...what everyone has been talking about is done," says Eugene Bard, a principal of Bard, Rao + Athanas Consulting Engineers Inc., Boston. "It’s becoming standard now. [Even] five years ago, we did not do it."

The guidelines have made ICRA a household word in health-care circles. "Risk avoidance is at the top of the list," says Andrew S. Quirk, vice president in the national health care group of Skanska USA Inc., Atlanta, ranked fourth among ENR’s Top 25 in Health Care based on annual revenue. "It’s a cultural change," he says. "We do it on all health care projects, from a janitor’s closet to major renovations," says Quirk.

Jim Eaton, vice president of health care business development for McCarthy Building Cos. Inc., St. Louis, which is ranked third among the Top 25, agrees that "awareness of infection control is increasing" in the health care field. "We are better [as a team] at identifying risks up front." But he says that does not mean there is no room for increased awareness.

A side effect of all this is that hospital work has become even riskier business and has become a specialty. In the recent past, any general contractor could do hospital construction, says James F. Case, principal and director of the Healthcare Design Group for Swanke Hayden Connell Architects, New York City.

Depending on the location and the type of project, hospitals cost about one third more than middle-of-the-road residential work. "If you don’t have the background [in health care], you will get killed financially if you don’t kill anybody else," says Cary Coltun, a senior vice president in the New York region for Bovis Lend Lease, ranked second among ENR’s Top 25 in health care.

Growing Market

It is a healthy market, which is a big draw. For 2005, McGraw-Hill Construction forecasts 94 million sq ft of construction starts in health care facilities, an increase of 3% from 2004, according to Robert A. Murray, vice president, economic affairs. McGraw-Hill, New York City, also publishes ENR. In 2003, the health care construction market hit $18 billion, according to Modern Healthcare magazine, published by Crain Communications Inc., Chicago.

Clean construction and dirt and dust-free sites are easier planned than done. Though the procedures to keep sites from spreading germs follow "the lines of common sense," they are difficult for workers to follow, says Bard. "If you are digging a hole, how do you contain the dirt?" he asks.

Contractor buy-in is important, but owners need to adjust as well. "Don’t put everybody under so much pressure," advises Carl Lawson, a commissioning agent with PWI Commissioning Services, Durham, N.C. "Don’t award something today and try to get it done tomorrow."

To help get everyone on the same page, the Chicago-based American Society for Healthcare Engineering (ASHE), which is affiliated with the American Hospital Association, offers an education program. At the start of 2004, 1,600 contractors, owners and architects had completed the Healthcare Construction Certificate Program, which kicked off in 2002. ASHE estimates that number will rise to nearly 3,000 by year’s end.

To accommodate the program’s popularity, ASHE plans to more than double the number of workshops offered next year. In addition, ASHE is launching an "e-learning" module for the certificate program, probably in April. It will be a prerequisite for the certificate program.

The program is getting good marks. It "is a very good process for teaching managers and supervisors the dos and don’ts of working in a hospital," says Jim Miller, senior vice president for health care at J.E. Dunn Group, Kansas City, Mo., ranked sixth on ENR’s health care list.

At about $2,000 a person, counting all related expenses, "it’s an expensive ordeal," says Bovis’ Coltun. But "it’s truly a great educational experience for it makes the project manager and super a partner with the hospital’s safety manager," he says.

The program also gives contractors an understanding of the regulatory environment and the consequences of noncompliance. "If we don’t follow certain procedures regarding dust control and infection control, a hospital can lose its accreditation," says Coltun.

Other infection control guidance is available for no charge from the "Safety Institute," an online public service of Premier Inc., a purchasing cooperative for hospitals (www.premierinc.com). The service, developed by Bartley, provides links to...