Author: Randall B. Charpentier, HEM, President/Principal Consultant – HealthSafe New England
The CDC healthcare-associated infection (HAI) prevalence survey provides an updated national estimate of the overall problem of HAIs in U.S. hospitals. Based on a large sample of U.S. acute care hospitals, the survey found that on any given day, about 1 in 25 hospital patients has at least one healthcare-associated infection. There were an estimated 722,000 HAIs in U.S acute care hospitals in 2011. About 75,000 hospital patients with HAIs died during their hospitalizations. More than half of all HAIs occurred outside of the intensive care unit. http://www.cdc.gov/HAI/surveillance/index.html. However, this post attempts to address some other elements that may play a role in affecting your nosocomial infection rates, commonly referred to as Hospital Acquired Infections (HAI’s) and the potential impact it may have on patient safety. What impact does construction and maintenance activities have in your facility?
In the mid 2000’s, I was asked to address construction and maintenance practices in a large urban teaching hospital in the Northeastern U.S. due to a clinical program shut down attributed to an increase in nosocomial infections/HAI’s. My background was conducive to this assessment as a former Safety Officer for 2 large urban teaching hospitals capital expansion projects, and as an experienced Industrial Hygienist with extensive experience overseeing asbestos abatement (worksite isolation) projects in healthcare construction.
My initial assessment included observing basic construction and maintenance safety practices. Those observations were obvious. Personnel were not wearing Personal Protective Equipment (PPE), the work site was not adequately isolated, secured and identifiable. Emergency management and life/fire safety practices were minimal as the work/job sites were cluttered with combustibles and obstruction blocking emergency egress.
The key point in this assessment as it relates to preventing HAI’s with maintenance and construction activities is worksite/project isolation. A worksite/project envelope must be completely sealed in an airtight fashion, with adequate negative pressure to filter/remove any particulate, gaseous, fume, vapor, or microbial contaminants that exist or may be produced during maintenance/construction activities.
I began the journey of addressing these issues one step at a time.
First and foremost, I introduced myself and role to all of the key managers representing the General, Sub-Contractors and hospital departments. I then established inspection protocols to all of the decision makers for participation and buy in. Once established, I surveyed all construction sites weekly and forwarded my observations to share-holders for corrective actions. They attempted to correct deficiencies to no avail. We made a decision to develop a training program specifically designed to educate the in-house project/facility manager(s), superintendents and supervisors so they clearly understood the expectations of not only regulatory requirements, but safe execution of projects.
Once the initial training was completed, we then began to enforce the program elements by utilizing inspection checklists and distributing to the affected parties for corrective actions to be implemented. In addition, we adjusted construction specifications and policies/procedures to assist us in fully implementing the program. We experienced a few road blocks (politically speaking) and speed bumps (bruised ego’s and reluctance to change) along the way including the shut-down of several projects. The program matured within a year and resulted in a “Best Practice Model” according to peers and industry professionals/experts. A prominent Infection Prevention/Disease physician mentioned that there are “zero” nosocomial infections related to construction according to their monitoring results. He also mentioned that staff, patients, and visitors do not notice when a project is occurring in the hospital.
Fast forward to today.
- Are construction & maintenance infection prevention practices/activities working in your facility?
- Are your nosocomial infections greater than industry norm? Are your injury/illness rates among facilities staff high?
- Is contracted personnel turn over high due to construction related incidents?
- Have you experienced interruptions to patient care or even forced to close beds due to construction or maintenance?
If you answer yes to any of these questions, you may want to assess your facility maintenance & construction practices. In reality, there are very few healthcare facilities that fully adhere to the principles set forth in the American Society of Healthcare Engineering (ASHE) Healthcare Construction Certification program.
The fact of the matter is that any maintenance work done in a healthcare facility requires the opening of ceilings, floors, chases, crawl spaces and walls to access critical utility systems, i.e. Electrical, Plumbing, Pneumatic Tube, Med Gas, HVAC, Security and Tele-Comm systems. Not to mention facility reconfigurations that require renovation and construction that occurs in and around patient care areas.
When these spaces are accessed, they expose any and all to the most contaminated parts of a healthcare facility if not protected/contained/controlled/managed, possibly endangering the safety and health of your patients. CMS is measuring safety and quality in healthcare facilities basing reimbursement on your outcomes. Do you measure up? If not, you should conduct a risk assessment. Are YOU compliance or results driven? You may contact HSNE/Randall for additional information: firstname.lastname@example.org., www.hsnellc.com, or linkedin profile https://www.linkedin.com/nhome/?trk=
Randall is a 20 year experienced, safety and risk management consultant specializing in healthcare compliance. Project experience ranges from leading teams on the construction of the west coast space shuttle project, working internationally & domestically for leading environmental engineering firms conducting real estate assessments involving occupational and environmental risks, assessing business operational risks concerning commercial insurance policies, and reducing/eliminating exposures/hazards, to leading world renowned, top ten/one hundred community based & BioMedical Research/Teaching hospitals, with development and management of environmental health and safety management programs. HSNE’s/Randall’s passion is keeping patients, staff and visitors safe in a healthcare setting.