Prevent the infections acquired by hospital during the construction projects

The question of the infections acquired by hospital is a serious problem. According to several sources, three to four million hospital-acquired infections occur annually, with up to 80.000 dead. It is estimated that the costs of these infections are between $4 billion and $5 billion per annum (of the systems of Air-Treatment for infections acquired by hospital of control, technology of HPAC, April 2, 2008).

The dispensaries are under the pressure of competition continuously to incorporate the new one and modern equipment, the new procedures of diagnosis and new the treatments, creating a constant need for restoration. However, the construction projects increase the risk of infection by the propagation of the microbes which cause the disease.

This article offers some proactives stages for the directors of equipment and the personnel of ordering of infection, to help to the minimum to reduce the risk of contamination during the construction projects and of restoration.

The airborne disease
At least 16 percent of infections acquired by hospital are airborne of origin. Moreover, a third of all the acute infections of hospital of care can imply the air transmission at a certain point (systems of Air-Treatment for infections acquired by hospital of control).

The diseases common to the sanitary facilities caused by the airborne bacteria and moulds include pneumonias, surgical infections of site, and contagious respiratory infections including/understanding tuberculosis and the influenza. Moreover, some infections of urinary tract and even infections of blood can result from the particles in the atmosphere arranging on the equipment. A list of the disease causing of the micro-organisms is provided on diagram 1 (diagram 1).

Moreover, 30 percent of case of pneumonias of hospital are ascribable to Legionella, a contaminant in the coolant circuits of hospital (Legionella in the hospitals: A review. The newspaper of the infection of hospital, 18, supplement has, 481-489). The infection of Legionella is caused by the inhalation of the aerosols of water containing the bacteria, which can be isolated during the construction projects.

the patients Immuno-compromise are particularly in danger to these infections. According to the centers for the control of diseases (CDC), they are patients whose immunized mechanisms are defective because of the immunological disorders such as the infection by the HIV, the congenital syndrome of immunized insufficiency, the chronic diseases or the immunosuppressive therapy.

The patients of high-risk are such who are the patients severely neutropenic and allogeneic undergoing the transplantation of marrow, and those which received intensive chemotherapy. (Directives for the environmental ordering of infection in dispensaries, the department of the United States of the health services and social affairs, the centers for the control of the diseases, 2003, page 20).

The members of medical staff are prone also to the disease of the aerobiological risks. They by practice are exposed to the tuberculosis and the influenza, which are from time to time mortals. Unsatisfactory ventilation is often quoted as causes. The risk increases if the contaminants enter the system of the CAHT during the construction projects and are isolated at the working areas.

The following section describes a process of six-stage to bring back the risk to these groups.

Stage 1: Establish a team responsible for the project
The construction projects require substantial planning and coordination to reduce the risk of infection to the minimum. The establishment of a leadership team can help. The team should include representatives of ordering of infection, laboratory, technology, environmental services, of administration and risk management. It should also include representatives of the team responsible for the project including/understanding the architect, the engineer of studies and the administrators of construction.

The matters to be addressed include: 1) the place, design and function of construction, 2) environmental risks for the airborne disease and occasions so that measurements of prevention 3) contain the dust and the moisture including/understanding of the specific protocols of work of site and 4) how to inform of the suppliers of personnel and outside of the procedures of order of infection.

Stage 2: Lead an evaluation of the risks
After the team approached exits, they should ask an evaluation of the risks of ordering of infection (ICRA) (see diagram 2). The ICRA helps to determine the level of the necessary orders by comparing the complexity of the project in the vicinity with the high-risk patient groups. The more the project are extended and the more the patient level of risk (C. – with-D. is raised, susceptibility to the infection), plus the necessary precautions are large.

So much for example, a construction project to renovate sectors of office (group at the weak risk) with new coats of painting and minor modifications at the electric exits (type the construction of A), would have as consequence the need for precautions of ordering of infection of class I. the precautions of class I are minimal and include dust mimizing operations and to replace construction immediately all the tiles of ceiling moved for the visual inspection.

However, a construction project implying a new continuation of the operating rooms (standard construction of D) beside a cardiac laboratory existing of cathedral (group of the largest risk), would have like consequence the need for precautions of ordering of infection of class IV. The precautions of class IV are extended and include stages such as isolating the system from the CAHT to prevent the contamination of the system of conduit; building a hall so that all the personnel passes through and for is HEPA cleaned with the vacuum cleaner before leaving the building site; and negative atmospheric pressure of maintenance in the building site to prevent microbes from emigrating of the working area.

Stage 3: Provide the formation
Once the ICRA of the protocols is achieved and infection established, the team must inform the personnel and the team of construction concerning of the risks of airborne infection and hydrous origin related on the projects and the methods of construction to order them. Some sectors specific to cover include:

� Modes of dispersion of dust and the micro-organisms during the construction projects
� Methods of control of contamination
� The front roles and responsibilities, during and after the construction project, including contacts of help should be suspectée contamination there

Improve is always to work with the preferred contractors who have already competence in these sectors. It is important to make sure that their subcontractors are as well trained of the procedures of ordering of infection, by offering the formation or by requiring it like prerequisite of employment. The formation and the resources can be obtained by several sources including/understanding the american company for the engineers of health care (ASHE), the American professionals in Infection Control and Epidemiology, Inc. (APIC) and the american company of the heating, the refrigeration and the engineers of air-conditioning (ASHRAE).

Stage 4: Apply the control measures
The team of construction should then install adapted control measures, based on the ICRA. To be some examples follow:
� Insulation of the working area with barriers of construction such as plastic covering
� Doors and windows of sealing
� Negative pressure of maintenance in the building site with units of filtering of HEPA
� Requiring that the workmen use the protective gears individual (EPP), like the protective gloves, respiratory protection and covers for shoes
� Building a hall to change into and out of EPP
� Placement of the plaits of dust at the entry and the exit of building site
� Supply of the containers narrowly covered for waste
� Replaçant personnel and patients like necessary

A list of precautions recommended based on the classification of ICRA is also available to (http://www.premierinc.com/quality-safety/tools-services/safety/topics/construction/downloads/02-icra-matrix-c-2006.pdf).

Stage 5: Monitoring of control
An environmental professional of technology should regularly check the quality of the air of the site and adjacent sectors. This implies to take a whole of readings of base line before installing the fences and beginning construction. Then, of the weekly samples should be taken and compared with the base line to make sure that the control measures of infection are still effective.

For example, as an element of a complete control program of infection at the hospital of Frankford (ideas of building of health care, thinking apart from the box, April 5, 2008), Environmental and measurement S of base line of conduits of Engineering Solutions, Inc. dust in the air, of the mould and the bacteria levels at the beginning of the construction projects. Readings of follow-up are led on a weekly basis inside the zone of construction, in the hall, immediately apart from the hall and in adjacent high-risk sectors, as well as all the units connected of the CAHT.

So coolant circuits are affected by construction, test of pipeline water, in particular in the piping which was interruption or rerouté during construction.

Stage 6: Carry out the test of inspection and release of construction of post
When the construction project is complete and final inspections and the need for test of release to be led before making turn new space for the occupation. The protective fences and halls should be maintained intact during this period.

Once the first principal cleaning is complete, a whole of samples of release should be taken and an inspection of release led being. After �clearly� is given, a final cleaning can be led and the fences of ICRA removed being. Only then if space is turned over to the hospital for the occupation.

The limitation of the risk is the name of the play
The age growing of the hospitals and other dispensaries produces of a continuous need for remediation and repair work. These projects, large or small, can increase the potential for infections acquired by hospital.

In the light of the public outcry requires above patient safety, like the increasingly significant number of the insurers refusing to pay infections acquired by hospital, of the hospitals and of the sanitary facilities should envisage these projects with the ordering of infection to the spirit. This can help them to limit the risk and to protect their patients and workmen, as the establishments which they serve.

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