Pre-construction Planning

Pre-construction Planning

PEP Topic 
Prevention of Infection: General
Description 

Pre-construction planning involves the planning and implementation of activities to maintain appropriate environmental measures to prevent patient exposure to potentially infectious agents that can be introduced into the environment during construction. Planning generally also involves education of contractors and construction workers and ongoing monitoring of conditions and compliance with required procedures under the guidance of professional infection prevention and control personnel.

Likely to Be Effective

Research Evidence Summaries

Kidd, F., Buttner, C., & Kressel, A.B. (2007). Construction: A model program for infection control compliance. American Journal of Infection Control, 35, 347–350.

doi: 10.1016/j.ajic.2006.07.011
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Study Purpose:

This study describes a five-year expansion project to build a nine-story employee garage, a new post-anesthesia care unit, a new cardiothoracic intensive care unit, and expansion of existing operating room space to include eight new operating rooms. The construction plan included demolition of five circa 1910 mostly unused buildings.

Intervention Characteristics/Basic Study Process:

One infection control practitioner (ICP) attended a University of Minnesota Health Care Facility Construction Management Indoor Air Quality Workshop.

An infection control education program for contractors was developed that all construction workers were required to complete the training prior to working on the construction project and annually thereafter.
The infection control training takes 30 minutes. The lesson plan is organized by sections that include precautions to take before, during, and after construction work. There also is an audiovisual program about Aspergillus and its transmission and the susceptibility of immunosuppressed patients.

An infection control team including the general contractor, project manager, ICP, and operating room nurse planner make rounds weekly or daily on all projects to monitor for compliance and answer questions. In addition, other precautions were implemented since patients could not be relocated away from the area of greatest activity.

  • All windows adjacent to the demolition site were sealed with plastic.
  • Prevailing wind direction was monitored, and extra pre-filters were added to all air intakes.
  • Any dust generated during demolitions was wetted down.
  • Air curtains were added to doorways directly facing the construction.
  • Immunosuppressed patients were notified to wear N95 protection when entering the hospital.

Sample Characteristics:

Members of the design and construction department are engineers and architects and have attended classes on construction and infection control.

Setting:

  • The University Hospital is a tertiary care hospital in Cincinnati, Ohio. It has a level 1 trauma center, seven intensive care units, including a level 3 perinatal research center and neonatal intensive care unit and an adult burn unit.  
  • There is an average daily census of 400.
  • Parts of the original hospital were built in 1910, 1927, and 1969.  
  • At any one time there are 4–6 major renovation projects.

Results:

During the first four years of demolition and renovation, the University Hospital had no nosocomial Aspergillus infections.

In the fifth year, of construction, two patients who had possible hospital-acquired infections were identified. An industrial hygienist was brought in to evaluate intervention and make recommendations, but nothing of concern was found.

Particle sampling remained the same from pre-construction to post-construction.

Both possible nosocomial Aspergillus infections occurred after a building that was connected to the hospital and shared air space began a large renovation project without using infection control prevention.

Conclusions:

Hospitals must be aware not only of what is happening inside their own facilities, but also what is happening outside. ICPs must establish collegiality with contractors, architects, maintenance, and engineering personnel to produce an effective, comprehensive infection-prevention atmosphere during construction and renovation.

Limitations:

  • Small study of one hospital initiative
  • Case study

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