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6th Edition In-Depth: FMS Standards for Demolition, Construction, and Renovation

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6th Edition in Depth: When planning for demolition, construction, or renovations, the organization conducts a preconstruction risk assessment.
Standard FMS.4.2.1: When planning for demolition, construction, or renovations, the organization conducts a preconstruction risk assessment.

Standard FMS.4 in the fifth edition of the hospital standards briefly addressed construction and renovation as part of the general facility safety program. However, demolition, construction and renovation can have a significant impact on an organization’s operations, utilities, environment, and patients. Thus, a new standard was added to the sixth edition, standard FMS.4.2.1, identifying that any time planned or unplanned demolition, construction or renovation occurs, organizations are required to have a pre-construction risk assessment (PCRA) process in place.This is in conjunction with standard PCI.7.5 found in both the fifth edition and sixth edition, which requires a process for the identification and mitigation of the infection control risks associated with construction and renovation (ICRA). 

The risk assessment covers potential risks to patients, staff, visitors, and/or resources for air quality, infection control, utility requirements, noise, vibration, emergency services, and any other hazards that affect the environment, or the care, treatment, and services provided to patients. For example, vibrations from construction projects can release dust and debris into the air from ventilation ducts or ceiling tiles which can impact air quality.  The use of chemicals or hazardous materials during construction can also have a negative impact on air quality. Noise levels may potentially cause increased anxiety in patients or have an impact on staff performance, particularly in areas where high risk procedures are performed.  Demolition and construction may also disrupt some normal utilities functions, or it may require that some normal pathways connecting wards and departments be temporarily blocked, possibly affecting response to codes and emergencies.  It is important for organizations to identify these risks prior to beginning any new construction project to ensure hospital operations are not negatively impacted and that patients continue to receive safe, quality care and services.

It may be helpful to use an assessment matrix that applies the intensity of the construction that will be taking place to the level of risk in the area in which the construction will occur and identifies control precautions relevant to the risk classification.  The area of construction can dictate the level of protection required, for example, an administrative or support services area may have a lower risk of hazards, particularly to patients, than high risk, sterile, or critical care areas.  The following link provides an example of an assessment matrix from the American Society for Healthcare Engineering (ASHE), however use of this tool is not required.  http://www.ashe.org/resources/tools/pdfs/assessment_icra.pdf

The standards do not dictate a specific risk assessment and implementation process, however, in addition to ASHE, there are several other resources that can offer suggestions, recommendations, or examples of tools, such as the Centers for Disease Control and Prevention (CDC), the National Institute for Occupational Safety and Health (NIOSH), and the Facilities Guideline Institute (FGI).  The following are links to several of these additional resources suggested.

https://www.cdc.gov/hai/pdfs/eic_in_hcf_03.pdf  (Beginning on page 21 of the PDF)

https://www.cdc.gov/niosh/topics/indoorenv/constructionieq.html

https://www.fgiguidelines.org/resource/safety-risk-assessment-toolkit-for-health-care-facility-environments/

 

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