According to the Cleveland Clinic Journal of Medicine (Vol. 86, 1 October 2019), infections acquired from hospital renovations or construction account for more than 5,000 deaths every year in the United States.

Healthcare facilities, in the past couple of years, have been renovating or reconstructing to meet the latest revolutions in the health care industry. While the renovation or construction eventually serves the patient’s interest, the probability of an infection spread, on most occasions, is overlooked.

Choosing a general contractor to renovate or construct a healthcare facility is normal, however, most stakeholders do not understand the importance of choosing an Infection Control Risk Assessment (ICRA) certified specialist.

As an Infection Control Risk Assessment (ICRA) certified professionals, Titan follows the following protocols when it comes to carrying out renovations or constructions in any healthcare facility.

Understanding the risks

Construction activities are linked to dust and debris. Airborne particles themselves can cause health concerns like asthma in addition to acting as an ideal fungi-mold spores vehicle.

The nosocomial infection risks associated with hospital construction can vary with respect to the following factors:

• The work location within the facility
• The equipment used
• The chemicals/cleaning agents used
• Designation of custom essential services and exit routes for workers

Hospital patients are most likely immunocompromised or have a weakened immunity shield. This makes them vulnerable to additional infections that can develop deadly pulmonary mold infections.

Safe Work Practices

Daily Monitoring and Safety Briefings:

We conduct daily pre-job safety meetings to restate /review responsibilities and deadlines. Any new work hazards are considered a priority and solutions will be discussed. Additional stakeholders are included if the situation demands it.

Local Exhaust/Vacuuming: 

The team examines and considers the possibility of dislodgement or disturbance of dust collected over areas including suspended or false ceilings due to activities including cutting and grinding. The team uses industry-grade local exhaust and ensures that the dust is vacuumed before re-occupancy.

Debris Removal:

Debris from the work site is transported in airtight containers. Designated traffic routes are used for debris removal and facilities including elevators and transport are restricted during the hospital peak hours.

If using chutes are used for transporting debris outside, air filters are used to maintain negative air pressure and the openings of the chute are double sealed and checked consistently. Exit paths are kept barrier-free and the used filters are sealed before transporting from the work area to the dumping location.

Traffic Control:

We coordinate with the hospital staff to designate elevators and exit paths for the workers. Clear-cut information on the scheduled and restricted times of the day to use the elevators and the exit paths are provided to all our workers.

Signages are erected to distinguish pedestrian pathways from worker’s routes. Access to worksites is restricted using photo ID badges.

Worksite Cleaning:

Workers are requested to clean their workwear to remove any dust or debris before leaving the worksite each day. The tools and equipment are cleaned with disinfectants or damp cloth each day as needed. Workers who work in sensitive sites are provided with disposable clothing including headwear and shoes.

Engineering Controls

Noise-Induced Stress: Stress from noise is a major concern in any hospital undergoing renovation or construction activities. Both the patients and the staff are equally stressed by unwanted noise. Some ill-effects of noise-induced stress are:

• Sleep deprivation
• Increased chances of re-hospitalization
• Overuse of medications and restraints
• Decreased oxygen saturation
• Abnormal blood pressure levels

To address the noise concerns from construction in hospital facilities we ensure the following:

• Use quieter well-maintained equipment
• We line the barriers of equipment with sound-absorbing materials
• Retro-fit existing equipment with mufflers, silencers, or damping materials
• Always rely on quieter alternative work methods when possible
• We site the noisy equipment as far as possible from the sensitive areas
• If required we also raise barriers with sound-absorbent materials like plywood around noisy machinery

Ventilation and Environmental Control:

Air has the tendency to flow from high pressure to low pressure, which makes it critical to maintain negative pressure within the work area. We utilize high-quality HEPA machines to ensure negative air pressure within designated work areas.

Pressure differential sensors are used at different locations consistently to ensure that the pressure levels remain at the standard required level throughout the construction period.

Barrier Systems & Contamination Control: We erect barrier systems throughout the worksite to prevent concerns of contamination, noise, and dust.

All the barrier systems that we use are noise and fire rated. High quality plastic sheeting is used to seal areas up to the ceiling with a minimum of two-foot overlapping flaps.

We foresee the dust or noise concerns associated with the construction of a rigid barrier and normally use plastic sheeting barriers to counter this. Barriers are inspected for tight sealing on a daily basis and the doorframes to the barriers are gasketed.

Hospital construction or renovation activities and the associated nosocomial infection risks are unavoidable. While the hospital staff and visitors may not be seriously affected, these activities can pose a serious threat to immunocompromised patients.  A proactive approach is inevitable to foresee and address the various aspects related to hospital-acquired infections related to construction and renovation. This is where Titan’s multidisciplinary team in conjunction with the hospital administration and other stakeholders can make all the difference.