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November 21, 2002

Hospital renovations can make people sick

  • New codes are in effect to reduce the spread of infection in healthcare facilities
  • By WESLEY ARMSTEAD
    CDi Engineers

    Armstead
    Armstead

    Each year, about 5,000 Americans die because of infections contracted from construction, renovation and maintenance activities in a hospital — despite the heroic efforts that go into hygiene.

    That’s the equivalent of one 100-passenger airliner going down almost every week. What’s worse, many of these deaths would be preventable if people in the design professions became more educated about working in healthcare facilities.

    New regulations are forcing us to change our ways. Last January, stringent Infection Control Risk Assessment (ICRA) codes went into effect, designed specifically to reduce the spread of infection in healthcare facilities. Most of the ICRA requirements are directed at construction efforts, as they should be. Often overlooked, however, is the fact that ICRA also applies to those of us who don’t wield hammers, wear hardhats, or really build anything, that is architects and engineering consultants.

    The new codes require that ICRA plans be developed and put in place for construction projects. It also includes short-duration activities or visits by design professionals — or by anyone who enters a space that may harbor bacteria, fungi or other contaminants.

    Why are the new requirements so tough? Think about the number of non-hospital workers on any healthcare construction site. Whether they’re interior decorators, painting contractors or information system technicians, they can all disrupt sanitary conditions and permit the spread of infections. One tip of a ceiling tile can release hosts of aspergillus spores or fungal agents hiding in the space above, exposing countless patients and employees throughout the hospital.


    Good ICRA compliance
    Put it in the contract. Incorporate ICRA compliance into all of your contract documents. Specify exactly how your employees and any related contractors must implement ICRA. This may protect you in the event that problems or omissions arise down the road.

    Talk about ICRA at weekly meetings and at briefings with your own staff members and any other companies working on-site. Make it a standing agenda item so everybody understands the importance of compliance and gives it top-of-mind attention.

    Enforce controls. Remind your staff and contractors that their livelihood at this and other hospitals could hinge on their ability to understand and follow the ICRA program. Ask peers in related disciplines to help monitor compliance. For example, an information systems consultant should be more then willing to monitor work done by computer cable contractors. Set a tolerance limit for non-compliance and stick to it.

    Document any deviation from the plan that could endanger patients or employees. Discuss it at the next meeting and at facility infection control and safety management committee meetings.

    Preliminary field work to document existing conditions of a facility — like when you poke around in ceiling cavities, chutes or shafts — can stir up disease-laden environmental dust.

    Put it on the radar screen

    Many design professionals are unaware of the rigorous ICRA codes because they typically work for a wide variety of clients, only a few of which are hospitals. Plus they have their own priorities. They may focus on doing a superior technical job and fail to remember infection-control precautions, simply because ICRA compliance is not normally one of the criteria for excellence in their industry.

    Still, it’s essential that any architect or engineer who works in a hospital learns about ICRA standards and applies them immediately. Pleading ignorance of ICRA codes won’t protect patients from illness or death, nor prevent lawsuits if infection should occur. Architects and engineers need to do their homework and have an ICRA plan ready before entering a facility to research a project.

    Prepare a plan

    If you’re a design professional working on a hospital project, check in with facility management prior to starting work. Ask for a copy of the facility’s infection control plan and ICRA guidelines, and assess them carefully to see how they apply to any of your activities while on site. The facility manager should be able to provide a procedure you can use during investigative work and follow-up activities.

    You might be surprised at the range of activities that require ICRA compliance. These include, but are not limited to, airborne contaminants, noise, odors and traffic interruption.

    Cover your contractors

    The second most important requirement of ICRA for designers is to educate sub-consultants. To be proactive, the architect and engineer should incorporate any and all specific requirements of ICRA in the contract documents, as appropriate, with sub-consultants. While there might be concern that this will pose a liability issue for some design professionals, there needs to be a way to convey the critical nature of these code requirements to the sub-consultants.

    In addition, ICRA requirements need to be conveyed to the construction contractor. This can be relatively easy. Download or reprint the Infection Control Risk Assessment Matrix and related action plan, and include it in the contract documents. This matrix is circulated in many trade publications and on various Web sites.

    You may want to modify or scale back the matrix and/or action plan to make them appropriate for the individual contractors and task at hand. This will depend in large part on the nature of work, type of investigation or project duration within the facility.

    Also, explain to your contractors that ICRA starts with them. Emphasize the enormity of hospital deaths due to infection control issues, and the impact that a contractor’s actions can have on the spread of life-threatening diseases like tuberculosis.

    Ethical contractors will understand ICRA’s intent and gladly honor its codes. Some may have their own ICRA standards in place to protect all present and future healthcare facility clients. Their professional expertise may even cover eventualities that you and the facility manager have not thought of.

    Our goal as A/E professionals in the healthcare market must be the total elimination of healthcare facility deaths due to construction, renovation and maintenance-induced infections — helping to ensure a safe, comfortable and infection-free hospital experience for everyone.


    Wesley Armstead has worked in healthcare-related services for nearly 18 years, including eight years as a facility director in an acute healthcare setting. He currently serves as the director of healthcare services at CDi Engineers in Lynnwood. A copy of the ICRA Matrix and action plan can be found on the American Society for Healthcare Engineers’ Web site at www.ASHE.org.



     


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