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2 0 1 8 WV S H E A N N U A L C O N F E R E N C E
INFECTION CONTROL RISK ASSESSMENT (ICRA)
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CAUTIONARY NOTE
• It is imperative that you follow the Health Care
Facilities’ guidelines, along with any local, state, or
federal safety rules, regulations, and guidelines.
• The information herein should not supersede the
legal responsibility of the employer.
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THE ICRA 8-HOUR COURSE
This course is designed to clearly communicate the Health Care Facility’s commitment to the
prevention and spread of health care associated infections through:
• Infection control
• Building infection control barriers
• Protocol working within the barrier
• Communications of all contractors
• Health care facility related controls
• Realities of non-compliance with health care facility rules and regulations
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• Recognize Hazardous Materials
• Control Exposure
• Limit Routes of Entry
• Understand Health Effects
• Site-Specific Considerations
• Understand Work Practices
• Understand that Interim Life Safety Measures are still in play during construction
IMPORTANCE OF ICRA AWARENESS
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• Primarily affects patients receiving care in health care facilities
• Can affect anyone who may be immune compromised
• Anyone sensitive to particulates in the air
• New Born Babies
• The Elderly
• Students at our education centers
• Indirect affects to loved ones
WHO CAN BE AFFECTED BY CONSTRUCTION, RENOVATION AND
MAINTENANCE ACTIVITIES?
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• Patients can become sick or die
from poor practice
• Delay in Care
• Added cost to health care
• Stress to Care Givers and Families
• Liability
WHAT ARE THE AFFECTS?
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INFECTIOUS AGENTS
• Molds
• Fungi
• Bacteria
• Viruses
• Other Microbes
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ASPERGILLUS
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ASPERGILLUS
© 2011 Carpenters Training and Educational Fund of Greater Pennsylvania
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ASPERGILLUS
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ASPERGILLUS
• Widespread, and part of the largest organism group in
the world
• Used commercially for:
• Food Preservation
• Tea Making
• Creation of Citric Acid
• .3 microns across
• We breathe in on average between 100-10,000 mold
spores per day
• Only 1 mold spore is needed to critically affect
the care of a patient negatively
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ASPERGILLUS
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WHAT IS INFECTION CONTROL?
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INFECTION CONTROL IS A SYSTEM OF PRACTICED CONTROLS
• Hand Hygiene
• Personal Protective Equipment
• Cleaning/Housekeeping
• Medications/Vaccines
• Best Practices
• Sterile Techniques
• Continued Education
• Infection Control Risk Assessment ICRA
• Following HCF Protocol
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CHAIN OF INFECTION
Mode of Transmission
Portal of Exit
Reservoir
Portal of Entry
Susceptible Host
Infectious Agent
Chain of Infection
© 2011 Carpenters Training and Educational Fund of Greater Pennsylvania
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LINKS THAT CANNOT BE BROKEN
• The Infectious Agent
• The Susceptible Host
• The Reservoir
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SUSCEPTIBLE HOST
• Immune Compromised
• Surgical Patients
• Higher Acuity
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BRAIN BIOPSY
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LUNG
© 2011 Carpenters Training and Educational Fund of Greater Pennsylvania
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RESERVOIR
• Hospitals are being built differently today
• Building Components
• Drywall
• Ceilings/Plenum space
• Ductwork
• Inaccessible areas
• Plumbing systems
• Cooling Towers
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RESERVOIR
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RESERVOIR
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LINKS THAT WE CAN BREAK
• Portal of Exit
• Mode of Transmission
• Portal of Entry
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PORTAL OF EXIT
• Walls and Doors
• Ductwork
• Open Plenum
• Plumbing
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WALLS AND DOORS
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DUCTWORK
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OPEN PLENUM
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PLUMBING
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PORTAL OF EXIT
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MODE OF TRANSMISSION
• Air Currents
• Water Supply
• Construction Equipment
• Carts and Debris
• Clothing of Worker (can be a Vector)
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AIR CURRENTS
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WATER SUPPLY
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CONSTRUCTION EQUIPMENT
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CARTS AND DEBRIS
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WORKERS AS VECTORS
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PORTAL OF ENTRYIN THE PATIENT CARE ENVIRONMENT
• Healthcare Workers
• Terminal Water and HVAC Supplies
• Patient Portals
Are you contaminating the patient
care environment?
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PORTAL OF ENTRY
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• HAI’s are the 5th leading cause of death in acute care
• Approximately 2 million hospital acquired infections per year
• Approximately 100,000 of those people die
• A percentage of those are related to construction, renovation or maintenance:
• 5%-10%
• 5,000- 10,000 are affected by the work we do everyday
POINTS TO CONSIDER
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WIDESPREAD HAI BELIEFS
• Most are avoidable
• HAI reporting (as a system for public surveillance) will lead to:
• Improved Medical Procedures
• Infection Control Best Practices
• Clinical
• Construction/ Maintenance
• Consequent lessening of HAI’s
This has led to the NHSN system of reporting
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2020 NATIONAL ACUTE CARE
HOSPITAL HAI METRICS
Measure (and data
source) Progress made by 2016
2020 Target (from 2015
baseline)
CLABSI (NHSN)1 10% reduction 50% reduction
CAUTI (NHSN)1 6% relative reduction 25% reduction
Invasive MRSA (NHSN/EIP2) 8% reduction 50% reduction
Hospital-onset MRSA
(NHSN)
6% reduction 50% reduction
Hospital-onset CDI (NHSN) 7% reduction 30% reduction
SSI (NHSN) Data to be released in
2018
30% reduction
Clostridium
difficile hospitalizations
(HCUP)3
Data pending release 30% reduction
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ICRA RESPONSIBILITIES AND OBLIGATIONS
The Health Care
Facility, Contractor,
and Individual
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WHO IS RESPONSIBLE FOR ICRA AT THE CONSTRUCTION SITE?
• Health Care Facility (HCF)
• General Contractor
• Subcontractors
• Vendors
• Visitors
• Employees of Everyone
The Infectious Agent does not differentiate all hold
crucial responsibility to stopping infection
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HEALTH CARE FACILITY OBLIGATIONS
• Moral
• Legal
• Financial
• Reputation
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HEALTH CARE FACILITY LEGAL OBLIGATION
• ACT 88 - Medical Care Availability and Reduction of
Error Act
• Establishes Patient Safety Authority
• Authorizes CDC to disperse funds to State Health Dept.’s
• CDC now supports more than 17,000 healthcare facilities in the 28 states that participate in the National Healthcare
Safety Network (NHSN)
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HEALTH CARE FACILITY FINANCIAL
• Preventable medical errors cost the U.S. economy
in excess of $30 billion each year
• Average cost of a patient with a hospital acquired
infection is 5 times greater for those patients with no
HAI
• Example – Patients with MRSA can cost roughly
$30,000 per case
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YOUR CONTRIBUTIONS CAN
MAKE OR BREAK THE SUCCESS
OF THE HEALTH CARE FACILITY
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CONTRACTOR OBLIGATIONS
• Moral
• Contractual• Health Care Facility requirement
• Require of all entities (GC’s, subs, vendors, and visitors)
• Financial• Potential lawsuits
• Reputation• Remain a Health Care Facility contractor
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EMPLOYEE OBLIGATIONS
• Moral
• The health of a son, daughter, mother, father, grandparent
depend on your actions!
• The health of all patients in the facility
• Employment
• ICRA compliance is a condition of employment
• Reputation
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DETERMINATION AND
EXPLANATION OF ICRA
LEVELS
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CONSTRUCTION ACTIVITY
• TYPE A: Inspection and noninvasive activities
• TYPE B: Small scale, short duration activities that
create minimal dust
• TYPE C: Work that generates a moderate to high
level of dust
• TYPE D: Major demolition and construction projects
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PATIENT RISK LEVELS
• Group I: Least Risk
• Group II: Medium Risk
• Group III: Medium - High Risk
• Group IV: Highest - Risk
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ICRA PROTECTION LEVEL MATRIX
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PREVENTION AND CONTROL
• Standardized Methods
• Centers for Disease Control
• OSHA
• Medical Asepsis
• Standard Precautions
• Universal Precautions
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STANDARD AND UNIVERSAL PRECAUTIONS PARALLEL
• Hand washing
• Gloves
• Mask and Eye Protections or Face Shield
• Gown
• Patient-Care Equipment
• Environmental Control
• Linen
• Occupational Health and Blood borne Pathogens
• Patient Placement
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ISOLATION
• Form of barrier control utilized by the health care
facility to contain a known infection
• These techniques are widely used amongst health
care facilities
• These techniques parallel Best Practice in health
care construction
• ICRA
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WELL DONE
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UNACCEPTABLE
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WELL DONE
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WORKING IN THE BARRIER
• Everyone’s responsibility
• To protect the safety of the patient
• Follow procedure outlined by the HCF in regards to:
• Site specific considerations
• Controlling exposure
• Trade specific considerations
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WORKING OUTSIDE THE BARRIER
Mobile pop-up
containment unit
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PENETRATING THE BARRIER
• Can only be done using proper techniques outlined
by the HCF
• Breaches Must Be Coordinated so that containment
can be restored as soon as possible
©
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RESPONSIBILITIES
• Follow the established rules of the HCF
• Clean up
• Peel tacky mats
• Report any barrier containment breaches
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REALITIES
• Potential risk of secondary infection
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OUR WORK IS GOING ON NEXT TO THIS!!!!!!!
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AND THIS!!!!!!
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RESULTS
• Patient Welfare
• Poor patient outcome
• Citation from the Department of Health
• Loss of revenue
• Decreased funds for construction
• Loss of employment opportunities for construction workers
• Decreased status of HCF
• Patient Welfare
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RESULTS
The Results ALWAYS:
BEGINand
END
with the Patients Welfare as the main catalyst for the work we do within the ICRA Environment!
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ANY QUESTIONS?
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Jeffrey D. Clair, RN, University of Pittsburgh Medical
Center Infection Control
Construction Coordinator
Special Thank you
in memory of: