Construction planning and design: Beyond the infection control risk assessment

ISSUE: Hospital construction and renovation projects have been associated with outbreaks of infection in immunocompromised patients. Successful implementation of dust control measures requires a partnership between infection control (IC), project managers, and contractors throughout the project from the planning and design phase to final clean-up. PROJECT: The hospital and medical center is a 607-bed tertiary-care teaching facility in Detroit, where construction and renovation projects are routine events. The infection control risk assessment (ICRA), incorporated in planning and design phases, identified risks and recommended appropriate infection control precautions. Despite these efforts, IC noted frequent breaches of dust control measures. We identified an opportunity to improve the management of construction-related infection risks associated with a projected 5-year master facility expansion plan by implementing strategies beyond our current ICRA process. An infection control construction permit (ICCP), listing key personnel contact information and a description of dust control methods, was displayed at the entrance of Class III and IV projects. Training of contractors was supported by IC through initiation of a formal orientation program and onsite education. Infection control practitioners surveyed construction projects daily utilizing a standardized checklist. Non-compliance issues were addressed directly with the contractors and project manager, trended on a corrective action log, and communicated to administration as appropriate. An infection control construction planning module was added to the hospital intranet that included the ICRA, ICCP, educational materials, daily checklist, signage, IC contact information, and a link to the IC home page. RESULTS: Communication between IC and construction groups and compliance with dust control measures has improved. Education to improve contractor and employee awareness of health risks associated with construction has contributed to improved project design and containment measures. LESSONS LEARNED: Implementation of the ICCP, daily monitoring, and promotion of the educational module has enhanced the importance of the role of IC during construction and renovation projects throughout the facility. Risk prevention strategies, identified as part of the ICRA process, must be implemented consistently using a multidisciplinary approach to ensure the safety of patients, employees, and visitors.