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Infection Prevention Boot Camp I for the Novice Infection Preventionist January 16‐17, 2020 Florida Hospital Association | Mission to Care Hospital Improvement Innovation Network 1
Infection Prevention in Construction and Renovation
Linda R. Greene, RN, MPS,CIC, FAPIC Barbara Russell, MPH, BS, RN, CIC, FAPIC
Basic Infection Prevention Issues
New Construction Renovation Repairs
Let’s Start with New Construction
Could be a new hospital, a new tower or a new ambulatory site. IP must have input for all of the following: Pre-design Design Build Preparation for occupancy Occupancy
SLIDE 2 Infection Prevention Boot Camp I for the Novice Infection Preventionist January 16‐17, 2020 Florida Hospital Association | Mission to Care Hospital Improvement Innovation Network 2
Pre- Design
Geographical ICRA Patient population Services and their scope Treatment areas Organizational structure What does the future look like?
Design
Build relationship with the team, architect, etc. Think about potential infection prevention issues What does IP bring to the table?
Room layout Med room Shower ? Nourishment stations
Other issues to consider
Dirty and clean utility rooms Flow of clean and dirty items Any HLD, Sterilization What about OR’s
SLIDE 3 Infection Prevention Boot Camp I for the Novice Infection Preventionist January 16‐17, 2020 Florida Hospital Association | Mission to Care Hospital Improvement Innovation Network 3
ICRA Elements in Design
Number and location of all negative and positive
pressure rooms
Location of special ventilation Air handling Water ( Water management plan) Finishes and surfaces
Important Issues
Research the literature- back up every request with
literature
Think critically Remember competing priorities Don’t forget about water issues
Other Issues
Install alcohol-based hand-rub dispensers at the bedside and in
- ther accessible locations to increase hand-washing compliance
and reduce contact transmission of infection.
Select easy-to-clean floor, wall, and furniture coverings, and
employ proper cleaning and disinfection procedures.
Design and maintain the water system at the proper temperature
and adequate pressure; minimize stagnation and back flow; eliminate dead- end pipes; regularly clean point-of-use fixtures; and consider the location of decorative fountains and carefully maintain them to minimize the risk of waterborne infection.
Provide single-bed rooms with private toilets to enable separation
- r isolation of patients on admission, so that those with
unrecognized infections can be tested and identified without being mixed in with uninflected individuals
SLIDE 4 Infection Prevention Boot Camp I for the Novice Infection Preventionist January 16‐17, 2020 Florida Hospital Association | Mission to Care Hospital Improvement Innovation Network 4
Negotiation and Critical Thinking Tools
The IDEALS are to Identify, Define, Enumerate, Analyze, List, and Self- Correct:
I Identify the Issue or Problem: What is the real question we are facing?
D Define the Context: What are the facts that frame this issue or problem?
E Enumerate the Choices: What are plausible options?
A Analyze Options: What is the best course of action?
L List Reasons Explicitly: Why is this the best course of action?
S Self-Correct: Look at it again … What did we miss?
Six Steps to Effective Thinking and Problem Solving, or “IDEAL (Facione,2007
Build Phase
Have a very detailed ICRA for each phase Ensure ICRA is part of a multidisciplinary team;
construction personnel must be at the table
Understand the risks and the tools to mitigate the risk
Resources APIC Text On line
SLIDE 5
Infection Prevention Boot Camp I for the Novice Infection Preventionist January 16‐17, 2020 Florida Hospital Association | Mission to Care Hospital Improvement Innovation Network 5
New Construction- we need to do an ICRA
Infection Control Risk Assessment Do you know what you are looking at? Consider walking the walk
Build Phase
Any special service disruption Identify specific hazards Any patient placement or relocation Barriers and protection How are we going to monitor?
The Infection Control Risk Assessment (ICRA)
SLIDE 6 Infection Prevention Boot Camp I for the Novice Infection Preventionist January 16‐17, 2020 Florida Hospital Association | Mission to Care Hospital Improvement Innovation Network 6
Permit ICRA check list Barriers
I am too busy Nothing to do with me
SLIDE 7
Infection Prevention Boot Camp I for the Novice Infection Preventionist January 16‐17, 2020 Florida Hospital Association | Mission to Care Hospital Improvement Innovation Network 7
Construction Inside and Out
Look directly inside and outside construction sites Determine if dust is escaping- enough negative air? HEPA filtered machines? Supply diffuses Where are the air handling units? Where is it exhausting?
SLIDE 8
Infection Prevention Boot Camp I for the Novice Infection Preventionist January 16‐17, 2020 Florida Hospital Association | Mission to Care Hospital Improvement Innovation Network 8
Other Issues Particle Counters
Particle counters Should be higher inside that outside of the construction site
Risk Factors
Persons at Risk for Aspergillus/Fungal Infection:
Any patient who is immunocompromised
Bone marrow and solid organ transplant
Chemotherapy
Prolonged steroid / antibiotic therapy
Dialysis
SLIDE 9
Infection Prevention Boot Camp I for the Novice Infection Preventionist January 16‐17, 2020 Florida Hospital Association | Mission to Care Hospital Improvement Innovation Network 9
Control Measures What’s Wrong With This Picture?
Documented Source of Spores in Construction Settings
False ceilings
Insulating material
Fire-proofing material Open windows/doors
Contaminated carpeting
Dust from construction site
•Dust from excavation site
SLIDE 10
Infection Prevention Boot Camp I for the Novice Infection Preventionist January 16‐17, 2020 Florida Hospital Association | Mission to Care Hospital Improvement Innovation Network 10
What About Facilities in Patient Rooms? High Risk Areas
Surgery Sterile Processing Procedure rooms Pharmacy Clean room
Emergency Repairs
Call IP Immediately Assess the clinical impact Identify barriers Any cancellations Notify administration
SLIDE 11
Infection Prevention Boot Camp I for the Novice Infection Preventionist January 16‐17, 2020 Florida Hospital Association | Mission to Care Hospital Improvement Innovation Network 11
Failure to Protect Problems Fungal Infections
SLIDE 12 Infection Prevention Boot Camp I for the Novice Infection Preventionist January 16‐17, 2020 Florida Hospital Association | Mission to Care Hospital Improvement Innovation Network 12
Outcomes Vibration
Five patients with severe postoperative Aspergillus endophthalmitis
All five patients came from one hospital in January and February
during a period of active hospital construction
All five patients were subjected to aqueous or vitreous tap Three patients had removal of the vitreous gel from the middle of
the eye
Final outcome in each patient was evisceration (removal of the
eye’s contents) or enucleation (removal of eye), despite an intensive course of antifungal therapy
Water Risks
SLIDE 13 Infection Prevention Boot Camp I for the Novice Infection Preventionist January 16‐17, 2020 Florida Hospital Association | Mission to Care Hospital Improvement Innovation Network 13
Water Risks
Construction (including renovations and installation
- f new equipment): Vibrations and changes in water
pressure can dislodge biofilm and release Legionella or
- ther waterborne pathogens. Biofilm is a slimy layer in
pipes in which pathogens can live; it can give pathogens a safe harbor from disinfectants.
Atypical Mycobacterium
Contaminated rinsing water of instruments
SLIDE 14
Infection Prevention Boot Camp I for the Novice Infection Preventionist January 16‐17, 2020 Florida Hospital Association | Mission to Care Hospital Improvement Innovation Network 14
Other Water Related Issues
Floods Sewage leaks Water back ups Requires a multidisciplinary team
SLIDE 15 Infection Prevention Boot Camp I for the Novice Infection Preventionist January 16‐17, 2020 Florida Hospital Association | Mission to Care Hospital Improvement Innovation Network 15
Renovation Issues Water
Reconnecting water lines
Lessons Learned
Communication to all affected areas Flush extensively before reconnection Involve multidisciplinary team Consult with experts
The Moisture Meter
Utilize a moisture meter to identify the extent of water
damage and to determine sufficient dryness
Typically, there is a 24-48 hour window after having been exposed to moisture. Once mold has begun to form, the contaminated areas must be removed and replaced
SLIDE 16 Infection Prevention Boot Camp I for the Novice Infection Preventionist January 16‐17, 2020 Florida Hospital Association | Mission to Care Hospital Improvement Innovation Network 16
Tips for Assessment
Infection Prevention know BEFORE Construction renovation activity is planned Take a walk with Architects and Construction before
hand
Visualizing the activity/location will help determine risk
Think
The project may be small in scale but big in dust Painting a wall? Dust free BUT- do you have to patch and sand the wall
first?
Pulling off wall covering? Is there mold behind that? Pulling electrical cables?
Protection
Coveralls Trash
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Infection Prevention Boot Camp I for the Novice Infection Preventionist January 16‐17, 2020 Florida Hospital Association | Mission to Care Hospital Improvement Innovation Network 17
Example – daily inspection What We Need
A High Functioning team of experts Control Plan – Contingencies Process to Evaluate
