Spectrum Health Infection Control Risk Assessment

• Document No.

• Project Title

• MMC#

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

General Information

• Project:

• Start Date:

  Date

• End Date:

  Date

• Project Location:

• Contact Person:

• Phone Number:

• Work Activities:

• Departments Affected:

• Above:

• Below:

• North:

• East:

• South:

• West:

• Comments:

Infection Control Risk Assessment (ICRA)

• Containment Area type

  Primary

  Secondary

• Construction Activity Type?<br>

  Type A:

  Type B:

  Type C:

  Type D:

• Type A: Inspection and Non-Invasive activity
  Type B: Small scale, short duration activities creating minimal dust
  Type C: Activity generates moderate to high levels of dust or requires demolition or removal of building components, or requires greater that 1 work shift for completion
  Type D: Major demolition or construction activities requiring consecutive work shifts

• Patient Risk Group:

  Low

  Medium

  High

  Sensitive

• Low: Office Areas
  Medium: Inpatient units, Outpatient units, Physical Therapy, Radiology
  High: Emergency Room, Labor & Delivery, Peds/Newborn, Lab/Pharmacy, Outpatient Surgery, Cafeteria, Treatment Center
  Sensitive: Operating Rooms (including C-section), Central Sterile, Cardiac Cath Lab, Oncology/Neuro, ICC, Dialysis, Pharmacy IV Room, Radiation, Chemo Pt's.

• ICRA Class
  I: Type A work Low, Medium, High patient risk group
  
  II: Type A work Sensitive patient risk group
  Type B work Low, Medium, High patient risk group
  Type C work Low, patient risk group
  
  III: Type C work medium patient risk group
  
  III/IV: Type B work Sensitive patient risk group
  Type C work High and Sensitive patient risk group
  Type D work Low patient risk group
  
  IV: Type D work Medium, High, Sensitive patient risk group

• Class I

  Off

  On

• Immediately replace any ceiling tiles displaced for visual inspection

• Clean Work Area upon completion of work

• Execute work by methods to minimize raising dust from construction operations

• No particulate testing required.

• Do not leave tools unattended in public areas.

• If more than one ceiling tile is removed for inspection in a non-critical area, a containment unit must be used.

• Class II

  Off

  On

• Provide active means to prevent airborne dust from dispersing into atmosphere.

• Seal holes, pipes, conduits and punctures appropriately..

• Seal unused doors with tape.

• Block off and seal air vents with filter media.

• Place dust mat at entrance and exit of work.

• Isolate HVAC system in areas where work is being preformed.

• Water mist work surfaces to control dust while cutting.

• Contain construction waste in tightly covered containers before transporting.

• Wet mop and/or vacuum with HEPA filtered vacuum before leaving work area.

• Wipe surfaces with disinfectant.

• Remove isolation of HVAC when project is completed

• Class III

  Off

  On

• Minimum particulate testing required is baseline, midway and at the end of the project.

• Isolate HVAC system in area work is being performed to prevent contamination of dust system.

• Seal unused doors with tape.

• Complete all critical critical barriers, (sheetrock, plywood, plastic) to seal area form non-work area or implement control cube method (cart with plastic covering and sealed connection to work site with HEPA vacuum for vacuuming prior to exit) before construction begins.

• Seal holes, pipes, conduits and punctures appropriately..

• Place dust mat at entrance and exit of work.

• Maintain negative air pressure within work site utilizing HEPA equipped air filtration units.

• Contain construction waste in tightly covered containers before transporting.

• Do not remove barriers until area is inspected by Infection Control Group and thoroughly cleaned by Environmental Services Department.

• Remove barrier materials carefully to minimize spreading of dirt, dust, and debris. Transport in tightly covered & sealed containers.

• Vacuum work area with HEPA filtered vacuums.

• Wet mop area with disinfectant.

• Remove isolation of HVAC when project is completed

• Class IV

  Off

  On

• Minimum particulate testing required is baseline, midway and at the end of the project.

• Isolate HVAC system in area work is being performed to prevent contamination of dust system.

• Seal unused doors with tape.

• Complete all critical barriers, (sheetrock, plywood, plastic) to seal area form non-work area or implement control cube method (cart with plastic covering and sealed connection to work site with HEPA vacuum for vacuuming prior to exit) before construction begins.

• Seal holes, pipes, conduits and punctures appropriately..

• Construct ante room & require all personnel to pass through so they can be vacuumed using HEPA vacuum cleaner before leaving work area or they can wear cloth or paper coveralls that are removed each time they leave the work area.

• Personnel entering work area are required to wear shoe covers. Shoe covers must be changed each time worker exits work area.

• Contain construction waste in tightly covered & sealed containers containers before transporting.

• Maintain negative air pressure within work site utilizing HEPA equipped air filtration units.

• Do not remove barriers until area is inspected by Infection Control Group and thoroughly cleaned by Environmental Services Department.

• Remove barrier materials carefully to minimize spreading of dirt, dust, and debris. Transport in tightly covered & sealed containers.

• Vacuum work area with HEPA filtered vacuums.

• Wet mop area with disinfectant.

• Remove isolation of HVAC when project completed.

Signatures/Distribution List/Dates

• Facilities Management

  Sign

• Infection Control

  Sign

• Safety and Security

  Sign

• Contractor

  Sign