Getting Contractors Engaged With Infection Control

If you’re like most healthcare facilities, you’ve committed to a comprehensive, tried and tested set of Infection Control Protocols to protect your patients and reduce liability for your organization.

But every construction, renovation or repair project brings new characters and variables into play that will undoubtedly challenge your tried and tested Infection Control Protocols.

The problems are two-fold:

1. Contractors will not be as familiar with your facility and your expert knowledge to confirm how critical building systems will be impacted by construction, renovation or repair activities.
2. Contractors will have to buy in to the Interim Infection Control Measures (IICM’s) you require and accept responsibility for implementing them on site.

The best way to help your contractors apprehend and manage potential project risks is to get your contractors involved in your Infection Control Risk Assessments so they can own and manage the Infection Control Protocols required for your project.

Unfortunately, your contractor may not exactly jump for joy at this suggestion. (A lot of contractors have had bad experiences with infection control healthcare projects in the past.)

Here are a few benefits you can share with contractors to get them on board with your plans. And remember, step into your contractor’s shoes when sharing these arguments!

Liability

Lots of people outside the healthcare realm have been asking: why is there suddenly this huge panic surrounding hospital-acquired infections (HAIs)? From stories on antibiotic-resistant bacterial infections to legionella outbreaks and beyond, reporting and investigations of HAIs is way up.

This is due, in part, to recent changes in Medicare and Medicaid requirements that require hospitals to report infections. But it’s also due to the increase in HAI lawsuits that are cracking down on hospital—and contractor—liability when it comes to infections.

There’s no way around it: HAIs are going to occur around your projects. That means everyone involved (hospitals and contractors alike) has to have data to protect their organizations from frivolous allegations of fault and costly face-saving settlements if a patient does develop a construction-related infection.

To Stay On Schedule

It’s possible that you’ve been in this situation before: everything was going fine until one of the workers borrowed the drop cord off of the air scrubber, causing you to lose negative pressure in the work area. Now your containment areas are compromised and construction dust has made its way into the hospital HVAC system.

Sounds like a recipe for serious delays, doesn’t it? Your contractor will not only have to spend time re-sealing the containment areas, but they’ll also have to help you investigate the spread of contaminated dust, spend time reworking the infection control plan, and maybe even stop work until the concerns of patient families have been addressed.

Not only do they risk getting behind schedule, but they’ll probably have to deal with stricter infection control oversight than before—which may or may not be carried out at their own expense.

Or there’s another option: contractors can provide their own infection control plan with their schedule and budget in mind. By providing their own plan, they’ll be able to think through how much time daily Interim Infection Control Measures (IICM’s) will take. And they’ll be able to create a contingency plan for how you’ll get back on track in the case that something does go wrong.

So They Can Have a Voice

One overlooked issue when it comes to hospital-provided Infection Control plans is that the dynamic often becomes one of policing contractor actions. Since you as the owner have provided the ICRA, your staff is in a position of power to supervise and enforce contractor actions.

You want your contractor to take full ownership of the IICMs, understand their importance, monitor their effectiveness and be prompted to action when elements of non-compliance are realized.

It’s A Necessary Skill

Healthcare construction is different from any other venture because construction activities are performed within close proximity to patients and present significant operational risks.  But due to it’s unique nature, not all contractors will be will have the infection control expertise necessary to make your project successful.

Just like any job interview, when you interview a potential candidate, you need that person to have the skills necessary to handle the most important aspects of the job—and one of those skills is infection control.

As it relates to your project’s successful execution, ICRA experience and commitment should be amongst the primary evaluation factors for contractors chasing your project scope.

Documentation

Documentation is an integral part of any construction or renovation project. Whether you’re simply reviewing the project or providing defense for a lawsuit, everything has to be documented. When it comes to providing proof, if it is not in writing, then it never happened.

Your project’s success will be dependent upon comprehensive ICRA monitoring.  It is imperative that the contractor routinely evaluate and document compliance.  When items of non-compliance are realized, it is imperative that the contractor effectively resolve said items and document the actions taken to return to compliance.

So They Can Be on the Offense

Whether it’s an HAI lawsuit or an accident on the job, when something goes wrong it’s easy to start pointing fingers. Oftentimes, whomever provided the IICM’s will assume they’ve done their part to protect patients and limit liability. If you, the hospital, has provided the IICM’s your contractors will be on the defense when it comes time to investigate what went wrong.

Explain to your contractors that if they’ve provided their own IICM’s, they’ll be able to demonstrate the steps they took to prevent the incident in question. But even more importantly: they’ll be in a proactive position to identify and rectify any non-compliance issues before they become issues in the first place.

And one last note: your infection control program has much greater chances of success if both you and your contractor are on the offense with a proactive infection control monitoring and documentation strategy.

Budget Integrity

You’ve likely already conducted an Infection Control Risk Assessment (ICRA’s) for your project and have infection control objectives specified. But the implementation of the plan will depend on your contractor, so the means and methods should be your contractors’ responsibility.

Still, you as the owner will ultimately pay for IICMs.  At best, these IICMs can be adequately accounted for in the project budget. Or they may simply be an inconvenient source of change orders. At worst they might be functionally missed during pre-construction planning, leading to serious budget problems down the road.

If your contractor is not well-versed in ICRA budgeting and simply throwing a dart at ICRA estimates – will they come remotely close to the bullseye?  An ICRA Consultant can help get things pointed in the right initial direction so your project doesn’t go off the dart board.

What if your contractors are totally lost on Infection Control?

We don’t know what we don’t know, every single time. If your contractors have never received effective ICRA training, how can compliance be expected?

In order to ensure understanding, compliance and functional success you can:

1. Suggest they work with an Infection Control Consultant. These consultants can help contractors develop manageable infection control plans for healthcare projects to keep them on schedule and on budget. Consultants can become valuable team members for contractors who need someone who knows their budgets and capabilities, but also need expert knowledge and a third-party viewpoint to evaluate their IICM’s. Having worked with both healthcare and construction clients, consultants can help contractors foresee potential infection control pitfalls from both a healthcare and contractor perspective.

2. Require infection control training in project specifications. Make your project’s life simpler by addressing the root of the issue: ensuring that you have an educated workforce that has bought-in to your objectives.  True expertise takes years to develop, but training will allow contractors to speak infection control language with healthcare owners. Perhaps more importantly, training will help contractors identify infection control problems on site—and teach them when and where to ask for help. Infection Control situations escalate quickly, so having a reliable Infection Control Specialist on call can save you and the owners lots of headaches and money when a problem needs fixing. We’d recommend you check out the Construction Infection Control Training Institute. They have some great training options for owners and contractors that will kick start your education in infection control.

Managing the infection control risks associated with any construction, renovation or maintenance project is critical to its success. One of the best ways to guarantee success is to get someone on the same team and encourage your contractors to get involved with IICM’s for your construction, renovation and maintenance projects.

If you have any questions about how to work with your contractors, architects or engineers on your projects, please reach out to Dan Taylor, President, at dantaylor@amienvironmental.com or 402.981.1000.

Here at AMI Environmental, we regularly provide infection control consulting for both contractor-engineering firms and healthcare owners. With 30 years of healthcare experience, we’re well versed in the needs of both large and small healthcare facilities, and the vendors who keep their facilities running smoothly.