Health-Care Construction

Comprehensive Plan Heals Safety Concerns

By Dave Murphy

Construction safety in an operating health-care environment brings greater-than-usual risks.

Like any project, contractors need to manage the typical, complex construction risks. In addition, they have to pay attention to safety issues affecting the users—patients, visitors and hospital staff—of the facility.

The hospital will provide contractors with an Infection Control Risk Assessment and Interim Life Safety Measures Assessment, but they need to be a part of the development of these basic plans and go beyond them in terms of comprehensive planning, communication and assessment of performance.

In the 22 years I have been with Pepper Construction Co., I have worked on dozens of hospital projects, from small renovations to major expansions. Currently, our Indianapolis office is involved in numerous new-construction projects in the Hoosier State, including Parkview Regional Medical Center in Fort Wayne, Simon Family Towers at Riley Children’s Hospital Indianapolis and Union Hospital in Terra Haute. We are also expanding Unity Surgical Hospital in Mishawaka, Ind.

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In Tennessee, we are a contractor on Mountain States Health Alliance Children’s Hospital In Johnson City.

Comprehensive Safety Planning

Coordination and planning meetings must be held with representatives from the hospital—infection control, safety and security, nursing, facilities and department managers—for the ICRA and ILSM assessments. Key members of the construction team should participate, including those in project management. They can ensure that these plans include the input of all stakeholders.

Discussions should include the scope of work, such as scheduling, project phasing, critical systems interruptions, supporting work in areas surrounding the project site and specific construction procedures.

For example, does it make sense to break the project into smaller phases to minimize interruption of the hospital’s existing traffic patterns? Or can phasing minimize interruptions to electrical service by dividing the work up along electrical circuiting zones?

Beyond the Basics

After the assessments are completed, they should be incorporated into a detailed project-specific safety plan.

This plan expands on the assessments and includes specific infection control and best practices—as well as the traditional safety considerations of construction—for the public and workers. When the plan is completed, it should be sent to each subcontractor for understanding and input.

Go yet another step. A preconstruction safety meeting should be held with each subcontractor to review the safety plan and ensure that team members are on the same page.

Is this a lot of effort? You bet, but keep in mind a top priority in a working hospital is to maintain a safe environment for the patients, visitors, staff and contractors. Poor planning could lead to deficiencies in construction, minor inconveniences and major problems.

Elements of Safety

Plans are meaningless unless the tradespeople have a complete understanding of interim life-safety measures, infection-control procedures and the specific details for each project.

They must be trained in what infection control and ILSM issues are and how they are achieved. Too often workers are sent to the project ill prepared for the intricacies of the health-care environment.

The safety skill of the tradespeople typically begins with the installation of temporary barriers or dust walls.

After that, do they understand the specs of the following:

• Full-height barriers from floor to ceiling with metal stud framing.
• Full-height plastic barrier from suspended ceilings to deck above with sealed penetrations.
• Walls sealed at floor and ceiling.
• Installation of anteroom if required.
• Self-closing and self-latching doors with floor sweeps.
• Sticky mats at entrances and exits to work areas.

Moreover, are tradespeople trained to know the procedures for moving material in and trash out of the work space, including procedures to contain dust and routing through the hospital corridors? Poorly installed or maintained dust walls contribute to the degradation of negative air and allow for dust and smoke migration—conditions we’ve gone to great lengths to prevent.

Can they identify fire-rated walls and do they have the knowledge and materials to seal penetrations they create for installation of their building materials? Are they well versed in utility shutdown and critical service interruption permits and procedures?

Also, language, attire, patient privacy and understanding of requests from staff about stopping work are factors that need to be considered.

Assessing Performance

Performance measurement and accountability, critical elements in hospital construction safety, are often overlooked.

A contractor can have great programs for safety planning and training, but it is crucial to identify deficiencies and initiate corrective actions before they result in negative patient outcomes.

We use software called SafetyNet, developed by San Carlos, Calif.-based DBO2, to record observations and corrective actions. It was customized for us with specific measurements for ILSM and infection-control implementation, monitoring and reporting.

We make regular observations on each project. We’ve developed a database of leading indicators of negative trends and evaluated the effectiveness of corrective actions. We also have tied this information into our accountability program for our Pepper team and subcontractors.

Construction safety in the health-care environment can be effectively managed. Planning, training, continuous measurement and accountability are the core requirements of all safety programs, acutely so in the health-care environment. It is good business for contractors, and, most important, it can save patients’ lives.

(Editor’s Note: Dave Murphy is the safety director of Pepper Construction Co. of Indiana. He can be reached at 317-681-1000 or davemurphy@pepperconstruction.com).

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