says. "It took several meetings just to begin talking each other’s language."

An initial misconception construction engineers may have, for example, is that all patients in the hospital are at roughly the same risk of infection, she says.

"Either they were going to do everything or nothing," she says, adding that developing the risk matrix was a more cost-effective approach because it avoids both overkill and under-protection.

The matrix incorporates infection control risk groups and levels of construction activity to determine the appropriate barrier precautions for construction projects within the facility. (See forms, pp. 27-28.) The four infection control risk groups range from low-risk areas such as offices (Group 1) to high-risk patient care areas such as intensive care and transplant units (Group 4), Kennedy explains.

Four levels of dust activity and dust control

In addition, the levels of construction also are broken down into a hierarchy of four groups based on the anticipated level of activity and dust dispersion. For example, Type A includes inspections and "non-invasive" activities like removing ceiling tile for inspections. Type D is the "high dust" category for major demolition and new construction. Likewise, Kennedy and colleagues also came up with four levels or "classes" of dust controls that range from minimal barrier efforts to altering the hospital air handling system.

"We looked at the amount of dust generation and duration — was it going to be in and out, or a long, drawn-out process," she says. "Then the whole issue of air handling systems. Because in a large facility like this that has grown tremendously over the years, these systems are shared among various areas. We had to really look at that in terms of construction."

The matrix is created by matching up the type of construction activity with the infection control risk group, then seeing which class of barrier controls will be necessary for the project. For example, a Group 4/Type D project (i.e., major renovation near a transplant unit) would require such Class IV measures as floor-to-ceiling barriers in the construction area, negative air pressure in relation to adjacent patient care areas, use of high efficiency particulate air (HEPA) filters, and external ventilation to prevent contamination of the hospital air-handling systems. To ensure compliance, an infection control permit is required for projects where Class III or IV measures are going to be implemented, she says.

"For all major projects, we actually participate in the meeting so that we all agree on the barriers required," she says. "And there have been times when, due to the amount of construction and because of the various air-handling systems that may be shared, specific patient populations have actually been relocated during the renovation."

Construction people don’t think clinically

In undertaking such collaborations, ICPs must look at their hospital a little differently, she says. For example, work being done on the floor of one story in the building may be causing problems in the ceiling on the story below. The impact on the clinical work flow must be assessed to minimize disruptions of critical services, she says.

"That needs to be assessed clinically because the construction people won’t have that thought process," she says.

The risk matrix has proven effective in a couple of initial projects and will be implemented again as major renovation plans continue, including an upcoming expansion and renovation of the hospital’s labor/delivery area, she says.

Reference

1. Centers for Disease Control and Prevention. Hospital Infection Control Practices Advisory Committee guidelines for prevention of nosocomial pneumonia. Infect Control Hosp Epidemiol 1994; 15:587-627.