Hospital and health care facility additions rank among the most demanding construction projects.
Along with co-ordinating work flow under often-tight deadlines at fully-occupied hospitals, builders face stringent infection control protocols set by hospital administrations to prevent outbreaks among patients.
“Contractors need to be able to say they did everything reasonable to protect the building occupants when they were doing their work,” explained Gordon Burrill, a health care engineer, who specializes in infection control compliance for builders.
Building appropriate barriers and incorporating sophisticated air-handling systems between work sites and hospital spaces has to be a top priority.
“You can’t just hang a plastic sheet from a T-bar ceiling and call it your barrier,” he said.
Some hospital contracts stipulate Canadian Standards Association (CSA) standards must be followed.
However, these can vary, based on patient risk assessment, but the requirements tend to be stringent, he said.
Burrill runs Fredericton-based Teegor Consulting Inc. and chairs the technical subcommittee of the CSA that creates the standard updates for infection control.
The standard for most large projects, he said, is two layers of six mil polyethylene sheet barrier, which is generally secured behind gypsum board on a steel stud frame wall.
A tight seal is required to create a differential pressure of 7.5 pascals between the construction site and adjacent spaces, the consultant said.
“That means the construction site is sucking the air towards the air-handling equipment, which has special filters to capture very small particulate.”
Generally a negative air pressure system is required, he said.
Burrill added that hospital administrators often require contractors to provide “absolute proof” their construction air-handling units are working properly.
Records of differential pressure are monitored to ensure that the pressure is maintained during construction.
As well, the handling equipment’s HEPA filtration is inspected regularly and some hospitals even demand that it is independently certified to meet HEPA standards, he added.
Burrill recommended that prior to starting a project, contractors and owners work out a common definition for site cleanliness because the word “clean” can mean something different to both parties.
To meet a hospital’s infection control, standards can be costly.
In some cases, contractors shell out close to as much as the construction contract is worth.
A sprinkler retrofit to a fully-occupied 60-year-old hospital is a case in point, said the consultant.
“Your project’s phases have to be very small. Building walls (enclosures) are often in confined spaces with little room and your sprinkler system has to continue to work during the contract. The labour efforts for containment can be as significant as the labour for the overall project itself.”
Not every containment job is expensive, however.
In some cases, the containment requirements can help minimize overall construction costs. An example is interior demolition, where high-powered labour-saving concrete slab cutters are permitted because barriers and air-handling systems prevent the passage of dust and exhaust fumes to occupied spaces.
Infection controls have come a long way over the past decade in part because forward-thinking contractors have developed cost-efficient practices and procedures.
There is good reason for contractors working in health care to jump on the bandwagon because they could, otherwise, face legal action for failing to meet contractual obligations concerning infection control, Burrill said.