ASHE: Dedicated to optimizing the healthcare physical environment
Sponsor: Grainger Sponsor: Johnson Controls Sponsor: Siemens Sponsor: Trane


Proposed changes to the current language (all changes or new language in red)

5.1.A. Infection Control
During the programming phase of a project, the owner shall provide an Infection Control Risk Assessment (ICRA). An ICRA is a determination of the potential risk of transmission of various biological agents in the facility. Based on the ICRA, the owner shall also provide recommendations for design to be incorporated in the program and Infection Control Risk Mitigation Recommendations (ICRMR), which will describe the specific methods by which transmission will be avoided during the course of the construction project. The owner shall also provide monitoring of the effectiveness of the applied ICRMR during the course of the project.

The ICRA shall be conducted by a panel with expertise in infection control, risk management, facility design, construction and construction phasing, ventilation, safety, and epidemiology. The panel shall provide updated documentation of the risk assessment together with updated Mitigation Recommendations throughout planning, design, construction, and commissioning. The ICRA shall address, but not be limited to, the following:

5.1.A1. Design. Building design features shall be addressed when developing the ICRA.

  1. Number, location, and type of airborne infection isolation and protective environment rooms.
  2. Location(s) of special ventilation and filtration such as emergency department waiting and intake areas.
  3. Air handling and ventilation needs in surgical services, airborne infection isolation and protective environment rooms, laboratories, local exhaust systems for hazardous agents, and other special areas.
  4. Water systems to limit Legionella sp. and waterborne opportunistic pathogens.
  5. *Finishes and surfaces.

5.1.A2. Construction. Building and site areas anticipated to be affected by construction shall be addressed when developing the ICRA.

  1. The impact of disrupting essential services to patients and employees.
  2. Determination of the specific hazards and protection levels for each.
  3. Location of patients by susceptibility to infection and definition of risks to each.
  4. Impact of potential outages or emergencies and protection of patients during planned or unplanned outages, movement of debris, traffic flow, cleanup, and testing and certification.
  5. Assessment of external as well as internal construction activities.
  6. Location of known hazards.

5.1.A3. Infection control risk mitigation recommendations. The ICRMR shall be prepared by the ICRA panel and shall address, but not be limited to, the following:

  1. Patient placement and relocation.
  2. Standards for barriers and other protective measures required to protect adjacent areas and susceptible patients from airborne contaminants.
  3. Temporary provisions or phasing for construction or modification of heating, ventilating, air conditioning, and water supply systems.
  4. Protection from demolition
  5. Measures to be taken to train hospital staff, visitors, and construction personnel.

The owner shall ensure that construction-related requirements of the ICRMR, as well as ICRA-generated design requirements, are incorporated into the project requirements.

The owner shall inspect the initial installation and provide continuous monitoring of the effectiveness of the infection control measures during the entire course of the project. This monitoring may be conducted by in-house infection control and safety staff or by independent outside consultants. In either instance, provisions for monitoring shall include written procedures for emergency suspension of work and protective measures indicating the responsibilities and limitations of each party (owner, designer, constructor, and monitor).