5 Healthcare Construction Best Practices for Occupied Healthcare Facilities

Renovating currently occupied hospitals and healthcare facilities can be challenging as construction activities may distrupt the optimal functioning of an organization. However, following the following five best practices can help hospitals and their contractors to minimize disruptions for patients, physicians and staff. Hospitals should be wary of contractors that do not follow these five practices.

1. Conduct a preliminary investigation/inspection of the site before construction or demolition begins. Prior to work beginning in any space, a preliminary investigation/inspection should be done by the construction team. The purpose of this investigation is to confirm the location of utilities and valves as drawn and to gain knowledge about the space and possible problems or issues. At this time, the contractor should work with the medical facility to acquire accurate asbestos, lead paint or other hazardous material reports related to the area. This process will allow early generation of any necessary Requests For Information (RFIs) or changes and will assist in maintaining schedule.

2. Develop an interim life safety plan that meets the needs of the facility. Prior to construction, an interim life safety plan should be drafted and submitted for approval to the facility. During any construction, the approved ILSP should be posted in a conspicuous place. It provides information regarding:

  • Emergency egress
  • Designated area for safe assembly
  • Existing/future wall ratings
  • Temporary partition locations/ratings
  • The project area, its entrances, the surrounding area, and pathways to temporary essential services.

3.  Understand the infection control/ risk assessment requirements and ensure they are met. Prior to construction, the contractor should request an infection control meeting with the facility as well as a thorough review of the risk assessment procedures. This meeting covers the following:

  • Project scope of work
  • Air monitoring requirements
  • Duration of the project
  • Pressure monitoring requirements
  • Location of the construction project
  • Containment and transport of construction waste
  • Identification of any associated work outside the construction area
  • Standard cleanup procedures (wet mop, HEPA-vacuum, disinfectant)
  • Project phasing
  • Employment of tear away adhesive dust control mats at entrances/exits
  • Locations and types of proposed barriers and barricades
  • Isolation and protection of existing HVAC systems
  • Ante room layout (if required)
  • Maintaining negative pressure ( no less than –0.01 in. wc/–2.5 Pa) through usage of HEPA-rated filtration devices and to be monitored continuously by the contractor via alarmed differential-pressure monitoring equipment
  • Proposed air filtration plan and procedure
  • Requirement of disposable coveralls
  • Personal protection equipment
  • Barrier deconstruction
  • Movement through or around sterile corridors
  • Final cleaning procedures.
  • Daily Documentation

The contractor should comply with the facility's risk management procedures, taking into consideration, items such as noise/monitoring, vibration/monitoring, scheduling, proximity of construction to patient areas, temporary partitions/walls, etc. A site logistics plan is then produced and approved by the facility

4. Ensure that utility shutdowns and switchovers are properly planned and clearly communicated. Most renovation work requires a planned, temporary interruption in utility services (typically called a "shutdown"). When these are required, the contractor and/or its subcontractors will schedule the shutdown in accordance with the facility's  procedures. The service that is being interrupted must be identified and the affected areas or people must be notified so that interim measures can be taken. Any utilities that are shut down must be locked/tagged out. The written plan must be clearly communicated to the hospital's facilities and engineering group as well as the department or staff being affected so that it is clearly understood what services are being disrupted, what equipment and/or services will be "down," and the anticipated time frame of the disruption.

5. Provide proper project closeout documentation.
Upon completion of the project, the contractor should provide the facility with the proper project closeout documentation, including Record Drawings ("As-Builts"), owner in-service training and equipment submittals — as well as any required commissioning. The contractor's role is to ensure that the project is constructed in accordance with the design that has been reviewed by any inspecting agency, such as the Division of Health Service Regulation. Prior to site inspection by DHSR, the contractor and the project team should assemble the proper documentation (electronic and hard copies). Before the site inspection is scheduled, the contractor should have the following documents in hand:

  • Certificate of Occupancy (or Temporary Certificate of Occupancy) issued by the local authority having jurisdiction
  • Contractor's material and test certificate for aboveground piping (Fire Protection)

In addition to these required documents, FLB the Contractor will assemble the following (as needed);

  • Compliance letter (issued to the facility's project manager)
  • Flame spread and smoke development test information for flooring, wallcoverings, curtains, etc.
  • Fire and smoke dampers with product information and installation instructions
  • Electrical ground resistance test reports (indicating resistance Ohms to three decimal points)
  • Medical gas certification and test reports (by a third party testing firm)
  • Domestic water certification (a certificate of analysis for coliform presence testing)
  • Fire stopping product information
  • Mechanical test and balance reports

The proper documentation helps to ensure that the medical facility's project functions as required and that the end users receive the healthcare that they need.

Although there are hundreds of best practices that need to be put in place prior to constructing within an occupied medical facility, these are five that have been are part of every successful healthcare project.

Frank L. Blum Construction Company (www.flblum.com), founded in 1923, holds the lowest actively used general contractor’s license in North Carolina. The company’s expertise includes construction and renovations for senior living communities, healthcare organizations, and higher education and private education entities, as well as religious organizations, manufacturing facilities, and not-for-profit agencies. Recent projects have spanned the greater Piedmont area from Chapel Hill and Southern Pines to Wilkesboro and Meadows of Dan, Virginia.

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