Understanding the ICRA Process Betty Ann Eash RN BSN CIC

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Understanding the ICRA Process

• Betty Ann Eash RN BSN CIC
• MidMichigan Medical Center-Midland

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Minimum Design Standards for Health Care
Facilities in Michigan

• www.michigan.gov
• Click on Health and Services icon
• On rightHealth quick linksclick on
• Health Professional Licensing
• On leftclick on Health Facility Construction
• On-line application for Plan Review Submittal
• On rightclick on
• Developing an Operational Narrative for
  Healthcare Facilities.

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Reasons for the ICRA processThe Joint
Commission standards

• EC 02.06.05 The hospital manages its environment
  during demolition, renovation or new construction
  to reduce risks to those in the organization.
• Uses state regs or AIA 2001 criteria
• Conducts a pre-construction risk assessment
• Takes action based on assessment to minimize risks

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Reason for the ICRA process the environment can
serve as a source of pathogenic organisms

• Aspergillus
• Legionella
• Penicillium
• Other Molds/fungus

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Phases of construction process

• Planning
• SD-Schematic design
• DD-Design development
• CD-Contract documents
• Construction
• phasing
• Commissioning

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Terminologies

• RFI
• CPR
• CO
• RFQ/RFD
• CSI

• Chase
• Decking
• Plenum
• Scope

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Infection Prevention role

• Design
• Provide for infection control and protection of
  patients throughout this process
• Provide updated documentation of risk throughout
  planning-design-construction.
• Research airborne needs/reasons/protective air
  environments
• Ergonomic consideration for employees
• Mitigation

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How do you get included?

• React to rumors
• Make friends with the secretary who schedules
  meetings
• Check weekly for meetings
• Be activecall with questions
• Establish policies with the team

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ICRA team members

• Infection prevention
• Risk management
• Safety officer
• Administration
• Facility services/Utility
• Housekeeping
• Dept manager
• Clinical departments
• Ventilation

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Getting Started

• Patient Safety Risk Assessment
• Assess degree of potential harm to
  patients/staff/environment
• Confirm protocols to prevent dust mitigation
• Decide on process for ICRA
• Confirm communication for ICRA
• Assess building needs
• Assess changes in process/patient flow

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ICRA information sources

• Environmental surveys
• History of building
• Facility services logs
• Input from housekeeping staff
• Traffic flow (pt, equipment, waste)
• Physical walk through
• Interview staff
• Pre-test air flow
• Dont forget staff needs
• What is going to be done in this area?

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What happens in the area involved in
construction/renovation?

• Sterilization
• Waiting room
• Clean dirty flow
• Procedures
• Exams only
• Radiation
• Storage
• Staff needs

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Airborne needs assessment

• Pull HIS data
• Walk through
• MDSS/LHD information on prevalence
• Ask staff
• Check your own files
• Check for TST conversion rates
• Assess surge capacity plans

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Communication to Designers

• Ceiling finishes
• Wall covering
• Floor finishes
• Sinks/faucets
• Eye wash stations
• Furniture
• Toilets
• Shower curtains

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Design Phase

• Force function
• Proper use of space
• Allows staff to use space in correct way only
• Protects patients
• Keeps environment clean and safe

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Design standards

• Use the State design standards.
• Ask how this design will work during phasing.
• AII and anterooms
• Protective isolation rooms

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The Narrative

• This will go out with the construction documents.
  You may be asked for assistance
• What they really want is to understand the flow
  of how the space will work when done and how it
  will work during the phasing/renovation/constructi
  on
• Helps to use room numbers in the document
• See document from the state.

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Another team functionestablishing the
protocolsmitigation requirements

• Some institutions include this information into
  the work permit, or as part of the contract or
  bid documents
• Use grid system to define risks of group (1-3 or
  1-4)
• Define what type of construction (A,B,C,D)
• Define the protocol (Class I,II,III,IV)
• Define compliance monitoring

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Infection Control Risk groupsdetermined by what
type of activity in area, type of patient, what
it is adjacent to in your building

• Group 1 lowest
• Office areas, lobby, engineering, env services,
  cafeteria
• Group 2 medium
• Admitting, PT, Lab draw, medical offices
• Group 3 medium-high
• ER, PACU, nursery, dialysis, med/surg areas
• Group 4 high
• OR, L/D, cardiac cath/procedure rooms, pharmacy
  admixture, ICU, burn unit, oncology, BMT

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Construction Activity Types

• Ainspection and non-invasive
• Bsmall-scale, short duration create minimal
  dust
• cabling
• Cmoderate to high level dust
• Sanding walls, ductwork, major cabling
• Dmajor demolition and construction

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Prevent Hazard Mitigation

• Dust/fumes
• Water contamination
• HVAC
• Steam sterilization
• Hazardous materials (ETOH, Hg)
• Noise/vibration
• Emergency procedures
• Utilities disruption

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Use Matrix to determine Class
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Class I

• Construction Area (General) Anytime mold is
  encountered Notify Infection Prevention
• Physical Separation of Construction Area
  Immediately replace materials that have been
  displaced. Clean area upon completion of task
• Special Considerations
• Execute all work by methods that reduce raising
  dust.
• Insure that visitor (and staff) traffic is routed
  away from work area.
• Insure that contaminated materials do not come in
  contact with clean supplies and fixtures.

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Class II

• Construction Area (General)
• Reroute traffic
• Dust control to ceiling level. Use mats/wipes
• Close windows seal doors/air vents (visquine,
  duct tape)
• Mist work surfaces when cutting or drilling
  concrete
• Cover any holes in walls open gt 4 hours.
• HVAC- block off and seal air vents.
• Trash Removal Define least intrusive trash route.
• Periodic Inspection by Infection Prevention

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Class III

• Construction Area (General)
• Remove staff, pts, equipment
• Dust control to ceiling use mats/wipes
• Close windows seal doors/air vents (visquine,
  duct tape)
• Mist work surfaces when cutting or drilling
  concrete
• HVAC block off and seal air vents.
• Maintain negative air flow/HEPA filter. Monitor.
• Physical Separation drywall, visquine, control
  cube
• Trash Removal Define least intrusive trash
  route/cover tight, during low activity
• Water obtain potable when needed flush lines

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Class IV

• Construction Area (General)
• Remove staff, pts, equipment
• dust control to deck above use mats/wipes
• Close windows seal doors/air vents (visquine,
  duct tape)
• Clean area regularly
• Mist work surfaces when cutting or drilling
  concrete
• HVAC block off and seal air vents.
• Maintain negative air flow/HEPA filter. Monitor.
• Physical Separation drywall, anteroom, self
  closing doors
• Trash Removal Define least intrusive trash
  route, cover tight, during low activity
• Water obtain potable when needed flush lines
• Dress contractor gowned/ shoe covers if passing
  through sterile area

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During construction

• Make roundsgo with the contractor
• Wear your PPE goggles, hard hat, vest, proper
  shoes
• Document your findings

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Elements to include on your checklist

• All equipment/pt items removed
• Tight barriers
• Ductwork sealed/covered
• Negative airflow
• Debris removed/covered
• Proper trash chutes
• Proper signage

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All work sites must be kept free of excess waste
as well as, food and beverage containers for
infection control purposes.