Understanding the risks to patients during construction
Whether it’s to create brand new wards, improve existing facilities or carry out essential maintenance works, construction is often necessary within hospital environments. Hygiene is obviously an ongoing responsibility in the healthcare sector, and the burden increases when necessary refurbishment works are carried out.
There are, of course, risks associated with construction in hospitals; most notably airborne particulate disease transmission. Depending on the nature of the project, construction works can pose moderate to significant risks to the immediate environment.
Construction and renovation projects can cause serious dust contamination and disperse large amounts of fungal spores, and construction activity has been reported to be an independent risk factor for invasive fungal infections.
Aspergillus is one of the most severe risks associated with hospital construction; specifically within demolition works or ceiling renovations where water damage has been an issue.
The mold spores can survive for long periods within the environment, specifically within walls and ceilings, and once disturbed, can drift long distances through the air.
Invasive aspergillosis, caused by aspergillus spores, can cause severe illness and even death in highly immunocompromised patients. In more common, less serious cases, aspergillus spores can still cause sickness and allergic reactions. These can include conditions such as aspergillus bronchitis, aspergillus sinusitis, chronic pulmonary aspergillosis, allergic bronchopulmonary aspergillosis (ABPA) and “fungal asthma” (SAFS).
According to research conducted by Health Protection Scotland, 11 Aspergillus outbreaks from 2006-2016 were analysed and the findings concluded that:
- The majority of recent outbreaks were associated with construction/renovation activities within healthcare settings
- A reported high mortality was typically attributed to the immunocompromised status of affected patients
- The majority of outbreaks occurred in immunocompromised patients including those in intensive care
- The majority of infections were associated with likely air-borne transmission of the fungus
- Direct infection via inhalation or contamination of medical surfaces/devices was reported in all cases
There’s also a risk of patients inhaling general construction dust which can cause respiratory problems. Depending on the construction materials being used, there are risks of patients inhaling silica (from concrete, mortar and sandstone), wood (from softwood, hardwood and wood-based products like MDF and plywood) or lower toxicity dusts (from plasterboard, limestone, marble and dolomite).
Contaminated dust dislodged during hospital renovation and construction is one of the main causes of infection amongst patients, because patients do not need to come into direct contact with the source, as spores can be transmitted through the air.
Patients with weakened immune systems are those who are most at risk of infection caused by construction, for example, bone marrow transplant patients, those with low white blood cells after cancer treatment, AIDS or major burns. Post-operative patients, children and the elderly are also patient groups who are most at risk.
A simple and usable review to plan when construction will need hoarding for infection prevention
It is essential to perform infection prevention risk assessments and implement recommended prevention measures to prevent healthcare-associated fungal outbreaks during construction and renovation.
Using the right containment barriers is vital for dust prevention. If the infection prevention plan does not specify the type of material to be used for the dust containment barrier, your decision should be based on two considerations: first, the amount of dust that will be generated, and second, the length of time the barrier needs to be in place.
There should also be an assessment of the process required and then the expected time frame for the works, as these can impact disturbance or dust expectations. For example, minor painting work may require initial sanding, which raises the dust level from minimum to moderate. For this reason, each stage of phased construction needs to be assessed to ensure the correct level of dust prevention is being carried out.
Along with construction impact, establishing high and low risk areas across the site will help to determine when and where patients, employees and visitors will be most at risk. For examples see the table below.
By assembling this information together, a clear view of the levels of risk can be created.
Even areas with low risk and little impact from the type of construction planned will require adequate consideration to ensure patient safety. As the level of risk increases, preventative measures, such as temporary hoarding, must be taken.
The dust containment solution
Effective hoarding systems should be used and offer the following features to ensure maximum dust and infection prevention:
- Simple and quick to install to reduce patient disruption
- Clean installation, panels pre prepared and don’t themselves create dust during installation
- Dust tight seal between panels due to unique tongue and groove connection
- Wipeable surface to allow for cleaning throughout the project
- Range of fire ratings to meet patient, visitor and employee safety
- Onsite or removed when you need it, collections and deliveries next business day
Westgate’s Hoardfast range has been used in many hospital refurbishments as it meets the above requirements. Many panels within the range have a 2.7m standard panel height option, specifically created to fit the average hospital ceiling height. This ensures any dust is contained throughout the duration of any construction works. Get in touch if Westgate can assist with internal hoarding in your heathcare facility.