FAIR WARNING

Infection control red flags during hospital construction

By Jim Gauthier

Construction, renovations and maintenance (CRM) projects within healthcare settings can cause serious issues for patients and staff. For this reason, infection prevention and control practitioners (IPCPs) have become more involved in the CRM process, which requires steps be taken to ensure those on-site are protected from dust and stagnant water.

Dust can carry mould spores, such as Aspergillus species, and stagnant water can have microorganisms like Legionella species. The control of dust during CRM is vitally important. The amount of dust, or the duration and complexity of the CRM activity, can indicate what level of precautions are required. As for water, remediation after a flood needs to be performed in such a way that mould does not have a chance to proliferate.

CRM projects require an infection control risk assessment that analyzes what is to be done and where. This is conducted by a multi-disciplinary team to ensure the safest outcome is provided to both patients and staff.

On The Lookout

An IPCP will frequently do a walk-around during a project to assess safety from their perspective. Most IPCPs also tour their entire site to remain visible and to help with other aspects of infection prevention.

During these walk-abouts, IPCPs are looking for red flags. Finding a hose hanging from a ceiling and draining into a bucket is an indication there is a leak. Once the area has been dried, the IPCP will become involved in the remediation. Seeing dusty footprints or the dusty tire track of a wheelbarrow are also red flags that something is happening without proper precautions.

In the case where the infection control risk assessment has determined barriers are required for the CRM, the IPCP will inspect these frequently, even daily in higher risk or long projects. If the construction zone is to be under negative pressure, the pressure differential will also be regularly monitored. The negative pressure can fluctuate based on numerous issues with hoarding, the air handling devices, or improperly sealed doors and windows.

SEEING DUSTY FOOTPRINTS OR THE DUSTY TIRE TRACK OF A WHEELBARROW ARE RED FLAGS THAT SOMETHING IS HAPPENING WITHOUT PROPER PRECAUTIONS.

Contractor meetings can help bring issues to the IPCP’s attention. Meetings can address infection control issues early in the agenda to free up the IPCP who may be handling the project along with routine dayto-day duties. Regular updates can help keep the IPCP in the loop on larger maintenance projects being done by the facility’s staff.

Other red flags are walk-off mats that are either no longer sticky (if using sticky mats) or saturated with dust (if using a short pile carpet). During the demolition phase of a project, dust control will be audited through several means. The simplest detection measure is to wipe surfaces outside the construction zone daily with a white wipe to see if dust has escaped the previous day. (A background of ‘daily’ dust can be established before the project gets started.)

Ductwork needs to be kept sealed as much as possible before, during and after installation. Use of HEPA filtered air blown into the ductwork can create a positive pressure to keep dust out of ducts during subsequent CRMs.

Wet drywall or cement board is another red flag. It can occur before the building is sealed to the elements. Any wetness that is not dried within 24 to 48 hours will allow mould to grow. This should not be encapsulated within walls during CRM activities.

Gross construction dust should never be covered within wall cavities. The IPCP will need to inspect wall cavities before they are insulated or sealed, as well as ceiling elements. This may require the IPCP to have fall arrest training in order to use scissor-lifts. Insulation should never be cut on a dusty floor because this will allow dust to be sealed into the walls.

Electrical and computer cabling should be protected as much as possible from dust during and after installation.

The IPCP role is to keep patients and staff safe from infectious agents, which can be liberated during CRM activities. Almost none of these trained professionals are skilled in any of the building or maintenance trades, so questions need to be addressed, even if they seem simplistic to a tradesperson. Once all involved in construction and maintenance understand everyone’s role, red flags will not pop up.

Jim Gauthier is senior clinical advisor, infection prevention, with Diversey Inc., a manufacturer of cleaning and disinfection products. He is also a microbiology technologist and board certified in infection control.