Quiet down, there are sick people in here!
By Bill Goodman
Renovating occupied healthcare facilities can be challenging as construction activities may disrupt the optimal functioning of the facility. In days past, there were no special requirements for healthcare clients. Skilled, prepared people and an extra level of supervision helped to minimize the amount of disruption for patients, healthcare providers and staff. From the beginning, immense pride was taken in the working conditions maintained at facilities, and that attitude carried over to the clients. From a long history of past experience, here are the following six best practices that can be utilized to minimize disruption to patients, physicians and staff.
- Site Investigation. Prior to work beginning for the project, a preliminary investigation should be completed 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 knowledge and/or issues specifically related to the facility. This investigation should help in getting the schedule off to a good start.
- Interim Life Safety. Before construction, an interim life safety plan (ILSP) should be drafted and submitted for approval by the facility. During any construction, the approved ILSP should be posted in a conspicuous place. It provides information regarding:
- Emergency egress
- Muster area for safe assembly
- Existing and future wall ratings
- Temporary partitions and their location/ratings
- Infection Control and Risk Assessment. 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. The meeting should cover the following:
- Project Scope of work
- Air monitoring requirements
- Duration of the project
- Pressure monitoring requirements
- Location of the construction project
- Project phasing
- Requirement of disposal coveralls
- Proposed filtration plan and procedures
- Barrier construction/deconstruction
- Final cleaning
- Daily documentation
- Utility Interruptions. Most renovation work requires a planned, temporary interruption in utility services. 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 plan needs to be clearly communicated to the facility’s engineering staff so that it is clearly understood what services are being disrupted.
- Accidents Prevention Planning. Prior to construction, the contractor should prepare and submit for approval an accident prevention plan from the owner. This plan should be written to address the specific work and hazards of the contract and detail the requirements for safety and occupational health. The safety plan should include at a minimum:
- Background information on the project
- Contractor’s emergency contact number
- Description of work to be performed and location of work to be performed
- A listing of phases of work and hazardous activities
- Means for controlling the work activities of subcontractors and suppliers
- Plans for safety orientation of new employees and subcontractors
- Means for recording inspection results
- Plans for maintaining job cleanup and safe access
- Prevention of drug/alcohol abuse on the job
- Close out Documentation. Upon completion of the project, the contractor should provide the facility with the proper closeout documentation including record drawings (as-built), owner in-service training, and equipment operation and maintenance manuals – as well as any required commissioning. The contractor’s role is to ensure that the project is constructed in accordance with the design. Referring to the contract for specific requirements, the contractor should assemble the following:
- Compliance letter
- Flame spread and smoke development test information
- Fire and smoke dampers with product information and installation instructions
- Electrical ground resistance test reports
- Medical gas certification and test reports
- Domestic water certification
- 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 patients receive the healthcare that they deserve.
Although there are hundreds of great practices that need to be put in place prior to construction within an occupied medical facility, these six have been an integral part of every successful healthcare project we have completed.
William Goodman, Senior Project Manager for Triune, is a highly accomplished, multi-talented project manager with over 30 years of construction experience. He encompasses excellent skills in preparing schedules and managing job costs, budgeting, contract negotiation, design-build and pre-construction services.
The Punch List is Triune’s proprietary blog for discussing issues and providing insight specific to the commercial construction industry. Copyright 2013 TMV, LLC (Triune). Any and all rights reserved.