Infection Control During Healthcare Renovations: ICRA 2.0 Revisited

In a recent webinar, experts discussed the importance of infection control during healthcare renovations, focusing on the updated ICRA 2.0 guidelines. Janet Haas, a seasoned professional in infection prevention and construction, highlighted the new checklist for assessing surrounding areas and the five classes of construction activities based on risk levels. The discussion emphasized the need for proper monitoring of negative pressurization and HEPA filtration to ensure safety during construction. Additionally, the webinar addressed the responsibilities of contractors and the involvement of Infection Preventionists in the process. Attendees were encouraged to stay informed through resources like the STARC Systems blog.

Full Webinar Transcript

For those who prefer text, we've included the complete webinar transcript below. Use it to quickly find topics covered in the presentation and reference important details shared by our speakers.

Welcome, everyone.

Thank you for joining us for today's webinar, Infection Control During Healthcare Renovations, ICRA 2.0 Revisited.

My name is John Farrell. I'm senior content manager for STARC Systems, and I'll be serving as your moderator for this event.

A couple of housekeeping items before we begin. Today's presentation is being recorded and will be sent to you in a follow-up email.

If you have any questions during this presentation, please type them into the question box in your control panel.

We will save time for questions at the end of the presentation.

Our speakers today are Doctor. Janet Haas, CEO and principal consulting epidemiologist with Innovative Infection Prevention, Leon Young, Network Infection Prevention Manager, Facilities and Construction, Allegheny Health Network, and Bruce Beckford, vice president of product development at STARC Systems.

Let me turn things over to our first speaker to get started. Welcome, Janet.

Hi. Thanks, everybody, for taking the time to be here today. My name is Janet Haas. And as you can see, I am CEO and principal consulting epidemiologist at Innovative Infection Prevention.

I have a long history in infection prevention and control and also in construction, having started my career as a mason tender and, and I'm a journeyman millwright in my past. So I'm passionate about both infection prevention and keeping things safe for everybody during construction.

Next slide.

So, today, we're talking about ICRA 2.0, which is the next version of the ICRA, that came out several years ago.

Ashley convened a work group of experts from many, fields participating in construction and, reviewed the processes of the ICRA after several years of using the original one. We get a lot of questions about whether this is a requirement by law versus a tool that you can use. And, I'll just say with the caveat that everybody's state and local regulations may be different different.

So you have to definitely check-in the area where you are working and practicing. But if it's not specifically required in your locality, it's really developed and devised to be a tool that you can use and that you can modify for your specific needs.

Next, please.

So let's take a little time to see where everybody is. How familiar are you with the ICRA process and the ICRA construction matrix? So a is very familiar, b somewhat familiar, and c is you're new to this and unfamiliar.

Okay. It looks like we have people who are, forty one percent are very familiar, and half of you are somewhat familiar with about ten percent being completely new to this.

So thanks. That that helps us to know what's going on with our audience.

So I'll just move on to what's new in ICRA 2.0 from the older version of the ICRA.

And I will say that there's a checklist for the assessment of surrounding areas, including noise vibration, pressurization, and system disruption.

Where before it used to just say check for, what what's happening and what's the impact on surrounding areas. Now there's a specific checklist for this, and it specifically goes through things that you can do to mitigate the impact of construction on these areas. So it's much more specific.

Next, please.

And there's also a specific, guidance for work completion.

And I will just say that this really focuses on dust and cleaning in HVAC systems and does not really check into the water mitigation strategies that you may have to use in your area if you are concerned about waterborne pathogens, including Legionella.

But you can see here that it gives you required activities upon completion of work activity of the work that's going on.

Next, please.

So here is the matrix, and you're probably familiar with this. It is a little bit different than the original version because there's an extra class. Now instead of class one through four of construction activities, you have a class one through five.

And, again, it goes through, the types of activities, type a, b, c, and d across the top, and then the risk groups coming down the left hand side. And the the marriage of what area you're in, what kind of risk group, and what kind of activity is going on gives you your construction activity designation.

Next, please.

So the type of work being done, type a still is inspection and noninvasive activities, and it's all the things that we knew about from before, but with more specific information on limited building system maintenance and cleaning, clean plumbing activities that are limited in nature where before it was really just about the ceiling tower.

Type b is your short small scale, short duration, minimal dust and debris, and these things are the ones that are one shift or less.

And I'm just I just highlighted what is new in this prolonged inspection or repair of firewall barriers, installation of conduit or cabling, fan shutdown and startup, new electrical devices or new flooring that produces minimal dust and debris, and some controlled sanding activities. Those these are new in the category.

Type c, many of the things that you know of, call your attention to the removal of drywall where a moderate amount of dust and debris is created. And this comes into play if you're creating, drywall barriers. You have to have some barriers to remove the barriers in that kind of case.

Work creating significant vibration and or noise is in this one. And remember that that vibration can also liberate dust in surrounding areas. So, that becomes really important. And, again, any activity that can't be completed in a single work shift is type c construction work.

So when you're thinking about how you're gonna stage your project, this becomes very important. If you are thinking about renovating a whole unit and you you, create the the ICRA as that, then it's at least type c or d. If you are planning to stage it and keep your unit open and do one room at a time, if you can complete one room in a day, then you might be in a a type b construction work. So it really depends on both the work that's being done and how you're planning it out.

And type D remains the major demolition and construction activities, including removal and installation of drywall partitions and renovation work in two or more rooms. So, again, it's, major construction is can be as little as two rooms that you're doing. Next, please.

So the risk categories have some changes. And, really, I don't think it's anything completely new. It's just more detail.

So the low risk areas are really non patient care areas. And you can see here it's public areas and areas that are off of clinical units. So office areas in clinical units are still considered part of the unit. This, low risk area is really all these areas that are not located in, clinical units.

Next, please.

The medium risk is waiting areas, clinical engineering, materials management. We have some separation of the sterile processing department. The dirty side is a medium risk. And then your ancillary areas like kitchen, cafeteria, gift shop, etcetera, are all in this medium area. So you'll notice that by the time you're getting into any patient care areas, you're already in the high risk. So next, please.

So the high risk areas are patient care rooms and areas that are not ICUs and that are not taking care of the most vulnerable of our patient populations. So acute care units, the emergency department, your employee health is included in here, which I thought was pretty interesting.

Pharmacy's general work zone, but not the compounding area, medication rooms, and diagnostic imaging areas, and the lab are all high risk areas. Next, please.

Then we get to the highest risk, and these are where invasive activities are happening or the most vulnerable patients are staying. So all transplant and intensive care units, all oncology units, the operating rooms, and the restricted areas around them, procedural, suites, pharmacy compounding, sterile processing on the clean side, transfusion services, and any dedicated isolation wards or suites, and anywhere that you're doing invasive imaging. So those are all the highest risk areas. Next, please.

So now we're gonna get into using the matrix, and I'll take care of the beginning and then pass off to my colleague Leon for for the, rest of the sections. Next.

So class one work is low to medium risk or high risk, even in the acute care units, but not the ICUs or places where you have your oncology and transplant patients. And it's that type a inspection and minimal maintenance work that can be going on. So this is noninvasive work activities, and we're gonna perform those without blocking or interrupting patient care in areas that aren't directly occupied with patients in a manner that does not create, dust or liberate dust, and then immediately replace any displaced ceiling tiles before leaving the area or at the end of the noninvasive work activities. So you can't leave those ceiling tiles open for sure.

And this is the most basic of work that you're gonna be doing, the inspection and limited maintenance.

Next.

And class two work is really the new, class. And you can see this is in the low and medium risk areas.

And it can be the, type B or C work that's going on, but it's really designated as the maintenance class.

So this is never to be used for construction or renovation activities to be used for your basic maintenance activities.

And note that we have highlighted here that you can use these following standing precautions procedures approved by your organization.

So in other words, you can choose to to, designate a bunch of your maintenance activities and come up with a standard set of ways that your, workforce should be performing them, and then just let them do them without having a walk through every time. So this can save time and and energy for everybody in the organization if these are routine maintenance procedures that folks are doing. I suggest that if you choose to go this route, you make sure there's some communication of the work that's being done to your environmental health and safety or and or infection prevention and control teams so that, they can just take a walk by and make sure that things are going as planned.

The danger here is that sometimes when issues are found on maintenance activities, you can get into more involved work to fix those things, and and you have to be sure that people upgrade the precautions if the type of work changes to designate more. More needs to be done.

So next, please.

Now I'm gonna pass this off to Leon Young. Thanks very much.

Thank you, Janet.

Welcome, everybody. Thank you so much to STARC, and Ashley for bringing us all together this afternoon. This is very exciting.

You can go ahead and start.

So let's move past the ICHR class one and two, your maintenance class. And let's move into the construction and renovation classes, which are your ICHR classes three, four, and five.

Next, please.

So our class three work, let's move into that, obviously, first. That's gonna incorporate all your construction activity types, your type a, b, c, and d, and you'll see in the in the top right there of the matrix. It also incorporates all of your patient risk groups, low to highest. Next, please.

So I'm gonna highlight here what is new, the new dialogue, the new language in ICRA 2.0, for ICRA class three, provide active means, to prevent your airborne dust dispersion and talk about areas. That was previously in the class two. That's now, been moved to class three.

Also, the means for controlling minimal dust dispersion, can include HEPA vacuum devices, excuse me, polyethylene plastic, or even isolation of work area by closing the room door.

Next to there, if work area is contained oh, I'm sorry. Previous slide. If work area is contained, then it must be neutrally to negatively pressurized at all times.

So old class three called for negative pressure only. This new class three, as you see here, essentially calls for any pressure other than positive. So I I find that very interesting.

Seal all doors with tape. They will not leave residue has also been put into there.

Install a sticky dust collection mat at entrance of contained work area, based on your facility policy. That is, you know, something that everybody already does. Contractors already do that. Facilities departments already do that. But, interestingly, it was never, actually written in ICRA one point o, so it is now actually written in ICRA 2.0.

And then also the last one, maintain clean surroundings, when area is not contained by damp mopping or HEPA vacuuming surfaces. Next, please.

Next, we move into ICRA class four. ICRA class four, I kind of break down into three categories categories, critical barriers, negative air, and HEPA air. So critical barriers, new in ICRA 2.0, construct meeting your NFPA two forty one requirements, extend to ceiling grid or deck above and obviously affix those to the ground and ceiling, seal your penetrations in your containment barriers using your approved materials, you have scheduled fire stop. Also, environmental containment units. ECUs are approved for class four precautions. These are your pop up containments, your HEPA carts, things like things like that.

Also, ICRA 2.0 says it says that these ECUs must have HEPA filtered exhaust air, and also anteroom is required. Now I say, anteroom required because the word anteroom is used in the class four numbered list of precautions.

Jumping to class five quickly, it states, quote, construct anteroom large enough for equipment staging, cart cleaning, and workers, end quote. The class four list of precautions does not include that same sentence. Instead, class four says, quote, negative airflow pattern must be maintained from the entry point to the anteroom and into the construction area, quote. Reading that, leads me to believe that an anteroom, would be needed for a class four.

Next slide, please.

So the next section I have for the air class four is the negative air requirements.

Negative air only required for class four. So it's bumped up from the neutrally to negative. It's now negative only for ERCA class four.

Airflow must cascade from outside to inside the construction area, and you're gonna see that word cascade again.

By use of HEPA exhaust air systems directed outdoors.

So if exhausted directed to the outdoors and also twenty five greater than twenty five feet from any entrances or air intakes, HEPA filter air is not required. So, a contractor is permitted to remove the HEPA filter, take the HEPA filter out of the negative air machine if they're dumping it outside, and it's, greater than twenty five feet from entrances or air intakes.

Next, please.

Last section for for ICRA class four are the HEPA air requirements that they've put in the ICRA 2.0.

Must be HEPA filtered if exhausted indoors.

Prior to start of work, HEPA filtration must be verified by particulate measurement. No less than ninety nine point nine seven percent efficiency, must not alter or change airflow pressure relationships in other areas.

Exhaust into shared or recirculating HVAC systems is not acceptable.

Next, there is install device on exterior of work containment to continually monitor negative pressurization. And to assure that the pressure is continuously maintained, it's recommended that the device have a visual pressure indicator.

Also, new language in ICRA 2.0 is particular data collection. They use the word consider during work to to ensure contaminants are not escaping construction site, and particular samples may be used to verify HEPA filtration efficiencies. So let me first focus on the first bullet, the HEPA filtration.

This is probably the the part that I'm most thrilled about, with ICRA 2.0 is the HEPA filtration verification.

This is something that I've been doing for years, you know, going around the part of the counter and making sure that these HEPA machines are actually producing and exhausting HEPA filtered air.

You'll see the pictures up there. The one on the left is a particle counter that is sitting on top of a negative air machine inside the construction site. So what that's doing is pulling in all the particulates and is taking account of the number of particles.

The picture on the right is the HEPA exhaust on the outside of the construction space taking a second particle count of the HEPA filtration HEPA HEPA filter there downstream of your HEPA filter. You compare those two numbers. And with those two numbers, you can get a percent reduction to verify your HEPA filtration.

If you wanna click, that that, calculation, I believe, comes up on the screen.

So we calculate the percent reduction.

By use of that particle counter, you take the particle count at the intake, subtract the particle count at the exhaust, which should always be much less than what you have from from inside.

Divide that by the particle tap count at the intake times a hundred. That gives you gives you your percent reduction.

It's actually large number minus the small number divided by the large number times a hundred. That would give you your percent reduction, and that's how you verify your HEPA filtration.

One thing I do wanna point out, though, is the no less than ninety nine point nine seven percent efficiency.

If you're doing particle accounting to complete this task, do not panic if you don't get ninety nine point nine seven. I rarely get that high efficiency.

HEPA filtration or the HEPA filters, they are certified and verified to remove particles down to point three microns at an efficiency of ninety nine point nine seven percent. When they certify these HEPA filters, it's done in a controlled environment. It's done in a laboratory environment. They're actually testing the same airflow.

They have more they have a, you know, two particle counters, you know, whatever whatever their setup they have, to make sure that they get this ninety nine point nine seven. You're not gonna always get ninety nine point nine seven, because you're not using a controlled environment. You're not all you're also not testing the same airflow. You would have to have two particle counters, one inside, one outside, testing the exact same airflow.

So you're not always gonna get as high as ninety nine. In my experience, I see anywhere from ninety five up to ninety nine, ninety four sometimes. When you start to get a little below ninety five, you might wanna start investigating. There could be could be an issue with the HEPA machine or the HEPA filter. There also could be an issue inside the construction site with the exhaust tube that's connecting that HEPA machine to the to your ICRA wall. There could be a hole, could be coming unattached, and therefore bringing in dusty air downstream of the HEPA filter.

And the other thing other thing I wanted to touch on for this slide, is the install device on exterior of work containment to continually monitor your negative pressurization.

So one of the questions from our September q and a session asked, what are the options for monitoring negative pressures? Great question.

So ASHI recently made some edits to ICRA 2.0, and I want to make sure everyone is aware of those revisions.

Probably the most notable edit was the removal of the line that stated, quote, magmahelic, manometer, or digital monitoring required, end quote.

That has been replaced with what you see on the slide.

The words visual and continuously are what, technically, what we need to focus on here. Most mechanical pressure devices will be satisfactory as long as they meet the parameters of visual and continuous.

A smoke test or a tissue test, on the other hand, they are not continuous, rather just a single point in time check. So just something to remember. What is chosen to monitor the pressure for health care construction, can and and truly should be decided by your project at our team.

Next slide slide, please.

The ICRA class five, our our our our last class, obviously. It's gonna include everything from your classes one through four.

Also, anteroom, the language in April 2.0 is large enough for equipment staging, cart cleaning, workers. Also must be constructed adjacent to entrance of construction work area.

Personnel required to always wear coveralls during class five work activities must be removed before leaving the anteroom. And here's the word cascade again. Negative air must be maintained and cascade from anteroom entry point and into the construction site. If you click a couple more times, I have a couple pictures on there. Thank you.

So in regards to the cascading, another question received during our most recent q and a was, does an anteroom require a separate HEPA negative air machine?

ICRA 2.0 does not require the use of a HEPA negative air machine inside the anteroom. Room. The question you need to answer when setting up ICRA containments is, are you establishing the cascading airflow pattern?

If the construction site HEPA machine or machines are creating enough negative air to establish that cascading airflow pattern from the entry room entry point and into the construction area, then your entry room will not need its own HEPA machine. Conversely, if the construction site HEPA machine or machines are not creating that cascading airflow, then the answering room will need a HEPA machine exhausting into the construction site, obviously, in order to establish that cascading airflow.

Next slide, please.

So in summary, where the changes meet for us with ICR one point o to ICR 2.0, essentially not that much different for the contractors. They're still gonna be doing the same thing. Just have a different, you know, a a a couple different things and a and a new ICR class, ICR class five.

My assessment of ICRA 2.0 is that ASHE wants IPs to get more involved, and I'm I'm thrilled about this. I really like what they've done here.

Some examples of that are particle counting, HEPA filtration verification, and the ICRA permit with more detail.

The the the matrix documents, the you'll see the ICRA permit, is gonna have more detail on it. It also requires more attention and thought from IP.

I will now turn it over to Bruce.

Hey. Thanks, Leon. Thank you, Janet.

Great update on the changes. And, so thought we'd review a little bit about how STARC can help you meet the ICA requirements in your facility.

Next.

So STARC Systems was founded around the need to create a better way of containing the dust, debris, noise, and general disruption of renovation in health care settings.

And in fact, is an acronym for simple telescopic airtight reusable containment.

So along the way, we've developed a full range of high quality products to meet your needs for containment and isolation focused in the health care environment, from the light and fast LiteBarrier product, to our flagship RealWall, and now our one hour rated FireblockWall. All have been engineered for maximum flexibility and adaptability to your situations.

They have great durability backed by our multi year warranties and superior negative air and fire performance.

Next. And from a from the beginning, we've been focused on health care becoming the gold standard for modular containment across the US and major medical systems and the contractors that support them. These are deep relationships with many of our partners holding warehouse inventories of panels, to support their operations.

As we've grown, our systems have found other applications in other verticals such as airports, manufacturing, education, office, and government.

Next.

But more importantly here, on the topic of ICRA, we've really optimized our products from the ground up to support health care in the ICHRA requirements.

Clean and cleanable, dustless going up and down, configurable for any situation, superior negative air performance, sound attenuation to reduce the construction noise and foul language. Sometimes you get, maintenance free engineering testing to determine and and demonstrate structural negative air and fire performance.

For the contractor, all of our products use just one tool for installation with lift and drop connections and new no loose hardware required.

All of them are easy and fast to install and reconfigure, and all are very durable with hundreds of uses reported by our customers.

What I'm most proud of is that our organization is laser focused on customer service. And in fact, that's really how we built the company. The entire team is dedicated to supporting our customers from day one, not only for account product issues, but especially value feedback so we can improve our systems.

Next.

Some of those improvements are things like a fifty four inch door. You know, you need to bring in dump carts, pallets and materials, patient beds. So we created the fifty four door, and with a removable threshold so the hospital beds move easily through it.

We've always are often asked for needs for tall ceilings or other special requirements that that require, additional bracing or other, needs to go over the tops of the walls.

And we also customize products, not only wall panels, but accessories as well, for our ceiling system, say, or for door security.

Next.

We spent a lot of time and effort in full scale development testing. All of our products, are tested to meet code, life safety, and facility requirements.

The testing always culminates in full scale tests with the final product, not just materials or components like our competitors.

We do impact and structural testing to simulate conditions in your facilities, and we test panels to require to the required fire standards and fully test them as finished products in order to be fully compliant with life safe life safety and code requirements.

All of our products utilize clean materials that are dustless, and we engineer the panels for maximum sound attenuation.

And our systems are tested for negative air performance and integration with HEPA discharge machines.

We we've written several white papers on the performance of our equipment.

Next.

It so it's important to recognize why we've developed our highly engineered wall systems. Our our founder, who had a daily presence in two major health facilities here, always struggled with drywall and secondary containment in his health care construction business.

And so the the whole problem of, visqueen or poly tarps, never really worked well. And how can you, you know, how so how can a system that's hard to put up and maintain be able to establish a seal, let alone negative pressure and prevent the spread of infections?

You can see the example on the left where our walls are in the foreground. And right behind it, another contractor had done what they always do, which is to put up poly walls. And the differences are pretty obvious in terms of the the quality, the look, and certainly the negative air performance, which you can see is pretty minimal in that poly example.

On the right here is another image of a competitor with, the walls are not very stable and, lots of tape to seal up all the leaks.

Next.

So if, you know, if on the job sites, if if the containment process is cumbersome or uncomfortable, the workers are less likely to comply with it. Zip walls seem simple and fast, but they're hard to put up actually, require daily maintenance. You know, the things like the zippers fail, the the tarp falls down from the supports.

And, again, they just don't provide very good seals for leakage or contamination.

Drywall on the right, you know, is very labor and material intensive. Lots of mobilization of dusty materials into the space, requires secondary containment to build it and then to demolish it. And construction and painting often often has to be done off hours. Lots of weekend work, lots of night work, and overall very wasteful at labor and materials.

Our systems, by contrast, were often done with one trade on shift, during the day.

So let's look at other some other specific ICRA 2.0 requirements, and how we handle that.

Again, we've been focused on providing negative air spaces for healthy, construction containment or isolation. Our LiteBarrier RealWall panels and modules provide the highest level and reliability of any temporary containment system, being specifically engineered to reduce or stop airflow across the wall and provide necessary accessories for HEPA machine integration and pressure monitoring with digital pressure monitors.

The flexibility of our system meet means creating anti rooms, corridor walls, negative pressure rooms, all equally straightforward and fully compliant with the new standards.

The non combustible panel FireblockWall can also be used as fire barriers in the areas. I'm sorry. Our non combustible panels, can be used as fire barriers when the area is fully sprinkler, such as our, RealWall panel, as Leon alluded to, with his comments about two forty one.

Next.

So here's, an example of some higher standards that we work towards.

This is a project that was early in COVID.

SUNY downstate, had an ED department, with curtain barriers. They wanted hard walls so they could develop negative pressure in each one of the bays.

The early stages of COVID, they were one of the only facilities in the state that were, allowed to treat COVID, believe it or not. To help contain the spread though, we we added in the walls. In this case, we put in glass panels on the front for visibility. So we had glass sliders with, our normal wall wall panels in between.

It was all installed very quickly within one day, allowing them to, get back up to operation very, very fast, obviously, now with the negative pressure capabilities.

Next.

So our latest system is FireblockWall. Again, a one hour rated fire barrier system.

So it's a fully compliant with NFPA two forty one, as called for in the class four and five sections of the 2.0 standard.

This wall has the same key features of our other products. It's clean, cleanable, installs and removes without generating dust or debris, is engineered for maximum adaptability and configuration while being airtight and fully compliant.

The system can be installed as a, fully compliant rated fire barrier when term terminated at a rated ceiling, or it can be used as a fire petition in other applications where it's approved.

The system consists of a modular supporting perimeter tracks. So wall, floor, corner tracks, door modules, and air panels, and regular panels, all come together as a modular system.

We have, approvals in California for seismic, and also, the state fire marshals in several states have approved it.

Another neat thing about our system's FireblockWall system is that, as a rated barrier, now you can continue to do things like build anti rums off of this fire barrier, using our LiteBarrier or RealWall products.

Next.

Here's another quick example. This is in a waiting room, in a in a facility.

Again, the code officials determined that, in this case, a, fire barrier true fire barrier was not required. They went up to the ceiling, non rated ceiling, but they wanted that one hour protection. And, also, this has the benefit of being sound attenuating with a very high STC of forty. So it's a great sound barrier, again, between the quiet spaces of that waiting room and the construction behind it.

Next.

So I think it's important to also talk about the elephant room. You know, one of the things that struck me about the 2.0 standard, was this, you know, very, visible statement about NFPA two forty one, barriers.

And it's important to recognize that, you know, this, 2.0 guidance, does not impose certainly new fire code requirements. That's the purview of code officials and the NFPA and and, people like the International Building Code.

But what we're doing here is reinforcing the requirements of the existing code. So under NFPA one zero one, two forty one, and others, that says that, again, if you've, had a change of use or penetrated adjacent wall assembly, meaning another rated wall, or you have other life safety concerns that are specific to, the facility and the renovation work going on, that's may require the, construction of a temporary barrier with a one hour rating. And that's what this product is all about.

So there still, however, will be a lot of situations where, in the image below, again, using our standard products or others, you know, two forty one doesn't apply. Either it's, you know, by code, by interpretation of the code officials, by your ILSM or ALSM, or what we call our alternative means of compliance, that the one hour barrier, may be avoided.

You know, a lot of cases, we see it, where, the, it's a short term project. It's only a day, a half a day, or it's a week maybe at most, or there could be a fire watch, put on, or there could be, some other means to mitigate the risk, without having to construct a one hour barrier. So, again, you're gonna find a lot of your situations, have not changed, and you don't need to install one hour barriers.

But, you know, when, you do need them, we're here to help you and be able to provide that capability, very quickly and easily.

So finally, last slide.

You know, just another quick example.

This is a sterile processing facility in a facility.

The contractor Mortensen, you know, wanted to have a a very, again, very clean isolation, for this area. He had about a dozen people working inside. And, so, in this case, RealWall was chosen and quickly installed with, HEPA machines, to create that negative pressure and the safety in that area.

And here, another benefit again of the sound attenuation, All the noise and disruption behind that wall was effectively isolated, to create a clean and quiet space outside. So, John, we'll turn it over back to you for questions.

Thank you, Bruce. Thank you, Janet, Leon.

To access the ICRA 2.0 form and permit from ASHI, please visit the website listed.

We'll go ahead and take some questions from the audience now. Just a reminder, please be sure to type your questions into the question box in your control panel.

Looks like we have quite a few that have come in.

Let's see.

So I'll throw this out to the group, and whoever wants to answer can jump in here.

What state regulations should we check? ACHA, JC?

So I'll take this one. Thanks for the question.

Joint commission isn't your state regulatory agency, so I would check with your health department or, the whatever legal document, covers hospitals or health care and, the requirements for health care in your area.

Okay. Thank you. Here's a question for Michael. Do type one and type two level of risk need formal written ICRA?

So I can jump in here as well.

You can use your facility standards if you choose to do that. You have to figure out what things you're gonna allow to happen without an ICRA review in person, and then what are gonna be the requirements for the for the work processes when you do this. So to perhaps specify that you can only do one tile every fifty feet, you know, ceiling tile if you're inspecting and make sure that everybody understands that that's the procedure, then you don't have to have a walk through and a written specific ICRA for every time you, you do those activities.

Thanks, Janet. Amanda asks, what if you have mixed patient areas, such as an oncology patient on a general med surg unit?

So, you know, you have to use your best judgment. I I saw a couple of those kinds of questions come up. And if you have, it can always happen that, you know, an oncology patient gets in a car accident and ends up in a trauma unit.

But if you know that you have a lot of those patients routinely placed all over your hospital, then you may have to think differently about it if you're doing, construction that's gonna liberate dust. Or you may have to work with your, patient placement, if possible, if you have a short term project to make sure that the most vulnerable patients are not in the area while you're doing that work.

Great. Richard asks, what about dusty clothing on workers? Any recommendations for clothing change or cover up?

I can take that, Janet. Mhmm.

Yeah. So construction workers, contractors, facilities personnel, whoever it is, they should not be leaving a construction site with dust on them with construction debris.

They should be clean when they come out of the construction site. How clean they should be really depends on, where they're walking out into, you know, how sensitive that area is at a patient care area that they're that they're exiting out of. You know, they exit out of the construction site into a corridor.

Is that a patient care area? Is it adjacent to a patient care area? Or is it, you know, possibly even an exit door? But, no, they they should not be they should not be coming out of construction construction site with dust, or debris on them.

One thing I one thing that I see very often are contractors that have a a a small HEPA vacuum inside their anteroom so the contractors can vacuum their cells off before they leave the construction site. And in addition to that, in highly sensitive patient areas, you may want to require, that the contractors do put on coveralls when they leave the construction space.

K. Great. Another couple of HEPA questions here.

Leon, how do they recommend verifying HEPA particulate measurement?

I'm sorry. The the evidence two words, measurement.

I'm sorry. Repeat that again, John.

How do they recommend verifying HEPA particular measurement?

They don't Ashley does not necessarily recommend how to verify it. They just say HEPA filtration needs to be verified, for certain ACRE ACRE classes if you were exhausting indoors.

The slide that I put up and I displayed was one it was one way and probably the only way that I know to verify HEPA filtration is with a particle counter, taking particle counts inside the construction site and then outside downstream your of your HEPA filtration and comparing those two numbers and, calculating your percent reduction.

K. And a follow-up to that from RJ. What is the reasoning behind not permitting HEPA filtered air into HVAC returns?

That can have, a couple of different issues.

One of the issues is if you're dumping if you're pushing air into a return duct, that has the the, possibility of affecting air flows everywhere else in your HVAC system, and that can really mess things up for other areas.

That's what, facilities personnel have told me, as far as, you know, trying to exhaust air into a into a return duct that really just messes up the messes up the pressures inside the HVAC system. And then you also do not want to, exhaust your HEPA air, which you're assuming is HEPA air unless you verify it into a return duct. Because if you could actually be dumping air that is dirty, you could be dumping construction dusty air into a return duct and, you know, that's the last thing you wanna do.

Okay. Couple of questions about particulate counters.

Let's see. Can you advise any handheld particular particle counters? And, this person's seen a wide range on prices. They're not sure what to look for.

Great question.

I cannot necessarily recommend or non recommend different part of the counters because I've only ever used one, so I have nothing to compare it to.

I personally use a a TSI. I think it's a ninety three zero three model.

And, but, yeah, that's that's what I've been using for years, but I like I said, I really can't recommend or non recommend any any certain type because I've only ever used one.

Okay. If the IFU for the HEPA device indicates ninety nine point nine seven percent required for operation, how will surveyors accept a percentage less than that?

That is an excellent question, and I've heard that before.

That's what kinda worries me about the fact that they did that actually did put ninety nine point nine seven percent in there.

But my advice is if you would do adopt ICRA 2.0 and you adopt the assessment, the matrix, and all the documentation, don't put it in your policy. Because if you do put it into your policy, then you're gonna be held to that ninety nine point nine seven. Rather make it a procedure, an in house, you know, construction procedure, you're gonna follow Ricker 2.0. That way you have a little bit of leeway to bounce back and forth between that ninety nine point nine seven, and the ICRA permanent is that way. You know, they're therefore, it's a it's a living document. You can make changes.

For instance, in a certain facility, I believe we're going to alter that language to say not, you know, no less than ninety seven percent or little less than ninety eight percent. Because like I said, it's very difficult to always get ninety nine point nine seven percent.

K. Bruce, a question for you from Latoya. Are these wall panels suitable for room disinfection procedures?

Yeah. Absolutely.

You know, we we've used panels in not only construction, but isolation, and any really any requirement to separate spaces. So, you know, they're chemically inert and, and therefore, if you wanna set up a space for a given procedure, then that's a great application for the panels.

K. And, Janet, a question from Teresa or Tia. Would you consider a clinic, for example, a PCP office, as covered under ICRA 2.0? Our infection prevention team believes it is, but our facilities team does not agree.

Well okay. Welcome to, the world of, reality. Right? So there isn't a designation that says it's not in the ICRA 2.0, But I think that you could probably come to some compromises based on the fact that these areas are not usually running twenty four seven.

So you have an opportunity to be there, doing whatever construction, renovation, maintenance has to be done when there are not patients around in the area.

And then you have the opportunity to make sure that it's clean before you're reopening for business.

It's really important to make sure that somebody is there on-site to assure that all that gets done and to assure that all the equipment is moved out of the way, covered, or, removed before the work happens. So part of the problem in off-site locations is that there's not that much oversight. There's often contracted cleaning, so they may not have the, the ability to just do this completely independently.

Great. Here's one I'll throw out to the group from Andy.

ASHI class four and class five indicate the need for negative pressure. Is there a specific pressure differential that is recommended or industry standard?

FGI says minus zero point zero three.

Asbestos is minus zero point zero two.

Isolation rooms are minus zero point zero one. Where do you think construction projects fall?

It the construction projects fall where you want them to fall. You're correct. The class four and five say negative pressure, and they do not give a number. They don't say, you know, negative point o one or negative point o two. And you're you're right. FGI has stated has recommended negative point o three pressure.

But, again, it's it's what you want. It's it's as a facility, it's whatever you dictate, you know, whatever you wanna put in your policy or your procedure or or whatever you wanna tell your contractor to to to, establish.

You know, some some projects, you know, might be, you know, in an area where there it's not very sensitive, you know, not not a patient care area. You may not require as much negative pressure. Or you might be doing a project adjacent or across the quarter from a bone marrow transplant unit where you wanna ask for at least negative point o three or negative point o four or whatever, you know, whatever your facility decides. So, again, it's just it's just up to your facility.

And, Leon, as I've talked about Sure.

The ASHRAE standard is point o three, I think. Right, Leon?

I believe that's correct. Yeah.

K. As a follow-up to that, again, to the group, does having a negative air machine within the anteroom exhausted into containment or outside the containment run the risk of the anteroom becoming more negative than the containment and drawing containment air into the anteroom?

You would likely need two manometers to continually monitor pressure in each room.

Yes. Excellent question.

So, yes, when you if you're gonna develop if if you're going to design it that way, if you're gonna put a HEPA machine in the anteroom that is exhausting in the into the construction site, and then the construction site is also negative. You just wanna make sure that you have less negative pressure in your anteroom than you do in your construction site. So your construction site should be for just for an example, construction site should be negative point o three to the anteroom.

Anteroom should be negative point o one to the corridor. That way you have less negative air in the anteroom. That way you're not pulling a lot of that air from the construction site. And if you have that negative point o one in the anteroom and then the higher pressure negative point o three in the construction site, you therefore develop your cascading airflow.

Great. Thank you, Leon.

Bruce, a question from Mindy. How do the temporary containment systems seal to the floor slash drop ceilings?

All of our panels include gasketing, hard rubber or excuse me, compliant rubber gasketing, both to the floor and at the top of the panels. So you the the weight of the panels compress that gasket on the floor and then the compression against the grid of the ceiling, also gaskets there.

K.

And how tall is the fire barrier wall to be able to go deck to deck?

The so the FireblockWall system really has been optimized for, soffit heights or ceiling heights of eight, nine, and eight to ten feet, because that's what most facilities are. To get to the deck, requires the construction of a soffit, or a one hour rated wall from the deck down to the ceiling plane, and then the FireblockWall would mount underneath that. So that raises the you know, it's an additional, complexity, but it does give you that full rated barrier with the benefits of the modularity and the, mobilization ease of the, FireblockWall system.

Okay.

Let's see here.

Can you define equipment staging and class five anterooms?

I'm not sure who that's geared towards. I'm guessing Leon.

Yeah. I'll take it. Equipment staging. I'm looking for the actual, actual sentence that says that.

Where is it?

Oh, I can't actually find it, but I know it is there. But, yeah, you're right. It says the, it says construct anteroom, big enough for equipment staging. Oh, there it is.

Equipment staging. Where did it go? Just like yeah. For equipment staging, cart cleaning workers.

In my experience, most hospitals, most areas are doing construction. They don't always have a lot of space for an ant room. So in most cases, a contractor is gonna have a difficult time building an ant room that is big enough for equipment staging, cart cleaning, and workers. When you have that, enough space for something like that, it's excellent.

But equipment staging, you know, in inside ant rooms, I've seen, you know, HEPA vacuums.

I've seen mop buckets, you know, a rack for hard hats, safety glasses.

They're you know, sometimes they can keep tools in there, you know, things like that. Equipment staging, also something I like to see inside the atrium are your debris cart covers.

If a contractor is using a a a a cover for the debris cart, you know, one of those covers that it's kinda like a kinda like for your gas grill, those covers that are elastic. I like to see those in the anteroom. That's something else that I'll see commonly in the anteroom. That way it's staying clean as opposed to being inside the actual construction space.

K. Great. Appreciate it, Leon.

Kristen asks if we can explain the one hour separation a little bit more. She's not familiar with this term.

Yeah. Sure. So code requires, again, when when a one hour separation is required, that's because of, life safety considerations.

And so the code had set forth standards, again, to define not only situations requiring the one hour standard, or maybe it may there are situations where maybe two hours or four hours is required.

Again, based on the use of facility, the type of construction, the, you know, elevator shafts have a higher rating than than, separations between a hazardous room.

You know, sometimes, a a storage room in on a floor, may be required to have a one hour separation. So, again, that room then becomes the ability to withstand one hour of of fire, and protect the patients and protect the staff outside that envelope.

And so, again, a lot of us determined by the, international building code, by, the NFPA codes, that go into that.

Okay. We have quite a few questions left, but unfortunately, we're coming up against the hour. Last question is for you, Janet.

This is from Britney.

Hi. I'm new to the ICRA process and was unsure how to determine future project types.

Let's see. Where would you put an HVAC being shut down for three days? Being done in zones over a period of time will include some of our high risk areas?

Yeah. I think that, you know, I'm not gonna this is like asking a doctor to diagnose a a patient, on a webinar. So I think that you really have to take a look at what are the components, how's it gonna be done, where are the highest patients, and really make an individual assessment based on all of that. You know, if you, if it's being done over three days, it's automatically, out of class, you know, type one and two, class a and b. It's our it's, high risk areas that are involved and so on. So you'd you'd really have to I can't to tell you that over over webinar.

Fair enough.

Well, on that note, I wanna thank all of the attendees for joining us today and submitting so many great questions.

I'd also like to give a big thank you to our speakers.

A recording from today's webinar will be available soon, and please be sure to check the STARC Systems blog for more information on ICRA 2.0. Thank you again for joining us today.

We appreciate you being here and hope you have a great day.