...almost every resource, direction or tool imaginable related to safe health care environments, including an ICRA checklist and other sample forms. There even is a form for an infection control building permit.

According to Streifel and Bartley, a risk assessment for projects close to existing hospitals should consider the patient population, project scope and duration,impact on mechanical systems and whether the facility will remain occupied during work.

"ICRA is not prescriptive," says Bartley. "The team has to make a separate assessment for each project."

Early Start

It is critical to begin the ICRA assessment during the project’s conceptual design, says Streifel. It also is critical to involve the project’s team leaders, including the architect, mechanical-electrical-plumbing engineer, the construction manager and the hospital’s safety manager, facilities manager and medical staff.

The infection control program must then be enforced. For example, Streifel cautions that the impact of value engineering decisions made after design is complete must be weighed against the potential for fungal growth and indoor air qual-ity (IAQ) problems down the line.

Monitor. Construction worker checks air quality in corridor of occupied hospital near project. (Photo courtesy of Bovis Lend Lease)

For construction near an operating hospital, some clients require preconstruction monitoring of air quality. That gives a benchmark for comparison during and after the work. Contractors should plan routes in and out for workers and materials to minimize disturbances. It is imperative to cover existing air intakes or relocate them out of harm’s way before construction begins, says Bard. Sticky "doormats" that clean the soles of work boots are a must for tramping in and out of sites.

Construction materials, when they are stored on site and after they are installed, must be kept dry to avoid mold growth. At the end of the work day, it is imperative to cover or seal any openings in pipes and ductwork.

To contain construction dust, partitions and enclosures around renovations should be "solid in nature," securely attached and sealed at the floor and structure above, say the guidelines. Rooms should be vacuumed with HEPA-filter machines. Contractors should maintain negative air pressure to keep dust within sites, using the new air-handling system or portable air scrubbers.

Differential air pressure monitors with data logging are available. The system provides a printout any time the pressure differential changes. The log helps prove "we were following the infection control program" if the infection rate in the hospital increases during construction, says Eaton.

At Skanska, contractors are not installing permanent sheetrock down to the floor, so if there is standing water, the wall does not absorb it like a sponge. For new construction, workers will enclose the building starting at the roof and work their way down. "It’s a lot easier to start at the bottom and go up, but it’s better to keep the materials dry," says Quirk.

It is one thing to build the hospital and it is another to make sure all building systems operate well. That’s why the guidelines recommend total building commissioning, not just the traditional commissioning of the HVAC system.

To help track everything, Skanska provides subcontractors with infection control checklists for each task, whether they are removing a desk or making a hole in the wall, says Quirk.

It is too early to tell whether attention to infection control in hospital construction has made a dent in nosocomial infections among hospital patients. But most agree that there have been "vast improvements" at construction sites in recent years.

"Everyone is beginning to work together" and that is critical for success, says Bartley.