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by HEPACART on Apr 20, 2022
Removing even a single ceiling tile can be a health hazard.
Before a construction crew starts digging into your hospital’s walls, floors, ceilings, or any area that could release harmful or hazardous materials into the air, the project in question should have passed through some critical checkpoints first. Because health is the number one priority of a hospital, there’s no “rolling the dice” when forging ahead with renovations or construction. Performing a construction project risk assessment is how you load those dice so the odds come out in your favor.
Now, the phrase “construction project risk assessment” may mean different things to people in various industries, but in health care, the guide to follow is the Infection Control Risk Assessment (ICRA) Matrix of Precautions for Construction and Renovation. We’ve written about ICRA before and gone through its steps, so here we’re going to discuss what we mean by “risk” and go over how and when to perform construction project risk assessments.
The Steps of Construction Project Risk Assessment
How to make sure you’re headed in the right direction before you start construction:
- Meet regularly with the construction management team.
- Make sure everyone is following the same risk assessment structure.
- Perform constant infection control.
- Test air quality and monitor the environment non-stop.
- Communicate with staff to keep them updated
Communication is one of the most important (and ignored) pieces of the puzzle. Don’t leave people in the dark!
Measuring Risk
According to the ICRA guidelines, there are four levels of risk. These levels correspond to areas of your hospital and increase in severity depending on the sensitivity of the people in those areas. Let’s break it down.
Low Risk
These are the people least sensitive to construction and renovation dust and debris. Generally, low-risk areas would be offices or parts of the hospital where there is hardly anyone at all, like a basement or utility room. The people here aren’t patients and, ideally, should be healthy enough to handle a small amount of dust.
Medium Risk
These areas house patients, but not ones who are highly susceptible to nasty air particulates or there are more known risk factors. Areas like:
- Cardiology
- Echocardiography
- Endoscopy
- Nuclear Medicine
- Physical Therapy
- Radiology/MRI
- Respiratory Therapy
It might seem odd to have “Respiratory Therapy” under medium risk, but remember that every level of ICRA construction project risk assessment treats the possibility of airborne contaminants seriously. It’s just that the risk levels get even higher from here.
High Risk
With high risk areas, it’s not just that the patient populations contain the kind of people who might have more severe reactions to construction dust, it’s also that these areas serve more people. The possibility of spreading nasty, harmful dust is higher in areas like:
- CCU
- Emergency Room
- Labor & Delivery
- Laboratories (specimen)
- Medical Units
- Newborn Nursery
- Outpatient Surgery
- Pediatrics
- Pharmacy
- Post Anesthesia Care Unit
- Surgical Units
So, in high risk areas, you see that there are infants and children. In other words, people whose lungs are still developing. In emergency rooms, there’s also unknown risk factors among patients because these are people who have not yet been evaluated or are in a critical state. Then there are areas where surgeries take place, and having construction dust settle in someone who’s undergoing a medical procedure that requires what is essentially an intentional open wound could be devastating.
Highest Risk
Now we arrive at the populations who could suffer the most damage from dust and debris:
- Any area caring for immunocompromised patients
- Burn Unit
- Cardiac Cath Lab
- Central Sterile Supply
- Intensive Care Units
- Negative pressure isolation rooms
- Oncology
- Operating rooms including C-section rooms
Patients here need the cleanest environment possible because they may have immediate or severe reactions to even the tiniest of contaminants. These are also areas where the most invasive surgeries take place.
Evaluating the Type of Construction
As we said earlier, anytime you’re going to have a crew digging into your building’s infrastructure, no matter how innocuous it might seem, you’re going to need to perform a construction project risk assessment because. Yes, even removing a ceiling tile can be dangerous. Under the ICRA matrix, there are four types of construction jobs, each increasing in severity as they go along:
Type A
Activities under type A are categorized as “inspection and non-invasive.” These types of project include:
- Removal of ceiling tiles for visual inspection only, e.g., limited to 1 tile per 50 square feet.
- Painting (but not sanding).
- Wallcovering, electrical trim work, minor plumbing, and activities which do not generate dust or require cutting of walls or access to ceilings other than for visual inspection.
These actions shouldn’t create much in the way of dust or debris, but still have the possibility of kicking up some contaminants into the air. Again, you don’t want to “roll the dice.” Remove a ceiling tile and you could have mold, asbestos, pest remnants, and other gross stuff come down. Could it be a totally clean ceiling tile? Sure. Let’s not gamble on it, though.
Type B
Now we’re getting to projects that will probably require cutting into a wall, floor, or ceiling, or at least will expose larger areas that may contain disgusting and toxic substances in the air:
- Installation of telephone and computer cabling.
- Access to chase spaces.
- Cutting of walls or ceiling where dust migration can be controlled.
If you’ve ever had to remove an electrical outlet cover, you’ve probably gotten a decent glimpse into the interior of your wall. There’s fiberglass insulation, drywall crumbs, paint flakes, and other such stuff just sitting there. No one wants to breathe that.
Type C
These activities can create a lot of dust. Type C projects might be demolition, like knocking down a wall, or removing fixed pieces or assemblies from your building:
- Sanding of walls for painting or wall covering.
- Removal of floorcoverings, ceiling tiles and casework.
- New wall construction.
- Minor duct work or electrical work above ceilings.
- Major cabling activities.
- Any activity which cannot be completed within a single workshift.
Another new element you see under type C is time. When the project might take a couple days, or even weeks, it increases risk. You now how multiple workers entering and exiting the work area and even with proper mitigation controls in place, this still increases the chances of construction dust finding its way out into your hospital.
Type D
These are the most invasive and aggressive projects possible:
- Activities which require consecutive work shifts.
- Requires heavy demolition or removal of a complete cabling system.
- New construction.
Perhaps you’re adding on entirely new rooms, destroying sections of your hospital, or just crafting a new building. Even fresh construction materials will break, chip, crumble, and float around in the air.
Making the Matrix
When conducting your construction project risk assessment, you’ll take your evaluations of your populations (risk levels) and cross-reference them with your construction types (A through D). This gives you your matrix:
So your best scenario is a low-risk group getting type A construction, and the most severe is the highest risk group with type D construction. Make no mistake, though, even when your project is in the green, you still have a legal obligation to take all safety precautions.
Download the ICRA Matrix Guide
There are a lot of rules to remember when performing your construction project risk assessment under the ICRA, so how about you download your own ICRA Matrix guide to keep handy? And don’t forget, we here at HEPACART® care about your air quality because you care about your air quality. When you’re looking for those pieces of equipment that will clear the air, we’ve got just what you need.
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