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Best Practices Reduce Risks During Hospital Construction and Maintenance

By Wayne F. Hannaka, CIE



A vendor who walks into the ER with muddy boots, an electrician who lifts a dusty ceiling panel or a contractor who allows contaminated air to enter an intensive care unit are all jeopardizing patient safety and comfort.

From infection control to construction noise and debris, South Florida hospitals face critical issues whenever contractors and vendors work within their facilities. Certainly, the stakes are high. Of the 90,000 deaths a year from hospital-acquired infections in the U.S. healthcare system, a significant number may well be linked to construction and facility maintenance. Yet many hospitals do not systematically address risks to patient and staff safety from projects as large as a major facility expansion or as small as a single telecom worker called in to replace a cable or switch.

In contrast, hospitals have done an excellent job in adopting and monitoring fire prevention policies, as shown by the numbers: just five fire-related deaths annually.

Implementing formal Construction and Maintenance Policy and Procedures can significantly reduce health and safety risks, minimize disruptions to hospital operations and assure compliance with state and federal regulations. The following is a guide to incorporating best practices:

Choose the Right Team
Developing effective policies and procedures is best done by a multidisciplinary hospital team that may include representatives from engineering, security, risk management, nursing, infection control or other departments. A key issue is establishing a construction-specific infection control (IC) policy that meets current regulatory and compliance requirements. A contractor experienced in healthcare construction can assist at this stage.

Map Various Risk Zones
The team should conduct a hospital-wide infection control risk assessment (ICRA) to map and color code low, medium and high-risk zones. Precautions to be followed during construction or maintenance should be clearly noted for each zone. For example, any construction work in a cancer treatment unit might require safety measures such as isolating the HVAC system, creating negative air pressure, using HEPA filtration and wearing disposable shoe coverings when entering the work zone. Before a project begins, the risk map alerts contractors and vendors to the level of precautions required.

Provide Written Policy, Procedures
Use a written Construction and Maintenance Policy, drafted by the hospital’s team, to clarify the special requirements every contractor must meet when working on hospital property.

For small and large scale projects, give contractors and vendors a list of procedures, and task a member of the hospital’s facilities team to ensure compliance. The list should begin with the basics, including where to park, any uniform and badge requirements, location of lunch areas and restrooms and which elevators to use. This document would also focus on operational issues, such as timing of the work, noise reduction measures and when applicable, more complex project specific ICRA requirements.

Train at Regular Intervals
It’s important for the hospital or its general contractor to conduct periodic training sessions for subcontractors, vendors and appropriate hospital staff on construction-related health and safety issues, including IC procedures to reduce potential airborne and waterborne contaminants. Hospital staff, especially those who oversee contractors, should understand the policies and procedures.

Set Up a Permit System
To better manage construction work, many hospitals have created a permit system for any cutting, welding or soldering on a construction project. In this way, facilities management and other relevant departments are informed in advance of any such “hot work” scheduled by the contractor. Interim life safety management (ILSM) procedures should also be set up in advance of the project and communicated to hospital staff. Another safety precaution is setting up a “lock-out, tag-out” control on electrical panels to prevent anyone from turning on a circuit that has been shut down for a project.

Document and Monitor
Finally, the hospital should monitor the health and safety steps taken during a construction project and document findings. For instance, a facilities manager or environmental inspection and air quality testing may also be needed to complete compliance requirements.

By offering their knowledge and experience, contractors can be effective partners with South Florida hospitals in developing effective policies and procedures to safeguard patient health and manage construction-related risks.

Wayne Hannaka, Director of Healthcare Construction, Miller Construction Company, has been responsible for construction projects within healthcare facilities for over 25 years. He holds the American Society for Healthcare Engineers’ Healthcare Construction Certificate, and is designated a Certified Indoor Environmentalist by the Indoor Air Quality Association.


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