When we think of indoor air quality (IAQ) issues asbestos, lead, inadequate fresh air exchange and mold come to the forefront, but what about infectious diseases. In hospitals, airborne infection risks are a constant battle. Our knowledge of infectious agents and their most likely pathways of infection allows us to implement practical safeguards to protect those who are recovering from surgery or who are otherwise immunocompromised. It may not be so obvious, but that risk could increase when construction and renovation projects are underway in hospitals. Extra precautions must be taken to protect hospital staff and their patients during such projects. Different areas of the hospital may require more aggressive measures than other parts of the hospital (general care areas compared to the ICU, the Burn Center or the NICU). To mitigate risk, health care facilities use a practice known as Infection Control Risk Assessment (ICRA), a documented process used to protect their patients while much needed renovations to their facilities are conducted. ICRA creates an organized system for architects and contractors to use to help the health care facility’s staff and at risk patients avoid potential airborne particles which may include simple dust of varying concern, bacteria and potentially pathogenic mold varieties. ICRA ultimately reduces the disruption of services to patients when major renovations are taking place.

Communication and coordination between the project team and healthcare staff is fundamental to the ICRA process. The design team and contractors must be able to anticipate potential impact during the construction process in order to prevent any lapses in the hospital services. They must understand the environmental conditions such as the levels of filtration, % relative humidity, and acceptable levels of other contaminants in the potentially affected areas. Then they must maintain those required conditions during the construction/renovation process. Planning is intensive due to the numerous variables that must be taken into consideration. These include, but are not limited to:

• Identifying specific hazards
• Construction area containment
• Effectively isolating infection
• Location of airborne infection isolation
• Protective measures
• Ventilation needs and atmospheric conditions
• Facility HVAC and water systems
• Patient relocation
• ICRA training

Understanding the different types of infectious agents and other contaminants as well as how they travel through the indoor environment will allow a team to effectively mitigate infection control risk. Ongoing IAQ oversight is recommended to ensure all precautions are initially achieved and maintained throughout the construction process. Building operations and maintenance (O&M) systems are interconnected; therefore, specific areas, such as surgical rooms, nurseries, laboratories and other areas must be protected to isolate and prevent airborne infection from spreading to these sensitive areas. Essential systems must be addressed to avoid lapses in power to HVAC and HEPA units, to maintain air quality and insure that pressure differentials in critical areas are maintained as well. Additionally, it should be made clear how to proceed should a power outage occur.

ICRA is an effective method for facilities looking to establish a protocol that allows a risk assessment plan to be adapted to each facilities patient population. The hospital staff and the project team should be well versed in the ICRA protocol to prevent spread of particulates, airborne infectious agents and construction dust throughout the facility. Element Environmental Solutions (E2S) is experienced with assisting health care facility managers and architects from schematic design through the construction phase at health care facilities. Renovation projects can be conducted seamlessly by working with abatement/renovation/construction crews and the healthcare facility team to ensure proper actions are taken to maintain patient safety and health. A detailed air sampling plan for appropriate parameters would be implemented within and outside the area of containment to determine whether particles are a risk for patients. Pathogens such as Legionella, MRSA and other bacterial varieties as well as potentially pathogenic varieties of molds can travel quickly in confined spaces. Construction particulates such as asbestos fibers, lead paint dust and other irritating or toxic particulates must be taken into consideration as well.

There are many measures that must be taken to prevent spread of infection during health care facility renovation projects that require communication and cooperation between the construction team and the hospital staff. The infection prevention and risk management measures outlined by ICRA will help to ensure construction does not interfere with the hospitals mission –saving lives.