By Herman McKenzie, MBA, CHSP, director, Department of Engineering
Infection control oversights during building design or renovations commonly result in regulatory problems, millions lost and even patient deaths.
This happens more than anyone would imagine, but it doesn’t have to. Better planned and executed projects help anticipate potential infection control issues – allowing health care organizations to sail smoothly to the ribbon cutting ceremony.
Involve the Infection Control Director Early
The number one problem most organizations make is involving the infection control director too late. It’s no accident that the most successful projects invite the infection prevention department to the design table during the conception phase.
Simply sending that invite to the infection control department goes a long way towards making sure infection control is considered during the pre-risk assessment, not the risk assessment.
During this phase, the infection control director can:
- review the construction location
- make recommendations on how to re-route patients in and out of patient care areas
- study air flows so as not to circulate “bad” air into patient care areas
- advise on proper barrier construction and pressure equalization.
Keep in mind: Nurses, doctors, infection control staff and other health care professionals don’t have a background in construction and need coaching on reading blueprints, etc. The growth of 3D planning capabilities help clinicians visualize their equipment and workflows and notice potential problems in a new space.
Common Infection Prevention Pitfalls
There are so many expensive and dangerous outcomes when infection control doesn’t have the opportunity to weigh in on construction or when their opinion is ignored.
For one, when dust penetrates patient care areas, patients can develop deadly mold infections. Areas above the ceiling that are filled with dust have a strong potential for growing mold. There also have been cases where the penetration of mold through an elevator shaft to the oncology unit hastened a patient’s death. The organization self-reported to the state health department and ended up spending 10% over its construction budget to rectify the issue.
Permits mandating a portable barrier protecting people from possible falling dust and mold are almost always required. This offers extra defense, as it’s also common to run cables along the ceiling.
In this situation, everyone involved in a construction project needs to know what to do if dust should penetrate patient care areas and patients or staff develop an allergic reaction. There needs to be a policy in place to investigate the tightness of construction, if mold is suspected.
Plumbing can also cause complications. A lot of organizations don’t know to remove dead legs, or sections of potable water piping systems that have been altered, abandoned or capped such that water cannot flow through them. Plumbing fixtures must be inspected for Legionella, which was discussed in a blog post
Standards & Helpful Resources
Chapter 43 in the Life Safety Code covers construction, asking organizations to identify risk and appropriate resources accordingly. Infection control resources can be considerable and we ask that these are budgeted in advance.
The Joint Commission developed two standards that relate to the infection control risk during building design and construction:
- IC.01.03.01 requires that organizations integrate all new services into their infection control plan.
- IC.02.01.01 compliments IC.01.03.01 in expecting the infection control plan to be implemented.
Though most organizations are aware of these standards, they’re often caught off guard by how much is encompassed. Day-to-day facility maintenance is included in this standard and this covers everything from fixing a leaky toilet to changing a door to building a new hospital.
Other organizations offer resources to help avoid infection control dangers during construction, including:
A few extra hours in training is well worth saving the cost and infection risk to your patients in an area designed to improve their care!
Herman McKenzie is currently the acting director, Department of Engineering in the Standards Interpretation Group at The Joint Commission. Mr. McKenzie has more than 25 years of health care experience having held managerial and director level roles in clinical engineering, plant operations and facilities services throughout the Chicagoland area. He was part of the team that opened the first new hospital in Illinois in over 25 years.