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Patient Centered Construction

by Doug Bailey, CHC, PMP

Patients come first. With hospital expansions and renovations on the rise, many healthcare facilities are challenged with protecting their occupants. Working in construction for the healthcare industry, you quickly realize that the focus is always on the patients. They are the reason why we set up and monitor infection control protective barriers, why we cover our carts before hauling construction debris through the hospital, why we check and verify that the plug-in on the other end is not a life support system before shutting off the breakers, why we confirm the fire and smoke barriers are properly sealed, and why we ensure proper negative/positive pressure and air exchanges in the hospital rooms.

Throughout the construction process it is critical to work closely with hospital staff, figuring out how to work through issues, and complete the project all without having a detrimental impact on the patient. Together, the top priority is keeping the patients safe during construction. One way to minimize the effects construction will have on patients is to implement mitigation strategies that will help to minimize dust, noise, vibrations, and shutdowns. One of the major concerns is the risk of infection caused by dust and other contaminates that may flow from the construction site into the patient areas. To avoid this, the Infection Control Risk Assessment (ICRA) matrix, developed by the American Society for Health Care Engineering (ASHE), can be used to identify the level of precautions required on the type of construction and the risk-level of nearby patients. With the proper barriers in place, it helps to keep the job site clean, carts covered, and barriers checked to keep any contaminates from patients. Arguably, there are not many ways to limit construction noise and vibration. However, our task is to figure out how to reduce the noise so that patients are not at risk or in discomfort from lack of sleep. This may be accomplished by rotating work shifts around patients, using less powerful/noisy tools, and using separate entrances/corridors away from patients to enter the work site. The shutdown of utilities is another critical item that requires close collaboration with hospital staff. It is important to give them time to prepare and institute effective life safety measures for patients effected by the shutdown. Unexpected shutdowns, such as cut cables, power lines, or gas lines are serious problems. This may not be critical in a standard commercial project. In a hospital, it is a matter of life or death.

As we continue working through the COVID pandemic, there has been more of a shift on the construction project to increase the HVAC air exchanges, increase the 99.95% HEPA Filters, and/or add Needle Point Bipolar Ionization (NPBI)) that reduces airborne particles and cleans the air. The goal is to increase the patient’s comfort level to come in and see their doctor and/or schedule surgeries. We are all adjusting to the challenges of the ever evolving rules that may be causing delays and, at times, substantial shutdowns that further postpone the delivery of much needed built medical space for hospitals and patients.

Below are examples of first-hand experiences.

We were constructing a small, four-story addition on top of an existing hospital. As the equipment was being moved, and the steel structure was being erected, an eye surgeon was performing surgery on a patient four floors down. The vibrations from the work were felt throughout the hospital building forcing the shutdown of the project. As you can imagine, any slight movement will affect the outcome of the surgery. Who would of thought there would be issues with a four-story separation? As a solution, we collaborated with facilities staff and performed work on the project around surgery schedules in order to eliminate any risks.

On another project we were working below an active Intensive Care Unit (ICU). Along the ceiling below the ICU, the team was installing duct work supports, conduit runs, sprinkler supports, and drop ceiling supports up into the concrete floor above. Needless to say, we were shut down several times due to the noise and vibrations resulting from drilling up into the concrete deck and then running the anchor up in with an impact drill. We had to sit down with the hospital staff and figure out how the project could be completed while creating less disruption to the patients and their families. Our solution was to break up the project into quadrants in which we would install everything we could into these areas, one at a time while moving patients into less active areas of the ICU.

With the standards and requirements becoming more and more complex, patient centered construction requires a deeper level of expertise on how to eliminate construction related infections and ensure patient comfort. Health and safety should be at the forefront of healthcare construction projects. Although smart planning and extensive communication play a key role, patient care takes precedence.

Doug has been a champion of the patient for more than two decades. Leveraging long-term professional relationships with clients in the healthcare industry, Doug brings significant expertise in construction, scheduling, field engineering, commissioning, and management leadership. He brings a deep portfolio of experience working on construction projects in healthcare environments where he’s managed projects ranging in size from small facility upgrades to multi-million dollar stand-alone building construction. A project management professional (PMP), Doug is well versed in the rigorous process that complex projects require at all phases of construction.