Hospital Construction and Infection Control: Does Everyone Measure Up?

Abstract

BACKGROUND/OBJECTIVES: Healthcare associated infections (HAI) related to construction projects are well documented. In June of 2004, a patient was diagnosed with a HAI aspergillus infection. This patient was housed on a nursing unit adjacent to a renovation project. While aspergillus levels are highest in late summer and early fall, the cause of this patient's infection could not be definitively determined. Infection Control Policies and Procedures are in place and were followed for this project. A review of current practices and evaluation of compliance with these policies was conducted to ensure that this facility does everything necessary to protect patients from exposure to airborne fungi and molds that may be generated or present during construction activities. METHODS: A Failure Mode Effects Analysis (FMEA) team was formed to evaluate current practice and compliance with policies. The team members represented Infection Control, Environmental Health and Safety, Design and Construction, Facilities Engineering, Nursing and Patient Safety and Quality. Hospital policies and procedures were compared to CDC environmental guidelines and process maps were created to identify the failure modes. The undesirable variations in the process were rated based on severity of risk. The team then identified corrective and preventive actions. Finally, the team took on the task of redesigning the underlying systems or the process itself to eliminate barriers to compliance. The process was revamped and the new processes were tested and evaluated. The new strategies were implemented and the results monitored. RESULTS: The Infection Control Risk Assessment (ICRA) was changed to make it easier to use. The process of contractor evaluation was changed. All departments involved in the construction and renovation process were included in the evaluation. Work permits were designed to ensure that smaller projects were included in the ICRA process. An educational program, including in-house contractors, was started. Since the implementation of the new form, and the educational sessions there has been a 283% increase in ICRA submissions. CONCLUSIONS: A multi-disciplinary team evaluating process and practice is beneficial in determining and eliminating barriers. In order for proper practice to be followed, all involved must be aware of process. The process cannot be too difficult, which creates barriers and sets process up to fail.