Infection control is a critical issue for any hospital. And for Loie Ruhl, infection prevention specialist at Barnes-Jewish Hospital in St. Louis, having evidence readily available to support her initiatives in protecting environments under construction was a goal she hoped to achieve.

“I want to say, ‘I need you to do this, because …’” she said during her session “Infection Prevention: Protecting a Vulnerable Patient Population” at the ASHE Annual Conference in Atlanta.

And while she had that opportunity thanks to a renovation project in a bone marrow transplant unit at her hospital, she had previous accounts to look to, as well.

First, in 2004, she said, a leukemia patient died after coming down with an invasive aspergillosis infection, the root cause of which was determined to be a renovation on the unit that had started a month earlier. Then in 2006, two patients in the hospital’s ICU had cultures that tested positive for Aspergillus fungus on the same day—both patients’ rooms were adjacent to lobby doors. In the lobby, wallpaper was being replaced, and though barriers were in place, they were frequently breached. In that case, one patient died. (While there's no concrete evidence that the deaths directly resulted from the infections, the infections were likely contributors to complications, Ruhl noted.)

“This got the attention of our in-house crew and facility staff,” she said. Today, Ruhl works closely with the hospital’s facilities staff to ensure a safe work and care environment despite whatever large-scale construction project or everyday maintenance issue may be taking place. “Working with facilities, there are a variety of things that happen,” she said.

From bleaching any ceiling tile that has to be removed to installing barriers where work is being done to seeking out measures to control dust, the infection prevention department oversees issues (and threats associated with them) like stagnant water, floods, utility interruptions, open penetrations, barrier access permits, and even the use of fans.

And when it came to that bone marrow unit renovation, the precautions already in place and then some were put into action to protect the hospital’s most vulnerable patient population over the course of the 15-month project. Those extra measures included construction staff outside of the barriers wearing gowns and non-construction staff wearing gowns when inside the project area.

The prevalence of aspergillus was measured, and the incidence rate actually dropped compared to the hospital’s average. “To me, that was a huge victory,” Ruhl said. And when it comes to finding a reason for her “I want you to do this, because …,” Ruhl can now say that these types of measures will lower the number of infections and help keep patients out of risk.

And while the initiatives may translate to projects large and small taking longer or being more complex in nature, Ruhl encourages the whole team to come on board with the process, to accomplish facility projects without risking patients’ lives.

“Ultimately, we’re all part of the same team that’s there to take care of the patients,” she said.