A lot of the time, that’s just fine. Most of these pathogens don’t pose too much of a threat to healthy bodies; our immune systems are able to fight them off and so we live in harmony most of the time.
Unfortunately, this is not the case in healthcare environments.
Medical advancements have made it possible to treat and save more people than ever before. But it also means that more patients in hospitals are older, weaker, sicker, or in more critical condition than before. These patients less capable of fighting off infections because their immune systems are not working at full force.
This situation provides a unique opportunity for environmental pathogens to exploit immuno-compromised patients who are unable to fight them off. Therefore, the presence of environmental pathogens in healthcare environments is cause for serious concern.
According to the CDC:
- Every year, 2 million people develop Hospital-Acquired Infections (HAIs).
- That’s 1 in 25 patients who will suffer a Hospital-Acquired Infection during their stay this year.
- Of those 2 million people, 110,000 patients will die from their hospital-acquired infections.
This, of course, is why infection control measures are put in place: to make it as difficult as possible for opportunistic microorganisms to survive. Or, at the very least, to eliminate their presence in environments where immuno-compromised patients reside.
But when construction, renovation and maintenance activities enter the picture, the level of control that we usually observe in healthcare settings is thrown off course. A myriad of new factors are introduced to the healthcare environment that can derail infection control plans and put patients at risk.
- New people, materials and bacteria are constantly being brought into the healthcare environment.
- More people and traffic in hospitals means particulates, bacteria, etc. can travel further through the healthcare environment.
- Construction workers and materials bring increased levels of dust and chemicals into the hospital.
- Vibration caused by construction and renovation activities can release dust and mold spores into the air.
- Vibration causes patient stress and affects instrument performance.
- Demolition activities can disturb, release and mobilize the spread of harmful bacteria and mold through the hospital.
What is the ultimate consequence for these increased risks?
The CDC estimates that approximately 5,000 people die every year from HAIs linked to construction and renovation activities.
Why do Infection Control measures fall short during construction and renovation?
Because every construction or renovation project introduces unique risks to the healthcare environment, hospitals are required to have an Infection Control Risk Assessment (ICRA) conducted for each new project. These assessments help determine how construction work will impact infection control measures. They also identify infection control risks renovation work will introduce to the healthcare environment so they can be corrected.
Unfortunately Infection Control Risk Assessments sometimes fall short. Why? Because you can only protect against risks you’re aware of. Sometimes construction, renovation and maintenance work can lead to unexpected hazards that aren’t uncovered until work has begun. Other times, external circumstances or seemingly trivial factors can go unaccounted for. Regardless of the cause, these small oversights can lead to full-on infection control emergencies.
One of the best ways we can prevent unexpected infection control hazards from sneaking up on us is to learn from our past mistakes.
We’ve put together some scenarios based on real-life infection control crises in hospitals around the country. They’ll show you how construction and renovation activities can cause unexpected infection control risks, and what you can do to prevent patient infections and deaths.
Let’s take a look.
The Culprit: Aspergillus fumigatus
The Problem: The mold was dispersed during demolition of ducts and the removal of drop ceilings.
The Result: The fungi affected patients with Leukemia, Myeloma, and Lymphoma. Twenty-two patients developed infections, resulting in 18 deaths.
What went wrong: According to the ICRA Matrix of Precautions for Construction & Renovation, oncology patients like those affected in this crisis are included in the “highest” Patient Risk Group. Patients in the “high” and “highest” risks groups are most at risk for HAIs because their immune systems are compromised and cannot fight off infections. Make sure to identify where high-risk patient units in your hospital are located and implement stringent dust control measures around these areas to prevent environmental pathogens from accessing these areas.
The Culprit: Aspergillus fumigatus
The Problem: A connecting bridge between an old and a new hospital unit allowed dust to circulate from a nearby construction project. Additionally, one air vent near the construction was not properly sealed.
The Result: Three heart transplant patients developed HAIs after exposure to dust carrying the fungi. Two of the three patients died.
What went wrong: Quality Control inspections should have also been implemented to make sure that the critical barriers in place were effective in controlling dust and other contaminants from infiltrating patient areas. Additional measures, including pressurization, could have also been used to reinforce physical barriers. As for the unsecured air vent, everyday routine inspections should have been in place to catch and correct obvious problems like this. Even small oversights can completely overthrow other infection control measures by allowing contaminated dust to circulate through patient areas.
The Culprits: Aspergillus fumigatus, Aspergillus flavus
The Problem: Mold growth was present on walls behind vinyl wallpaper. The wallpaper removed without proper controls.
The Result: These two fungi infected 10 patients who had received kidney transplants or were suffering from hematological malignancy. All 10 patients died from their infections.
What went wrong: Common sense and caution could have prevented this infection control disaster. It’s been well documented that vinyl wallpaper on interior parameter walls unintentionally forms vapor barriers and can create an environment where mold is likely to grow. This common knowledge should have resulted in a pre-demolition site investigation for mold (and subsequent mold removal) before any work began. It is also important to note that the kidney transplant patients affected in this instance fall into the highest Patient Risk Group on the ICRA Matrix. Infection control precautions should have been in place to protect these high-risk patients from any construction, renovation or maintenance work going on in the hospital.
The Culprit: Aspergillus fumigatus
The Problem: Renovation activity was taking place on the floor above the patients’ rooms. Mold was dispersed from the drop ceiling.
The Result: Three kidney transplant patients developed HAIs after exposure to the mold. One of the three patients died.
What went wrong: Whenever construction, renovation or maintenance work is being planned, it is essential that high-risk patient units be identified so that infection control professionals can evaluate how to best protect patients in these areas. These kidney transplant patients belong to the Highest Patient Risk Group on the ICRA Matrix, so they were very likely to acquire an HAI after exposure to environmental pathogens. Even if renovation activities are taking place in a different area of the hospital, proper infection control barriers still need to be put in place to protect the highest-risk patients.
The Culprit: Aspergillus spp.
The Problem: Air return vents were not covered during demolition.
The Result: The affected patients resided in the Burn Unit, Dialysis Unit and Oncology Unit of the hospital. Five patients developed HAIs and four later died.
What went wrong: This was a fairly obvious mistake that should have been caught and corrected during routine inspections. Infection control managers should make a point to check “critical barriers” like air vents on a regular basis because they are essential to control infection during construction activities. Once again, it is important to note that burn unit, dialysis, and oncology patients are in the “highest” Patient Risk Group for HAIs. Maintenance of critical barriers around these high-risk patients areas should be made a priority for the duration of any construction, renovation or maintenance work.
The Culprit: Aspergillus
The Problem: Patient rooms overlooked the excavation site where the hospital was being rebuilt. Mold was drawn in through leaky windows in isolation rooms that housed the patients.
The Result: Eleven patients in the hematology unit of the hospital unit developed HAIs. Five of the patients later died.
What went wrong: These patient rooms should have been inspected so that the leaky windows could be identified and corrected for. In this case, adequate positive air pressure should have been confirmed in the patient rooms to keep outdoor air from infiltrating the patients’ rooms. This is also a good reminder to pay attention to external construction (construction going on outside the hospital) as these contaminants can find their way inside if proper infection control measures are not in place.
The Next Step
Take a few moments to consider the processes you currently use for Infection Control Risk Assessments. Would they have prevented these infection control emergencies? If you you’re not sure, it may be time to take a second look at the infection control measures in place at your hospital.
Keeping these scenarios in mind, consider:
- Are there any gaps that need to be filled?
- Are there any items that should be added to your ICRA checklist?
- What unique infection control challenges does your hospital face?
- Are you planning any construction, renovation or maintenance work near units that treat high-risk patients? These would include (but are not limited to): the emergency room, the ICU, Labor and Delivery Units, Operating Rooms, Oncology Units, etc.
- Are there external factors (like construction on a neighboring building) that need to be considered?
Keep these scenarios in mind when you start your next healthcare project. They’ll help you avoid the same pitfalls so you can keep your project on track, preserve your reputation, and most importantly protect your patients.
If you have any questions about a current healthcare construction or renovation project, please feel free to contact me at any time. I can help you identify your facility’s unique infection control risks so you can better protect patients and complete your project as planned.