by Wes Armstead

Every year, nearly 88,000 deaths occur in the United States from "nosocomial" infections - illnesses acquired while in a hospital. To help remedy this situation, stringent Infection Control Risk Assessment (ICRA) codes went into effect this past January, which hospitals must meet for accreditation.

The ICRA is designed to assess the risk to patients resulting from construction and associated noise, disruptions, dust, and other potential for "contamination."

Most of the ICRA requirements are directed at construction efforts. But they also apply to nonconstruction contractors - the design engineers, architects, painters, cable repairmen or information system workers. One tip of a ceiling tile has the potential to release hosts of aspergillus spores or fungal agents hiding in the space above and expose countless patients and employees throughout the hospital.

An ICRA plan must be developed and put in place for anyone who enters a space that may harbor contaminants. And contractors need to be aware of ICRA codes whenever they undertake work in a health-care facility.

Survey the scope

To create an ICRA compliance plan, start by listing types of work and types of contractors that work at the facility. Anyone who makes modifications of any kind, performs maintenance, does renovation, interrupts essential services, or even opens a sealed place (like a wall or floor) for a cursory inspection counts as a possible ICRA violator.

This includes consultants, architects, interior designers, communications firms, indoor gardeners, painters, electricians, mechanical engineers and TV cable crews. Review activities that workers do and the impact they could have on ICRA compliance, including:

Airborne contaminants. ICRA standards must be considered each time a ceiling or floor tile is moved, settled dust is disrupted or repairs are done under sinks. Think about isolating the area to avoid contamination.

Noise. Noise and vibration disrupt patients' peace of mind, which can have a negative impact on their immune systems. Communicating with patients and staff members helps a great deal. Explain exactly what's going on, the anticipated duration of disturbance, and long-term benefits.

Odors. Patients can become upset by even a seemingly inoffensive construction smell. Tell them what is causing the smell and how long the odor might last.

Traffic interruption. Putting Visqueen barriers around maintenance areas protects patients and employees, but it also disrupts normal traffic flow in the corridor. Ladders and work carts have the same effect. A good fix is to schedule contractors' activities during periods when traffic is slow.

Protection from infractions

Hospitals can protect themselves from liability by putting ICRA compliance into contract documents. Talk about ICRA at weekly construction meetings and at briefings with consultants and contractors. Make it a standing agenda item so everybody understands the importance of compliance and gives it top-of-mind attention.

Enforce controls, reminding contractors that their livelihood at your facility could hinge on their ability to understand and follow the ICRA program. Make your engineering staff members and other department managers your eyes and ears for monitoring compliance.

Contractors' impact on the hospital's ability to control infections needs to be emphasized. Responsible contractors will not only honor all of your ICRA requirements, but should go one step further.

Ideally, they would have their own ICRA standards in place to protect all health-care facility clients. Their professional expertise will allow for maximum infection risk