Implementation of Infection Control & IAQ Measures for...

Implementation of Infection Control & IAQ Measures for Healthcare Facilities During Construction, Renovation or Maintenance

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Presenter: Peter L. Semchuk, FCSC, RSW, CET, CCCA, LEED AP, BD+C Senior Associate, IBI Group April 10, 2013

CSC Winnipeg Chapter APRIL MEETING PRESENTATION

The importance of establishing infection and climate control strategies in Healthcare Facility construction• Publisheddataidentifiesover90,000deathsannuallyduetoinfections

• Asignificantportionisattributabletoairbornepathogensexacerbatedduringdemolition,constructionandmaintenanceactivities

• Primarycause-dustparticlescreatedduringtheseactivitiesactastransmittersoffungalsporesthroughoutthefacility.


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Importance of Establishing Infection and Climate Control Strategies


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Preventative measures to reduce the airborne transfer risk include:

• Enactingfundamentalchangestocurrentconstructioncleaningprocedures

• Managingtheinternalenvironmentduringconstruction

• Developingnewinnovativemethodologiesusingconstructionairhandlingequipmenttocontrolinternaltemperatureandhumidity

Preventative Measures to Reduce Airborne Transfer

Scissor lifts were utilized to provide access for the purpose of conducting a detailed review and cleaning of complete d installations.

Ducts were pressurized with HEPA filtered air to prevent any build-up of dust and debris.

Inspection Monitoring Report by the Contractor


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Challenges faced are:

• Constructionsitesthatareclutteredanddebrisridden

• Intermittentclean-upprocedureswithfinalcleaningassignedatprojectcloseout

• Poorindoorairqualitycreatedbyantiquatedtemporaryfacilitiesandequipmentprovidinginternalheatingandcooling(directfiredcombustionheaters,highvelocitycirculationfans,openordiscontinuousexternalbuildingenvelopeenclosures,etc.)

Challenges


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Site Photos of Inferior/Ineffective IC/IAQ Procedures

Open hoarding enclosures

Unprotected building openings

Direct fired heating equipment

Unsecured/non-fixed temporary enclosure


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Past practices, procedures and temporary facility installations are no longer acceptable in today’s construction and renovation environment.

• Requiredimplementationofacceptedstandardsforhealthcareconstructioninclude:

• CSA Z8000-11 CanadianHealthCareFacilitiesConstruction

DesignandConstructionFacilityEngineeringandPhysicalPlant(September2011))

• CAN/CSA Z317.13-07 InfectionControlDuringConstruction,

Renovation,andMaintenanceofHealthCareFacilities(August2008)

Past Practices


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How can accepted standards be easily implemented during renovations of existing or construction of new health care facilities?

• Stringentpoliciesandproceduresprescribedintheacceptedstandardsareoftendifficulttomeet,andinsomeinstancescounterproductive.

• Integratingstandardswithotherprojectparameters-CaGBC-LEEDEQc.3.1/3.2ConstructionIAQManagementPlanduringconstruction/testingbeforeoccupancy.

Implementation of Standards


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The Challenge

ImplementanintegratedIndoorAirQualityPlan/InfectionControlPlanthatwouldincorporatetherequirementsofbothCSA317.13.07andCaGBCLEEDCredit3.1(ConstructionIAQManagementPlanDuringConstruction),fromenclosureofbuildingenvelopethroughtofacilityturnover.

CSA 317.13.07

Infection Control Plan

From Enclosure of Building Envelope

To Facility Turnover

LEED Credit 3.1/3.2

+

Develop Infection Control Plan Implement Infection Control Plan

IC/IAQ - An Integrated Approach


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Developing a Comprehensive Team Approach for Implementation of a Project IAQ Plan.

• StrikeaprojectteamtooverseetheInfectionControlPlan(IFC)

• Multi-disciplinaryparticipantsincluding:

• ConstructionManager

• TheOwner

• TheClient

• TheDesignTeam(A/M/E/C)

• TheEndUser(Operator)

• ThirdParty(InfectionControlPractitioners)

Comprehensive Team Approach


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EllisDon

Alberta Infrastructure

Alberta Health Services

Design Team

Hospita

l

Client

Con

stru

ction

Manager

IFC Plan

Archi

tectHea

lthca

re

Sp

ecia

list

Engineer

Clinical CoordinatorAdministration

Infection

Control

Housekeeping

Staff

Facility O

perato

r

Clin

ical

Coo

rdin

ator

Project

Manager

Subcontractors

IBI Group Architects Engineers

Stantec

Fort Saskatchewan Community Hospital

Teegor Consulting Inc.The Team

TheIFCteamhadnumerousmeetingstodeveloptheIFCPlanandthentooverseetheimplementationofthesame.

Regularmeetingswereheldthroughouttheproject,fromstartoftheconstructionoftheinteriorstoafterturn-over.

Thisteamnotonlyhadtomanage(contractor,designers)thePlan,butlivewiththeoutcome(usersandoperators).


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The IFC Team (Structure from the Fort Saskatchewan Community Hospital)


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The goal of Implementation of and Integrated IC/IAQ Plan:

IndevelopingtheIC/IAQplan,thepreliminarygoalistolimitthepotentialforfurther(postoccupancy)generationoffungalsporesandbacteriaresultingfromtheconstructionprocess.Theaimisto:

• Controldustgeneration

• Preventdustfrominfiltratingoccupied(orcompleted)areas

• Preventgenerationofaerosolsfromcontaminatingwatersources

• Preventmoldandbacteriagrowth

• PreventdustinfiltrationintoHVACsystems

• Maintainingambientinteriortemperatureandhumiditycontrolsandcontrollingorpreventingdustanddebrisbuildup,afuturesourceofnutrientsforsporesandbacteriaisminimized.

• Turn-overofthecompletedfacilitywouldbesooner,withlessneedtoaddressfinaldeficiencies,suchas,re-cleaningductwork,oraddressingexpansionorshrinkageofsensitivefinishmaterialinstallations.

Goal of Implementation


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Risks

• Fungus and bacteria(suchasAspergillusandLegionella)whichhaveahighmortalityrateinimmunodeficientpersons.

• Construction activities thatwillgeneratedustandspreadoffungalsporesandotherfungiandbacteria.

• Plumbing Systems interruptionsthatcanintroducebacteriatowatersupplyorallowwatertositandallowexistingbacteriatogrow.

• Water / humidity damage to construction materialsthatcanallowmicroorganismsintheenvironmenttothrivebeforeandafterinstallation.

• Contamination of duct work / mechanical equipment during constructionwhichcreateawarmenvironmentformicroorganismstogroworcreatearepositoryforsuchmicroorganisms.

IC/IAQ Implementation Risks


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• Construction,unfortunately,isadirtyprocesswithcontinualgenerationofdustandaccumulationofdebristhroughoutthefacility.

• Executionofworkisphasedorstagedwithdegreesofactivityandratesofcompletionvaryingthroughoutthefacility,basedonthescopeofwork,andassignedimplementationplan.

• AnintegratedIC/IAQPlanmustbedevelopedwithconstructionphasingandstagedimplementationoftheworkinmind.

• Theconstructionteam,inthefirstinstance,willdeveloptheimplementationoftheIC/IAQPlan.

• Thecontractor’sexpertise,andimplementationofthework,throughrequiredconstruction‘meansandmethods’willdeterminetheinitialimplementationstrategy.

• SubsequentreviewandacceptanceoftheIC/IAQPlanbytheIFCteamisrequired,priortoon-siteexecution.

The Approach to Developing and IC/IAQ Plan


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The GoalLimitthefuturegenerationoffungalsporesandbacteriaasaresultofconstructionpracticesandproceduresby:

1

2

3

4

5

6

Controlling dust and debris accumulation.

Preventing dust from infiltrating into occupied (or completed) areas.

Preventing generation of aerosols from contaminating water source.

Preventing mould and bacteria growth.

Preventing dust infiltration into HVAC systems.

Maintaining ambient temperature and humidity controls.%

The Approach to Developing an IC/IAQ Plan


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FORT SASKATCHEWAN COMMUNITY HOSPITAL IFC PLAN

Thehospitalwasdividedintothreeareas,theinpatient unit,health services,anddiagnostic and treatment.

Air-lockvestibuleswereintroducedbetweeneachoftheseareas,whichallowedincreasedcontroloftheindoorairqualityofeachareadependingonwhichstageofconstructionitisat.

Diagnostic and Treatment

Inpatient Unit

Sterile Core (Operating Theatre)

Health Services

LEGEND

Fan Bank and Mist Machine

Temperature and Humidity Instrument

Air Intake

Suspended Mezzanine Above Operating Theatres

Operating Theatres

Air outtake

Air -lock Vestibule

Boot Cleaners & Door Signage

CCA EXCELLENCE IN INNOVATION AWARDFORT SASKATCHEWAN HOSPITAL FLOOR PLAN

The hospital was divided into three areas, the inpatient unit, health services, diagnostic and treatment. The design of the Hospital allowed for relatively easy demarcation and separation of these areas by permanent full height walls. Air-lock vestibules were introduced between each of these areas to demark the separation.

Air-lock Vestibules

Boot Cleaners

Entrance

Air Flow

Temperature and Humidity Instruments

Fan Bank and Mist Machine

T/H

T/H

T/H

T/H

T/H

T/H

T/H

Implementing the Infection Control (IFC) Plan


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The Approach

Thegenerationoftheamountofdustanddebrisvariesfromextensively,intherough-inphases,tolimited,duringthefinalfinishingphase.Workthroughouttheconstructionsiteisneverallatthesamestage.Someareasarecompletedearlyandothersduetothecomplexityorspecialrequirementsfinishlater.

Eachphasehaddifferentmeasuresinstituted,reflectingthestageofconstruction.The5phasesincluded:

• PHASE1A–Rough-inofundergroundservices,concretepouredandreadyforstuds.

• PHASE1B–Rough-inofsystems,steelstudanddrywallpartitions.

• PHASE2–Installationoflocalsystems/branchlines,millwork,painting

• PHASE3–Installationoffinalfinishes,accessoriesandequipment.

• PHASE4–Nolongerconsideredaconstructionsite,butratherasaHospital

Implementing the Infection Control / Indoor Air Quality (IC/IAQ)


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PHASE 1A PHASE 1B PHASE 2 PHASE 3 PHASE 4

No Smoking, No Food or Drinks (except water)

Daily Cleaning with Dustbane Sweeping Compound and HEPA filtered Vacuum

Walk-Off Mats at Entrance to Areas

Monitor and Control Temperature and Humidity

Negative HEPA Filtered Work Air Vented to the Outside

Seal Duct Work

Pressurized Vestibules Separating Construction Areas

Before Walls Enclosed, Vacuum and Inspect All Stud Tracks Electrical Boxes.

Implementing the Infection Control / Indoor Air Quality (IC/IAQ)


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Dust collectors when sanding drywall.

Daily Cleaning with Dustbane Sweeping Compound and HEPA filtered Vacuum

IC/IAQ - Phase 1B


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IC/IAQ Phase 2 - 4

Walk-off mats and boot cleaners at entrances and exits.


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Ends of duct work properly capped.

IC/IAQ Phase 2 - 3


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IC/IAQ Phase 2 - 3

Negative air intake.


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After thorough cleaning, a second review of the ceiling plenum space was conducted to ensure residual dust was removed.

IC/IAQ Phase 2

Visual evidence of construction dust on the grid and fixture.


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Negative air unit inside corridor.

IC/IAQ Phase 2 - 3


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IC/IAQ Phase 2 - 3

Air lock vestibule separating areas in different phases of construction.


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IC/IAQ Phase 4

Final infection control inspections before facility turnover.


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Improvements to Health and Safety

• Bycontrollingorpreventingdustanddebrisbuild-up,futuresourceofnutrientsforspores and bacterial would be minimized.

• Thesitewasbetterorganizedandthereforesafer

• Reducingtheriskcreatedbyspillageandleftoverfoodstuffs

Improvements to Productivity/Profitability

• Therewerefewerissueswithcaseworkandmillworkrejectedfromsite

• Mitigatingshrinkageproblemsfordrywallandflooring

• Thesitewascleaner,andthetradesenjoyedworkingthere,

• Turn-overwasachievedquickerwithlessissuesparticularlyinregardstoductwork cleanliness,

• Allowedforimprovedserviceabilityduetoabilityforsegmentedshutdownsformaintenance

Success of the Infection Control / Indoor Air Quality (IC/IAQ)


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Value as a Sustainable/long-term solution

• Thisapproachwassosuccessful,that the experience at FSCH hashadasignificantinfluenceon the current updating of CSA Z317.13.12.

• The new version, now published, (December 2012) incorporates many of the ‘lessons learned’ practices implemented on this project,improvinghealthcareconstruction procedures across the country.

Success of the Infection Control / Indoor Air Quality (IC/IAQ)


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• IBIGroupArchitectsEngineers

• Alberta Infrastructure

• Alberta Health Services

• Ellis Don Construction Services Inc.

• Teegor Consulting Inc.

• Stantec Consulting Ltd.

The IFC Team

Acknowledgements


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Q & A

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