How to Control Disease Infection in Your Workplace

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Hospitals are under competitive pressure to repeatedly upgrade and expand their facilities. Aging infrastructure, new technologies, and therefore the increasing demand for more patient-friendly facilities all generate a continuing need for construction and repair.

Any one of those activities has the potential to release dust, bacteria and mold-spores into the air. a number of the more common microbes found which will be spread through construction activities include Stachybotyrs atra, Penicililum funiculosum and Aspergillus fumigatus , a thermophillic fungus often found in construction dust. an inventory of common potentially harmful organisms found in hospital settings are often seen in Figure 1. (Figure 1).

The Centers for Disease Control (CDC) publishes guidelines designed to manage the potential health impact of construction activities . These guidelines include resources for understanding modes of disease transmission, ventilation, environmental monitoring and infection control.

While the CDC recommendations were devised primarily with patient populations in mind, they’re fully applicable as recommendations for workforce protection.

The following section discusses how Frankford Hospitals incorporate these recommendations, also as many of its own disease-management solutions, into its infection control program.

Frankford Hospitals
Founded in 1903, Frankford Hospitals operates three hospitals and three outpatient centers in Northeast Philadelphia and Bucks County, Pennsylvania. With a mixture of older infrastructure and newer facilities, it’s commonplace for there to be several construction projects underway at just one occasion . These range from simple repairs to complex renovations, like building a replacement heart center or converting an OR to accommodate new equipment.

Disturbing any artifact , even something as simple as replacing a damaged ceiling tile, has the potential to release mold and mud . Patients, particularly those that are immuno-compromised, can become sick from exposure to those infectious agents within the ventilation or within the beverage supply. Sick patients can pass diseases onto workers, or workers are often sickened directly by the contaminants. Therefore, every project must be considered for its potential health impacts.

To manage this risk, Frankford has developed procedures for infection control during construction projects. These include: 1) regular meetings of a construction management team, 2) standardized risk assessments for building projects, 3) ongoing infection control training for workers and construction vendors, 4) air quality testing and environmental monitoring, and 5) guidelines for communicating with staff during a timely and accurate way.

Brief descriptions of those procedures follow:

1. Construction Management Team:
The team meets weekly to review current construction activities and communicate with staff. The committee includes representatives from the laboratory, engineering, environmental services, administration and risk management. counting on the complexity of the project, meetings can also include architects, design engineers, contractors and construction administrators.

2. Risk Assessment:
An Infection Control Risk Assessment (ICRA) is conducted for construction projects to work out the potential risk to patients and staff, also as inform the acceptable regulatory agencies of ongoing activity. In Pennsylvania, these include the Department of Health and therefore the Joint Commission (formerly Joint Commission on Accreditation of Healthcare Organizations – JCAHO).

The ICRA compares the complexity of building activities to their proximity to patient populations to work out what controls are needed. additionally , the ICRA process leads to recommendations for the security of construction personnel, like wearing personal protective equipment, maintaining negative atmospheric pressure within the construction zone, or constructing an anteroom to stop the spread of dust.

Frankford actually developed its own ICRA form which was later adopted by the Pennsylvania State Plans Review Division. An example of this will be seen in Figure 2 (See Figure 2).

3. Training:
Hospital staff, contractors and sub-contractors are all required to be conversant in infection control procedures. Contractors and sub-contractors are required to pass a two-hour infection control course that Frankford offers. a number of the topics covered within the course include tuberculosis control, asbestos hazards, and blood-borne pathogen safety. Contractors that aren’t conversant in these procedures aren’t eligible to bid on projects.

4. Environmental Monitoring:
Environmental monitoring involves two sorts of activities: 1) daily physical monitoring of activities to form sure that building activities and ICRA barriers conform to infection control and safety standards, and 2) air quality testing to assess whether the ICRA barriers are preventing construction dust from entering the active areas of the hospital. Air quality testing typically includes real-time particulate testing, and should also include culturable fungal and bacteria samples.

Environmental and Engineering Solutions, Inc. (EES) assists Frankford with its environmental monitor program by providing weekly contractor and ICRA barrier monitoring. EES also conducts weekly air quality testing during construction activities. Both baseline measurements in areas faraway from construction and on-site measurements of areas near the development zones are conducted.

Air quality testing, lab time and generating reports adds costs, so facilities should review their budgets and objectives to form the simplest decisions about ICRA monitoring. Typically, these services are prioritized for situations when:

there’s evidence of water or water damage in an affected area
o Mold growth is observed
o Construction activity will generate dust
o The project has the potential to affect the domestic water system
o The ventilation could also be suffering from construction activity

5. Communication:
The construction management team meetings are wont to keep the affected departments informed of ongoing construction activities. Information is then disseminated through a spread of means including departmental meetings, memos and email.

There also are standard procedures for communication between the development team and hospital administrators. for instance , if a possible hazard is discovered, the director of facility design and construction is instantly involved. Additional steps may then be required to stay the staff informed.

The following section describes an instance where Frankford’s procedures were implemented to deal with an infection control situation.

Putting the Plan into Action
Frankford was converting an OR into a replacement central sterilization suite. Workers had removed an autoclave, exposing the wall behind it. During a weekly air quality test, EES discovered large patches of mold on the wall.

We immediately informed Frankford’s director of facility design and management, who ordered a hold on construction. supported our recommendation, he also had the world quarantined off and ordered that staff whose work areas were near the development be relocated until we could determine if the mold was toxic.

Next, Environmental and Engineering Solutions took bulk samples to spot the sort of mold and therefore the extent of the contamination and determine if there was any danger to hospital staff or construction employees. Frankford’s management also informed the staff who worked within the area that that they had found the mold.

Unfortunately, variety of their employees were upset and anxious that their health would be affected. during this day of instant communications, things had the potential to escalate, so Frankford’s management was wanting to allay people’s fears.

Fortunately, the laboratory report came back negative for toxic mold, bacteria or harmful particulates. These results were made known to the staff at a special meeting. the workers were allowed to read a replica of the report back to validate our findings.

Using these results, we also made recommendations to Frankford regarding what remediation steps needed to be undertaken and what protective measures were required for the workers. We then conducted a visible inspection before giving the go-ahead for construction activities to resume.

These steps were repeated on several other occasions for other mold issues unrelated to construction. The investigations included visual inspection, mold and bacteria sampling and analysis, interviews with affected employees and proposals on remediation.

Conclusion
Hospitals will still build new and upgrade older facilities. Planners got to address the impact of those building projects on the health of workers and patients alike.

By that specialize in infection control, hospitals can avert potentially hazardous situations and reduce the risks to patients and staff. Communication, environmental monitoring and training, also as adherence to strict infection control procedures are all essential steps within the process. With preplanning, training and active communication, hospitals can manage the risks and maintain active construction schedules confidently .

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