By Richard Parker, MBA, CHFM, CLSS-HC, FASHE, FACHE
As technology and equipment advance, and new procedures are added, every surgery department may confront demolition, renovation or construction at some point. Assessing risk prior to construction includes looking at utility requirements, air quality requirements, infection control, vibrations, noise and other hazards.
OR leaders and staff need to evaluate risk from a big picture perspective and with a detailed focus on safety for the organization and its patients. A pre-construction risk assessment (PCRA) anticipates potential impacts of construction and establishes proactive plans to minimize undesirable situations for staff and patients.
What is a Pre-Construction Risk Assessment?
A PCRA is an in-depth preparation document to define risks and determine the compensating measures that must be implemented so that the hazards and risks created by construction activities do not have a negative impact on patient care and staff work in adjacent areas.
The PCRA will look at each construction hazard to establish its scope, timing and implications. When performing the risk assessment, it is also important to consider the impact on adjacent spaces including those above and below the work.
Six elements of the PCRA
Utility Requirements: Often, construction activities require interrupting utilities. For example, an electrical circuit may need to be shut off and this could affect multiple ORs. In this situation, the OR leader will define the acceptable time frames for the service interruption to avoid cancellation of surgical procedures. There may be ancillary impacts; bone and tissue freezers may need to be relocated during the outage, or equipment may need to be reset after the interruption, so it is ready for the next scheduled surgery. Air handling equipment providing HVAC is critical for patient and staff safety. If there is a planned interruption, this must be understood by the OR manager and scheduled. Evaluating further whether temperatures can be maintained within the manufacturer’s instructions for use through a service shut down will determine the impact on supplies and equipment. And an expected impact on air pressure relationships across critical areas, may demand compensating measures to protect items in sterile storage. This same thought process should be applied to plumbing to mitigate the impact on handwashing, steam used in sterilization and/or medical gases.
Air Quality Requirements: Containment barriers help protect occupied areas from the dust and fumes that may be generated by construction. These barriers may perform several functions; an infection control measure that separates the air from the adjacent spaces and a life safety measure to protect from fire or smoke. Air quality risk might also be identified in the infection control risk assessment, often resulting in the use of negative air fans to make the construction space negative pressure to the occupied space. If the PCRA identifies that some of the work will produce odors, this, too, requires a mitigation plan. This could be associated with new flooring, new paint, welding or other activities.
Infection Control: Construction workers have to get to their work location. If this involves traveling through other occupied space, an aggressive infection control risk assessment will include approving a path for workers, for new construction materials, and for demolition materials for disposal. Measures must be taken to make sure there is no impact on the clean and sterile environments while surgery continues to be performed. These might include a defined donning/doffing process, an anti-room to the construction area, tacky walk-off mats, covering trash and waste bins, and ongoing surveillance. The goal here is to make sure there is no evidence of construction outside of the construction area.
Vibrations and Noise: These risks are often coupled because it’s typically the same activity that causes both. An example might be percussive equipment used to remove flooring. The noise and vibration of that work will travel through slabs and walls to adjacent areas, disturbing and even disrupting OR staff work. It’s also particularly noticeable on floors below the construction area. Mitigation of this risk is most commonly accomplished by scheduling the activity and may include relocating patients or staff below or adjacent to the activity during that period of time.
Other Hazards: There may be other hazards created by demolition, construction or renovation work. Impacts on life safety systems, such as the fire alarm system or fire sprinklers are common. In those situations, a separate risk assessment process is initiated to determine alternate life safety measures (ALSM).
These compensating measures may include revising the route of egress for OR staff when construction activities or containments block exit routes. If fire protection systems are out of service there may be a fire watch performed, or there may be additional fire drills to educate staff on the changes to the environment.
OR leaders and staff should welcome and insist on being involved in the risk assessment process to inform construction staff about the needs of this specialized environment. And it’s not a one-time participation by OR leaders. If the project will continue over months, the OR leader should plan to have regular interactions with the construction team to make sure the surgery department remains safe. This includes providing adequate notice of construction activities and communicating any time measures that need to be changed.
– Richard L. Parker is associate director, physical environment and life safety at Accreditation Commission for Health Care, Inc. where he provides guidance to customers and surveyors in the ASC and hospital programs. Prior to joining ACHC served as Executive Director of Facilities for a 615-bed hospital system in Arizona.
