Construction and Renovation Activities in Healthcare Facilities

1. Construction and Renovation Activities in Healthcare Facilities What construction crews should know, but were afraid to ask!

2. Construction/Renovation andInfections • Describe how construction and renovation may be associated with infections in certain patients. • Review methods to control infections associated with construction and renovation.

3. Definitions • Airborne Infections • Aspergillus • Legionella • Immunocompromised patients • High efficiency particulate air (HEPA) filters • Negative air pressure ventilation

4. Aspergillus (I) • Is a mold: found everywhere • Very hardy: spores difficult to get rid of • Collects in dust and thrives in moisture: • ventilation systems • false ceilings • walls • Becomes airborne when disturbed

5. Aspergillus (II) • Construction and renovation makes spores airborne • In immunocompromised patients: • lung infection: inhaled • sinus and brain infections: inhaled • skin infections: settles on “broken” skin • infection in other parts of the body: eye, liver, bone, heart

6. Immunocompromised Patients • Transplant recipients, especially bone marrow • Chemotherapy • Chronic Diseases: lung • Premature infants • Intensive care unit patients

7. Disturbing the Peace: “ComeFly with Me” • Removing and demolishing: • fireproofing material • ceiling tiles • plasterboard • cabinets • “wet” material: plumbing fixtures • Transportation of uncovered debris

8. Hospital control and Patrol:Hold the Dust • Provide floor to ceiling barriers that completely enclose the work areas: • For small projects: thick plastic (visqueen) dust abatement curtain: must be well-sealed • Moderate and large projects: wall boards and door with caulked seams

9. Hospital Control and PatrolHold the Dust • Dust mats • at places of entry and exits • replace when soiled • Cover work clothes for high risk areas • use head gear • shoe covers • coveralls

10. Hospital Control and Patrol:Hold the Dust (II) • Negative air flow: all corridor air is “sucked” into work area: • HEPA filter in work area removes spores • Exhaust fans allow external venting • Closed windows and doors maintain negative air flow • Block ventilation ducts prevent contamination of ventilation system

11. Hospital Control and Patrol:Hold the Dust (III) • Traffic patterns • Use designated elevators, stairs • Go from clean to dirty • Use wet mops to remove dust in work areas and path of debris carts • Clean equipment before entry and removal from work areas • Use HEPA filter vacuum for heavy dust

12. The Intrusive Water and Asperillus • Stop the leak and dry completely • Molds will grow if spills are not dried within 48 hours • Molds grow well in humidity > 60% • Use meter to detect “wetness” • Notify project manager and infection control if area still wet after 48 hours

13. The Watchful Eye • Monitor air flow in construction area daily • Keep barriers in place • Prevent dust accumulation • Seal debris and debris carts • Careful with work clothes • Questions? Ask Infection Control!

14. Legionella: Water Distribution • Excavation may aerosolize organism from soil: • contaminate cooling towers • air intake systems • water pipes • Causes severe pneumonia • Inhalation of contaminated aerosol

15. Outdoor Construction and Demolition • Locate fresh air intake systems • Change filters more frequently • Control dust with water mist • Fracture of the water lines may contaminate water supply