Before construction can commence in a hospital environment, proper consideration must be given to the isolation and control of contaminants that may arise due to construction-related activities. The control and remediation of these contaminants are addressed in project specific Infection Control Risk Assessment (ICRA) Plan, the development of which is critical to the elimination or minimization of risk to hospital patients and staff. The development of a project specific ICRA plan involves the careful coordination of a hospital’s Infection Control Practitioner, Safety Officer, Director of Facilities, Director of Construction, representatives from departments adjacent to affected areas, and the contractor employed to perform the work.The first step in developing a cohesive ICRA plan is to identify the invasiveness of the construction activities that are to take place based on scope and duration, typically identified as type ‘A’, ‘B’, ‘C’ or ‘D’ activities. Obviously, a project involving the repainting of walls (type ‘A’) or replacement of telephone/computer cabling (type ‘B’) will be less invasive than one involving demolition of partitions (type ‘C’) and relocation of major mechanical systems (type ‘D’), or one where the envelope of the building is compromised for an extended period due to the potential for water infiltration (type ‘D’).Once the scope of work is adequately understood, the risk level of the areas affected must be evaluated, commonly referred to as identifying patient risk groups. Risk assessment is based on the sensitivity of patients in adjacent areas and described from ‘low’ risk to ‘high’ risk. Less stringent measures would be required in a Radiology Department (‘medium’ risk) as compared to one where there are heavily immune compromised patients, such as Oncology (‘high’ risk).
Once the scope of work is defined and the risk level to patients assessed, preventative measures can be adequately delineated. Low risk projects might simply require the isolation of areas with fire retardant plastic sheet barriers and the cleaning of the space during and after completion with an approved disinfectant. A high risk project might involve such extensive measures as isolating the mechanical system, keeping the space under negative pressure using HEPA filtration units, incorporating anterooms where workers can be cleaned before re-entering active hospital spaces, requiring workers to wear shoe/clothing protection (“bunny suits”), etc. Whatever the measure may be, they must be clearly and effectively specified so they may be properly carried out by the construction team. It is quite common to use an “ICRA Matrix” to assist in identifying the above-mentioned types and risks when implementing an ICRA plan. Not only will this ICRA Plan become the most critical part of the preconstruction planning between the General Contractor and Subcontractors, but it will also serve as a rubric by which the site must be continually graded for effective infection control.