Infection Control: Adapting Worksites at Active Healthcare Facilities

Construction companies are familiar with safety and mess-control; however, with the COVID-19 pandemic, there are some more factors to consider when working at healthcare facilities.

COVID-19 has forced nearly every industry imaginable to enhance safety protocols for workers and customers alike. Perhaps more than others, those working in construction are well-prepared for these changes. When constructing or renovating healthcare facilities, it’s critical to routinely consider how construction impacts factors like emergency management, patient flow, security, life safety and infection prevention and control affect—and to consider ways to minimize the work on occupied spaces.

In many ways, the precedent has already been set for infection control precautions in healthcare construction. Maintaining access to jobsites and coordinating shutdowns in a way so as not to impact any patient or operating rooms during the COVID-19 pandemic is not new to those who work on construction sites at medical facilities. The level of infection control employed on any given project is a function of the work type to be performed, its adjacencies to sensitive areas and the associated risk level. Based on the determined risk level, and in adherence to the hospital’s published requirements in its contractor handbook (if it has one), an infectious control and containment plan is developed well in advance of the construction start. Routine internal inspections by dedicated craft workers during construction ensure adherence to the established plan.

To control infection, first and foremost, sites occupied by patients must remain dust- and contaminant-free. To do this, you should employ a variety of containment systems ranging from finished, hard partitions to fabric or plastic barrier systems. We also set up anterooms to keep negative air pressure within the workspace and out of patient rooms. Anterooms look like small boxes and comprise two doors: one to get in and one on the other side with a door or zippered opening to block debris from escaping. Manometers, or digital displays, inform construction workers of the room’s pressure. In some cases, two anterooms may be necessary to ensure maximum imperviousness.

Exhausting out of a window to create negative pressure is common. But more challenging cases—like maintaining negative pressure while working in interior, positively-pressurized rooms, like operating rooms—necessitate creative solutions. As a rule, ORs are positively pressured to keep contaminants out. It helps to use a two-pronged approach of temporarily adjusting the supply air balance of the room while exhausting a significant amount of air through temporarily-installed ductwork above ceiling and through a circuitous route across other spaces to reach that exterior window.

Depending upon patient populations within and adjacent to our work areas, temporary walls may be installed that reach the ceiling grids. In cases where the worksite is next to more sterile or more patient-sensitive areas, walls may need to be erected to the underside of the deck above to contain the air above the ceiling. In drywall containment procedures, plastic barriers may be necessary to work above plenum space. Covers may be placed over mechanical ducts, floors, and ceilings to prevent dust and debris from escaping.

These tactics are paramount for keeping debris and construction particles out, but, as hospital clients have observed, are also useful for keeping infectious pathogens contained. COVID-19 has prompted some hospital clients to request that while on-site for a separate job, workers construct similarly pressurized isolation rooms for COVID-19 patients.

To that end, increased COVID-related, hospital-wide sanitation efforts have prompted us to introduce additional infection control measures at the worksite. Hospital staff routinely administer temperature scans of everyone entering worksites, and temperature checks are also self-conducted by the construction teams on-site. Without exemption, construction workers don PPE face masks. Worksites are cleaned up and sanitized at the end of each day, and tools are regularly wiped down with disinfectant.

As able, project teams space out the daily schedule and worker placement to allow for as much social distancing as possible. Staggered start times and physical separation of active worksite areas limit exposure between various groups of workers. Where they might not have before, work is being sequenced around the clock; evening shifts allow for fewer trades to be on the job site during the day.

Construction is, by nature, messy. Good construction firms have always done everything in their power to mitigate the mess, limit the debris and control the spread of contaminants on the worksite—especially when that worksite is an active, occupied healthcare facility. With proper adherence to these outlined recommendations, hospitals will remain safe places for patients, healthcare workers and construction crews.

This article originally appeared in the August 2020 issue of Occupational Health & Safety.

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