On infection prevention, management
and communications through construction
On infection prevention, management and communications through construction
 |
With Linda Dickey, RN,
MPH, CIC Assistant Director for Epidemiology & Infection Prevention University of California, Irvine Healthcare Orange County, Calif. Press play to listen to the complete interview |
AORN Management Connections (AMC): What are several steps necessary
to building an infection prevention strategy during
construction?
Linda Dickey: The first thing you need to have is a clear idea of what the scope of work is and what it's going to affect within the area where patient care or any type of clinical support care is provided. Once you have a clear understanding of that, the infection preventionist is going to provide some guidance on the space being worked on. From the infection prevention standpoint, they'll be looking at airflow, at materials used in the room, several different things.
The infection preventionist will then weigh in on how the space needs to be controlled during [construction] to prevent any infections while the work is occurring. Those strategies will usually be outlined and will be in the construction document so it can go out to bid and a contractor will know how much they need to plan for once they get into construction. Once the construction gets under way, often times those instructions will need to be augmented or changed somewhat. Usually in the bidding process you want to be pretty up-front with expectations.
AMC: What challenges do managers face in ensuring infection prevention during construction?
Dickey: Many times communication does not happen as well as it could. For example, if there's going to be vibration or noise it's helpful to coordinate that with particular procedures that are going on. If that doesn't happen it can raise concerns. Again, I would really emphasize that the managers of an area communicate effectively with the contractor, with the manager of the project on the owner's side and have clear understanding of the timing, the phasing, who they communicate with and how they can perform that communication, whether it's through walkie-talkie or a phone call.
AMC: How do you ensure buy-in and compliance from staff?
Dickey: It's very important to make sure the communication about what's going to be done, the timetable and who to contact if there are any issues are being communicated clearly. It's also helpful if the perioperative services staff - the OR staff - are clear on why it's important to make sure that they honor whatever barriers are up and posted signage is in place, and that they use areas that are designated for use.
Have good communication up front and then make it clear what things the perioperative staff needs to be aware of if there are concerns are essential - for example, if they see dust outside the area or monitoring devices that indicate whether negative air pressure in spaces has changed from neutral to positive. They should also know the chain of command as far as who they need to contact or to make aware of anything they see that's out of the ordinary.
AMC: Do you have advice as to building effective communications during construction?
Dickey: I think the communications process needs to start early and it needs to be frequent. With the unit or the area where the redesign is going to be, there obviously needs to be a lot of input into the design of the space and what the use or need is. As much as possible, managers need to work with the project manager and need to know the contractor's principal contact if any concerns arise.
If there are concerns or questions, things that are not clear because contractors speak a different language than we do - and many times those of us on the clinical side are not going to understand how to read plans - you have to continually ask questions. You want to be clear on what the space is going to look like, what kind of barriers are going to be in place, how your work is going to be affected during construction, so the manager can support the staff to help them continue to do their work during that time.
AMC: What is the infection preventionist's role in construction planning?
Dickey: Once it's underway, there are processes in place usually both with the contractor and with the facility to monitor compliance with the infection prevention measures. There are some organizations that will have the infection preventionist rounding on projects as well, and that will vary in different organizations depending on what their resources are.
But primarily our role is to provide support if there are any issues that do come up during construction. For example, we just had a project at my facility where there was dust unexpectedly coming into a procedure area and we had to revise our plans for barriers. We need to be ready to provide that support to the project team when those types of issues arise.
Infection prevention will also be monitoring for particular infections, such as those caused by Aspergillus [a fungus], and if we were to see any that were related to construction, we would certainly relay that information.
AMC: In what ways does construction affect the perioperative department and the facility in general?
Dickey: It depends on the scope of work, but if there is construction on an area that needs to remain operating while the work is going on, you have to work around that. There are going to be barriers. We have to be careful that those [barriers] offer appropriate egress for fire safety. Often there are functions of work, such as maybe cleaning instruments or packing instruments that need to be moved to a different area to be performed.
Management needs to look at what is going to be the flow of function as construction is going on and how they can maintain as best an operation as possible while at the same time accommodating the work that's being done. It's also important to make sure there is appropriate signage so people know what areas are restricted and how patient movement should go. Those are all things that will help the operation go more smoothly.
AMC: What are some of the more common building renovations and construction items that you've seen?
Dickey: We've seen renovation of clinics of various types. We built a new hospital here at UC Irvine Healthcare that is a seven-story building with all-new ORs. We've built links from that hospital to our existing hospital that had to tie into our labor and delivery area. There isnew construction [projects] and we've also done clinical support-type areas as well, where there isn't direct patient care involved.
AMC: So you have to be prepared for anything…
Dickey: Absolutely. Unexpected things can happen, but preplanning and having a communication plan ahead of time is a really good process to make sure that you can respond if something occurs.
AMC: What else would you like to add?
Dickey: I do a little bit of teaching for another organization, and we talk a lot to contractors. Contractors are sometimes very concerned about their own staff's safety when they come into a healthcare environment. It's important for us to understand that they may have questions too about things they see in our work environment. We need to partner with contractors, reach out them and make them feel welcome as they try to recreate our spaces so we can provide care for our patients.
The APIC website has resources on the role of infection control during contruction in a healthcare facility. Learn more here.
Linda Dickey, RN, MPH, CIC is the Assistant Director for Epidemiology & Infection Prevention at University of California, Irvine Healthcare in Orange, California. Her responsibilities include providing both leadership and support throughout the organization on initiatives aimed at epidemiology & infection prevention. Dickey helped develop and implement a comprehensive infection prevention plan for the construction of a new, seven story, 474,353 square foot university hospital for UC Irvine. Dickey is a member of the Association for Professionals in Infection Control (APIC) Communications Committee, serves on Facility Guidelines Institute 2010 Health Guidelines Revision Committee, and is faculty for the American Society of Engineering (ASHE) Infection Control during Health Care Construction course.
Learn more about healthcare design and construction in the July issue of AORN Connections.
Read more news in AORN Management Connections.
Linda Dickey: The first thing you need to have is a clear idea of what the scope of work is and what it's going to affect within the area where patient care or any type of clinical support care is provided. Once you have a clear understanding of that, the infection preventionist is going to provide some guidance on the space being worked on. From the infection prevention standpoint, they'll be looking at airflow, at materials used in the room, several different things.
The infection preventionist will then weigh in on how the space needs to be controlled during [construction] to prevent any infections while the work is occurring. Those strategies will usually be outlined and will be in the construction document so it can go out to bid and a contractor will know how much they need to plan for once they get into construction. Once the construction gets under way, often times those instructions will need to be augmented or changed somewhat. Usually in the bidding process you want to be pretty up-front with expectations.
AMC: What challenges do managers face in ensuring infection prevention during construction?
Dickey: Many times communication does not happen as well as it could. For example, if there's going to be vibration or noise it's helpful to coordinate that with particular procedures that are going on. If that doesn't happen it can raise concerns. Again, I would really emphasize that the managers of an area communicate effectively with the contractor, with the manager of the project on the owner's side and have clear understanding of the timing, the phasing, who they communicate with and how they can perform that communication, whether it's through walkie-talkie or a phone call.
AMC: How do you ensure buy-in and compliance from staff?
Dickey: It's very important to make sure the communication about what's going to be done, the timetable and who to contact if there are any issues are being communicated clearly. It's also helpful if the perioperative services staff - the OR staff - are clear on why it's important to make sure that they honor whatever barriers are up and posted signage is in place, and that they use areas that are designated for use.
Have good communication up front and then make it clear what things the perioperative staff needs to be aware of if there are concerns are essential - for example, if they see dust outside the area or monitoring devices that indicate whether negative air pressure in spaces has changed from neutral to positive. They should also know the chain of command as far as who they need to contact or to make aware of anything they see that's out of the ordinary.
AMC: Do you have advice as to building effective communications during construction?
Dickey: I think the communications process needs to start early and it needs to be frequent. With the unit or the area where the redesign is going to be, there obviously needs to be a lot of input into the design of the space and what the use or need is. As much as possible, managers need to work with the project manager and need to know the contractor's principal contact if any concerns arise.
If there are concerns or questions, things that are not clear because contractors speak a different language than we do - and many times those of us on the clinical side are not going to understand how to read plans - you have to continually ask questions. You want to be clear on what the space is going to look like, what kind of barriers are going to be in place, how your work is going to be affected during construction, so the manager can support the staff to help them continue to do their work during that time.
AMC: What is the infection preventionist's role in construction planning?
Dickey: Once it's underway, there are processes in place usually both with the contractor and with the facility to monitor compliance with the infection prevention measures. There are some organizations that will have the infection preventionist rounding on projects as well, and that will vary in different organizations depending on what their resources are.
But primarily our role is to provide support if there are any issues that do come up during construction. For example, we just had a project at my facility where there was dust unexpectedly coming into a procedure area and we had to revise our plans for barriers. We need to be ready to provide that support to the project team when those types of issues arise.
Infection prevention will also be monitoring for particular infections, such as those caused by Aspergillus [a fungus], and if we were to see any that were related to construction, we would certainly relay that information.
AMC: In what ways does construction affect the perioperative department and the facility in general?
Dickey: It depends on the scope of work, but if there is construction on an area that needs to remain operating while the work is going on, you have to work around that. There are going to be barriers. We have to be careful that those [barriers] offer appropriate egress for fire safety. Often there are functions of work, such as maybe cleaning instruments or packing instruments that need to be moved to a different area to be performed.
Management needs to look at what is going to be the flow of function as construction is going on and how they can maintain as best an operation as possible while at the same time accommodating the work that's being done. It's also important to make sure there is appropriate signage so people know what areas are restricted and how patient movement should go. Those are all things that will help the operation go more smoothly.
AMC: What are some of the more common building renovations and construction items that you've seen?
Dickey: We've seen renovation of clinics of various types. We built a new hospital here at UC Irvine Healthcare that is a seven-story building with all-new ORs. We've built links from that hospital to our existing hospital that had to tie into our labor and delivery area. There isnew construction [projects] and we've also done clinical support-type areas as well, where there isn't direct patient care involved.
AMC: So you have to be prepared for anything…
Dickey: Absolutely. Unexpected things can happen, but preplanning and having a communication plan ahead of time is a really good process to make sure that you can respond if something occurs.
AMC: What else would you like to add?
Dickey: I do a little bit of teaching for another organization, and we talk a lot to contractors. Contractors are sometimes very concerned about their own staff's safety when they come into a healthcare environment. It's important for us to understand that they may have questions too about things they see in our work environment. We need to partner with contractors, reach out them and make them feel welcome as they try to recreate our spaces so we can provide care for our patients.
The APIC website has resources on the role of infection control during contruction in a healthcare facility. Learn more here.
Linda Dickey, RN, MPH, CIC is the Assistant Director for Epidemiology & Infection Prevention at University of California, Irvine Healthcare in Orange, California. Her responsibilities include providing both leadership and support throughout the organization on initiatives aimed at epidemiology & infection prevention. Dickey helped develop and implement a comprehensive infection prevention plan for the construction of a new, seven story, 474,353 square foot university hospital for UC Irvine. Dickey is a member of the Association for Professionals in Infection Control (APIC) Communications Committee, serves on Facility Guidelines Institute 2010 Health Guidelines Revision Committee, and is faculty for the American Society of Engineering (ASHE) Infection Control during Health Care Construction course.
Learn more about healthcare design and construction in the July issue of AORN Connections.
Read more news in AORN Management Connections.