Design & Construction, Wellbeing
Infection Control and prevention during Construction By: Paul Gentile, Shalom Patel, Siyeh Gretzinger and Aaron Milloy Environment of Care is a fundamental domain of the infection prevention scope of practice. Infection prevention programs are responsible for recognizing and monitoring the elements of a safe environment including assessing and reducing the infection risks of design, construction and renovation that impact healthcare settings. Infection Preventionists are utilized as consultants, collaborators, and enforcers to provide best practice guidelines and recommendations to ensure quality and safety within a clinical setting during these projects. Industrial hygienists can also serve in a similar capacity in regards to construction inside and outside of healthcare. Developing a team of key stakeholders including Infection Preventionists, industrial hygienists, safety officers, engineers, architects, project managers, contractors, and construction workers lays the foundation for a successful blueprint.
Pre-Construction Prior to the start of any construction project, no matter the size and scope, it is important to incorporate infection prevention standards and, where possible, consult with Infection Preventionists or Industrial Hygienists to identify the potential infection risks during and after construction. Conducting a pre-risk assessment is an important step not only in the healthcare industry, but any setting where individuals are present during and after project completion. This assessment provides support structures that identify infection control, air quality, utility requirements, noise, vibration and any other hazards applicable to create an environment of care that promotes prevention and control of airborne and waterborne contaminants. This is necessary because microorganisms dispersed during construction projects have been documented to cause infections. Dust contamination, and potential dispersal of fungal spores, from construction and renovation projects, account for approximately half of all healthcare-associated Aspergillus outbreaks (1). Water distribution systems are also an essential part of the environment of care, and any project affecting these systems should establish proper precautions, as bacterial and fungal contaminants have been found in drinking water as well as aerosolized from construction activities (2). An essential next step in the planning process is an Infection Control Risk Assessment (ICRA). This is an important method for assessing and preventing all hazardous risks to those who will be in the vicinity of the construction project (3). Following this risk assessment various interventions and monitoring programs can be developed and put into practice to continuously prevent and assess the airborne and waterborne hazardous risks while the construction project is taking place. Interventions can include containment barriers, personal protective equipment, air filtration, negative airflow ventilation, and debris removal (3). Use of an ICRA is beneficial in the assessment of the type of interventions necessary for a project.
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CRE Insight Journal • Special Issue • 2021
Another significant component prior to construction and renovation, is the design planned for the space(s) being completed. How the space is designed, the materials used, as well as the type of air and water systems, are all relevant parts of preventing infections in individuals that inhabit the space after it is built. Studies have shown building-associated infections have been attributed to the design and maintenance of heating, ventilation, and air conditioning (HVAC) and water systems (2, 4). Other features such as the characteristics of wall surfaces and ceiling tiles, type of flooring, sink and faucet design, as well as the placement of hand hygiene soap and sanitizer dispensers are all important parts of the design process that can help prevent infections (3).
Mid-Construction During the mid-construction phase, it’s important to continue to monitor for any risks that could potentially compromise the environment. As part of the development of the ICRA, risk mitigation strategies should have already been discussed to prevent the spread of any waterborne and airborne biological contaminants. Depending on the length of the construction projects, contractors will work with the Infection Preventionist and construction team to develop a timeline based off of a phased approach. During this period, modifications may be made to contractor requisites and to the ICRA created during the pre-construction phase. Requirements for long-term construction projects will entail constant evaluation of the area to ensure safety standards continue to be met. Barriers will consist of more rigid material such as a hard plastic or sheetrock. Contractors should also make sure that the barriers are sealed and intact to prevent dust and contaminants from escaping the work site. Food and drinks should not be at the construction site as they increase the risk for insects and pests and exposure to potentially hazardous substances (i.e. chemicals) that are being used. Standard wet or sticky walk-off mats should be applied at construction entrances and exits to reduce the spread of dust and debris. These mats should be changed daily or when the mats are no longer able to capture dust and debris. Depending on the ICRA matrix, contractors may also be required to wear certain personal protective gear such as a coverall and shoe/ hair covers while working in specific areas. For construction projects being performed in high risk areas, personal protective equipment (PPE) will be important to prevent the spread of any biological/ airborne contaminants. Contractors should also have clean PPE readily available on site to prevent re-use of contaminated PPE. For ventilation purposes, a high-efficiency particulate absorbing (HEPA) filter or an air scrubber may be used depending on the ICRA classification of the construction project. These pieces of equipment
