In 2002, the Joint Commission adopted AIA Healthcare Guidelines as the required means to document Infection Control compliance during construction. To help make sense of the terms and acronyms, below are a few key terms you should know. If you're still eager for more, visit the Center for Disease Control.

ICRA (Infection Control Risk Assessment): This is a process that includes:  (1) the risk of patient exposure; (2) the classification of the work involved on a project and (3) the impact of patient areas above, below and adjacent to the project work area.

HEPA (High Efficiency Particulate Air):  Healthcare projects typically incorporate these filgered fans to create negative pressure differential between occupied space and the construction area.  The airflow moves clean air through the construction area to the outdoors.

JC (Joint Commission) See previous blog post 

PCRA (Preconstruction Risk Assessment): This JC term requires hospitals to assess and mitigate fire safety, air quality, utility impact, noise, and vibration in addition to infection control.

The ICRA and the PCRA should be incorporated into contract documents of healthcare projects.  This can be accomplished by adding a specification section to the documents or adding a matrix to the cover sheet of the documents.  The goal here is to give the contractor specific guidance for compliance during the project.   Project phasing is often required in the healthcare setting.   Phasing will minimize patient disturbance, ensure the flow of clean air to dirty air is attained, emergency procedures are followed, and noise and vibration control are addressed.

A Sample ICRA

Determine the required Infection Control precautions by Class. Circle each measure that applies to the work.  ICRA measures may change if scope of work changes.  Any above ceiling activities (inspections, installations, etc) require an Above Ceiling Permit from Engineering Services.  A HEPA filtration unit is required for every 50sf of work area.

CLASS During Construction Project Upon Completion of Project
  

I

 

Use work methods that minimize the raising of dustReplace tile when not working in ceiling, even if job is not complete. Ensure all ceiling tiles are put back in place with a tight fit If any ceiling tiles have been damaged the must be replaced.
  

II

 


Includes Class I Actions


Spray water mist on work surfaces to control dust while drilling or cutting, us vacuum if sanding.

Seal unused doors with air-tight barriers.

Seal any natural air vents.

Isolate or remove HVAC systems in areas where work is being performed.

Place construction walk-off mat at entrance / exit of work area.

Wet mop construction route at least 3 times daily.


Includes Class I Actions


Wipe all work surfaces with disinfectant.

Contain all construction debris in tightly covered containers before transport.

Wet mop or vacuum entire area with HEPA filtered vacuum before leaving work area.

Put HVAC back in operation.  Remove any duct tape, plastic or other barriers.

  

III

 


Includes Class I and II Actions


Install critical non-flammable barriers, such as, sheetrock, plywood or plastic to seal off work area from non-work area (LSM).

Maintain negative air pressure within work site utilizing HEPA filtration units.

Contain construction waste before transport in tightly covered containers or carts.  Covering must be taped if not solid lid.

Includes Class I and II ActionsBarriers shall only be removed when project is complete and has been disinfected by Environmental Services and approved by Infection Control.Vacuum work area with HJEPA filtered vacuumsWet mop area with disinfectantBarriers shall be removed carefully to minimize spreading of dirt and debris associated with constructionRestore HVAC systems and replace fan coil filters in areas where work has been performed.
  

IV

 


Includes Class I, II and III Actions


Construct anteroom where all workers must pass thru and to be cleaned with HEPA vacuum prior to leaving work area.

 

All workers must wear shoe covers.  Shoe covers must be changed each time the worker exits the work area.

 


Includes Class I, II and III Actions


Disassemble anteroom only after area has been disinfected and approved by infection Control.

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