Hospitals are very important institutions. The continued population growth and increased health concerns have led to the need of expanding the existing hospital facilities. This metropolitan hospital serves a large number of the public, and this is the reason for the planned expansion. I have been appointed to manage the whole additional construction project. The biggest challenge is the fact that this facility must continue operating alongside the construction work. There are a number of risks that are associated with this. For instance, the risk of infection to the patients and the staff of this hospital are high. My first major assignment is to develop a comprehensive Construction Safety and Infection Plan that would ensure that the patients and other workers are safe from the infection that may result from the construction activities (Bartley, 2000).
In most cases, people only tend to focus on the long term benefit of the additional facility to be constructed. However, there are a number of short term effects that may injure the staff and the already sick patients. In regard to that, this Construction Safety and Infection Plan is aimed at ensuring that infection is effectively controlled, noise and other overall safety measures are put in place. The below plan has been modeled as per the guidelines provided by the relevant authorities. The authorities include: American Institute of Architect (AIA) "Guidelines for Design and Construction of Hospitals and Healthcare Facilities", Association for Professionals in Infection Control and Epidemiology, Inc. (APIC), and the latest edition of the Joint Commission HAS/SAC.
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For this Construction Safety and Infection Plan to succeed, all the relevant stakeholders within and without the hospital will be involved. In fact, it is intended that an inter-disciplinary team of personnel, including the contractor, will be established to oversee this construction work. This will also ensure that everyone takes responsibility of the concerned area. At the long run, all the measures will have been followed to the latter for the safety of the environment, patients, and the hospital staff. It also prudent to mention that an Infection Control Risk Assessment (ICRA) will have to be done before the additional construction is commenced. Though, the assessment is something that will be required from the beginning, throughout the construction period, and will still be done after the completion of the project (MMWR Recommendations and Reports, June 6, 2003).
Definitions of Construction Activity
Construction activity in this metropolitan hospital will be defined by the amount of dust that will likely be generated, the duration of the activity, the likelihood of water to aerosolize, and HVAC systems sharing. Generally, there are four types of the construction activities that have been identified. They range from Type A to D, respectively depending on the increasing amount of dust produced. For the sake of this additional construction project, the main types are known as type A and D which are: inspection and non-invasive activities and the work that generate high levels of dust respectively.
Inspection and Non-invasive Activities
This is the Type A activity construction activity. It will be one of the major activities taking place during the project. As indicated above, this is an activity that produces less dust. It will, therefore, include: installation of wall coverings, paintings which produce minimal dust, removal of ceiling sections for inspections, this will, however, be limited to 1tyle per 50 meter square feet. Minor plumbing and electrical work also falls in this category. In order to mitigate against effects from these activities, the adopted work practices must be those that produce minimal dust as much as possible. Immediate replacement of ceilings removed for inspection will also be necessary (Bartley, 2007).
Work Generating High Levels of Dust
This is a type D activity that comprises of major construction projects. This will apply to our construction due to a number of reasons: it will require a closure of the wing where the addition will be made. This means that the patients in the wing will have to be transferred to another unit or wing. There will be major installations and even demolitions of heating, ventilation, air conditioning (HVAC) and electrical systems, medical gas, and even cabling. There will be a construction just besides this wing (close proximity). Excavating the foundation for the addition will also affect the patients in the adjacent wing. According to the ICRA guidelines, there will be high levels of dust that may lead to the infection of the patients and the hospital staff.
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To tackle this problem, control and prevention measures will involve total isolation of HVAC from the construction area, appropriate sealing of the punctures, holes, and other conduits. Wearing shoe covers for all the personnel getting into working area. Maintenance of negative pressure will also be of paramount importance. Wastes from the working area should be collected and transported in tightly closed carts or containers. Mopping the adjacent areas with disinfectant frequently will ensure that infections are kept at bay. Installation of fire-rated barriers will serve to maintain safety. These barriers should be kept intact until completion and cleaning of the working area. Personnel will also have to be provided with working clothing that is removed in certain room before leaving the area. Otherwise, they will have to be vacuumed by the use of a HEPA vacuum cleaner (AIA guidelines, 2006).
The risk factor differs from one area on the hospital to another. There are those areas that handle delicate cases and any contamination or infection may lead to fatalities. These areas can also be categorized low, medium, high, and highest risk areas. The categories also depend on the locations and the kind of activities they handle. In our hospital, the low risk areas include: public areas that are not near to the rooms used for the treatment of the patients. Office areas not used for patient examinations also fall under this category. The medium-risk areas include: the admission room, outpatient hall, kitchen, physical therapy room, linen building, and echocardiography.
High-risk areas are: blood bank, post partum, lab collection areas, respiratory care, new born nursery, labor and delivery, nuclear medicine, radiology/ultrasound, emergency department, and outpatient surgery. Last in this category are the very high-risk areas. These are places which handle very delicate and life threatening matters. Any kind of infection or contamination can lead to a disaster. These areas include: radiation therapy, surgery, endoscopy, Bronchoscopy lab, C-section rooms, interventional radiology, fertility processing, and dialysis center.
Infection Control Department Responsibilities
This department has the biggest role when it comes to any construction activity within a hospital. The officer in charge should, in consultation with other personnel, ensure that all high areas are identified. The department should also be able to assess the risk expected, give recommendations on the need to transfer patients to another area or wing not affected by the addition. It is mandated to come up with the infection control measures and to train all the hospital staff on the potential dangers of exposure to the inorganic and other microbial particulates from the construction activities. After the construction, this department has the responsibility of inspecting the structure and to the final approval and opening .
Plant operations and Engineering Responsibilities
The head of this department has to see to it that ICRA requirements are included in the contract document by the contractor. The department must also ensure that the ICRA is adequately adhered to. Training and education of the employees of the hospital on the safety measures is also part of their mandate. They will have to do this before the start of construction work. Finally, the department will also thoroughly inspect the finished building after cleaning to ensure its safety giving go-ahead for opening (Barbara, et al., 1987).
Safety Department Responsibilities
Safety department must ensure that periodical safety committee meetings are held to review ICRA effectiveness of the ongoing construction. They must also be able to gather and share safety information to other relevant departments as may be necessary.
The contractor has to ensure that all the safety measures are well incorporated in the plan at the design stage. This must in line with all the regulations and guidelines put in place by different bodies and authorities. To ensure that everything is running well, the contractor must also work with all the stakeholders that include the different hospital health and safety managers. This will ensure that effective review is done to ensure that all the patients are safe from any infections. Appropriate signs must be placed at appropriate places to ensure that people are warned of potential dangers. Construction workers may be potential agents of spreading infections. Therefore, the contractor must ensure that the right working clothing is provided for all workers.
Unit Manager Responsibilities
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The unit manager will have to be part of the process from the identification of the risks stage to the end. He/she will also have the responsibility of ensuring that ICRA guidelines are strictly adhered to. He will constantly consult with the other managers to ensure that all the potential dangers are adequately dealt with. The manager will also be able to supervise other departments, like housekeeping, to ensure that cleaning is thoroughly done with the disinfectant to minimize infection probability.
Construction Infection Control Permit
Construction Infection Control Permit is document that contains the summary of the whole construction project. This is a very important document due to the fact that it contains relevant information concerning the project at a glance. This is a construction type of project. It also requires some renovation of the adjacent hospital wing. Other information will be important include: the estimated start and completion date of the project, the hospital project manager, the contractor, and the infection control officer and their contacts. The location of the hospital will also feature there. This section will also include a summary of the important elements like risk areas, construction type, and risk assessment status. There is also an expectation of utility outages during construction. These utilities will include: portable water, sewer, electrical, and even HVAC (Premier Inc.).
Non-Invasive activities are those construction activities that not lead to much production of dust. They also have the potential of causing infection if not well managed. There will be the need of ensuring that the adopted construction practices of undertaking these will not result to too much production of dust. In case of minor openings that will have been made for the sake of inspection or maintenance, there will be the need for the replacement as soon as possible. Barrier systems will also be necessary while doing this. Opening of the tiles for inspection work will only be limited to one tile per fifty square feet. Such measures will help keep dust at bay (Noskin and Peterson, 2001).
As mentioned above, high-risk activities are major construction work that leads to the much production of dust. Our additional construction work falls under this category. The expected pollution will affect both air and surfaces. Excavation of the foundation and building process itself will have the potential of causing more harm to the patients and the staff working within the hospital premises. To this effect, the patients at the hospital wing adjacent to the construction site will have to be evacuated. There will also be major electrical and cabling work going on.
There will be need of ensuring that adequate planning is done, at the planning stage, to see to it that basic infection control facilities are fixed. These will include: installation of adequate water systems at different point to keep away opportunistic water pathogens. Hand washers, soap dispensers, and clinical sinks will have to be strategically placed during the construction process. Personal Protective Equipments (PPE) will also be very necessary. Creation of a strong barrier that is constantly cleaned by the housekeepers will ensure that infection is minimized. This barrier will only be removed after the completion of the construction process. Wastes will also be well contained and transported to the appropriate disposal under tight cover.
Implementation of the above plan will enable effective containment of different kinds of pollution that may lead to the infection of the patients and other hospital staff. This plan, however, will be subjected to changes within the construction process depending on the issues at hand. The continued monitoring of the situation will enable the management to make the necessary ICRA changes.