Safely Managing Construction/Renovation and Maintenance in Healthcare: A Facilities Management Perspective February 10, 2009

Transcription

1 Safely Managing Construction/Renovation and Maintenance in Healthcare Bryan Connors, MS, CIH, HEM Healthcare Practice Leader, EH&E Agenda The Joint Commission Requirements Case Studies (What Can Go Wrong) Management of Data and Program Documents Proven Management Techniques 2 Page 1

2 Why Do We Care About PCRA? Outbreaks of hospital-acquired mold infections Minimizing liability Compliance Improving flow of work 3 Proven Success Strategies Clear Responsibilities Central Coordination Consistent Review Process Committee, Inspections, Permits Competencies/Skills Metrics, Follow-up Contactor Training 4 Page 2

3 Construction in Healthcare 5 Examples of the Risks 6 Page 3

4 7 PCRA Components PCRA Risk Mitigation Program ICRA ILSM Utility Impacts, Noise, Vibration, IAQ 8 Page 4

5 Joint Commission Requirements The PCRA process should identify: 1) Potential impacts on air quality 9 Joint Commission Requirements 2) Potential impacts on fire and life safety 10 Page 5

6 Interim Life Safety Measures Major deficiencies in the life safety code May be due to construction or other causes of deficiencies 11 Life Safety Case Study Hot work + sprinkler impairment =? 12 Page 6

7 Joint Commission Requirements 3) Effects of noise and vibration 4) Utilities and medical equipment 13 Joint Commission Requirements 5) Potential impacts on Infection Control 14 Page 7

8 Infection Control Risk Mitigation Construction = Dust Dust = Mold Mold + High Risk Patients = Elevated Risk Patient risk group Low risk group Medium risk group High risk group Highest risk group Construction Project Type Type A Type B Type C I II II I II III I II III/IV II II III/IV Type D III/IV IV IV IV 15 ICRA Case Study 16 Page 8

9 Examples: Containment Practices Good Bad View from inside site 17 Example: Life Safety Risks 18 Page 9

10 What Can Go Wrong Nosocomial fungal infections Staff injury and illness OSHA inspections Joint Commission Accreditation Insurance premiums and liability Staff complaints and dissatisfaction 19 Root Causes of Failure Interdepartmental responsibilities = ambiguity, lack of ownership Construction contractors focused on job completion & schedule Subcontractor management Limited hospital resources/resource allocation Contractor orientation & unfamiliarity with healthcare environment 20 Page 10

11 Consistent PCRA Process 21 Permits for Each Project 22 Page 11

12 Inspection Data and Program Metrics 23 Other Issues to Consider Site inspections, deficiency resolution Contractor vetting and selection Management of sub-contractors Include PCRA and safety performance requirements in contract documents OSHA compliance issues Asbestos, LO/TO, confined space Above the ceiling permit, fire stopping, hot work permit 24 Page 12

13 Proven Success Strategies Define the management process Clearly define roles Assure accountability 25 Proven Success Strategies Vet/select contactors and subcontractors Train contactors Determine vulnerabilities Act to address the vulnerabilities 26 Page 13

14 Safely Managing Construction/Renovation and Maintenance in Healthcare Bryan Connors, MS, CIH, HEM Healthcare Practice Leader Page 14