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.
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:
To make the construction phase go smoothly, the team should assess the following:
In addition, your team should make recommendations for:
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.
The role of HVAC systems as a non-pharmacological strategy in preventing HAIs is to maintain optimal air quality by controlling:
Temperature (heating, cooling) | |
Water content (humidifying, dehumidifying) | |
Pathogens (filtering out or irradiating dust particles, bacteria, viruses, fungi) | |
Ventilation (mixing in outdoor air) | |
Distribution (flow patterns, moving air from "clean" to "less clean") |
Older HVAC systems should be reassessed by experts regularly and may be candidates for upgraded filters, ultraviolet germicidal irradiation (UVGI) equipment, or flow pattern revisions.
One factor that's often ignored is the role of maintaining humidity between 40 and 60% in reducing infection. You can read more about how important humidity control is in our post, Pair HVAC & Humidification to Keep Air Clean In Healthcare Facilities During Winter.
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.
The ICRA 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).
Such tools should be simple to use, easy to clean, made of durable aluminum, and designed to be portable for quick setup and teardown. These recommendations apply to negative air machines, dust containment carts, air purifiers, anterooms, portable containment walls, and smaller equipment.
In-house infection control personnel must be trained in such things as:
In addition, make sure your contractors have conducted sufficient training of their workers. Emphasize the importance of patient safety and dust containment from day one. Every construction worker must fully grasp the concept that any dust is potentially hazardous and possibly deadly to hospital patients.
Finding and deploying the right dust containment and air purification equipment is a critical part of the success of any hospital construction project. Make sure you have the right tools at your disposal for use during any ICRA I-IV project. To learn more, read 3 Medical-Grade Air Purification Machines for Hospitals & Healthcare Facilities.
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