Patient-Centered Construction: Ensuring Safety during Health Care Building Projects

By Avis, Ed | Health Facilities Management, July 2014 | Go to article overview

Patient-Centered Construction: Ensuring Safety during Health Care Building Projects


Avis, Ed, Health Facilities Management


Health care facilities managers have many responsibilities when a hospital is building a new facility or renovating existing space, but a top priority is keeping patients safe during construction.

Interim life safety measures often are needed when construction interrupts the flow of a hospital or other health care facility. Brian Cotten has seen the precautions construction contractors take when renovations on a patient tower required a shutdown of the sprinkler system, including an around-the-clock fire watch.

"They constantly made tours through the entire area to look for smoke or anything else related to fire," says Cotten, PE, CHFM, FASHE, executive director of design and construction at the University of Arkansas for Medical Sciences in Little Rock.

Unlike typical building projects, hospitals rarely can shut down when additions are built or spaces are renovated. And patient needs--including their safety, comfort and protection from infection--trump construction needs every time.

"Figuring out how to work through the issues, how to get the project done and, at the same time, not have a detrimental impact on the patients--that is the challenge," says Tim Adams, FASHE, CHFM, CHC, director of leadership development for the American Society for Healthcare Engineering (ASHE). "It would be great if there were a cookie-cutter solution, but there is not. We have to come up with a solution for every project."

Infection control

One of the largest concerns when a hospital is being torn up for renovations is the risk of infection caused by dust and other contaminants that may flow from the construction site to patient areas. Construction zones are inherently dusty, while many parts of hospitals must be kept pristine.

"Infection control is certainly one of the largest issues," Cotten says. "Trying to keep the environment clean is always a challenge, especially during construction."

The contaminants from construction can enter patient areas multiple ways--through the ventilation system, through open doors and windows, or tracked in on the boots of workers walking through patient areas. The effects vary depending on multiple factors--a little dust in the lobby may be harmless, but fungal spores in an operating suite may pose serious consequences.

A key resource in the fight against construction-related infection is the "Infection Control Risk Assessment Matrix of Precautions for Construction & Renovation," which is available on the ASHE website at www. ashe.org/resources/tools. The matrix provides a quick way for facilities professionals to determine the level of precautions required based on the type of construction and the risk-level of nearby patients.

One side of the matrix identifies the level of construction, from Type A (e.g., noninvasive work, such as painting or minor plumbing) to Type D (e.g., major demolition or new construction). The other side of the matrix identifies the risk to patients normally found in the area affected by the construction, from lowest risk (i.e., office areas) to highest risk (i.e., burn units and operating rooms). Matching the construction level to the risk group results in prevention-control recommendations ranging from Class I to Class IV.

For example, Type C work in a medium-risk area requires Class III infection prevention measures, such as isolating the HVAC system in that area and other precautions. For highest-risk areas, even Type A work requires Class II infection prevention measures such as sealing doors with duct tape, blocking and sealing air vents, and placing dust mats at the entrances and exits of work areas.

"The matrix helps us to determine what we have to do based on the area and the job," says Cotten, who has overseen more than $500 million in construction on his campus over the past eight years, including a new cancer institute and a new patient tower.

While the problems of infection control are obvious in an occupied health care facility, they also need to be considered in new construction. …

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