Page 164 - policy and procedure infection control

Policies and Procedures on Infection Control

10. ENVIRONMENT

10.1 Infection Control During Construction and Renovation

10.1.1Introduction

Construction and renovation activities in the hospital may be associated with transmission
of pathogens such as filamentous fungi , including Aspergillus spp, Candida spp , Fusarium
and also bacteria such as Legionella and Nocardia. The most commonly reported hospital
contruction-related infection is Aspergillus, which represent the greatest threat to
neutropenic patients.

Construction and renovation activities in the hospital facility are associated with variable
levels of risks to the patients and it is important to understand what these risks are.
Activities that are associated with significant generation of dusts create appreciable risks
to mainly immune compromised patients such as oncology, bone marrow transplant,
burns and intensive care units such as NICU and ICU. Examples of these construction
activities include new construction projects and major demolition of buildings. These activities
create a lot of dust which may carry aspergillus spores. Moderate levels of dust may be
associated with activities such as sanding of walls prior to painting, construction of new
walls and major cabling activities. Inspection and noninvasive activities such as removal of
ceiling board for visual inspection, painting and minor plumbing works are low risk activities
that generally cause minor generation of dusts.
Patients who are at risk should be identified prior to the construction and renovation activities.
Immunocompromised and ventilated patients are at high risks of construction-associated
aspergillosis. These include cancer patients, transplant patients, neonatal intensive and adult
intensive care patients and patients in the operating theater. Medium risk patients include
endoscopy, cardiology, radiology and physiotherapy units. Office areas pose low risks to patients.

Pre-construction and renovation consultation should be carried out in advance between all
the stakeholders, including hospital management, infection control unit, microbiology unit,
security unit, project architects and engineers and the contractor. This will help to identify
the scope and nature of work and also to assess the degree of risks and potential patient
groups that may be affected. Close monitoring of filamentous fungi isolation rates, especially
aspergillus by the microbiology laboratory and prompt feedback to infection control units
may be helpful to implement control measures.

Procedures to contain or minimize dispersal of dust are necessary during construction
activities. Examples include physical partitioning, rerouting of human traffic away from
work areas, wet mopping and door mat placement at entrance, prompt debris removal,
blocking and sealing of air vents where appropriate, and use of negative pressure at the
construction sites. For specific containment measures, please refer to Facility Engineering
Management Services Project Operational Guidelines.

Ministry of Health Malaysia 153