Are you keeping up with the healthcare construction requirements? It is now required to provide workers with new training about chemicals; and companies that work in hospitals or other healthcare facilities must provide
infection control training to all workers on site. If you are not already familiar with the acronyms GHS and ICRA, then it’s time to get caught up! The terms Globally Harmonized System (GHS) and Infection Control Risk Assessment (ICRA) are getting focused attention from regulators, business owners, and property managers with new requirements. Do the contractors and staff working in your healthcare facilities have their necessary training certificates for compliance?
This white paper provides information on:
- Healthcare Construction and Renovation Requirements Summary with Resource List
- Caution: The Training Requirements are Constantly Changing!
- Contractor Selection and the Impact on Compliance: Get the Right Credentials and Qualifications
- Useful Tools: GHS Hazardous Class Matrix & ICRA Checklists
Did you know it takes ongoing specialized training to perform construction work in a healthcare facility?
Healthcare and university teaching healthcare facilities are included in these requirements. Training and accreditation is now necessary as a result of the regulatory environmental changes and the PPACA (Patient
Protection Affordable Care Act) as mandated by TJC (The Joint Commission) and CMS (Centers for Medicare and Medicaid Services). Healthcare workers and the construction teams working in healthcare facilities need to have their Infectious Control Risk Assessment (ICRA) training certificates as well as OSHA’s annual Bloodborne
Pathogen Training. To help expedite following the latest guidelines, a list of tools and documents can be downloaded for use at http://www.ashe.org/resources/ tools. This library helps facility managers with checklists and updates so that compliance can achieved with confidence.
Compliance standards for all construction activities in healthcare facilities are mandated and they continue to evolve every year. These standards are specific to the impact of exposure of airborne pathogens during construction and their impact on the Health, Safety, and Welfare of patients, caregivers, workers, and employees during the construction process.
The ASHE resource site listed above is a great place to start but we want to share resources and access to the documents and research needed for compliance. In addition to OSHA standards, guidelines from the following organizations apply to construction and renovation activities conducted at or within healthcare facilities:
The Joint Commission (TJC) sets requirements for con- struction and renovation projects that address design and planning criteria, fire safety, patient privacy, employee training and performance, and infection control. To help health care facilities comply with Environment of Care standards, the Joint Commission has issued Planning, Design, and Construction of Health Care Environments. The Joint Commission also requires that organizations develop a policy to compensate for hazards. These stan- dards and documents are also located at both the ASHE site http://www.ashe.org/resources and the Joint Commission site http://www.jointcommission.org.
The American Institute of Architects (AIA) has issued guidelines for the design and construction of healthcare facilities that contain information on standards for construction, ventilation, and equipping new medical facilities. According to the AIA, facility managers should inform contractors of the following planning and design elements:
Involvement of infection control, safety, and risk management
Risk assessment of susceptible patient locations
The effects of shutting off power, shutting down heating, ventilation, and air conditioning systems, disruptions of ventilation and air flow, and outdoor wind patterns
Air flow (from patient-occupied areas to constructionsite)
Instructions on building services interruption
Communication requirements-both internal and external
Workers need Infectious Control Risk Assessment (ICRA) Training certificates and OSHA’s annual Bloodborne Pathogen Training.
The Centers for Disease Control (CDC)’s Hospital Infections Program addresses infection control issues related to construction and renovation projects. CDC works 24/7 to protect America from health, safety and security threats, both foreign and in the U.S. The CDC provides information regarding the use of ventilation and ultraviolet germicidal irradiation for preventing the transmission of tuberculosis in healthcare facilities. Recommendations for engineering controls include:
local exhaust ventilation (i.e., source control)
general ventilation considerations, including dilution and removal of contaminants, airflow patterns within rooms, airflow direction in facilities, negative pressure in rooms, and TB isolation rooms
air cleaning or disinfection, accomplished by filtration of air (e.g., through high-efficiency particulate air filters) or by ultraviolet germicidal irradiation
The National Fire Protection Agency (NFPA) has developed building construction codes that include standards for windows and doors; chimneys and vents; the fire-resistivity of floor-ceiling assemblies, walls used to form compartments and other finish materials; exterior or interior bearing walls; and other structures. http://www. nfpa.org/codes-and-standards
Contractor Selection: How do you make sure the workers have the right credentials?
Many healthcare institutions have decided to include ICRA training certificate requirements and proof of completion of Blood borne Pathogen training in the project qualification/bid process to ensure compliance. This is the easiest way to qualify proposed staff and it creates documentation with copies of certificates on file to demonstrate compliance. The most common courses are Construction ICRA: Best Practices in Healthcare Construction in addition to OHSA’s required Blood borne Pathogen standard.
TRIVIA
Did you know the most important unnecessary infection in a healthcare facility is due to Aspergillus (a fungal spore)?
Environmental disturbances due to construction and/or renovation activities in and around hospitals raise the airborne Aspergillus spore counts in hospitals and have been associated with unnecessary pneumonia. Aspergillus commonly occurs in soil, water, and decaying vegetation.
The fungi have been cultured from unfiltered air, ventilation systems, contaminated dust dislodged during hospital renovation and construction, horizontal surfaces, food, and ornamental plants.
About the Authors:
Delbert Bittinger is a SDB healthcare project manager specializing in facility renovation projects with a 30-year career focused on the dedication to serving the healthcare industry. He serves as a subject matter expert (SME). He can be reached at Delbert.Bittinger@sdb.com.
Rhonna Endres, CME, FMP, RID is the Director of Business Development at SDB with over 25 years of experience in client development serving both healthcare systems and university teaching institutions. She can be reached at endres@sdb.com.
Resource Library For Facility Managers, Project Managers and Contractors:
AIA Academy of Architecture for Health (AAH)—Contains reports, and other documents related to healthcare design & Construction. http://network.aia.org/academyofarchitectureforhealth
Guidelines for the Design and Construction of Health Care Facilities by the Facility Guidelines Institute http://www.fgiguidelines.org/
OSHA’s Bloodborne Pathogens and Needlestick Prevention Safety and Health Topics web page at: https://www.osha.gov/SLTC/bloodbornepathogens
American Hospital Association—Information generally focused on financial and organizational issues, but includes a good resource center and checklist tools.
American Society for Healthcare Engineering (ASHE)—An advocate for continuous improvement in the health care engineering and facilities management professions. http://www.ashe.org
Green Guide for Health Care™—A best practices guide for healthy and sustainable building design, construction, and operations for the healthcare industry. http://www.gghc.org
Joint Commission on the Accreditation of Healthcare Organizations (JCAHO)—Has some facility related information, though it is largely concerned with operational issues. http://www.jointcommission.org
Practice Greenhealth—The nation’s leading membership and networking organization for institutions in the healthcare community that have made a commitment to sustainable, eco-friendly practices.
https://practicegreenhealth.org/
Obtaining the Certified Healthcare Constructor certification provides qualified personnel the opportunity to be recognized among the elite in the critical field of healthcare construction. http://www.aha.org/certifcenter/CHC
The Center for Health Design An extensive site focusing on healthcare facility design and EDAC certification. https://www.healthdesign.org
VA Office of Construction & Facility Management
(CFM) Technical Information Library—Includes manuals, guides, and other standards covering all aspects of health care facility design. http://www.cfm.va.gov/til/index.asp
LEAN Construction Project Delivery Methods - Job Order Contracting, IPD, 5D BIM 