Improving the Infection Control Permit Process in a University Medical Center Janet Szychowski BSN RN CIC, Tamara Cooley BS, Mandy Creech MS, Susan Johnson MS MT ASCP OHST,

Don Hayes BE MBA, Terry Ralph, Larry TuckDepartments of Infection Control and Prevention, Environmental Health and Safety, Plant Services, Space and Facilities,

Vanderbilt University Medical Center, Nashville, Tennessee

Results

Issue

Lessons Learned

Abstract

Project

Issue: Construction is an ongoing and major factor of life in large university medical centers. While an Infection Control (IC) construction permit process had been in place for several years, the process was becoming quite burdensome. Every permit issued required all parties to be present at the same time. Problems with scheduling, time constraints, personnel, and non-permitted construction projects were increasing. We aimed to restructure the process for evaluation of construction permits to reduce these limitations.

Project: The Construction Safety Committee (CSC) comprised of representatives from Environmental Health and Safety (EHS), Plant Services, Space & Facilities, and Infection Control & Prevention (IC&P) implemented changes to the construction policy and permitting process. The construction permit was revised using standards from The Joint Commission (JC), Association for Professionals in Infection Control & Epidemiology (APIC) and the Institute of Architects (AIA). Projects were classified into one of 4 classes (I-IV) based upon the extent of the project, the potential for dust generation, and the potential patient populations at risk in and around the construction area. After the policy changes were made, the education component was developed by the EHS Safety Officer and the IC&P Practitioner. The facility’s Biomedical, Information Technology, and Plant Services departments – electrical, plumbing, heating, air, refrigeration, carpentry, and paint shop – mandated that their managers and members attend the educational sessions. Space and Facilities oversaw the outside contractors and required their management to also attend these sessions. The educational presentation created featured hospital staff in various construction scenarios. The IC construction permit process was outlined in detail with emphasis placed on the infection control risk group, construction activity type, and infection control class. Mandatory annual updates are planned for the future.

Results: A better understanding of infection control and construction now exists, creating a smoother permitting process. Thirteen training sessions were given over a 7 month period. Two 90 minute blocks of time, per week, are now dedicated for construction permits, allowing for better utilization of staff time and resources and reduced instances of “urgent” evaluation of construction work sites. Class I and II projects are reviewed individually and the permit signed by all parties involved. Class III and IV projects require an onsite meeting with EHS, IC&P, Plant Services/Space and Facilities, the project supervisor, and a unit representative. This group reviews the construction activity, the construction class, the IC class and the precautions that are to be taken. During the time period from July 2006 - June 2007, 302 permits were reviewed, including 200 onsite evaluations. The CSC also conducts weekly tours through all ongoing Class III and IV projects to ensure that all appropriate precautions are observed.

Lessons Learned: This standardization of the construction permit process has been a positive step toward an efficient process for IC permits, education and training, and improved working relationships. The need for IC construction permits had continued to increase with the growth of both inpatient and outpatient areas throughout the medical center. All departments involved are working to protect our patients. One private contractor now promotes itself and being “IC Trained” and notes this with stickers on their hard hats.

Project Info

Construction Activity Type

Infection Control Risk Group

Infection Control Class

Signatures & Comments

VUMC Construction Permit A policy and process for Infection Control (IC) construction permits was in place and being utilized within the medical center. However, with an increase in construction projects the permit process was becoming quite burdensome. Problems existed including:

• Scheduling and time constraints of required personnel to attend the permit review• An increase in the number on non-permitted projects was noted• The use of outside contractors with little or no infection control knowledge

The Construction Safety Committee (CSC) met to discuss the issues with the permit process. The project included changes to the IC Construction policy, the IC construction permit was redesigned and education was developed.

POLICY: The construction policy was revised based on current applicable guidelines from the Joint Commission (JC), Association of Professionals in Infection Control & Epidemiology (APIC) and the American Institute of Architects (AIA). This policy :• Identifies Infection Control Risk Group based on the risk to patients for developing an infection• Determines Construction Activity Type based on the amount of dust that will be generated by the construction activity• Establishes the Infection Control Class for the construction project. The class determines which dust control measures must be followed for the specific project.

PERMIT: (See figure) The IC Construction Permit incorporates the following: Project Information; Construction Activity Type - Type A, B, C, D; Infection Control Risk Group – Low, Medium, High; Infection Control Class – Class I, II, III, IV; Matrix; and Comments & Signatures

EDUCATION: Mandatory education was developed and presented by Environmental Health and Safety Officer and the IC&P Practitioner to both in-house staff and outside contractors. Thirteen sessions were given over 7 months.

The entire process had led to a much smoother process and an excellent working relationship between EHS, IC&P, Plants Services, Space & Facilities and independent contractors. Class I and II projects are reviewed by permit only. There are two 90 minute blocks set aside each week for Class III and IV onsite evaluations. Additional time can be scheduled for special needs projects. From July 2006 – July 2007 there were 302 permit reviews which included 200 onsite evaluations. Future plans include moving the permits to an online system.

Utilizing all of the involved departments brought together an array of ideas and compromises that resulted in a successful permit process and improved working relationships. Process improvement ideas continue to surface for all involved. One private contractor promotes itself as being “IC Trained” and notes this proudly with stickers on their hard hats.

Contact Information:Jan Szychowski RN, BSN, CIC

Vanderbilt University Medical CenterInfection Control

B-145 Vanderbilt University HospitalNashville, TN 37232-7345

Phone: (615) 936-0725Email: janet.szychowski@vanderbilt.edu

There are no financial disclosures

www.mc.vanderbilt.edu/infectioncontrol