Construction and renovation in any facility will introduce debris, pollutants, and contaminants that can compromise indoor air quality—possibly impacting the health of its occupants. These contaminants often travel through HVAC systems or via personnel moving through barriers, potentially impacting areas far beyond the immediate work site. This issue is particularly critical in healthcare settings, where patients and individuals with existing health concerns face elevated risks of nosocomial infections, also commonly known as hospital-acquired infections (HAIs).
Planning and Administrative Controls
Several regulatory agencies and accrediting bodies require healthcare facilities to produce an Infection Control Risk Assessment (ICRA) prior to any construction or renovation to determine what impact it will have on patient care. The ICRA is led by an Infection Control Staff with collaboration from the construction teams, engineering, and safety managers. Effective advance planning by project managers and proactive communication are essential to address concerns throughout construction. Facilities must assess potential hazards and establish controls to mitigate these hazards, including identifying areas that will be unusable during the project and scheduling work to minimize disruption (this will be variable depending upon whether it is an ambulatory or inpatient facility). Whenever possible, areas undergoing construction should be designated as a non-operational or vacant hospital zone.
Key Hazards
Particulate Matter (PM)
Construction and demolition generate particulate matter, such as dust and fibers—respirable dust poses the greatest health risks. These particles are so small that they can evade the body’s natural defenses (mucous, cilia and coughing reflexes), settling deep in the lungs and potentially causing long-term health problems, including impaired lung function, cancer, and heart disease.
Biological Hazards
Demolition and renovations may release microorganisms, such as fungi (like Aspergillus and Candida), bacteria, and medical waste. They may disturb and release animal droppings, insect remains and standing water which are common when breaching dormant areas. Damp building materials can harbor microbial growth. Construction may uncover leaking medical equipment—typically behind walls—possibly releasing medical waste into the air or directly exposing workers.
OSHA defines bloodborne pathogens as infectious organisms present in blood, such as Hepatitis B, Hepatitis C, and HIV. Hepatitis B and C are especially concerning in healthcare construction because they can survive outside the body for up to a week. Construction activities can make these microorganisms airborne, further threatening indoor air quality and increasing risks for workers and vulnerable patients.
Engineering Controls
The ICRA process will determine the types of engineering controls best suited to mitigate the risk of airborne hazards. They include:
Containment
The purpose of containment is to isolate the construction area from other areas of the building, preventing recirculation of air into other spaces of the facility. A proper containment includes an initial barrier, such as installing fire-rated 6 MIL polyethylene sheeting around work areas to isolate contaminants and sealing HVAC intakes within the containment. Next, establish a second containment or “dirty” area just outside the initial containment barrier with sticky mats on the floor to prevent tracking contaminants, and a designated place for contaminated PPE disposal. A third area, or a “clean” area for fresh PPE between the dirty zone and facility’s operational spaces should be created. All openings in the barriers should feature high-traffic zippers. The sticky mats should extend six feet from the containment entrance and be replaced daily or whenever they are too dirty to be effective.
Air Cleaning and Negative Pressure
Deploy Negative Air Machines (NAM) with HEPA (High Efficiency Particulate Air) filters within enclosures and maintain negative pressure to prevent contaminated air from escaping. Filters should be changed as needed. The negative pressure environment needs to be established prior to the start of construction and must stay on for the duration of the project whether construction is going on or not. A micro-manometer must be used to verify that negative pressure is established and maintained.
Dust Monitoring and Microbial Sampling
Continuous dust monitoring outside the containment—using direct-reading instruments with alarms for immediate corrective action zone—helps assess the effectiveness of the engineering controls. This can be done with direct-reading, real-time monitoring equipment. Independently collecting surface and air samples for microbiological analysis can further support preventive measures for patient and staff safety.
Personal Protective Equipment (PPE) and Prophylaxis
Hospital construction increases the risk to construction workers of exposure to contaminated waste and bodily fluids. Vaccinating workers 4 to 5 months prior to construction against Hepatitis B is good practice. Inoculation consists of three-doses; an initial dose, a second dose after 30 days, and a third dose four months later.
OSHA requires PPE to prevent contact with blood or infectious materials, and mandates that all PPE selected for construction use at any healthcare facility must be appropriate for the task at hand, i.e., it does not permit blood or other potentially infectious materials to pass through to or reach the employee’s work clothes, street clothes, undergarments, skin, eyes, mouth, or other mucous membranes under normal conditions of use and for the duration of time which the protective equipment is used. In damp or contaminated areas, workers should wear liquid-resistant Tyvek suits, gloves, shoe covers, respirators/N95 masks, and goggles, discarding all PPE before leaving containment.
Housekeeping and Post-Construction Cleanup
Ensuring that thorough cleaning is completed post construction is vital. After all trash, dirt, and larger debris have been removed, construction dust should be addressed by using HEPA vacuums to collect the majority of construction dust, followed by using wet rags to wipe down all surfaces within the containment and other areas immediately surrounding it. The ICRA may require that the trash be wiped down or cleaned and placed in a covered cart for transport away from the construction site to the waste dumpster so as not to spread contamination in sensitive areas. Areas must be sanitary before handover to hospital staff, with careful inspection and testing to verify cleanliness.
Planning and Collaboration
Construction, renovations and maintenance are a common occurrence in healthcare facilities—whether a long-planned project or an unplanned urgent repair. Protecting the health of patients, staff, and construction workers hinges on thoughtful planning, clear communication, and adherence to best practices for indoor environmental quality and industrial hygiene. The success of the project is also dependent upon the partnership of the medical staff, management personnel and all the outside resources that will address problems and ensure that the construction is completed without creating any additional health issues.
Contact Novisal
If you have any questions about construction or renovation at a healthcare facility or clinic, please reach out to Novisal. Our experts can help develop or review your ICRA and other EHS practices.