A university medical center aimed to improve its infection control construction permit process, which was becoming burdensome due to increased construction projects. The construction safety committee implemented changes including classifying projects into risk groups and activity types. The permit was redesigned and education sessions were conducted with over 300 permits reviewed in the first year. The standardized process improved efficiency and relationships between departments involved in infection control and construction oversight.

1. Improving the Infection Control Permit Process in a University Medical Center
Janet Szychowski BSN RN CIC, Tamara Cooley BS, Mandy Creech MS, Susan Johnson MS MT ASCP OHST,
Don Hayes BE MBA, Terry Ralph, Larry Tuck
Departments of Infection Control and Prevention, Environmental Health and Safety, Plant Services, Space and Facilities,
Vanderbilt University Medical Center, Nashville, Tennessee
Abstract Issue VUMC Construction Permit
A policy and process for Infection Control (IC) construction permits was in place and being utilized
Issue: Construction is an ongoing and major factor of life in large university medical centers. While
within the medical center. However, with an increase in construction projects the permit process was
an Infection Control (IC) construction permit process had been in place for several years, the Project Info
becoming quite burdensome. Problems existed including:
process was becoming quite burdensome. Every permit issued required all parties to be present at
the same time. Problems with scheduling, time constraints, personnel, and non-permitted • Scheduling and time constraints of required personnel to attend the permit review
construction projects were increasing. We aimed to restructure the process for evaluation of • An increase in the number on non-permitted projects was noted
construction permits to reduce these limitations. • The use of outside contractors with little or no infection control knowledge Construction Infection Control
Activity Type Risk Group
Project: The Construction Safety Committee (CSC) comprised of representatives from
Environmental Health and Safety (EHS), Plant Services, Space & Facilities, and Infection Control &
Prevention (IC&P) implemented changes to the construction policy and permitting process. The Project
construction permit was revised using standards from The Joint Commission (JC), Association for Infection Control
Professionals in Infection Control & Epidemiology (APIC) and the Institute of Architects (AIA). The Construction Safety Committee (CSC) met to discuss the issues with the permit process. The
Projects were classified into one of 4 classes (I-IV) based upon the extent of the project, the project included changes to the IC Construction policy, the IC construction permit was redesigned and
Class
potential for dust generation, and the potential patient populations at risk in and around the education was developed.
construction area. After the policy changes were made, the education component was developed by
the EHS Safety Officer and the IC&P Practitioner. The facility’s Biomedical, Information Technology, POLICY: The construction policy was revised based on current applicable guidelines from the Joint
and Plant Services departments – electrical, plumbing, heating, air, refrigeration, carpentry, and Commission (JC), Association of Professionals in Infection Control & Epidemiology (APIC) and the
paint shop – mandated that their managers and members attend the educational sessions. Space American Institute of Architects (AIA). This policy :
and Facilities oversaw the outside contractors and required their management to also attend these • Identifies Infection Control Risk Group based on the risk to patients for developing an infection
sessions. The educational presentation created featured hospital staff in various construction • Determines Construction Activity Type based on the amount of dust that will be generated by the
scenarios. The IC construction permit process was outlined in detail with emphasis placed on the construction activity
infection control risk group, construction activity type, and infection control class. Mandatory annual • Establishes the Infection Control Class for the construction project. The class determines which dust
updates are planned for the future. control measures must be followed for the specific project.
Results: A better understanding of infection control and construction now exists, creating a PERMIT: (See figure) The IC Construction Permit incorporates the following: Project Information;
smoother permitting process. Thirteen training sessions were given over a 7 month period. Two 90 Construction Activity Type - Type A, B, C, D; Infection Control Risk Group – Low, Medium, High;
minute blocks of time, per week, are now dedicated for construction permits, allowing for better Infection Control Class – Class I, II, III, IV; Matrix; and Comments & Signatures Signatures &
utilization of staff time and resources and reduced instances of “urgent” evaluation of construction Comments
work sites. Class I and II projects are reviewed individually and the permit signed by all parties EDUCATION: Mandatory education was developed and presented by Environmental Health and Safety
involved. Class III and IV projects require an onsite meeting with EHS, IC&P, Plant Services/Space Officer and the IC&P Practitioner to both in-house staff and outside contractors. Thirteen sessions were
and Facilities, the project supervisor, and a unit representative. This group reviews the construction given over 7 months.
activity, the construction class, the IC class and the precautions that are to be taken. During the time
period from July 2006 - June 2007, 302 permits were reviewed, including 200 onsite evaluations.
The CSC also conducts weekly tours through all ongoing Class III and IV projects to ensure that all
appropriate precautions are observed. Results Lessons Learned
Lessons Learned: This standardization of the construction permit process has been a positive step The entire process had led to a much smoother process and an excellent working relationship between Utilizing all of the involved departments brought together an array of ideas and compromises that
toward an efficient process for IC permits, education and training, and improved working EHS, IC&P, Plants Services, Space & Facilities and independent contractors. Class I and II projects are resulted in a successful permit process and improved working relationships. Process improvement
relationships. The need for IC construction permits had continued to increase with the growth of both reviewed by permit only. There are two 90 minute blocks set aside each week for Class III and IV onsite ideas continue to surface for all involved. One private contractor promotes itself as being “IC
inpatient and outpatient areas throughout the medical center. All departments involved are working evaluations. Additional time can be scheduled for special needs projects. From July 2006 – July 2007 Trained” and notes this proudly with stickers on their hard hats.
to protect our patients. One private contractor now promotes itself and being “IC Trained” and notes there were 302 permit reviews which included 200 onsite evaluations. Future plans include moving the Contact Information:
this with stickers on their hard hats. permits to an online system. Jan Szychowski RN, BSN, CIC
Vanderbilt University Medical Center
Infection Control
B-145 Vanderbilt University Hospital
Nashville, TN 37232-7345
There are no financial disclosures Phone: (615) 936-0725
Email: janet.szychowski@vanderbilt.edu
www.mc.vanderbilt.edu/infectioncontrol