ICRA: New four-letter word exists for health-care design

Gone are the days of a hospital throwing in a door here, demolishing a wall there, adding an office across the hall now there is ICRA infection control risk assessment with temporary walls, wet mats outside construction areas, negative pressure and name badges.

Infection control during construction has become an issue because of several cases studied by the Center for Disease Control, which have been linked back to aspergillus and/or other molds resulting from construction practices. There are several issues, such as water, dust control and air pressure, which must be ad-dressed for each construction project.

One of the air control issues for patients is aspergillus, which is a mold that can easily get into the air and harm an auto-immune patient such as someone with AIDS, cancer, bone marrow transplants, intensive care and respiratory patients.

If aspergillus exists but is not stirred up, it is harmless, but it becomes a problem when it is disturbed and it becomes airborne.

The Joint Commission on Accredita-tion of Health Care Organizations, which accredits hospitals, is making infection control part of its accreditation process by setting up standards in which medical facilities must comply an infection control risk assessment. Most hospitals have started doing this on their own because of the liability issues. The problem is that the joint commission tells these facilities they must have an infection control risk assessment plan for each job, but it is not specific on what to do to keep the areas "clean".

Some of the things in effect at St. John's Regional Health Center are temporary, cleanable walls around the construction areas to keep dust from traveling down hallways, etc. Negative pressure must be maintained in the construction areas at all times, which means there is an exhaust fan in the construction area moving the dust to the outside. Sometimes it is not possible to ex-haust outside, and in those cases, HEPA filters are used to clean the air and the filters are changed periodically.

Even though these items are great ideas, there has to be someone to enforce them. The joint commission suggests in-corporating an ICRA team comprising the appropriate people, perhaps the architect, general contractor, HVAC de-partment and most importantly, support from administration.

The guidelines must be set by the medical facility, and the architect can help enforce them by noting what must be done prior to and during construction, and by attending construction meetings to ensure infection control issues are addressed. At St. John's, they have infection control nurses who on a daily basis check construction sites for negative pressure levels and cleanliness, and they discuss construction procedures with contractors prior to working outside the construction area and educate themselves on the most current issues.

Another aspect of patient security is the wearing of name badges for contractors at a hospital site. This is obviously linked to the Sept. 11, 2001, terrorist attack. Contractors have access to sensitive items, such as medical gas connections, power supplies and hospital areas which are not normally visited by the public.

The hospitals want to be sure they know who is coming and going and into which areas. Eventually some hospitals will be going to an electronic security system which will automatically keep track of who is at what location. These security systems can have different levels of security for accessing areas in which the badges can be used as a filter to keep people from accessing areas which they are not authorized.

It is interesting how none of these issues were discussed five years ago but are so important today. The more information we receive about the world around us and how it works, the better we can help protect the people for whom we are responsible. Be assured your local hospitals are doing all they can to ensure the safety of their patients from all aspects.

(Stephanie D. Ireland, AIA, is principal of Ireland and Associates Archi-tecture.)