Pre- Construction Risk Assessment is no surprise that construction, renovation, repair and maintenance activities at healthcare facilities can potentially affect its patients, patients’ family, staff and the visitors.

As we all are aware that Healthcare associated infections (HAIs) can be contracted from stays in virtually any type of healthcare facility – hospitals, emergency care centres, surgical centres, and nursing homes. One of the recent studies states that more than 200 patients die each day from HAIs during their hospital stay. This is all about twice the number of Americans who die each day in motor vehicle accidents. But, what most us are not aware is that the demolition, construction and renovation activities rank as a significant causal factors for acquiring Healthcare associated infections.

The permanent solution for this problem statement is to have a functional Pre-construction risk assessment, what we call as PCRA
The objectives of PCRA is that
1. The hospital can manage all of its demolition, construction and renovation activities in an environment of minimal risk
2. The risk assessment is just not limited to infection control practices but also comprehensively covers all the significant factors such as life safety, air quality requirements, utility requirements, noise, vibrations, and the other hazards that affect care, treatment, and services.
3. The hospital takes the action based on its assessment to minimize risks during demolition, construction, or renovation
The joint commission international accreditation mandates all the healthcare organizations to have a pre-construction risk assessment process in place, ready to be applied at any time for all of its planned or unplanned demolition, construction or renovation occurs. Additionally, organizations must have a process that allow for minor work tasks to be performed using predetermined levels of protective practices. The Joint Commission does not dictate the particular risk assessment and implementation process. Recommendations can be found in the FGI Guidelines for Design and Construction of Hospitals and Outpatient Facilities, 2014 and the website of Centres for Disease Control and Prevention (CDC), Atlanta. .

Many healthcare organizations use an assessment matrix that applies the construction intensity to the risk level of the work area, which results in particular protective practices that are to be implemented. Construction intensity type has been categorized into four types.
Type A – Activities which do not generate any dust
Type B – Activities generates Minimal dust
Type C – Activities generates moderate to high level of dust
Type D – Activities involves major demolition and construction projects

The location of the work would also dictates the level of protection and this also has been categorized into four types. Low Risk, medium risk, high risk and highest risk.  The degree of protective practices varies from work area to work area. For example a lower risk administrative or support services area versus a high risk sterile or critical care area.

What is important here is not the definition used for demolition, construction or renovation but the context of the work and what must be determined is that whether the activity will pose a significant environmental risk for patients, staff and visitors.

HCO’s can ensure that there are policies in place to manage low risk and high risk demolition, construction or renovation activities. Staff and contractors performing the work need to have working knowledge of the established criteria, to include why protective measures are necessary. Because end of the day they are ones who makes polices into practice.

Most of the times, hospital makes this PCRA as a multidisciplinary approach to ensure that the risk assessment is more comprehensive. Members are included from the departments such as Engineering, Housekeeping, safety and environment, quality, security, biomedical engineering, hazmat technician and the HOD of the concerned area.  The team uses a checklist to complete PCRA. The action items are identified and made as deliverables for respective department.

Infection control team, engineering, housekeeping, security department deploys their own check mechanism to sure that PCRA deliverables are implemented during the construction or renovation activity.

Upon completion of construction or renovation activity, the Infection control team release the work area for its functional use after evaluating the PCRA and its outcomes.

If there is any significant deviation, appropriate consequence management is initiated after analysing the root cause. Which subsequently gets into PCRA checklist. Thus making it a continual improvement tool.

At Apollo Hospitals, Chennai, Patient safety is our top priority”.

 Balaji V

Deputy General Manager
Quality System Office & Southern Region
 Apollo Hospitals, Chennai,
E-mail : Balaji_v@apollohospitals.com

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