A 55-year old man who underwent surgery at a western Massachusetts hospital to repair herniated discs contracted an infection that required two more operations and 115 days in the hospital. His infection was caused by an airborne fungus that contaminated the surgical site.
Water in the hospital’s air-handling ducts was determined to be a likely source for the fungus. The man sued the general contractor and sheet metal contractor responsible for installing the operating room air-handling system, the environmental testing company that evaluated the system, the hospital itself, the chairman of the infection control committee, and the infection control practitioner. After years of litigation, the case was eventually settled for $717,000.
Andrew J. Streifel, public health specialist in the Environmental Health and Safety department at the University of Minnesota, served as a hospital environmental health expert for the case. He says, “Mold is everywhere. It’s as common as the air we breathe. A problem starts when those microbes can affect patients.” All patients are at risk from the environment, “especially when we start to do construction,” Streifel notes.
Liability related to health care construction can be costly, and much more than money is at stake. The risk is particularly high for patients whose immune systems are severely compromised, including premature infants, transplant recipients, or people being treated for cancer or burns, who are susceptible to invasive aspergillosis, an often fatal infection caused by a very common environmental fungus, or mold. According to the U.S. Centers for Disease Control and Prevention, “studies have shown that invasive aspergillosis can occur during building renovation or construction.”
“It’s critical that we maintain infection control measures as we’re doing construction, because when things go wrong it can be fatal,” says Tim Adams, CHFM, CHC, FASHE, director of professional growth for the American Society for Healthcare Engineering (ASHE).
With proper training, however, construction professionals can learn techniques for upholding a hospital’s infection control program during a building project, as well as dealing with other issues exclusive to health care construction.
To assure the safety, privacy, and comfort of patients, visitors, and hospital staff and facilitate good planning, design, and construction of health facility projects, ASHE has developed an array of educational resources for those involved in the field at every level—tradespeople, subcontractors and specialty contractors, and general contractors and project leaders.
Trades
Although some construction workers may spend only a short time on the job site, it is still essential they understand how everyone in the health care environment affects patient care. “Today You Are Healthcare” is a 30-minute video that outlines general precautions for protecting patients, visitors, and staff in an occupied hospital where construction or renovation is taking place. “It’s designed for the folks in the field doing the hands-on work,” says Adams.
Facility managers, contractors, and hospital administrators can use this video to illustrate how workers can help prevent infections; lessen physical risks like fires or patient falls; reduce noise and vibration so patients can rest; and avoid making mistakes that could cause harm, such as unexpectedly taking important equipment out of service.
“Today You Are Healthcare” is the second in ASHE’s Healthcare Construction Television (HCTV) series.
Subcontractors and specialty contractors
This year ASHE will offer a new e-learning program for contractors who work in health care. “The idea is to really make people aware of what is different about doing construction in health care, as opposed to other types of commercial construction,” Adams says.
The self-paced online course features multimedia presentations, a written study guide, and quizzes. Upon completion of the program, users can review a summary and check their understanding with a self-test.
Lessons cover health care codes and standards; patient and owner expectations; construction risk assessment; infection prevention principles and risk assessment; non-infectious environmental risks; construction practices; life safety and fire safety practices; and project closeout and management.
“For companies that haven’t done health care, it’is a whole new ballgame. Projects generally take longer and cost more,” Adams says. Understanding why and how health care construction is unique can help contractors bid, estimate, and complete a project successfully.
General contractors and project leaders
Adams estimates that since 2003 nearly 10,000 health care and construction professionals have attended ASHE’s Healthcare Construction Certificate program, an intensive, two-day course with a short online prerequisite. Following the training, participants can identify the needs and expectations of facility owners, staff, and patients and describe how these relate to the construction process; work more collaboratively with owners; and understand the critical factors involved in healthcare planning, design, and construction. “We cover a lot of territory,” Adams says.
The HCC program is distinct from AHA’s more recently developed Certified Healthcare Constructor (CHC) credential, which combines education and experience, a certification examination, and periodic renewal requirements. (For information on AHA certification, see http://www.aha.org/aha/Certification-Center.)
ASHE also offers two-day programs related to health care construction. Healthcare Construction Project Management examines health care construction from a scheduling and budget standpoint. Infection Control: Managing Risk During Construction, Operation, and Maintenance of Facilities
uses case studies and real-life examples to consider infection prevention in the health care environment from an operations and construction perspective.
Mark of approval
Brian Cotten, PE, CHFM, FASHE, executive director of design and construction, University of Arkansas for Medical Sciences, says his organization likes to issue a request for qualifications on hospital projects to assure contractors and designers are qualified and understand how to work in a health care setting. “Especially if they’re going to be working on a project in a patient care area, we want to make sure they are trained and qualified,” he says.
For Cotten, the ASHE education offerings provide the necessary background for all aspects of health care construction. “They’re excellent training programs. I highly recommend people attend them and get their certification,” he says.