Every year, about 90,000 patients in U.S. hospitals contract nosocomial infections — they get sick (or sicker) from something they caught in the hospital. Two or three thousand of them die as a result.
Building Teams are helping to attack this problem by taking steps to control the spread of infection sources during construction of new facilities or additions, or during renovation of existing hospitals.
BD+C talked to two experts from Skanska USA Building Inc., headquartered in Parsippany, N.J. Andrew Quirk, VP for national healthcare, in Atlanta, and Chris Gilbert, senior project manager, in Philadelphia, offered this advice:
• Develop a plan and "work it." "All the parties have to get involved right off the bat, so infection control doesn't get left behind," says Quirk. It's especially important to make sure subcontractors meet your standards, he says. "Plan, plan, plan, then implement."
• Skanska uses "infection control risk assessment" in planning all hospital work. "ICRA" became a key component of the AIA's Guidelines for Design and Construction of Hospital and Health Care Facilities in 2001. It was developed by two pioneering health specialists, Judene Bartley, a VP at Epidemiology Consulting Services, Beverly Hills, Mich., and Andrew J. Streifel, of the University of Minnesota Department of Environmental Health & Safety.
• Skanska has incorporated the AIA's ICRA guidelines into its proprietary hospital construction manual. "We're finding more and more architects are inviting us to their offices in the design phase to ask us about ICRA and how to phase the project to deal with infection control," says Gilbert.
• Set a baseline. Bring in an HVAC balancing contractor, and measure the airflow devices in every space you're going to work in. "You may need to change a filter, or have to shut down the air supply in certain sections, or you may have to add fans," says Gilbert. The baseline tells you what you're going to need. Then, if your crew accidentally uncovers mold or some other source of infection (and they will), it will stay there.
• Beware the spread of fungus. Patients with open wounds are the most vulnerable to infection, and the biggest threat to them is from aspergillus, a "filamentous, cosmopolitan, and ubiquitous fungus" found in soil, plant debris, and indoor air, according to Internet mold authority Doctorfungus. To control it on warm, dry days, says Gilbert, you may have to water the site. "We also try to get blacktop down as fast as possible" so trucks don't stir up soil, he says.
• Check out the neighborhood. "Step outside, and see if your project could impact an adjacent activity, such as a surgical center," says Gilbert. This precaution is crucially important when the adjacent use is an oncology facility, because many cancer patients are severely immunocompromised.
• Enlist help from the hospital. "We go to the owner and ask for someone to be identified to work with us on infection control — the facilities director, a nurse or nurse practitioner, even a doctor," says Quirk. "We had an M.D. on a recent project, and he was a great ally on infection control."
• Conduct daily inspections. "Walk the job every day with a representative from the hospital," says Gilbert. Are the fans running? Are barriers sealed? Are door controls working? Your written checklists leave a paper trail for the closeout of the project, and the hospital can even use them for subsequent reviews by regulatory agencies.
• Look into new products for infection control. Several manufacturers offer mold-resistant antimicrobial drywall products, and there are new and improved HEPA-filtered fans on the market, says Gilbert. He and Quirk like a product called ZipWall (800-718-2255; www.zipwall.com), a sticky tape with its own zipper that allows a construction crew to build a barrier wall that can be zipped open when necessary.
What does infection control during construction cost? "Probably $5–8 a square foot, depending on the job," says Quirk. A reasonable price, if it saves lives.