Healthcare facilities must comply with Infection Control Risk Assessment requirements despite labor shortages, tight capital budgets, and lack of appropriate equipment. Renting equipment from a knowledgeable provider offers an effective approach to overcome those challenges.
In a healthcare facility, patient care is everything. And during construction, renovation, or general facility maintenance, keeping patients and employees safe becomes more critical than ever. Maintenance staff and contractors need to be aware of the hazards unique to work in the healthcare setting. To overcome those hazards, you must implement additional precautions and conform to best practices—because lives depend on taking meticulous care.
That’s why the Centers for Disease Control require healthcare facilities to perform an Infection Control Risk Assessment (ICRA) before any construction, renovation, or repair project, including removal of building materials. The American Society of Health Care Engineering (ASHE) governs ICRA to ensure contractors establish and maintain appropriate containment for dust and moisture. Everyone on the job site, including the crew, needs to understand and conform to the requirements.
Also critical for contractors and maintenance staff is having access to the equipment, tools, and staff to get the job done safely and effectively. But healthcare facilities face several challenges that complicate ICRA compliance, including labor shortages, budget constraints, and unanticipated conditions on-site.
This Guide to Infection Control in Healthcare covers:
- hazards construction creates
- precautions during planned or unplanned facility maintenance
- steps required for a risk assessment
- challenges healthcare facilities face in meeting ICRA
- equipment needed to implement precautions
- ways rental providers can support hospital facilities staff and mechanical contractors.
Hazards of Construction Activities in Healthcare Facilities
Hazards of Construction Activities in Healthcare Facilities
Construction, renovation, repair, and demolition in healthcare facilities require careful planning and coordination to minimize the risk of airborne infection during and after activities. It’s not just major projects that create issues. Even removing a few ceiling tiles during routine maintenance or minor renovation can let infectious particles become airborne.
During construction activities, dust and moisture are the greatest threats to patient health. Any time particulate matter becomes airborne, people in the vicinity can breathe it into their lungs—and if moisture is present, mold, bacteria, and microorganisms may become part of the mix. An individual already fighting infection, injury, or disease or who is immunocompromised is particularly at risk.
And the risk may continue even after the construction ends. Particles released into the air during healthcare construction projects can remain suspended for hours, days, and even weeks. Particles can also migrate from one area of a facility to another and pose a threat. Steps to contain particles during construction and thorough cleaning afterward mitigate the risk.
Implementing ICRA Protocols
The infection control risk assessment is a systematic process that determines risk to patients in various areas of the hospital—from diagnosis and treatment, such as clinical laboratories, imaging, and emergency rooms, to inpatient care including oncology and burn units. The location of activities is critical. Even if you’re working outside the facility, you need to keep dust and moisture from infiltrating. Inside, you’ll need barriers and controls to clean the air in and around the site. In addition, you must maintain positive or negative air pressure as required. The goal is always to properly clean all areas during and after work to avoid the risk of spreading infection.
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Here's a look at the four steps of the ICRA protocol.
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Step 1. Identify the type of construction project activity.
ICRA divides construction activities into four types for the purpose of assessment.
Type A: Inspection and non-invasive activities. Example: removing ceiling tiles for inspection.
Type B: Small-scale, short-duration activities that create minimal dust. Example: running cable in the ceiling.
Type C: Work that generates a moderate to high level of dust or requires demolition or removal of fixed building components or assemblies. Example: sanding a wall for painting or performing mechanical or electrical work above ceilings.
Type D: Major demolition and construction projects. Example: removing a complete cabling system.
Step 2. Identify the patient risk groups who will be affected.
Healthcare facilities have unique populations with susceptibility to construction-related infections. Requirements for renovating the lobby will clearly be different from those for Central Sterile Supply. Here’s each risk level and an example of the relevant area.
Low risk: Office areas
Medium risk: Endoscopy and Physical Therapy
High risk: Emergency Room, Labor & Delivery, Surgical units
Highest Risk: Oncology or Burn unit
Step 3. Match the construction project type with the patient risk group to determine the appropriate precautions to follow.
After you’ve identified the construction project type and risk group, you can use a matrix to determine which of the four infection control classifications is right for the activity. Cross-referencing will tell you what precautions are associated with activities both during and after completion of the project.
Class I precautions are easy. You need to minimize raising dust and replace a ceiling tile immediately if you removed it for visual inspection. When the task is done, you need to clean the area.
Class II, III and IV precautions are more stringent and often require specific equipment to perform:
- Prevent airborne dust from dispersing
- Water mist work surfaces
- Place dust mats at entrance and exit of work area
- Isolate HVAC systems
- Wet mop and/or vacuum with HEPA filtered vacuum
- Implement control cube method
- Install negative air pressure units
- Construct sealed anteroom
- Provide barriers
If Class III or Class IV control procedures are required, you’ll also need to get infection control approval first.
Step 4. Assign appropriate controls needed to reduce or eliminate risk to patient or staff groups.
The remainder of the ICRA matrix helps you put a plan into place. You’ll identify the site of activity, issues related to it, containment measures, and specifics for the facility. Contractors generally work through these steps and discuss infection prevention with the project coordinator, construction superintendent, manager, and foreman for the job.
Tools and Equipment to Support ICRA
Working with a company like Sunbelt Rentals can make compliance with ICRA much easier. We have all the equipment necessary and can provide it to healthcare facilities or mechanical contractors on a temporary basis:
Air Scrubbers
Scientific Air Management System-400 3-stage air scrubbers with UV-C light technology kill up to 99.9995% of airborne pathogens, including mold
HEPA filtered vacuum
HEPA vacuums in many sizes provide wet/dry operation and multi-stage filtration
HEPA filtered negative air machine
3-stage filtration including pre-filter, HEPA filter, and post-filter removes both larger and microscopic particles
HEPA Cart
Mobile HEPA soft containment cart can contain negative pressure airborne particles in many applications
Dehumidification or Humidification equipment
Maintain ideal humidity to make critical care environments safer for patients
Heating and air conditioning equipment
Maintain indoor design temperatures for the facility with temporary or supplemental heating and cooling solutions
Air Handling Units
Collect outside and room air, remove dust and other particles, and adjust temperature and humidity to supply healthy, comfortable air to rooms
Temporary Containment Walls
Aesthetically pleasing STARK modular walls exceed ICRA Class IV requirements, keep dirt and debris inside the construction site, and provide optimal flexibility for different project phases.
Doors for rigid wall/zippers for poly barriers
Accessories like hinged doors and preassembled windows solve containment issues
Floor Scrubbers
Effectively and efficiently keep floors clean and dry and avoid risk of slips and falls
Electrostatic Spray Guns
Disinfect in a powerful, efficient, and cost-effective way
Portable Manometer
Ensure appropriate differentials across isolated spaces with a system to monitor air pressure
Various Hand Tools
Full range of high-performance tools meets every construction and demolition need
Tip: Establish a Sunbelt Rentals account before you ever need equipment or tools to save time and keep your project on schedule.
Whether or not a healthcare facility is undergoing construction or renovation, you may need critical environmental products to maintain uninterrupted power, temperatures, humidity, indoor air quality, and facilities. Sunbelt Rentals provides the following equipment to help:
- Spot cooling
- Temporary generators
- Electric heaters
- Heat pumps
- Light towers
- Lifts
Contingency Planning
Healthcare facilities perform a critical service but are not immune from natural disasters, from hurricanes and wildfires to tornados and floods. To be ready, develop a contingency plan with a rental company that can provide the equipment you need as soon as you need it.
In terms of ICRA, you need a contingency plan to handle dust and moisture intrusion if an HVAC system fails during construction or repair. A rental partner can save you precious time by working through scenarios and ensuring you have the equipment you need, down to a generator to run it and a transformer to adjust for power differentials.
Partner with an expert.
Sunbelt Rentals maintains a fleet of reliable, high-quality equipment to help you establish and maintain containment according to ICRA standards. Our experienced team understands the hazards created by dust and moisture in a healthcare facility and can help you engineer an effective and budget-conscious solution.
You can trust that we will deliver the equipment you need on time and support you throughout the rental. If anything goes wrong, we will fix it. We have equipment locations around the country and deliver the right solution immediately.
Our people and processes make the difference that gives your organization a superior outcome. For a free consultation or to discuss equipment to comply with ICRA requirements, reach out to our team at 844-247-9693 or visit us online at sunbeltrentals.com.