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Infection prevention and control is a serious issue for healthcare facilities during renovation projects. While most hospitals understand the implications of larger renovations, facilities often overlook infection control when planning smaller projects. The risk to patients and employees remains regardless of the projects size, and medical centers must enact their infection control protocols accordingly.
Tom Petersen, president of Environmental and Engineering Solutions, Inc., who has significant experience with Infection Control Risk Assessment (ICRA) and infection control measures, believes smaller renovation projects often present a greater risk to patients and staff, due to their decreased visibility. "Small-scale construction projects can easily fly under the radar," Petersen says. "These projects can create an out of sight, out of mind mentality, and leave the facility vulnerable to healthcare-associated infections (HAIs)."
Facilities can easily reduce this risk by learning from the mistakes of others. Petersen offers the five most common infection control mistakes during smaller renovation projects.
1. Not conducting an Infection Control Risk Assessment (ICRA)
An ICRA, or a multidisciplinary, documented process that focuses on the reduction of risk from infection and acts through the phases of facility planning, design, construction, renovation and maintenance, provides guidance to administrators and construction personnel on proper infection control protocols. While most large renovation projects require an ICRA, smaller projects often do not. Petersen suggests that all facilities conduct an ICRA before starting a project. This ensures that all necessary measures are in place before a project begins, and educates administrators on the requirements so they can evaluate the maintenance of these items throughout the renovation.
2. Under-sizing the negative pressure system
Facilities often consider negative pressure systems less important in small construction projects, and consequently they utilize the incorrect system size. The improper sizing of negative pressure systems does not allow for the recommended negative pressure of 0.01 inches of water, and can result in construction zone dust escaping into the general hospital area.
3. Conducting renovations during off hours
While this may seem like an appealing option, it can quickly lead to sloppy work practices. Many healthcare facilities believe that by conducting construction during off-hours they can reduce costs and avoid the necessity of installing proper contaminant barriers; however, hospitals operate 24/7, therefore the risk to patients and staff exists 24/7. These contaminant barriers, or ICRA containment, and other preventive measures exist for a reason and their misuse can result in unnecessary contaminant exposure.
4. Improper design of the containment barriers and anterooms
Improper placement of containment barriers and anterooms can make the difference between successful infection control and an outbreak. If the containment walls and other enclosures interfere with the placement of equipment or utilities, workers may bypass or dismantle them, which could lead to hospital-wide contamination. Personnel must consider the entire construction zone and the project flow before building these structures.
5. Failure to follow industry protocol for mold
Upon discovery of mold in a construction zone, personnel must enact specific measures to prevent the spread of mold spores. Failure to take all the appropriate steps, such as those outlined in the November 2008 Guidelines on Assessment and Remediation of Fungi in Indoor Environments published by the New York City Department of Health and Mental Hygiene, could place the facility at serious risk for an outbreak.
While this does not outline every possible mistake for small-scale construction projects, it does provide guidance and forewarning for healthcare facilities considering such renovations. Regardless of the project's size, infection control must remain paramount.
"Small hospital renovation projects can have large negative consequences if they are not done right," Petersen says. "By keeping infection control a top priority before, during and after your next construction project, you can protect your patients and staff from exposure to contaminants and minimize the chances of illness."