If you're in hospital facility management, you know that clean air is critical to patient health and recovery.
About 2 million patients suffer healthcare-associated infections annually in the USA — these infections are caused by airborne pathogens and particulates (dust, mold spores, etc.). Providing clean air for patients is a moral obligation and a business necessity since hospitals are not reimbursed by insurance or Medicare for HAIs. In the USA alone, direct costs of HAIs are estimated to be between $28 billion and $45 billion annually.
Because hospital construction generates demolition debris, facility management must take special care to manage dust. These dust control measures must take place alongside — or, in some cases, instead of — carefully-designed airflow and filtration being provided by an HVAC system. While a good HVAC system keeps contagion from spreading between patient isolation rooms, operating rooms, and waiting areas, more must be done to keep the air clean in your hospital during construction. We'll review a few key areas, along with air purification systems that do what HVAC alone cannot.
1. Assess risk.
Planning how to mitigate risk from construction dust is part of an overall infection control risk assessment (ICRA) process. This is a multidisciplinary, documented process that should be an integral part of facility planning, design, construction, and maintenance from the very beginning. As soon as major construction is anything riper than a twinkle in the CEO's eye, somebody had better get cracking with infection control plans.
In the design phase, the infection control risk assessment team must consider:
Number and location of patient isolation rooms.
Air handling and ventilation needs in ORs, infection isolation rooms, and labs.
Water systems to limit Legionella sp. and other waterborne opportunistic pathogens.
Finishes and surfaces.
To make the construction phase go smoothly, the team should assess the following:
Impact of disrupting essential services, including power
Location of patients by susceptibility to infection
Movement of debris, traffic flow, and cleanup
Location of known hazards
In addition, your team should make recommendations for:
Patient placement and relocation
Barriers, anterooms, negative pressure machines, air purification equipment
Temporary modification of heating, ventilating, air conditioning, and water supply systems
Protecting patients and staff during demolition activities
Training hospital staff, visitors, and construction personnel
Once construction is underway, the ICRA team should ensure continuous monitoring of the effectiveness of infection control measures, whether by in-house staff or independent consultants.
Within the construction zone, HVAC should be removed or isolated to prevent contamination of the ductwork. A very high level of air filtration is then provided by HEPA-filtered negative air machines, which are used to create differential air pressure that keeps dust inside the work area. HVAC is returned to service only after a thorough post-construction cleaning.
3. Choose the best tools.
TheICRA Matrix generates four classes of precautions by crossing patient risk groups with progressively greater construction activity. Class I is the least worrisome for healthcare construction and facility managers (painting, trimming, sanding in office areas), while class IV is the most (major demolition and new construction near the highest-risk patients).
Subject to available funds, you should try to select equipment that can handle a broad spectrum of projects. This will actually make the most of a tight budget in the long run. An investment in a sturdy, reusable dust containment cart, for example, provides the same time and labor-saving benefits whether the cart is used to remove a ceiling tile in an ICU (Class IV) or an office (Class I).
In-house infection control personnel must be trained in such things as:
When to use containment tools
How to clean tools properly
When to call for maintenance (such as filter changes)
How to read pressure and airflow monitors (to track air changes per hour)
Education is a continuous need, so be sure that employees get ongoing training on operating and maintaining the systems they use. Track how well they’re doing, rather than assuming the training is 100% effective. And get free help where it’s available. Sometimes the manufacturer of the equipment can be called upon to come in and provide training, updates, and pointers.