The document discusses risks associated with construction and renovation projects in healthcare settings and provides guidance to minimize these risks. It outlines several key points: 1. Construction projects can increase the risk of infectious outbreaks through exposure to dust and debris. The hospital must assess these risks and implement controls. 2. Common pathogens in construction-related outbreaks include Aspergillus, which has caused many nosocomial outbreaks through airborne spread during demolition or construction. 3. A safety risk assessment should be conducted during planning and continued throughout the project, considering factors like infection control, patient handling, and security. 4. An infection control risk assessment also guides precautions based on the construction type and

2. IPC.17
• Infection risks during demolition,
renovation, or construction
projects are reduced

3. What Are the
Risks Associated
with
Construction
and Renovation
in Healthcare
Settings????

4. • Demolition, construction, or renovation anywhere within the hospital
, can be a major risk to infection prevention and control.
• Exposure to construction dust and debris and other biohazards can be
potentially dangerous to lung function and to the safety of staff and
visitors.
• The hospital shall assess the magnitude of the risks resulting from the
impact of the renovation or new construction on the predetermined
air-quality, IPC and utility requirements and initiate a plan to minimize
such risks.

5. • MOST COMMON PATHOGENS
ASSOCIATED WITH CONSTRUCTION
OR RENOVATION OUTBREAKS

6. NOSOCOMIAL ASPERGILLOSIS IN
OUTBREAK SETTINIGS
53 studies with 458 patients
(78%) were lower respiratory tract
Aspergillus fumigatus (154) and A. flavus (101)
Underlying disease-hemotologic malignancies 299 (65%)
Overall fatality rate in these 299 patients (57.6%)
Construction or demolition probable/possible source-49%; virtually
all outbreaks attributable to airborne source, usually construction
Patients at risk should not be exposed to Aspergillus

7. In 2014 the Guidelines require a safety risk assessment (SRA) that
includes an overarching risk identification process, with considerations
for infection control, patient handling, falls, medication safety, psychiatric
injury, immobility, and security.
The purpose of the SRA requirement is to help foster a proactive
approach to patient and caregiver safety by mitigating risks from the
physical environment that could directly or indirectly contribute to harm.

8.  In the 2014 Guidelines, the safety risk assessment is
described as “a multidisciplinary, documented assessment
process.
The SRA is started during the planning phases of a project and
continues to evolve with additional levels of detail throughout
the project life cycle

9. Assessment
Risk Safety SRA
‫عناصر‬
‫تقيم‬
‫مخاطر‬
‫السالمة‬

10. The project type
determines
which
components of
the safety risk
assessment
apply.
For example, medication safety, psychiatric
injury, patient handling, and immobility
would most likely not need to be considered
for a kitchen renovation; potential issues for
infection control and security would need to
be considered for such a project.
More SRA components would apply to the
renovation or construction of a nursing unitor
a surgery suite

11. INFECTION
CONTROL RISK
ASSESSMENT
(ICRA)
ICRA is an multidisciplinary, organizational, documented process
Considering the facility’s patient population
and type of construction project (non-invasive to major demolition)
• Focuses on reduction of risk from infection

12. Matrix of
Precautions
for
Construction,
Renovation
and
Operations
Step One
• Identify the
Construction Project
Activity Type (A-D).
Step Two
•Identify the Patient Risk Group(s)
that will be affected.
Step Three
•Match the Patient Risk Group
(Low, Medium, High, Highest)
from Step Two with the planned
Construction Activity Project
Type (A, B, C, D) from Step One
Step Four
•Assess potential risk to areas
surrounding the project

13. Step One
Identify the
Construction Project
Activity Type
(A-D)

16. STEP TWO
IDENTIFY
PATIENT RISK

17. STEP TWO
IDENTIFY
PATIENT RISK

18. STEP
3
•MATCH RISK GROUP WITH CONSTRUCTION TYPE

20. Step 4:
• Assess potential risk to areas surrounding
the project.
• , Identify the surrounding areas that will be
affected and the type of impact that will
occur

21. Surrounding Area Assessment
Noise Vibration Dust control
Ventilation
Impact to other systems,
such as:
• Data
• Mechanical
• Med Gases
• Water Systems

22. Infection Control Precautions
Before &During &Upon completion work
Seal hospital construction areas behind impervious barriers
Clean construction area daily (i.e., remove dust)
Assure that ventilation system does not transport dust from
inside construction area to other locations
Move immunocompromised patients from adjacent areas
Thoroughly clean construction area prior to patient use
Avoid transporting construction material through patient areas
IF necessary, Conduct surveillance for airborne fungal infections

24. Evidence of
compliance:
1. The hospital has an approved policy for infection
risk assessment for areas under demolition,
renovation, or construction.
2. Infection risk assessment of renovations, or new
constructions has defined criteria
3. Staff members involved in
demolition/construction/renovation are trained on
approved policy.
4. There is a mechanism, such as work permission, to
empower infection risk assessment and
recommendations
5-Infection prevention measures, considerations and
recommendations are considered during any
demolition, renovation, or construction projects.

25. Survey
process
guide:
• Surveyor may perform an infection control
program review to assess developed policies
and procedures, training records of
healthcare professionals
• Surveyor may visit areas under
demolition/renovation/construction and
review infection risk assessment for these
areas.
• A documented work permission from the IPC
team, if required by the hospital policy, may
be reviewed as well.

26. IPC.21
Food services are safe and
effective

27. Working
personal

29. Policy and Procedures to
guide safe food services
that addresses at least the
following:
a) Food receiving process
1-Transport
Cleaning & temperature
2- Cleaning of delivery personnel
3- Rerecording of process
Never put any food on the ground

30. • A safe storage process including food rotation system
that is consistent with first in first out principles

31. •Monitoring of
temperature during
preparation and
storage

32. Prevention of cross-
contamination of food
• whether directly from raw
to cooked food, or
indirectly through
contaminated hands,
working surfaces, cutting
boards, utensils, etc.

33. Food
transportation
process

35. Evidence of
compliance:
1. The hospital has an approved policy that
addresses all the elements mentioned in
the intent from a) through e).
2. Staff members involved in food services
are aware of approved policy.
3. There are separate areas for receiving,
storage, and preparation of food and
nutritional products.
4. There are measures to prevent the risk of
cross-contamination.
5. The hospital prepares and distributes
food using proper sanitation and
temperatures

36. Survey
process
guide:
Review hospital policy during document review
session,
Review recorded food storage temperatures
Interviewing staff to check their awareness.
Observe the measures for prevention of cross
contamination.
Observe the sanitary food storage, preparation
and distribution

37. IPC.22 Postmortem
care is safe.

38. Policy and
Procedures Of
Postmortem
a) Infection hazard assessments.
b) Procedures to minimize these hazards.
c) Use of appropriate engineering devices and personal protective
equipment to minimize exposure.
d) Sorting of waste.
e) Record keeping.
f) Environmental cleaning procedures.
g) Reporting accidental exposures

39. Generally, standard IPC
precautions are applied and any
transmission-based precautions
that were applied on patients
shall be continued after death

40. GAHAR IS COMING UP

42. Infection
prevention
and control
program
review
Why will it happen?
GAHAR surveyor will Learn about the
planning, implementation, and evaluation of
infection prevention and control program
Identify who is responsible for its day-to-day
implementation,
Evaluate its outcome and Understand the
processes used by the hospital to reduce
infection

43. What will
happen?
Discussions in this interactive
session with staff include:
The flow of the processes,
including identification and
management of risk points,
Integration of key activities and
communication among
staff/units involved in the process

44. Discussions
in this
interactive
session with
staff
How individuals with infections are identified, Laboratory
testing and confirmation process,
if applicable, Staff orientation and training activities,
Current and past surveillance activity
Strengths in the processes and possible actions to be
taken in areas needing improvement;
Analysis of infection control data,
Reporting of infection control data, Prevention and control
activities (for example, staff training, staff vaccinations
and other health-related

45. How to
prepare?
GAHAR surveyor may need a quiet area for brief
interactive discussion with staff who oversee the
infection prevention and control process. Then time
is spent where the care is provided
Infection prevention and control policies
Infection control education and training records
Infection control measures data

46. Who should collaborate?
The infection control coordinator; physician member of the infection control team;
Healthcare professionals from the laboratory
Safety management staff
Organization leadership
Any staff involved in the direct provision of care, treatment, or services