Medical Construction & Design

JUL-AUG 2018

Medical Construction & Design (MCD) is the industry's leading source for news and information and reaches all disciplines involved in the healthcare construction and design process.

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MCDM AG.COM | J U LY/AUGUST 2018 | Medical Construction & Design 53 communicate the project's progress like information boards outside project barri- ers and weekly A3s — 11-by- 17 placemat-style progress reports for owner, architect and contractor meetings. Each proactive step leads to more open communication among construction and hospital per- sonnel, which leads to better risk management, Jones said. Rising trend: Intermediate barriers Aside from the procedure- driven aspects of the project, there is one major trend catch- ing across many healthcare projects: intermediate barriers. In years past, there have been traditional "hard wall barri- ers," also known as temporary walls, that keep a construc- tion project away from active hospital floors by essentially installing metal studs and drywall that will be later de- molished to open the space, or soft barriers — a series of con- nected plastic sheets, enterable by a zipper doorway. While there is no sub- stitute for an actual wall, JJ Jenkins, owner of Jenkins Risk Management and founder of the Construction Infection Control Training Institute, says that intermediate barri- ers are beginning to take the place of many soft barriers. Intermediate barriers are of- ten characterized by interlock- ing panels raised and fastened to the ceiling grid, with doors in the panels to isolate poten- tially harmful dust. Many com- panies sell these interlocking barriers, however Jenkins has also seen several companies fabricating their own onsite with lightweight metal studs and chloroplast. Despite the convenience, some balk at the initial sticker price of the intermediate bar- rier paneling system versus polyethylene plastic barriers, but Jenkins said the paneling systems can be cleaned and reused over a short period of time. A contractor would actually spend more on plastic barriers. Addressing non- compliance in infection control In addition to not being cost-effective or environmen- tally sustainable, the failure of plastic barriers is one of the top non-compliance issues in infection control. Because of the need to use negative air pressure on the jobsite, barriers also need designated makeup air. While the panel system accomplishes this with a des- ignated opening that may be covered with a filter allowing air to enter the barriers and preventing dust from escap- ing, there is no real option to acquire the needed makeup air in a plastic barrier without putting a hole in it, which is an at-risk behavior. Because of the lack of makeup air in that scenario, plastic barriers are likely to collapse on them- selves, exposing the area to harmful dust and particles. Jenkins said that while time and money will always be a consideration, planning- based solutions are key. For example, planning for ante-rooms — spaces be- tween the active hospital and construction that allow people and material to enter the jobsite without exposing the healthcare facility to construc- tion dust. "Often, ante-rooms are made too small to accomplish the objectives of the ante- room," Jenkins said. "But if your ante-room isn't large enough to accommodate people and associated materi- als, it can't do its job." Careful planning Jenkins said the solution to this is to plan the area care- fully and know there may be a need to revise the flow of some flooring and above-ceiling work as a result. Another challenge, Jenkins sees, comes with rigid barrier placement. While rigid bar- riers are a superior solution to polyethylene sheets, some barrier placement can nega- tively affect important hospital operations. "Sometimes barrier place- ment can impact operational traffic flow and trauma routes," Jenkins said. "For example, they can create choke points or increase travel time in emergent situations." By being cognizant of how construction barriers may change the landscape of an existing corridor and ensuring the barrier's corresponding door swings inward instead of outward, contractors can mitigate operational impacts where the hospital and jobsite merges. "[To avoid these risks] it's imperative that people get proper training as it relates to infection control containment and procedure," Jenkins said. Jones and Coleman both echo that sentiment when working to protect the pa- tients, staff and their fam- ily members on their own projects. "We just think about how we want people to act around our families. We have to remember it can be life or death," Jones said. "We have to treat it that way, understand- ing risk, checking and double checking to protect people that are already sick." To best problem solve and ensure the risk is not there, Coleman knows that working with hospital staff and ensur- ing they are pleased with the plans made is the only way to conduct a successful project, from barrier choice to order of phasing. "[Starting construction] inside a hospital is like some- one moving into your house for a short amount of time, and saying, 'hey, I'm going to build a wall here,'" Coleman said. "Our goal is to keep them informed, onboard and satis- fied." Rachael Farr is communications coordinator at Robins & Morton. On interior renovation projects, project teams can place communica- tion boards on the outside of the construction barriers as a proactive measure with healthcare facility staff.

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