You hear it all the time from friends and family: living in a renovation zone is difficult. The dust, the mess, the need to improvise to complete normal daily tasks; it’s a constant struggle. Now think of running a hospital during a renovation. The list of factors to consider and risks to mitigate grows exponentially. From sealing off construction zones, to creating negative air pressure to ensure air quality, to rerouting foot traffic to ensure safety – the tasks are tedious and there is very little room for error.

The success of a health-care construction project is contingent on many elements.  Whether designing a new health care facility from the ground up to renovating your old infrastructure to provide modern health care, the hospital’s  Infection Prevention and Control (IPAC) team is vital throughout each stage of planning, design, demolition and construction; continuing through to final commissioning, and activating the facility or department into full clinical service.  IPAC participation from the beginning of the project ensures a vital communication link between clinical user groups and contractors is established.

Markham Stouffville Hospital (MSH) recently finished an extensive four year expansion and renovation project, adding a new 385,000 square foot building seamlessly to the existing 325,000 square foot building and extensively renovating the existing building – all while continuing to care for patients.

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“In considering how we were going to manage the project and who we needed on the team, we knew that IPAC needed to be an integral part of the group, right from day one,” says Suman Bahl, Vice President, Corporate Services and Capital Development.  “Making sure our construction site met all the infection prevention and safety criteria was built in from the very beginning and was a critical part of our project plan.”

In order to provide critical insight and recommendations on best practices, Infection Control Practitioners (ICPs) learned how to read design plans and how to understand the needs of contractors and necessities of project phases. This knowledge allowed the ICPs to make recommendations around work associated risk related to patients and staff during phases of the work, and advise the contractors on specific requirements of working conditions in various areas of the hospital. During a project where staff are working in the environment and providing care, the ICP is a key advisor, playing an important role of facilitating a safe and successful health-care construction project.

“Renovating an area where there are no patients is vastly different than renovating one where there are patients down the hall receiving treatment,” says Bahl.  “We needed to work collaboratively to make certain the work could be done on time and on budget while making sure that it was being done in a way that wouldn’t breach any of our infection or safety protocols.”

An example of this is the established requirement of putting up drywall hoardings to contain and separate the hospital environment from the construction environment. Once the hoarding is up, it needs to be monitored regularly to make certain it’s doing its job of properly separating the two environments.

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Part of creating a safe work environment starts with containing the construction and developing a good plan to separate the renovation areas from the patient areas.

“Making sure that our patient care areas were free from any kind of debris or dust was a huge priority. The teams worked closely together to make certain the areas were contained, safe, and workable for everyone,” says Bahl.

Good containment design and project management reduces the risk of infections related to construction/renovation work. The importance of documentation and record keeping is paramount. This includes the background infection rates of a unit or area.  IPAC surveillance is critical to the early detection of breaches in the care environments surrounded by construction – it allows for rapid interventions and mitigation of impacts to client and staff health if required.

In assessing the risks associated with renovations in a given area, the team looked at a number of variables including:

• The type, duration and scale of activity (e.g. disruption of water supply and for how long, digging, demolition, fugitive dust control in and around the building sites)
• Patient groups at particular risk (e.g. immunocompromised patients, especially oncology patients, including bone marrow transplant, solid organ transplant, and those with hematological malignancies)
• Areas of specialty service (e.g. ORs, ICU, NICU, SPD, and pharmacy departments)
• Potential pathogens (e.g. Aspergillus, Legionella, spore forming bacilli )
• Other factors (e.g. the nature of adjacent clinical areas, type of ventilation, location of air intakes and return discharge, patient movements, access for construction workers, materials protection and storage, waste removal and transportation through the facility, etc.)

“A project of this size and scope requires a great deal of collaboration,” says Bahl.  “We needed to make certain our IPAC team could access the construction site and our contractors needed us to make sure we understood the health and safety systems in place on the building site.”   To further facilitate the partnership, IPAC members were provided health and safety training by the primary contractor and were able to provide input into the infection control training provided to all the sub contractors.  “This allowed us to make certain everyone was on the same page with regards to the understanding and the expectations related to health and safety and infection control.”

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As the project progresses, it’s important to continually evaluate the risks and modify plans accordingly.  Having a mechanism in place to quickly bring the entire team together, review the logistical challenges and determine a plan going forward is critical.  It’s also important to document the changes with photos and material samples. Records of designs are also useful in showing where specifications have changed.

“Construction projects are challenging.  It’s critical that both the hospital and the construction team agree on the overall goals, have a consistent commitment to patient safety and can be flexible to make changes with respect to construction logistics.  This is key to a successful construction project.” says Bahl.

If you would like to learn more about the expansion and renovation project at Markham Stouffville Hospital, email myhospital@msh.on.ca