Infection Control Risk Assessment - ICRA 101 Provide the health care facility with the best trained,...

Infection Control Risk Assessment - ICRA 101

Provide the health care facility with the best trained, knowledgeable and qualified construction workforce in order to get the job done right and protect the health and safety of patients, staff, workers and the public with minimal disruption of daily activities and operations.

THE MISSION

Hospital associated infections (HAIs) like MRSA and aspergillus continue to be a problem in health care facilities.

It is estimated that each year in the US:

• 1.7 million patients acquire HAIs• 99,000 patients die from these infections• 5,000 HAI deaths are from construction related activities• Studies indicate invasive aspergillosis can occur during

construction and renovation

THE CHALLENGE

• Describe the various risks and challenges involved in working in occupied health care facilities

• Explain how to develop a health and safety plan between the facility owner and contractor

• Identify different effective procedures to protect patients, staff, workers, and the public from any hazardous materials, contaminants or infectious agents

• Recognize and understand the remediation of hazardous materials, contaminants or infectious agents

• Differentiate the responsibilities of the contractor, architects, and facility owner

OBJECTIVES

• The primary goal is to maintain the patients’ health

• Patients are vulnerable to infections and diseases due to weakened immune systems

• Immunocompromised patients include burns, premature babies, organ & bone marrow transplant, ventilator, dialysis

• Daily operation of facility is critical

• Protect PATIENTS, staff, workers and the public

HEALTH CARE FACILITIES

When working with or around hazardous materials it is essential to warn others of the possible dangers using:

• Placards• Labels• Containers• MSDS

HAZARDOUS MATERIALS

• Materials that pose risk to: health, safety, and the environment

• Present at jobsites within health care facilities in many different forms

• Acute and chronic health effects can result from exposures over OSHA’s PEL

HAZARDOUS MATERIALS

• Materials that pose risk to: health, safety, and the environment

• Present at jobsites within health care facilities in many different forms

• Acute and chronic health effects can result from exposures over OSHA’s PEL

• Permissible Exposure Levels – What is your level?

• What are some Hazardous Materials you see at work?

HAZARDOUS MATERIALS

Hazards found in occupied building:

• Asbestos

• Lead

• Fungi

• Silica

• Chemicals

HAZARDOUS SUBSTANCES

Hazards found in occupied buildings:

• Bacteria

• Mold

• Radiation

• Mercury

• Medical Waste

HAZARDOUS SUBSTANCES

• Interim Life Safety Measures (ILSM) team’s goal is to ensure safety of patients

• Implements emergency evacuation plans and identifies fire, safety, and security measures

• Must have and maintain an unimpeded exit plan. If construction work blocks the exit plan, the ILSM team must have an alternate plan

• PATIENT safety must come first

I.L.S.M. TEAM

• Infection Control Risk Assessment (ICRA) team’s goal is to minimize risk of hospital acquired infections (secondary infections)

• Studies scope of work to be done and evaluates risk factors and potential hazards

• Matrix: Matches project type and patient risk group

to determine work area classification

• ICRA forms – required by The Joint Commission (TJC)

I.C.R.A. TEAM

• Classification determines the type of barriers

• Can change if mold, lead or asbestos are found

• Air tight seals are essentialPortable cubesSoft wallsHard wallsAnterooms Positive and/or negative air pressures

CONSTRUCTION PROCEDURES

PORTABLE ISOLATION CUBE

• Small single person containment used for inspection or short term

• Collapsible barrier that can be easily maneuvered and deployed

• Great for working above ceilings

• Negative HEPA air seal and vacuum cleaner

• What is the estimated total cost of all the items in this picture?

• Quick and safe

• Suitable for short term

• Convenient for emergencies

• Zipper door for access

• Will this work with negative and/or positive air pressure?

SOFT WALL SYSTEM

• Long term temporary partition

• Protects patients and the public from contaminants

• Built with common construction materials like metal studs and drywall

• Sealing is essential

• Sustains impacts from gurneys

HARD WALL SYSTEM

• Changing room for PPA

• Extra protection in sensitive areas

• May be hard or soft wall systems

• Excellent transition between differential air pressures

ANTEROOM

• Positive

• Negative

• Equal

• Monitoring: Flutter gauge Ball gauge Magnehelic

• Documentation - using data from an air particulate counter

AIR PRESSURE

• Personal protection equipment (PPE) is worn inside contaminated and protects workers from hazards or contaminated material

• PPE is donned prior to entering contaminated area and removed prior to entering patient occupied area

• What is PPA?

PERSONAL PROTECTION

• Protective apparel designed to prevent transferring of contaminants from worker to patients

• Used when entering or exiting the containment area

PATIENT PROTECTION APPAREL

• Before construction work commences existing finishes must be protected

• Fixtures, furniture, floors, computers, walls, floors, doors, windows, window treatments, casework and contents, elevator cabs and all equipment

• Protective materials – polyethylene sheeting, hardboard, plywood, cardboard, tape and self sticking floor protector

• Decommission any equipment or computers in cooperation with hospital staff.

• Patient privacy must be protected at all times, ie.. charts

WORKSITE PREPARATION

• Obtain inspection documents

• Jobsite cleaned and disinfected by contractor and the hospitals environmental services team

• Fire alarms and smoke detectors tested

• HVAC systems functioning properly

• Remove barriers and signs

• Final cleaning performed by the facility

JOB COMPLETION

• UBC members get a 24 hour class that includes classroom and “hands on” shop activities

• 8 hour Trades Awareness class available to everyone

• AIA continuing education class – 1 ½ hour lunch and learn

• Look at the shop picture, see anything wrong or concerning?

WORKER TRAINING

• To minimize risks of secondary infection and other issues, contractors and workers must understand procedures of working in an occupied health care facility (29 CFR 1926, OSHA, NYC Guidelines for mold remediation)

• Knowledgeable facility managers and employees will help reduce risk of secondary infections (CDC, TJC, CMS, ASHE)

• Architects recognize the risks and protocol involved and inform contractors and facility managers of specific precautions. Recognize the importance of a highly trained workforce. (FGI - 2010 edition)

WORKING TOGETHER AWARENESS – COMMUNICATION - PROTOCOL

• The United Brotherhood of Carpenters and Joiners of America is a Registered Provider with The American Institute of Architects Continuing Education Systems (AIA/CES) for AIA members. Certificates of Completion for both AIA members and non-AIA members are available upon request.

• This program is registered with the AIA/CES for continuing professional education. As such, it does not include content that may be deemed or construed to be an approval or endorsement by the AIA of any material of construction or any method or manner of handling, using, distributing, or dealing in any material or product.

• Questions related to specific materials, methods, and services will be addressed at the conclusion of this presentation

Infection Control Risk Assessment - ICRA 101

The Carpenters International Training Fund responded by creating:

Construction ICRA:Best Practicesin Health CareConstruction in Occupied Facilities

Training and Qualification Program 28

Construction ICRA: Best Practices in Healthcare Construction

Training Program Goals

• Develop comprehensive skill-sets to address the concerns of health care administrators for containing pathogens, protecting patients, and working without disrupting operations

• Heighten the sense of accountability and responsibility by those working in occupied facilities

• Create a workforce for all levels of the project: From apprentices and journeymen, to foremen and superintendents

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Developing Core Training Protocols

• Consulted with industry experts in pathogen containment during construction work in occupied facilities to collect relevant, up-to-date technical material

• Researched which best practices would deliver the trained professionals that a health care jobsite requires

• Established a system for the ongoing review of all training materials with industry experts to refine technical information and anticipate emerging job site requirements

30


Training Delivery

Tier 1: Train-the-TrainerPrerequisite: CITF Master Instructor Status

Parameters:• 40-hours of hands-on training in

simulated conditions at the CITC

• Frequent refresher courses are required

• Qualification certificates issued by CITF

• Re-certification mandatory every 48 months

31


Training Delivery

Tier 1: Train-the-Trainer:Topics focus on awareness and best practices in:

• Blood-Borne Pathogens

• Hazmat Material Overview

• Recognizing Hazardous Material

• Lead, Asbestos, Silica and Mold

• Controlling Exposure

• Exposure Limits

• Routes of Entry• Health Effects

• Site-Specific Considerations

• Work Practices

• Health Care Facility Awareness

• Individual Responsibilities

• Regulatory Agencies and Organizations

• Risk Evaluation

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• Documentation

• Contaminants and Infectious Agents

• Controlling Contaminants

• Air Pressure

• Containing the Work Area

• Pre-work ActivitiesWork Activities

Training Delivery

Tier 1: Train-the-Trainer:Instruction also covers…

• Work Area Classifications

• Mold in a Health Care Facility

• Pre-Remediation Activities and Considerations

• Personal Protection

• Remediation

• Work Practices for Mold Remediation

33


34

Training Delivery

Tier 2: UBC member training

• 24 HOURS of TOTAL TRAINING (16 hrs. of class time/8 hrs. hands on)

• Training spans all levels needed on a health care jobsite- Apprentices - Journeymen- Foremen - Superintendents

• Qualification cards earned: • Best Practices in Health Care Construction

• Refresher & ongoing training courses required• Re-certification mandatory every 4 years

• Blood Borne Pathogens Card• Re-certification available every year


35

Training Delivery


Protocol and skill development addresses: • Hazardous Materials Awareness

• Lead, Asbestos, Silica, and Mold

• Individual Responsibilities to Patients

• The Structure of the ICRA Form

• Regulatory Agencies and Organizations

• How to Deal with Hospital Personnel

• Containing the Work Area


36

Training Delivery


Protocols and skill development addresses:

• Work Area Classifications

• Anteroom Construction

• Erecting and Sealing a Soft Wall

• Working Within a Portable Isolation Cube

• How to Establish a Negative Pressure Environment

• Personal Protective Equipment Familiarization

• How Secondary Infections are Acquired


37

The ICRA form is broken down into steps

Step 1: Project Type

38

Step 2: Patient Risk Group

The four types of Patient Risk

Groups are:

Low Risk Group

Medium Risk Group

High Risk Group

Highest Risk Group

39

Step 3: ICRA Matrix

The ICRA matrix is the graph used to match project type and patient risk to determine work area classification I, II, III, or IV.

40

Step 4: Surrounding Project Area

Potential impact to rooms surrounding the project area is

assessed.

The patient risk group above, below, and around the project area is

determined.

41

Step 5: Identify Specific Site

The specific site is recorded: patient room, clean utility room, medication room, or other.

Step 6: Related Issues

All issues related to facility systems such as ventilation, plumbing, and electrical.

The probability of system outages is indicated.

42

Step 7: Containment Measures

Are containment measures needed?

If so, is a soft or hard wall barrier needed?

Is HEPA filtration required?

Step 8: Potential Risk of Water Damage

Information is determined and recorded, such as:

potential risk of water damage

information concerning structural members and sprinkler or plumbing pipes to be removed or altered

Any potential risk of compromising structural integrity is determined.

43

Step 9: Work Hours

The actual time the work will be performed is recorded:

Will it be done during nonpatient hours?

Will it be done in segments?

Steps 10–13: Facility Design

building codes

Americans with Disabilities Act (ADA)

American Institute of Architects® guidelines (AIA)

Step 14: Placement of Containment

Barrier placement is determined by:

traffic patterns, debris removal

housekeeping needs, fire codes

44

Infection Control Construction Permit

completed and issued by the ICRA team

issued only for a Class III or Class IV project per the TJC

Changes in Work Classification

The classification level can change during the course of the project.

Changes may occur due to processes that create dust or due to the discovery of mold or other hazardous material in the containment area.

If there are any hazardous materials discovered on the jobsite, the supervisory staff must be notified immediately.

Communication is essential for the success and safety of projects.

How Can We Help You?

• We aren’t looking to re-write your hospital’s protocol; we simply want to work collectively ensuring the patients safety remains the

#1 Priority!• Use the resources that are

available to you right now45


8 hour awareness for other trades or maintenance

• Can your maintenance personnel use some brushing up?

• Educate hospital staff, RN’s, and FM’s on the basics of Construction ICRA

• What do insurance carriers think about Continuing Education?

• Remember, this training can be tailored to fit your Hospital’s needs

*Worker training is a critical component of a multifaceted approach to Infection Control* 46


8 HOUR OVERVIEW

• Gain a better understanding of infection control in an

occupied facility

• Adhere to all work class precautions

• Have the ability to recognize hazards

• Basic understanding of barriers, HEPA machines,

air changes, regulatory agencies, finding mold, etc.

• Have the ability to recognize hazards

• Understand their responsibilities during emergency

situations47


How Can You Help Yourselves?

*You have the resources available NOW to implement the Construction ICRA Qualification in your Facilities*

*Put language in your Pre-bid Docs, Hospital Spec Docs, and Construction Docs.*

48


How Can You Help Yourselves?

**REQUIRE OR MANDATE ALL

CARPENTERS WHO WORK IN

YOUR FACILITY SHOW PROOF

THEY HAVE TAKEN THE UBC 24

HOUR CONSTRUCTION ICRA

TRAINING**

Both stickers and qualification cards49


Coalition Building

5050


A Collaborative Approach Meeting the Needs of Health Care Organizations…

• This Best Practices program is designed to

enhance the existing craft skills of UBC members

• Its training is consistent with the CITF’s standard protocol of industry-based, expert-reviewed, certified-instructor curriculum delivery

• The needs of the end-user remain a focal point during training, so that UBC members meet and exceed project expectations

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Working Together• Healthcare facility managers who understand the procedures involved

in construction-related infection control help to reduce the risks

• Architects who understand the specific risks involved help to communicate the facility’s needs to the contractor

• Contractors and workers who understand the issues involved when working in a healthcare facility help to add value, safety and professionalism to healthcare construction projects

Communication is key!

52


Q & A

*Thank you for your time and we

enjoyed speaking to you about

our Construction ICRA Training* 53


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