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)

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.

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

• 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

• 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?

• 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?

INFECTIOUS AGENTS

• Molds

• Fungi

• Bacteria

• Viruses

• Other Microbes

INFECTIOUS AGENTS

MOLD

ASPERGILLUS

ASPERGILLUS

ASPERGILLUS

© 2011 Carpenters Training and Educational Fund of Greater Pennsylvania

ASPERGILLUS

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

ASPERGILLUS

WHAT IS INFECTION CONTROL?

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

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

LINKS THAT CANNOT BE BROKEN

• The Infectious Agent

• The Susceptible Host

• The Reservoir

SUSCEPTIBLE HOST

• Immune Compromised

• Surgical Patients

• Higher Acuity

BRAIN BIOPSY

LUNG

© 2011 Carpenters Training and Educational Fund of Greater Pennsylvania

RESERVOIR

• Hospitals are being built differently today

• Building Components

• Drywall

• Ceilings/Plenum space

• Ductwork

• Inaccessible areas

• Plumbing systems

• Cooling Towers

RESERVOIR

RESERVOIR

LINKS THAT WE CAN BREAK

• Portal of Exit

• Mode of Transmission

• Portal of Entry

PORTAL OF EXIT

• Walls and Doors

• Ductwork

• Open Plenum

• Plumbing

WALLS AND DOORS

DUCTWORK

OPEN PLENUM

PLUMBING

PORTAL OF EXIT

MODE OF TRANSMISSION

• Air Currents

• Water Supply

• Construction Equipment

• Carts and Debris

• Clothing of Worker (can be a Vector)

AIR CURRENTS

WATER SUPPLY

CONSTRUCTION EQUIPMENT

CARTS AND DEBRIS

WORKERS AS VECTORS

PORTAL OF ENTRYIN THE PATIENT CARE ENVIRONMENT

• Healthcare Workers

• Terminal Water and HVAC Supplies

• Patient Portals

Are you contaminating the patient

care environment?

PORTAL OF ENTRY

• 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

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

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

ICRA RESPONSIBILITIES AND OBLIGATIONS

The Health Care

Facility, Contractor,

and Individual

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

HEALTH CARE FACILITY OBLIGATIONS

• Moral

• Legal

• Financial

• Reputation

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)

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

YOUR CONTRIBUTIONS CAN

MAKE OR BREAK THE SUCCESS

OF THE HEALTH CARE FACILITY

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

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

DETERMINATION AND

EXPLANATION OF ICRA

LEVELS

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

PATIENT RISK LEVELS

• Group I: Least Risk

• Group II: Medium Risk

• Group III: Medium - High Risk

• Group IV: Highest - Risk

ICRA PROTECTION LEVEL MATRIX

PREVENTION AND CONTROL

• Standardized Methods

• Centers for Disease Control

• OSHA

• Medical Asepsis

• Standard Precautions

• Universal Precautions

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

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

WELL DONE

UNACCEPTABLE

WELL DONE

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

WORKING OUTSIDE THE BARRIER

Mobile pop-up

containment unit

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

©

RESPONSIBILITIES

• Follow the established rules of the HCF

• Clean up

• Peel tacky mats

• Report any barrier containment breaches

REALITIES

• Potential risk of secondary infection

OUR WORK IS GOING ON NEXT TO THIS!!!!!!!

AND THIS!!!!!!

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

RESULTS

The Results ALWAYS:

BEGINand

END

with the Patients Welfare as the main catalyst for the work we do within the ICRA Environment!

ANY QUESTIONS?

Jeffrey D. Clair, RN, University of Pittsburgh Medical

Center Infection Control

Construction Coordinator

Special Thank you

in memory of: