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The healthcare facility has decided to renovate an existing unit. There is a process that organizations should follow to ensure a safe and effective work environment for all. Let’s discuss what that process would look like.
PCRA (Pre Construction Risk Assessment)
The first step is to perform a PCRA. This is a process that will include a multidisciplinary team approach. Potential members would involve the following:
The goal of this group is to discuss the construction activities and all the potential/expected hazards and risks. While there may be many different topics of discussion occurring during this PCRA process we will be focusing on ILSM and ICRA processes.
ILSM (Interim Life Safety Measures)
As part of the PCRA process, the multidisciplinary team will identify life safety code deficiencies that are expected during the construction project. As the deficiencies are identified, there should be interim measures to be put in place to establish an element of life safety during the period of construction. Here are some examples of what this might look like.
Example 1
A construction barrier will be in place. The construction barrier will be erected in the middle of the patient care unit. One of the required exits for the patient care unit will now be obstructed by this construction barrier. Therefore, staff/visitors will no longer have access to one of the two required exits. The assessment has determined that there is a need for an alternate exit route. To provide information as to where the location of the alternate exit is, the team says that they will be providing signage that will direct staff/visitors to the alternate exit. Additionally, the team feels that it would be a good idea to provide education to the staff that will be working on the unit to know where this alternate exit is located. There will also be an additional fire drill performed quarterly on this unit so that staff ensure they know how to safely shelter-in-place or evacuate to an alternate smoke compartment in an emergency.
Example 2
During the second phase of the construct project there will be a shut-down of the fire sprinkler system on the unit that will last approximately four days. Based on NFPA (National Fire Protection Agency) requirements, this would require that the organization either evacuate (which will not be practical for the organization) or that a fire watch be established during the time that the fire sprinkler system is down. The team will need to determine which personnel will be dedicated to performing the fire watch during this time. A training program will need to be established and implemented for those individuals who will be tasked with this assignment. The organization has determined that they will provide a map for the route the fire watch personnel will take to ensure that all areas are checked for any fire/smoke.
Note 1: Organizations should take the opportunity to determine if a fire watch would be needed during a construction project. This way the expense of performing the fire watch can be included in the cost of the project and not be an unexpected expense.
Note 2: It is important to note that individuals who are assigned the role of a fire watch do not have any other duties assigned to them during this time. Their sole responsibility will be performing the fire watch.
Example 3
The team has discussed the amount of dust that will be generated during the demolition of the unit. This potentially could cause false fire alarms by way of a smoke detector. The team does not want to risk placing a cover over the smoke detectors for fear that they will not get removed at the end of the workday. Therefore, they determine that they will install temporary heat detectors in the space to eliminate the opportunity for false alarms. The facilities director informs the team that this will trigger a monthly test of the temporary system and that a testing log will need to be created.
ICRA (Infection Control Risk Assessment)
The infection control practitioner is the primary leader of this discussion. Since construction will be occurring it is important to assess what type of potential infection risks can occur during the project. This process will include an evaluation of the area where the work is occurring, the type of work being performed, and the risks associated with that work. The infection control practitioner will use this information to determine what class of work this project will be and will implement procedures to reduce the risk of any infection control risks. There are a couple of tools that are widely used by hospitals that can be found from:
and
ASHE
https://www.ashe.org/system/files/media/file/2022/08/ICRA%202.0%20Tool%20%2B%20Permit.pdf
Here is an example of what might occur from an ICRA process:
Example
During the discussion of the construction project, it was determined that demolition will be occurring at the beginning of the project. As a result, it was identified that there will be large amounts of trash being removed from the construction area and taken to an outside dumpster. The construction area is located on the 5th floor of the building, and it is not feasible to carry all the trash down the stairwell or to use a chute outside of the building. It is determined that the best way to remove the trash is via a dedicated elevator. The infection control practitioner has stated on the ICRA permit that trash container must have a hard cover over it and cannot be overflowing where the cover cannot completely close. The wheels on the container must be cleaned before moving thru the building so as not to track dirt thru the building. The practitioner has worked with facilities and has dedicated a single elevator to use for construction purposes only and cannot be used for patient transport, visitor or staff access. The construction area must be maintained at negative pressure, and the use of a HEPA filtration system must be used within the construction area. A walk-off mat shall be placed at all the entrances to the construction area so that workers can dust off the bottom of shoes. The placement of shoe covers is placed at the entrances as well so that personnel can use these in cases where the shoes cannot be fully cleaned.
Ultimately, successful healthcare renovation depends on more than schedules and budgets. It depends on proactive planning, cross-functional collaboration, and a clear understanding of the risks that construction introduces. When PCRA, ILSM, and ICRA are taken seriously from the beginning, healthcare organizations can complete projects more safely, more efficiently, and with better outcomes for everyone affected.
Learn more about Soleran Healthcare’s Project Risk Manager app (including PCRA, ICRA & ILSM)
Save time & resources with Soleran Integrated Compliance Management.
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