Before a construction company can begin the process of design, construction or renovation of any health care facilities, it is necessary to gather data regarding architectural, mechanical, electrical, plumbing and fire protection requirements established by OSHA and other federal, state and local agencies. Collection of this data is critical because it can affect issuance of a certificate of occupancy and site considerations; planning and zoning requirements; fire safety ordinances; state and local codes; natural gas supplies; domestic and fire water requirements; electrical power; and sanitary sewer facilities.

Use a checklist to prevent the possibility of overlooking essential zoning and code requirements, which could delay the construction or renovation project.  Be sure the checklist assigns key individuals who serve as technical sources throughout the project, such as the fire marshal, inspectors (city/state/local), zoning authorities, utility company officials, health care facility officials, etc.  These key assigned individuals will establish clear lines of communication with the authority having jurisdiction and can prevent misunderstandings and delays on the project with the design/construction company.

When seeking approval for new construction or renovation of existing health care facilities, it is recommended that your proposal and design plan consider the following important factors:

1.  The scope and purpose of the proposed construction project;

2.  The services necessary for the complete operation of the health facility, including:

• The size and function of each space,
• Any special design features,
• The projected occupant load, and
• Numbers and types of staff, patients, residents, visitors and vendors;

3. The types and projected numbers of procedures to be performed in each treatment area and circulation patterns for staff, patients or residents, and the public;

4. The projected demand or utilization, staffing patterns, departmental relationships, space requirements, and circulation patterns that are a function of infection control requirements and for clean and soiled materials;

5. Equipment requirements, including building service equipment and fixed and moveable equipment; and

6. Potential future expansion that may be needed to accommodate increased demand.

Use of dust-control procedures and barriers during construction, repair, renovation, or demolition is essential to protect other parts of health care facilities. Whenever possible, avoid inactivating or shutting down the entire HVAC system, especially in acute-care facilities. If feasible, design and install fixed backup ventilation systems for new or renovated construction of operating rooms, laboratories other critical-care areas.

During the construction or renovation, establish a multidisciplinary team that includes infection-control staff to coordinate demolition, construction, and renovation projects and consider proactive preventive measures at the inception. This team should educate both the construction team and health-care staff in immune compromised patient-care areas regarding the airborne infection risks associated with construction projects, dispersal of fungal spores during such activities, and methods to control the dissemination of fungal spores. Incorporate mandatory adherence agreements for infection control into construction contracts, with penalties for noncompliance and mechanisms to ensure timely correction of problems. This team should also establish and maintain surveillance for airborne environmental disease as appropriate during construction, renovation, repair, and demolition activities to ensure the health and safety of immune compromised patients.

The construction company should implement dust-control measures on surfaces and divert pedestrian traffic away from work zones. Relocate patients whose rooms are adjacent to work zones, depending on their immune status, the scope of the project, the potential for generation of dust or water aerosols. Provide construction crews with designated entrances, corridors, and elevators wherever practical; essential services (e.g., toilet facilities) and convenience services (e.g., vending machines); protective clothing (e.g., coveralls, footgear, and headgear) for travel to patient-care areas; and a space or anteroom for changing clothing and storing equipment.

The above guidelines are just a sample of things to consider when approaching  renovation, construction or demolition of health care facilities. Be sure to research all applicable OSHA codes and local and state regulations regarding full requirements for health care facility construction, renovation or demolition.