Construction projects require IP diligence

Renovation raises threat of infections

Increasingly common across the health care landscape, construction and renovation can make patient safety challenging. The need to expand facilities or upgrade existing space creates dust and particles that can easily become aerosolized, potentially transporting infectious Aspergillus and other fungal and bacterial organisms toward vulnerable patient populations.

And this risk may change with the time of day or night, notes Larry Lee, CIH, owner and founder of Pacific Industrial Hygiene of Kirkland, WA.

At night, buildings often turn their air conditioning systems to economizer modes, which can change a construction area's air pressure, resulting in dust and contaminants either escaping construction areas or coming into clean areas, he says. This problem can occur in non-construction areas as well, including in operation suites and other highly-sensitive patient care rooms.

"An operating room needs to be under positive pressure so you are delivering air to the room, and it's pushing out contaminants," Lee says. "Whenever there's an open door or leak, air is pushing out so potential contaminants and dust don't come into this nice clean area."

If the air pressure becomes negative, dust and contaminants can enter the room, so infection preventionists need to be aware of air pressure changes. Of course, certain hospital rooms need to maintain negative air pressure, such as those designated for patients in airborne isolation (i.e., tuberculosis, measles).

Developing a comprehensive approach

Xiaoyan Song"When we started the process of focusing on infection control during construction projects, our hospital was growing from 260 to more than 300 beds in 2009," explains Xiaoyan Song, PhD, MBBS, MSc, associate director of hospital epidemiology at the Children's National Medical Center in Washington, DC. In addition, the medical center had 150 construction projects last year, and one-third of those were rated at the highest risk levels with regard to infection control and prevention.

Construction work was routine, ranging from small-scale renovations to larger projects and upgrades, she adds. Monitoring the sites required an average eight hours per week. Infection preventionists spent time inspecting construction sites and communicating with construction project managers, as well as looking for patterns of deficiencies. Project managers and construction crews come with a wide variety of experience, with some knowing a great deal about infection control measures during construction work and others having no training or knowledge in this area, Song says.

"So we have to lay out our expectations differently," she says.

Guidelines from the American Institute of Architects (AIA), Association for Professionals in Infection Control and Epidemiology, Inc. (APIC), and the Centers for Disease Control and Prevention are useful for developing best practices and protocols, she adds.

Use such sources to develop policies that will best work in your facility. "When I came on board at the hospital I was given the role of point person to work with construction projects," says Tracie Harris, MT, ASCP, CIC, infection preventionist at the the Medical Center.

Harris and Song worked together to develop policies, best practices, and risk assessment tools. "Previously, we'd receive a phone call or visit a project and notice that not all of our recommendations were being followed," Harris explains. "So we developed a checklist and a procedure for monitoring those projects weekly." The weekly checklist provides consistent monitoring and is designed to catch problems quickly. (See sidebar, below.)

Hospital uses weekly construction checklist

Problems are headed off quickly

A weekly checklist for construction projects used at the Children's National Medical Center in Washington, DC includes the following key assessments, which are marked Yes, No* or NA (not applicable).

Temporary Construction Barriers

  • Barriers are appropriate and properly sealed
  • Construction/authorized personnel signs
  • Doors properly closed and sealed
  • Walk-off mats before and after door
  • Walk-off mats properly maintained
  • Lockable door in place

Air Handling/Dust Control

  • Negative air at barrier entrance checked and verified
  • Negative air machine running
  • Documentation of filter service
  • HVAC ducts (supply & return) sealed

Project Area

  • Debris removed in covered container
  • Trash in appropriate containers
  • Routine cleaning done in patient care area adjacent to job site by
  • Construction crew or housekeeping as needed
  • Staging of materials and supplies in isolated secure room

Traffic Control

  • Job site restricted to construction workers and necessary staff only
  • Patient traffic separated by time or space from construction traffic flow activity

Dress Code

Appropriate for the area

*All "No" items must be corrected or mitigated within 24 hours.