Every medical facility has an infection-control program to provide a safe environment for patients, visitors, staff, and outside vendors. Medical staff are familiar with infection-control procedures and must deal with them on a daily basis. Their knowledge and activities relating to controlling infection are ingrained in them through their education, training, and daily work. These procedures are new territory for some construction managers, but it is essential that they take actions and precautions to prevent the introduction and spread of infectious substances in functioning healthcare facilities during construction projects—whether they are additions or renovations of existing buildings or spaces.

Because the construction process brings a variety of new, potentially hazardous conditions to the hospital environment, we must stringently control these conditions. Renovating and/or expanding a hospital presents a risk of infection to both staff and patients—especially immunocompromised patients. Both major and minor construction projects can be done in such a manner as to minimize the risk of fungal or bacterial infections by preventing the introduction and spread of unwanted “guests.”

Many different types of contaminants such as bacteria, chemical irritants, and fungal spores are found in unfiltered air, ventilation systems and, most notably, in contaminated dust dislodged during hospital renovation and construction. Fungal spores, for example, have been recognized by the Centers for Disease Control and Prevention as a cause of illness and mortality in immunocompromised patients. This must be prevented—one death is too many. Through proper planning, communication, and strict adherence to an infection-control program, the potential for unnecessary illnesses and deaths can be eliminated.

Identifying Infection Risks

The first action necessary in preventing the spread of infection is to identify potential risks. This starts with performing an infection-control risk analysis. This analysis of the construction activities considers the types of problems likely to be encountered. These include traffic routing, dust control, and handling of construction materials and debris. Once these potential problems are identified, the project team needs to collaborate to find the best ways to address them.

Limiting Access

One of the best ways to lower infection risk during construction is to prevent nonconstruction personnel—including patients, visitors, and medical staff—from entering work areas. A simple barrier can accomplish this. Most barriers can be designed and built with dust (and sound) control and, therefore, minimize the migration of airborne particles and debris (as well as unwanted noise). To be successful, the barrier must be built in much the same way a standard wall is constructed.

The use of barriers, while preventing dust and debris from being tracked out of the construction area and into patient, staff, and public areas, also provides infection control for construction workers because it protects them from being exposed to healthcare-related hazards, such as needles, medical waste, and infectious substances.

Another method for keeping construction activities separate from the healthcare facility's operations is routing the flow of construction traffic, building materials, and refuse away from patient, staff, and public areas. At times, however, moving materials and equipment through the occupied, functioning areas of a medical facility is unavoidable. The impact of this traffic can be minimized if it takes place during “off hours,” or at least when the areas are least busy. A “flagman” walking in front of the material being transported can help direct the construction crews and control patient and staff traffic. To eliminate the contamination of an area by dust or falling debris, materials and trash should be transported in covered containers.

Dust Control

A complete system for controlling construction dust should be designed before any renovation or new construction activity is started. As mentioned earlier, barriers are a good first step, but construction methods can also accomplish this. For example, creating a negative air space, where the air is pulled into the construction area, will eliminate the dust from migrating into occupied or sterile spaces. The air can be drawn through a HEPA vac to trap particles before the air is discharged. We have done this recently on a project where the area being built was an operating room in the center of the building. Temporary ducting allowed us to create negative airflow in the construction space, and then the air being drawn was vented through the corridor and out the back of the medical facility. Again, this must be done with the utmost care to avoid contaminating sterile areas.

Yet another way to eliminate dust is to “wet cut” concrete and masonry. To do this, water is sprayed on the cutting surface in front of the saw blade. As the saw is cutting, it is always cutting into a wet area, thus eliminating the dust. Then, to eliminate the “dusty” water, a wet vacuum is held just at the front of the saw blade, vacuuming the water as it is discharged.

Communication

Communication is the most effective tool in construction infection control. Steps can be taken to make the project safer and more efficient for all if the project team and the medical team understand one another's expectations. “User meetings” should be held so that staff members can be informed of the upcoming construction activities and, in turn, make the construction workers aware of the activities of the facility's departments. This sets the stage for proper infection control throughout the life of the project. Because staff requirements for the project are explained during these meetings, the construction team knows precisely what the hazards might be and what methods or procedures are necessary to prevent them. With adequate communication, the infection-control strategies can be customized for each medical facility and for each construction activity. This individualization is what truly makes infection control effective.

This first “kickoff” meeting should be held before construction begins. This is the time to communicate the specifics regarding construction activities to the staff and to set forth the details of the construction project's infection-control program, to minimize the project's impact on the staff, patients, and other users of the facility.

We have found that after this initial meeting, distributing “look ahead” schedules that show the daily construction activities for the next two weeks is an excellent way to keep the medical staff informed as the project proceeds. Also, colored diagrams showing phasing can be posted in staff areas to show traffic flow or construction activities that might have an impact on the hospital's routine operations.

Regular meetings held throughout the building program help both staff and construction crews keep each other informed about their activities and concerns. In addition, the construction manager can provide photographs and project news to the staff and the public to keep them updated on the project's progress and activities. In the end, informed staff members and patients are far less likely to complain or, worse yet, be exposed to any infectious substances as a result of the construction activity. HD