October 2021
(Updated May 2022)
Infection Control Risk Assessment (ICRA)
and
Preventive Measures Toolkit
for
Construction, Renovation and Maintenance
Infection Control Risk Assessment (ICRA) and
Preventive Measures Toolkit for Construction, Renovation and Maintenance
October 2021 (Updated May 2022) Page 2 of 26
Version History
Copyright © 2022 Alberta Health Services, Infection Prevention and Control. This material is protected by Canadian and other international
copyright laws. All rights reserved. This material may not be copied, published, distributed or reproduced in any way in whole or in part
without the express written permission of Alberta Health Services (please contact the senior provincial director at Infection Prevention and
). This material is intended for general information only and is provided on an "as is", "where is"
basis. Although reasonable efforts were made to confirm the accuracy of the information, Alberta Health Services does not make any
representation or warranty, express, implied or statutory, as to the accuracy, reliability, completeness, applicability or fitness for a particular
purpose of such information. This material is not a substitute for the advice of a qualified health professional. Alberta Health Services
expressly disclaims all liability for the use of these materials, and for any claims, actions, demands or suits arising from such use.
Date
Minor/Major Revision
Description
2022-05
Minor
Update to Appendix C – Plenum Box Position Statement
2021-10
Major
Updated – Preventive Measures Tools condensed to one tool; separated
from Design Requirements; general revisions based on updated standards.
Infection Control Risk Assessment (ICRA) and
Preventive Measures Toolkit for Construction, Renovation and Maintenance
October 2021 (Updated May 2022) Page 3 of 26
Introduction
Serious health risks for patients, staff and visitors are created during construction, renovation and
maintenance activities. At the initial stages of design and planning, the completion of an Infection Control
Risk Assessment (ICRA) by the multidisciplinary team (MDT) is an essential component of all
construction, renovation and maintenance projects in a healthcare facility. Any situation that poses a risk
to patients and staff shall be reported immediately. [CSA Z317.13-17: 6.1.14]
1
The ICRA and preventive measures toolkit has been
developed to help MDTs determine the actions required
to minimize the risk of infection for patients, staff and
visitors during construction renovation and
maintenance activities.
The term “construction activity” is defined as major and
minor facility activities that disturb or modify facility
structures and systems. This includes all new
construction, renovation, maintenance, repurposing
and remediation activities. [CSA 317.13-17: 3.1]
1
Note: Modification of a facility or area with the intent to
change the original functional purpose is considered new
construction, and shall necessitate the need to meet
current and applicable standards. [CSA 317.13-17, 3.1]
1
Risk factors related to construction renovation and maintenance
Construction, renovation, and maintenance projects in healthcare facilities pose a potential threat of
infection to current and future occupants, particularly those with reduced immunity. During construction,
environmental sources including soil, water, and dust, which can be contaminated with fungal spores,
bacteria, or other micro-organisms, can lead to serious infections, including death. For more information on
construction renovation and maintenance related risks, see CSA Z317.13-17, Section 0.1-0.3.
Guidelines for ICRA and preventive measures
1. Construction activities shall include IPC personnel in the project planning stages prior to blue print
creation, contracting and commencement of activities. [CSA Z317.13-17: 6.2.1.5, 6.2.2, 6.3.2]
1
, [CSA
Z8000-18: 4.5.1.2]
2
, [FGI: 1.2-1.2.1]
3
2. There shall be an assessment of occupied areas adjacent to the construction area, and the systems
serving those areas, to identify potential risks to the occupants. [CSA Z317.13-17: 6.1.3]
1
3. An infection control risk assessment (ICRA) shall be conducted before construction, renovation, and
maintenance begins on any project involving preventive measures III or IV (PM III or IV) and
Population Risk Group 3 or 4. For other projects (PM I or II), an ICRA should be conducted. [CSA
Z317.13-17: 6.1.3]
1
Note: Sufficient advance notice allows the MDT to make the appropriate preparations and organize
alternative arrangements if needed. Notice should be provided at least three business days in advance.
4. For new construction and contracted renovations the ICRA and preventive measures analysis shall be
completed collaboratively by project MDT before construction begins. [CSA Z317.13-17: 6.1.3, 6.1.4]
1
Note: The project manager confirms that ICRA and preventive measures analysis is completed by the
MDT and is documented in the project records.
5. ICRA and Preventive Measures Analysis (PMA) shall be included in tendering documents. [APIC:
117]
4
, [CSA Z8000-18: 4.5.1.3, 4.5.5, 5.3.1.1]
2
, [CSA Z317.13-17: 6.1.6]
1
, [FGI: 1.2-1.2, 1.2-3.1.2]
3
What is a multidisciplinary team (MDT)?
A group of professionals from various
disciplines in the healthcare facility that
works with the project management team
and others to ensure that the appropriate
infection prevention and control measures
are followed during construction activities.
Membership on a MDT should include:
Infection Prevention and Control (IPC),
Facilities Maintenance and Engineering
(FME), operational or clinical representative,
Project Management, Environmental
Services, Designers and Constructors
Adapted from: CSA Z317.13-17, 3.1
Infection Control Risk Assessment (ICRA) and
Preventive Measures Toolkit for Construction, Renovation and Maintenance
October 2021 (Updated May 2022) Page 4 of 26
6. The constructor leadership shall have demonstrated experience and knowledge of the principles and
practices of infection control during construction.
Note: Experience and knowledge of infection control during construction may be demonstrated, for
example, by presenting proof of training classes completed, documentation showing work on HCFs in
the past, or work performed with experienced supervisors. [CSA Z317.13-17: 6.1.7]
1
7. Development of a written infection control plan,
describing the procedures, process, and
safeguards for the specific construction project
shall be completed by the constructor or their
qualified representative. [CSA Z317.13-17:
6.1.5, Annex D]
1
8. A documented plan for meeting the required
PMA shall be completed and reviewed by the
project MDT including the contractors. [CSA
Z317.13-17: 6.1.5]
1
, [FGI: 1.2-3.1.4, 1.2-3.3.2,
1.2-3.4.1]
3
9. PMA identified shall be implemented,
monitored and updated as required. If the
scope of the construction activity changes, a
new ICRA shall be required [CSA Z317.13-17:
6.1.10]
1
, [APIC: 117]
4
, [FGI; 1.2-3.1.2]
3
10. For construction activity that involves ceiling access for minor work or inspection, refer to CSA
Z317.13-17 for specific recommendations and preventive measures.
11. Monitoring of construction activity is a shared responsibility between the project MDT members (IPC,
Project Management, FME, Operations, etc.). A documented monitoring plan shall be developed,
reviewed and implemented. [CSA Z317.13-17: 6.1.11]
1
, [FGI: 1.2-3.3.3]
3
12. If events that can present an infection risk occur during construction, intervention procedures shall be
implemented immediately to resolve the problems. [CSA Z317.13-17: 7.3.4.9]
1
13. Written protocol for a stop work order shall be identified prior to beginning work. A stop work plan will
include lines of authority, communication, investigation and remediation prior to restarting activity.
[CSA Z317.13-17: 5.3.11]
1
, [CSA Z8000-18: 6.1.15]
2
[APIC: 117]
4
, [FGI: 1.2-3.3.3]
3
. See Appendix B
for a Stop Work Order protocol.
14. The facility shall have an IPC education plan for staff and external contractors regarding construction
related potential risks and preventive measures. [CSA Z317.13-17: 6.3.1.5]
1
, [FGI: 1.2-3.4.1.5]
3
,
[APIC: 117]
4
15. Food and drink (other than water) should be prohibited on all construction sites, except in designated
eating areas (e.g., a lunch room or trailer). [CSA Z317.13-17: 6.1.16]
1
16. Infection prevention and control personnel shall ensure that an effective surveillance system is in
place to monitor patients for Legionella in the event that soil excavation takes place on, or in proximity
to, HCF grounds; or the water supply has been disrupted and then repressurized [CSA Z317.13-17
7.2.3.3]
1
Any lab-confirmed clinical cases of Legionella will be investigated.
What is an infection control plan?
A sequence of events that includes:
• Healthcare Facility identification of potential
risks, done through an ICRA
• communication of risks and preventive
measures in tendering documents
• contractor development of infection control
plan that is appropriate to the project
• MDT approval of the infection control plan
• implementation of the infection control plan,
including the necessary training of personnel
• updating the infection control plan as needed
throughout the project
Adapted from: CSA Z317.13-17, 6.1.6
See Appendix A for the table of contents of a
sample infection control plan.
Infection Control Risk Assessment (ICRA) and
Preventive Measures Toolkit for Construction, Renovation and Maintenance
October 2021 (Updated May 2022) Page 5 of 26
Infection Control Risk Assessment (ICRA) Toolkit
Contents of ICRA Toolkit:
Form 1: Infection Control Risk Assessment (ICRA)
Form 2: Construction Activity Type (detailed)
Form 3: Population Risk Group (detailed)
Form 4: Infection Control Preventive Measures Tool
Form 5: Infection Prevention & Control Construction Site Monitoring Tool
Form 6: Infection Control Post Construction Checklist
Instructions for Using the Infection Control Risk Assessment (ICRA) Toolkit
1. Complete the ICRA (Form 1) using the following instructions:
a. Project MDT designate to collect and record project information.
b. Use Form 2, Construction Activity Type to identify construction activity type.
c. Use Form 3, Population Risk Group to identify the population risk group.
d. Using the Risk Analysis and Preventive Measures Class Matrix identify the Preventive
Measures required and record on Form 1.
e. Include any additional IPC recommendations or comments.
f. Obtain all necessary signatures from the project MDT.
g. Circulate copies of Form 1 to the project MDT.
2. There are four Preventive Measure Levels. Use Form 4 to identify the preventive measures for
each construction project.
a. For Infection Control Preventive Measures Level 1, the form may be completed by
project MDT or their Designate to identify required the preventive measures for the
activity described in the Infection Control Risk Assessment and Preventive Measures
Analysis (Form 1). Identify the appropriate measures by marking X in the check boxes
that apply.
b. For Infection Control Preventive Measures Level 2, Level 3, and Level 4, the form is
completed by the project MDT or designated person(s) to identify the required
preventive measures for the activity described in the Infection Control Risk
Assessment and Preventive Measures Analysis (Form 1). Identify the appropriate
measures by marking X the check boxes that apply.
c. Responsibility for each item is determined by the project MDT at start-up meeting,
before any work is initiated.
3. Form 5 Construction Site Monitoring Tool may be used for compliance and quality monitoring,
at the discretion of the project MDT or any of its members, to monitor preventive measures
required during construction/renovation activities.
4. Form 6 Post Construction Checklist should be completed prior to area occupancy. This form is
used by Infection Control Professional or their designate to ensure the post construction area
is ready for patient/staff occupancy.
Infection Prevention and Control
Healthcare Facility Infection Control Risk Assessment and
Preventive Measures for Construction, Renovation and Maintenance Activities
October 2021 (Updated May 2022) Page 6 of 26
Form 1: Infection Control Risk Assessment (ICRA) Form
This form shall be completed by project multidisciplinary team, which may include Project Management, Facilities, Maintenance
and Engineering (FME), Infection Prevention and Control (IPC) for all maintenance, design, planning, construction, renovation or
remediation activities. Refer to Preventative Measures Tool.
Project Number:
Project Name and Description:
Facility/Location:
Scope of Work (brief summary):
Project start date:
Estimated duration:
Construction Activity Type
These categories are not limited to the examples provided; refer to Form 2 for details. [CSA: Table 3]
1
See CSA Z317.13-17, Clause 7.5 for exceptions if activity requires only ceiling access for investigation or minor work.
Type A
Inspection and non-invasive activities such as: a single controlled opening in a wall or removal of one ceiling tile or wall
panel for inspection, painting (no sanding), wall covering, electrical trim work, activities that do not generate dust or require
cutting of walls, or work in ceiling, minor plumbing limited to one patient care room/area that does not disrupt water for more
than 15 minutes
Type B
Small scale, short duration, creates minimal dust activities such as: access to chase spaces, where dust can be
controlled, cutting of walls/ceilings for cabling, wiring, minor electrical, ventilation or plumbing. Minor sanding and repair of
surfaces, plumbing work in one or more patient care rooms that does not disrupt water for more than 30 minutes.
Type C
Moderate to high levels dust, requires demolition or removal of fixed components. May include: major sanding,
removal of flooring, ceiling tiles, casework, new wall construction, minor duct or electrical work in ceilings, major cabling,
plumbing work in two or more patient care rooms not disrupting water more than one hour. Activities cannot be completed in
a single work shift.
Type D
High levels of dust, major demolition and construction, includes:
complete removal of cabling, demolition of wall(s),
plumbing that disrupts water in two or more patient care rooms for more than one hour, requires consecutive shifts to
complete.
Population Risk Group (these groups are not limited to the examples provided descriptions; refer to Form 3 for details)
Consideration should be given to adjacencies (above, below and beside) when determining the population risk group.
Group 1 Group 2 Group 3 Group 4
• Office areas
• Unoccupied
spaces*
• Public areas
• Laundry, soiled
linen
• Patient care areas not
listed in Group 3 or 4
• Outpatients (except
oncology and surgery)
• Admission, discharge,
waiting areas
• ER (except trauma rooms)
• DI, nuclear medicine, MRI
• Labour, delivery and nursery
• Pediatrics
• General medical/surgical units
• Continuing Care units
• Geriatric units
• Respiratory therapy
• Operating Rooms
• Trauma rooms
• Oncology
• ICU, CCU, NICU
• Bronchoscopy/Endoscopy
• Medical Device Reprocessing and
sterile storage
*An unoccupied space refers to an area where there are no patients or patient-related activities and that is absent of any medical supplies or equipment.
Unoccupied spaces may include vacant wards, basements, shelled spaces for future development, or spaces only accessed for equipment servicing.
Patient care areas that are intermittently unoccupied due to designated working hours are not considered unoccupied spaces.
Infection Prevention and Control Healthcare Facility Infection Control Risk Assessment and
Preventive Measures for Construction, Renovation and Maintenance Activities
October 2021 (Updated May 2022) Page 7 of 26
Risk Analysis & Preventive Measures Class Matrix:
IPC must be notified when Risk Level indicates Class III and IV
* Denotes where modified preventive measures level may be used (see Clause 10, ICRA and Preventive Measures Toolkit).
Population Risk
Group
(choose one)
Construction Activity Type (choose one)
Preventive Measures
Determined
□ Type A
□ Type B
□ Type C
□ Type D
□ Group 1
I
II*
II
III/IV
□ Group 2
I
II*
III
IV
□ Group 3
I
III*
III/IV
IV
□ Group 4
I-III
III/IV*
III/IV
IV
Additional Recommendations (include hoarding details, exhaust location and other critical notes. Consideration
should be given to HVAC and Plumbing systems)
Please attach corresponding Preventative Measures checklist.
Monitoring Tool Form 5
Required: YES NO
Post Construction Checklist Form 6
Required: YES
NO
Stop Work Order
(see Appendix B of guidelines)
Approved by team N/A
Contractor training
Done Not required Checklist
Approval (Print Name and sign)
Date
Project Manager:
Facilities Maintenance & Engineering:
Contractor:
Infection Control Professional:
Clinical Representative:
Other:
Other:
Infection Prevention and Control Healthcare Facility Infection Control Risk Assessment and
Preventive Measures for Construction, Renovation and Maintenance Activities
October 2021 (Updated May 2022) Page 8 of 26
Form 2: Construction Activity Type
Construction
activity type
Description [Refer to CSA Z317.13-17 Table 3]
1
Type A
Inspection and non-invasive activities. These include, but are not limited to:
a. activities that involve a single controlled opening in a wall or ceiling for minor work or visual inspection, that
is accessed by:
i. removing no more than one ceiling tile; or
ii. opening of an access panel on a wall or ceiling;
b. painting (but not sanding) and wall covering;
c. electrical trim work;
d. minor plumbing work that disrupts the water supply to a localized patient care area (i.e., one room) for less
than 15 minutes; and
e. other maintenance activities that do not generate dust or require cutting of walls or access to ceilings other
than as specified in item a.
Type B
Small-scale, short-duration (e.g., less than two hours) activities that create minimal dust. These include, but are
not limited to:
a. activities that require access to and use of chase spaces;
b. cutting a small opening in a contained space where dust migration can be controlled, e.g., cutting of walls or
ceilings to provide an access point for installing or repairing minor electrical work, ventilation components,
telephone wires, or computer cables;
c. sanding or repair of a small area of a wall; and
d. plumbing work that disrupts the water supply of one or more patient care areas for less than 30 minutes.
Type C
Activities that generate a moderate to high level of dust, cause a moderate service disruption, require demolition,
require removal of a fixed facility component (e.g., sink) or assembly (e.g., countertop, cupboard), or cannot be
completed in a single work shift. These include, but are not limited to:
a. activities that require sanding of a wall in preparation for painting or wall covering;
b. removal of floor coverings, ceiling tiles, and casework;
c. new wall construction;
d. minor ductwork;
e. electrical work above ceilings;
f. major cabling activities; and
g. plumbing work that disrupts the water supply of one or more patient care areas for more than 30 minutes but
less than one hour.
Type D
Activities that generate high levels of dust, activities that necessitate significant service disruptions, and major
demolition and construction activities requiring consecutive work shifts to complete. These include, but are not
limited to:
a. soil excavation;
b. new construction that requires consecutive work shifts to complete;
c. activities that involve heavy demolition or removal of a complete cabling system; or
d. plumbing work that disrupts the water supply of more than one patient care area (i.e., two or more rooms) for
one hour or more.
Infection Prevention and Control Healthcare Facility Infection Control Risk Assessment and
Preventive Measures for Construction, Renovation and Maintenance Activities
October 2021 (Updated May 2022) Page 9 of 26
Form 3: Population Risk Group
Population Risk
Group
Description [Refer to CSA Z317.13-17, Table 2]
1
Group 1
Lowest Risk
• Office areas (i.e., non-clinical)
• Unoccupied spaces*
• Public areas not intersecting a patient care area
• Laundry and soiled linen sorting or storage
areas
• Physical plant workshops
• Housekeeping rooms and closets
*An unoccupied space refers to an area where there are no patients or patient-related activities and that is absent of any medical supplies or
equipment. Unoccupied spaces may include vacant wards, basements, shelled spaces for future development, or spaces only accessed for
equipment servicing. Patient care areas that are intermittently unoccupied due to designated working hours are not considered unoccupied
spaces.
Group 2
Medium Risk
• Patient care areas, unless listed in Group 3 or Group 4
• Outpatient clinics (except oncology and surgery)
• Admission and discharge units
• Waiting rooms
• Autopsy and morgue
• Occupational therapy and physical therapy
areas remote from patient care areas
Group 3
Medium to High
Risk
• Emergency (except trauma rooms)
• Diagnostic imaging
• Labour and birthing rooms (without operating room
capability)
• Nurseries for healthy newborns
• Nuclear medicine
• Hydrotherapy
Echocardiography
• Laboratories
• General medical/surgical wards or units
(includes all areas within the units, e.g.,
soiled and clean utility rooms)
• Pediatric units
• Geriatric units
• Continuing care units
• Food preparation, serving, and dining areas
• Respiratory therapy
• Clean linen handling and storage areas
Group 4
Highest Risk
• Intensive care units (ICU, PICU, NICU, etc.)
• Operating rooms (including prep, induction,
post-anaesthetic care unit (PACU), and scrub areas)
• Anaesthesia storage areas and workrooms
• Oncology care (including inpatient units and outpatient
clinics)
• Transplant care (including inpatient units and outpatient
clinics)
• AIDS/immunodeficiency diseases (including inpatient
units and outpatient clinics)
• Dialysis units
• Critical care nurseries
• Labour and delivery operating rooms
• Interventional or high-risk diagnostic imaging
(e.g., cardiac catheterization and angiography,
interventional radiology, endoscopy, bronchoscopy,
cystoscopy).
• Cardiovascular and cardiology patient areas
• Pharmacy admixture rooms
• Medical device reprocessing areas
(wherever located)
• Central sterile supply
• Clean and sterile storage
• Burn care units
• Trauma rooms
• Protective isolation rooms
• Tissue culture laboratories
• Pacemaker insertion rooms
• Dental procedure rooms
Infection Prevention and Control Healthcare Facility Infection Control Risk Assessment and
Preventive Measures for Construction, Renovation and Maintenance Activities
October 2021 (Updated May 2022) Page 10 of 26
Form 4: Preventive Measures Tool
This form is completed by the multi-disciplinary team (MDT) or designated person(s) to identify the required preventive measures
for the activity described in Form 1 Infection Control Risk Assessment and Preventive Measures Analysis.
All CSA standards identified below refer to CSA Z317.13-17 Infection control during construction, renovation and maintenance of
healthcare facilities. The tool below is not an exhaustive list of preventive measures: for new construction in a new location, an
existing detached location, or existing connected location, refer to CSA Z317.13-17, Section 8: Infection prevention and control
measures for new construction projects; for complete details of all preventive measures refer to CSA Z317.13-17.
Project Name:
Location:
Scope of Work (Brief Summary):
Project start date:
Estimated Duration:
Mark X in the check boxes ( ) to identify the appropriate preventive measures for your project.
Item
Level
1.0 Preventive Measures – Before Construction
Project MDT
Designate
Responsible
Comments
1.1
All
The Project Manager shall identify essential services (e.g., water supply,
electricity, and ventilation systems) that could be disrupted and
appropriate measures to address the disruption. [CSA: 7.2.2.1].
1.2
All
Identify high-risk patients who might need to be temporarily moved away
from the construction area. [CSA: 7.2.2.2]
1.3
II-IV
Determine a safe route for the transportation of clean or sterile supplies
and equipment away from the construction area.[CSA 7.2.3.1, 7.3.3.8]
1.4
II-IV
Establish traffic patterns for construction workers that avoid patient care
areas. [CSA 7.2.3.1, 7.3.3.8]
1.5
II-IV
Minimize exhaust output from elevators serving construction areas to
ensure that construction dust is not re-circulated into the health care
facility. [CSA 7.2.3.1]
1.6
II-IV
Designate an elevator for use exclusively by construction workers. [CSA
7.2.3.1]
1.7
II-IV
Confirm water temperature standards for the health care facility.
[CSA 7.2.3.1]
1.8
II-IV
Determine whether domestic cold, hot, and recirculation water lines will
be affected by the construction.
This assessment shall include:
1. Identifying plumbing lines that will need to be
a. Shut off or interrupted using existing valves; or
b. Isolated by additional valves.
2. Determining the method to be used to disinfect the water lines before
occupancy.
3. Drafting the procedure to be used to disinfect the water system,
including identifying the required equipment.
4. Determining the flow path to be used to hyperchlorinate and flush
water lines affected by the construction[CSA 7.2.3.2]
See Plumbing section in Design guidelines for further guidance on
assuring adequate water quality during construction.
1.9
II-IV
Drawings shall be obtained that show the layout of the ventilation
systems that supply air to, or exhaust air from, the work area. The
project plan shall state whether it is necessary to close outlets, modify
performance, shut down systems or make other changes to the HVAC
system. [CSA:7.2.3.4]
1.10
III-IV
Plan for regular monitoring (Form 5) and develop a process for issuing
and documenting a Stop Work Order (see Appendix B).
Infection Prevention and Control Healthcare Facility Infection Control Risk Assessment and
Preventive Measures for Construction, Renovation and Maintenance Activities
October 2021 (Updated May 2022) Page 11 of 26
Item
Level
2.0 Preventive Measures - During Construction
Responsibility
Comments
Dust Control
2.1.
All
Immediately after Type A activity (e.g., visual inspection) has been
completed, close access panels, replace displaced tiles, clean work
area with a HEPA-filtered vacuum cleaner. [CSA 7.3.1.1]
Project Manager/
Contractors/ FME
2.2.
All
Patient care equipment and supplies are relocated or protected from
dust exposure. [CSA 7.3.1.5; 7.3.3.9]
Healthcare Staff
2.3.
II-III
Place a walk-off mat outside the entrance to the construction area to
trap dust from the equipment and footwear of personnel leaving the
area. [CSA 7.3.2.2(g)]
Project Manager/
Contractors/ FME
2.4.
II-IV
Use drop sheets [CSA 7.3.2.2(a)]
Project Manager/
Contractors/ FME
2.5.
II-IV
Control dust by water-misting work surfaces while cutting.
Note: Caution should be exercised when such techniques are used
on cellulose or fibre-based materials that are intended to stay in
place following construction work. [CSA 7.3.2.2(c)]
Project Manager/
Contractors/ FME
2.6.
II-IV
Seal windows and unused doors. [CSA 7.3.2.2(d)]
Project Manager/
Contractors/ FME
2.7.
II-IV
Seal plumbing penetrations, electrical outlets, and any other sources
of potential air leaks in the construction area. [CSA 7.3.2.2(e)]
Project Manager/
Contractors/ FME
2.8.
II-IV
Seal air supply and return ducts in the construction area, [CSA
7.3.2.2(f)]
Project Manager/
Contractors/ FME
2.9.
II-IV
Walk-off mats shall be of sufficient size to ensure that constructors
have to place both feet on the mat at least once on exiting the
construction area and vacuumed (with a HEPA filter-equipped
vacuum cleaner) or replaced daily and when visibly soiled. [CSA
6.6.1.9]
Project Manager/
Contractors/ FME
2.10.
III-IV
Erect an impermeable dust barrier, from the floor to the underside of
the deck (including the areas above false ceilings) consisting of two
layers of 0.15 mm (6 mil) fire-retardant polyethylene (or an
equivalent barrier accepted by the MDT) and gypsum wallboard
protective layer. The polyethylene membrane shall be present under
all circumstances to maintain the required pressurization. Fire
retardant polyethylene shall be used for exposed surfaces. The
surface closest to the hospital zone shall be wipeable. The dust
barrier shall remain in place until the project is complete and the
area has been cleaned thoroughly and inspected. After construction
has been completed, the dust barrier shall be removed in such a
manner to prevent the spread of dust and other debris particles
adhering to the barrier. [CSA 7.3.3.2.1]
Where deemed appropriate by the MDT, the composition of the dust
barrier may be modified to suit time, space, or impact constraints.
[CSA 7.3.3.2.2]
Project Manager/
Contractors/ FME
Infection Prevention and Control Healthcare Facility Infection Control Risk Assessment and
Preventive Measures for Construction, Renovation and Maintenance Activities
October 2021 (Updated May 2022) Page 12 of 26
Item
Level
2.0 Preventive Measures - During Construction
Responsibility
Comments
2.11.
III-IV
Use impermeable temporary containment units constructed to
contain contaminants that have a monolithic (one-piece) exterior
shell constructed of a minimum of 0.20 mm (8mil) fibre-reinforced,
fire-retardant polyethylene (or an equivalent barrier). The
construction of the containment unit shall allow for containment of
contaminants within the vessel and have ports through which
HEPA-filtered vacuum cleaners or portable construction air handling
units (CAHUs) can be easily attached to draw the unit under
negative pressure. [CSA 7.3.3.2.1]
Where deemed appropriate by the MDT, the composition of
containment units may be modified to suit time, space, or impact
constraints. [CSA 7.3.3.2.2]
Project Manager/
Contractors/ FME
2.12.
III-IV
HEPA vacuum mechanical and electrical systems and spaces above
drop or false ceilings, if necessary. [CSA 7.3.3.2.1]
Project Manager/
Contractors/ FME
2.13.
III-IV
Measures to ensure that contaminants from the construction site are
not transferred to patient care areas on workers’ clothing, such as:
routes from construction areas should be away from patient care
areas; use of protective clothing while in construction areas that is
removed before entering patient care areas, or don protective
clothing when entering patient care areas. [CSA 7.3.3.2.3]
Project Manager/
Contractors/ FME
2.14.
IV
Ensure that all access be from outside the occupied areas of the
healthcare facility, or construct anterooms at access points to the
construction area if access is from within the healthcare facility.
[CSA 7.3.4.2, 7.3.4.3(a)]
Project Manager/
Contractors/ FME
2.15.
IV
Place a walk-off mat outside and inside the anteroom to trap dust
from equipment, debris, and the footwear of personnel leaving the
construction area. [CSA 7.3.4.3(b)]
Project Manager/
Contractors/ FME
2.16.
IV
Ensure that all workers leave the construction area through the
anteroom so that they can be vacuumed with a HEPA filter-equipped
vacuum cleaner before leaving; or wear protective clothing that is to
be removed each time they leave the construction area and before
going into patient care areas. [CSA 7.3.4.3(c)]
Project Manager/
Contractors/ FME
2.17.
IV
Repair holes in walls or breaches in the containment system
immediately when found. [CSA 7.3.4.3(e)]
Project Manager/
Contractors/ FME
2.18.
IV
Carefully remove barrier walls and use short term protection to
minimize environmental contamination during removal. [CSA
7.3.4.3(g)]
Project Manager/
Contractors/ FME
Ventilation
2.19.
II
If possible, the ventilation system should be disabled until the project
has been completed. If not possible, an engineering analysis shall
be performed to ensure that the fan systems are performing as
intended to maintain relative pressurization and exhaust
contaminated air, and that the operation of the HVAC system is not
compromised. [CSA:7.3.2.3]
Project Manager/
Contractors/ FME
2.20.
III-IV
Disable the ventilation system and seal duct openings in the
construction area until the project is completed. [CSA 7.3.3.3.1]
Project Manager/
Contractors/ FME
2.21.
III-IV
The main facility system shall be verified for operation in accordance
with design during construction work. [CSA 7.3.3.5]
Project Manager/
Contractors/ FME
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Preventive Measures for Construction, Renovation and Maintenance Activities
October 2021 (Updated May 2022) Page 13 of 26
Item
Level
2.0 Preventive Measures - During Construction
Responsibility
Comments
2.22.
III-IV
Ensure that the facility’s permanent ventilation system is functioning
properly and is cleaned if contaminated by soil, dust, or moisture
after construction is complete. [CSA 7.3.3.3.1]
Project Manager/
Contractors/ FME
2.23.
III-IV
The healthcare facility and constructor shall verify the pressure
relationships for critical areas near the construction area (e.g.,
Population Risk Group 4 areas). [CSA 7.3.3.5]
Project Manager/
Contractors/ FME
2.24.
III-IV
Ensure that the air is exhausted directly outside and away from
intake vents and filtered through a HEPA filter. In conditions that
prohibit exhausting to the outside, air may be re-circulated in
accordance with CSA Z317.13-17, Clause 7.3.3.6. [CSA 7.3.3.3.1,
6.6.3.1] or as determined by the MDT (see Item 2.30 below).
Project Manager/
Contractors/ FME
2.25.
III-IV
When planning projects in facilities with operable windows that may
be used for exhausting construction air, consider adjacent rooms,
and lock windows so that construction air is not reintroduced to the
building.
2.26.
III-IV
Permanent air handling systems should not be used for exhausting
air from construction or renovation work areas, except if:
a. the air handling system is an exhaust system leading
directly to the outdoors;
b. an engineering analysis is performed to ensure that the
exhaust system continues to perform its intended function
and that the operation of the HVAC system is not
compromised;
c. the operation of the exhaust fan is monitored and alarmed
to building operations staff and alarmed in the construction
zone. [CSA 7.3.3.6.1, 7.3.3.3.5]
If the conditions outlined in the above three (3) items cannot be
satisfied, then the steps outlined in CSA Z317.13-17, Clause 7.3.3.6
shall be followed.
Project Manager/
Contractors/ FME
2.27.
III-IV
In cases where air cannot be exhausted directly outside, exhaust air
may be temporarily ducted to the building exhaust system if an
engineering analysis has been performed by qualified personnel to
ensure that exhaust air will not be re-entrained into the occupied
building and the MDT approves temporary ducting to the exhaust
system. [CSA 7.3.3.6.2]
Project Manager/
Contractors/ FME
2.28.
III-IV
In cases where air cannot be exhausted directly outside or piped
through the building exhaust system, it may be re-circulated into
areas of the building occupied by Risk Group 1 or 2, if MDT approval
is granted. [CSA 7.3.3.6.3]
Project Manager/
Contractors/ FME
2.29.
III-IV
Construction exhaust air shall not be re-circulated into building areas
occupied by Risk Group 3 or 4 [CSA 7.3.3.6.3, 6.6.1.7]. Refer to use
of permanent exhaust in Item 2.26 above. See Item 2.30 below for
use of plenum boxes for recirculation.
Project Manager/
Contractors/ FME
2.30.
III-IV
If approved by the MDT to use a plenum box for exhausting
construction air, after all other options have been considered, follow
the guidelines indicated in the AHS Plenum Box Position Statement,
and document rationale for use. (See Appendix C of the ICRA and
Preventive Measures Toolkit).
Project Manager/
Contractors/ FME
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October 2021 (Updated May 2022) Page 14 of 26
Item
Level
2.0 Preventive Measures - During Construction
Responsibility
Comments
2.31.
III-IV
Measures related to re-circulated air shall require approval from the
MDT, and include arranging on-site and in-place performance leak-
testing of construction air handling units (CAHUs). [CSA 6.6.1.7]
Project Manager/
Contractors/ FME
2.32.
III-IV
Use portable HEPA filter-equipped CAHUs that include pressure
gauges and an alarm, according to CSA Z317.13-17, Clause 6.6.
Project Manager/
Contractors/ FME
2.33.
III-IV
CAHUs used for Preventive Measures III or IV shall be performance
leak-tested and verified at the beginning of the project, except as
provided in CSA Z317.13-17, Clause 6.6.4.4. [CSA 6.6.4.3]
Project Manager/
Contractors/ FME
2.34.
III-IV
HEPA filters and pre-filters for CAHUs shall be visually inspected,
according to manufacturer’s instructions, before installation and at
least daily and their condition shall be documented. [6.6.3.3]
Project Manager/
Contractors/ FME
2.35.
III-IV
HEPA filters shall be replaced if: airflow falls below 70% of the
manufacturer’s specified level; the unit fails a performance leak test; or
the filter is visibly damaged, wet, or clogged. [CSA: 6.6.4.5, 7.3.3.3.1]
Project Manager/
Contractors/ FME
2.36.
III-IV
Minimum negative air pressure of 7.5 Pa is monitored by a device that
constantly displays the pressure differential between the construction
area and occupied areas, continuously monitors and is connected to a
local alarm, with pressure recorded daily.
If the pressure is less than 7.5 Pa for more than four hours
(cumulative over 24 hours), or less than 2.5 Pa for more than 90
seconds, the contractor will take immediate corrective actions to
restore and maintain the required pressure differential. [CSA: 6.6.1.3,
7.3.3.3.2, 7.3.3.3.3]
Project Manager/
Contractors/ FME
2.37.
IV
Ensure that ventilation systems are working properly in adjacent
areas. [CSA 7.3.4.3(f)]
Project Manager/
Contractors/ FME
Plumbing
2.38.
All
Use gasket material that is smooth and does not promote buildup of
biofilm and scale and replace gaskets if worn or rough. [CSA:7.3.1.2]
Project Manager/
Contractors/ FME
2.39.
All
Ensure that faucet aerators are not installed or used. [CSA:7.3.1.2]
Project Manager/
Contractors/ FME
2.40.
All
Schedule water interruptions in advance and receive approval before
starting. [CSA:7.3.1.2]
Project Manager/
Contractors/ FME
2.41.
All
Maintain a dry work environment and report any water leaks through
walls or substructures. [CSA:7.3.1.2]
Project Manager/
Contractors/ FME
2.42.
All
Perform work during periods of low user activity (e.g., evenings).
[CSA 7.3.1.3]
Project Manager/
Contractors/ FME
2.43.
II-IV
Avoid using collection tanks and long pipes (which allow water to
stagnate). [CSA 7.3.2.4]
Project Manager/
Contractors/ FME
2.44.
II-IV
After construction and immediately before occupancy, disinfect water
systems, in accordance with CSA Z317.13-17 and CSA Z317.1-16,
as determined by the scope of work and the MDT. [CSA 6.8.1; CSA
6.7.10]
Project Manager/
Contractors/ FME
2.45.
IV
Plumbing and HVAC systems shall be supplied, installed, and
commissioned in accordance with CAN/CSA-Z317.1, CAN/CSA-
Z317.2, and CAN/CSA-Z8001. [CSA 7.3.4.10]
Project Manager/
Contractors/ FME
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Preventive Measures for Construction, Renovation and Maintenance Activities
October 2021 (Updated May 2022) Page 15 of 26
Item
Level
2.0 Preventive Measures - During Construction
Responsibility
Comments
Site maintenance
2.46.
All
Report discoloured water and water leaks to maintenance and
infection prevention and control personnel. [CSA 7.3.1.5; 7.3.3.9]
Environmental
Services/
Healthcare Staff
2.47.
II-IV
Place supplies and equipment in covered containers during
transportation through the healthcare facility to prevent
contamination in other areas. [CSA 7.3.2.5.1(c)]
Wipe the wheels of mobile equipment, transport carts, and bins
before entering occupied areas. [CSA 7.3.2.5.1(d)]. Equipment,
carts, and bins should be clean before entering occupied areas.
Project Manager/
Contractors/ FME
2.48.
II-IV
Remove the debris in the evening when patients are in their rooms
and visitors have left. If this is not possible, debris should be
removed at the end of the workday. Exposure of the occupants of
the healthcare facility to debris shall be minimized. [CSA 7.3.2.5.2]
Project Manager/
Contractors/ FME
2.49.
II-IV
Place debris in covered containers or cover it with a moistened sheet
before transporting it for disposal [CSA 7.3.2.5.1(b)]. Containers
should be clean before entering occupied areas.
Project Manager/
Contractors/ FME
2.50.
II-IV
Clean the construction area with a HEPA filter-equipped vacuum
cleaner, a wet mop, or both, as necessary. [CSA 7.3.2.5.1(a)]
Project Manager/
Contractors/ FME
2.51.
III-IV
MDT shall be responsible for collaboration with the environmental
services staff to ensure that the construction area is thoroughly
cleaned when work is complete. [CSA 7.3.3.8]
Project Manager
MDT
2.52.
III-IV
Environmental services staff shall:
a. increase the frequency of cleaning in areas adjacent to the
construction area while the project is underway;
b. wet mop and vacuum the area with a HEPA filter-equipped
vacuum cleaner as necessary and when the work is
complete (See Item 3.5 for Return to Service Cleaning);
c. wipe exposed surfaces with a hospital-grade disinfectant.
[CSA 7.3.3.7.2]
Project Manager/
MDT/
Environmental
Services
2.53.
III-IV
The MDT shall designate responsibility for maintaining cleanliness
outside the work area. A HEPA filter-equipped vacuum cleaner shall
be used every day or more frequently if necessary. [CSA 7.3.3.7.1]
Project Manager/
Contractors/ FME
2.54.
III-IV
A designated member of the MDT shall regularly visit (frequency
determined by the MDT) the construction area to confirm preventive
measures are being followed, including inspecting the integrity of
dust barriers, and document findings. Review at the regular
meetings of the MDT(Refer to Form 5). [CSA: 7.3.3.8, 7.3.4.7,
7.3.4.8]
Project Manager/
Contractors/ FME
MDT
2.55.
III-IV
Ensure patients, staff, and visitors do not go into or through the
construction area. [CSA 7.3.3.9]
Healthcare Staff
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October 2021 (Updated May 2022) Page 16 of 26
Item
Level
3.0 Preventive Measures - After Construction
Responsibility
Comments
3.1.
All
Environmental Services and healthcare staff shall report
discoloured water and water leaks to the maintenance and
infection prevention and control departments. [CSA 7.4.2.2(b)]
Environmental
Services/
Healthcare Staff
3.2.
All
The MDT shall review the preventive measures that were
undertaken and assess their effectiveness.
Project Manager
MDT
3.3.
II-IV
The MDT shall conduct a final inspection to ensure that the
ventilation system is functioning properly in the construction area
and adjacent areas. [CSA: 7.4.2.1]
Project Manager
MDT
3.4.
II-IV
The constructor shall ensure that the construction area has been
cleaned with a HEPA filter
-equipped vacuum cleaner, a wet mop, or
both, as necessary, and that horizontal work surfaces have been
c
leaned. [CSA 7.4.2.2 (a)]. For new construction projects, this is
completed before hoarding is removed [8.3.5.1.5]. The need for
additional facility environmental services
pre-hoarding removal cleaning will be determined by the MDT.
Environmental
Services/
Healthcare Staff
3.5.
II-IV
MDT shall ensure that the construction area has undergone
“Return to Service Cleaning” before building occupants are allowed
to occupy the new space. The cleaning shall be performed by the
facilit
y’s environmental services department or designated
alternative cleaning contractor using a cleaning procedure
approved by the MDT. [CSA 7.4.2.3]
Project Manager
MDT
3.6.
IV
Before patient or staff occupancy of the construction project work
area is permitted, a project infection control work plan completion
debrief shall be completed. If the commissi
oning process identifies
any uncompleted work from the infection control plan, this shall be
listed as a project deficiency. [CSA: 7.3.4.11]
Project Manager/
Contractors/ FME
3.7.
IV
The engineering or operations and maintenance staff or
constructors shall ensure that the construction area is free of
equipment and debris.
Project Manager/
Contractors/ FME
3.8.
IV
Before the completed construction area is occupied, any parts of
the infection control plan still in effect shall be reviewed by the
MDT. If necessary, such parts shall be incorporated into the
healthcare facility’s ongoing operating policies and procedures.
[CSA 7.4.3]
Project Manager
MDT
3.9.
IV
Complete the post construction checklist (See Form 6).
Project Manager
MDT
Additional comments:
Approval (print name and sign)
Date
Project Manager:
Facilities Maintenance & Engineering:
Contractor:
Infection Control Professional:
Clinical Representative:
Other:
Other:
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October 2021 (Updated May 2022) Page 17 of 26
Form 5: Infection Prevention and Control Construction Site Monitoring Tool
This form is used for compliance and quality monitoring by the infection control professional or other member of the
multidisciplinary team to monitor preventive measures required during construction/renovation activities.
Project:
Date/Time:
N/A means not applicable or not observed
Preventive Measure Compliance Comments
Barriers
ICRA is posted for the area
Yes No N/A
Construction signs posted for the area
Yes No N/A
Doors properly closed and sealed
Yes No N/A
Floor area clean, no dust tracked
Yes No N/A
Walk-off mats clean/free of debris
Yes No N/A
Tape adhering to surface
Yes No N/A
Hoarding Intact
Yes No N/A
Air handling
All windows closed behind barrier
Yes No N/A
Negative air monitored at entrance (7.5 Pascal)
Yes No N/A
Construction Air Handling Unit running
Yes No N/A
Current maintenance label visible
Yes No N/A
Air exhausted to appropriate area/outside
Yes No N/A
Project area
HEPA-filtered vacuum on job site
Yes No N/A
Debris removed in covered container daily
Yes No N/A
Designated construction route/map posted
Yes No N/A
Trash in appropriate container
Yes No N/A
Routine cleaning done on job site
Yes No N/A
Air vents sealed/duct work capped
Yes No N/A
Traffic control
Restricted to construction workers and necessary staff only
Yes No N/A
All doors and exits free of debris
Yes No N/A
Dress code
Is appropriate for the area (OR, MDRD, L&D, etc.)
Yes No N/A
Protective clothing worn when required
Yes No N/A
Workers clothing clean on exiting work space
Yes No N/A
Reported to:
Signature:
Reported to contractor:
Contractor signature:
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Preventive Measures for Construction, Renovation and Maintenance Activities
October 2021 (Updated May 2022) Page 18 of 26
Form 6: Infection Prevention and Control Post Construction Checklist
This form is used by Infection Control Professional or their Designate to ensure the post construction area is ready for patient/
staff occupancy.
Item/Action
All work is
completed:
List deficiencies
or comments:
Date
Completed
Yes No N/A
Post construction cleaning
Before hoarding removal, job site is clear of dust, construction debris/
equipment. Area has been cleaned, including HEPA vacuuming and/or wipe
down of surfaces including hoarding to remove dust.
Facility based cleaning (e.g. environmental services) performed prior to
hoarding removal (if required by the MDT).
After removal of hoarding, contractor completes final construction cleaning
followed by facility based Return to Service cleaning.
Where required, HVAC ductwork cleaning has been performed
Finishes
Area is dust free (all horizontal surfaces, headwalls, ledges, inside of
cabinets, drawers, tops of clocks etc.).
Hand hygiene dispensers filled and functioning and properly located.
Hand drying paper towels available and properly located.
Provisions for sharps and proper personal protective equipment supplies
Integrity of walls/ceiling tiles are maintained e.g. not stained or damaged.
Surfaces in patient care/procedure/service areas are appropriate (e.g.
smooth, nonporous, water resistant)
Area surfaces are free of fissures or open joints and crevices that retain or
permit collection of debris or facilitate bacterial and fungal growth.
Infrastructure
If plumbing has been affected/shutdown plumbing has been flushed,
superheated or hyperchlorinated, as determined by the MDT.
Verified by: (name and position, required if applicable)
Plumbing if affected has been checked for leaks.
Verified by
(name and position, required if applicable)
Correct hand washing sinks/faucets present, properly located, and functioning
Faucet aerators are NOT present in patient care areas.
Ceiling tiles are in place, well approximated and not stained.
HVAC systems are clean, function restored, balanced and verified.
Verified by : (name and position required if applicable)
Correct room pressurization (negative or positive)
Verified by: (name and position required if applicable)
All mechanical spaces, including ceiling space should be cleaned of dust and
debris.
Other
:
Project Name:
Location:
Date:
Preventive Measures Required:
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Healthcare Facility Infection Control Risk Assessment and
Preventive Measures for Construction, Renovation and Maintenance Activities
October 2021 (Updated May 2022) Page 19 of 26
Appendix A
Sample table of contents for an infection control plan
[CSA Z317.13-17, Annex D]
1. Introduction
Plan overview
Purpose of the plan
Objectives
Scope
2. Standards, criteria, additional references
References to CSA Group Standard(s)
Additional References
3. Definitions and abbreviations
4. Key responsibilities
Constructor/prime contractor/design builder
Constructor project representatives
Construction/project managers, site superintendent(s)
Plan administrator
Industrial hygienist (infection control specialist)
Healthcare facility staff (medical/nursing)
Healthcare facility – Facilities, maintenance, and operations (FM&O)
Site joint health and safety committee
Assistant superintendents/foremen
Safety personnel (e.g., CSO, project safety coordinator)
Workers
Subcontractors
Construction material suppliers
Visitors, other suppliers, consultants
5. Communication and reporting
Project organizational chart
MDT members
Reporting requirements and protocols
Reporting hierarchy
Communication means and methods
Non-compliance/disciplinary action
6. Risk identification, factors, and assessment
Risk factors
Risk groups
Contamination/infection sources
Contamination factors
Infection control risk assessments (preventive measures analysis)
7. Risk prevention measures and controls
Proper material handling
Infection Control Risk Assessment (ICRA) and
Preventive Measures Toolkit for Construction, Renovation and Maintenance
Preventive Measures for Construction, Renovation and Maintenance Activities
October 2021 (Updated May 2022) Page 20 of 26
Appendix B
Stop Work Order Protocol
Monitoring of construction activity is a shared responsibility between all members of the project
multidisciplinary team. A written protocol for a Stop Work Order shall be identified before
beginning construction. Stop Work Order may be used when unresolved non-compliance to
preventive measures is identified by a member of the project MDT.
Who issues a Stop Work Order?
Stop work orders are issued by the Project Manager, Project Coordinator or FME Designate.
Process for issuing a Stop Work Order:
In the event of a breach, follow the instructions for emergency notification of the Project Leads as
identified on the Emergency contact sheet (for both during business hours and outside of business hours)
posted on the outside of the hoarding.
Notify the on-site Contractor/FME worker that you have identified a breach and are issuing a Stop
Work Order.
Complete a Monitoring Tool identifying the exact nature of the breach.
Notify Project Manager/FME site lead as soon as possible.
The Project Manager/FME site lead will investigate the breach and ensure that remediation is
complete prior to authorizing resumption of activity.
All breaches and Stop Work Orders will be reviewed at the next regular construction team
meeting.
Minor breaches in preventive measures that can be rectified immediately (e.g., ECU door left open,
scant amount of debris/dust visible outside of ECU, absence of covered container for disposal of
materials) do not require a Stop Work Order.
Major breaches in preventive measures (e.g., ECU not in place, moderate/ large amount of debris/dust
visible outside of ECU, HEPA-filter vacuum or damp mop not present, patient in room, appropriate dress
code not being followed) or situations that pose a safety risk to persons in the building do require a Stop
Work Order.
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Healthcare Facility Infection Control Risk Assessment and
Preventive Measures for Construction, Renovation and Maintenance Activities
October 2021 (Updated May 2022) Page 21 of 26
Appendix C: Plenum Box Position Statement
Infection Prevention and Control
Healthcare Facility Infection Control Risk Assessment and
Preventive Measures for Construction, Renovation and Maintenance Activities
October 2021 (Updated May 2022) Page 22 of 26
Infection Prevention and Control
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Preventive Measures for Construction, Renovation and Maintenance Activities
October 2021 (Updated May 2022) Page 23 of 26
Glossary
Adjacent areas: all of the areas surrounding an area where construction, renovation, or maintenance
work is occurring, including, where applicable, all or part of the floors above and below.
Anteroom: a small room that is immediately adjacent to or within a construction area and is intended to
be used by constructors for purposes such as storage or removal of protective clothing, cleaning of
debris-removal containers, and/or removal of contaminants from footwear.
Commissioning (commissioning process): a systematic verification, documentation, and training
process applied to all activities during the design, construction, static verification, start-up, and functional
performance testing of equipment and systems in a facility to ensure that the facility operates in
conformity with the owner's project requirements and the basis of design in accordance with the contract
documents.
Construction: major and minor facility activities that disturb or modify facility structures and systems, the
term includes not only construction but also renovation, maintenance, and repair work.
New construction: construction to produce all or part of an HCF that did not exist before the project.
Renovation: construction to modify or upgrade an existing HCF to be used for similar purposes.
Construction air handling unit (CAHU): a machine used to move HEPA-filtered air into or out of a
construction site.
Construction clean: cleaning performed at the end of a workday by construction workers that removes
gross soil and dirt, construction materials, and workplace hazards.
Note: Cleaning to the “construction clean” level may include sweeping and vacuuming, but usually does
not address horizontal surfaces or areas adjacent to the job site.
Constructor: a person who undertakes a construction or renovation project for an owner. A constructor can
be a contractor, subcontractor, construction manager, construction worker, or tradesperson. The term also
includes an owner who personally undertakes all or part of a construction or renovation project.
Continuing care: a range of services that support the health and wellbeing of individuals living in their
own home, a supportive living or long-term care setting. Continuing care clients are defined by their need
for care, not by their age or diagnosis or the length of time they may require service.
Critical care area: a patient care area where the induction and maintenance of general anaesthesia
routinely occurs in connection with the examination or treatment of patients, or where contact between
patients and medical electrical equipment is frequent or normal.
Environmental services: HCF services (e.g., general housekeeping, waste management, pest control,
and hazardous material cleanup).
HEPA (high-efficiency particulate air) filter: an air filter with an efficiency of 99.97% in the removal of
airborne particles 0.3 μm or larger in diameter.
Infection control risk assessment (ICRA): a process used to identify design elements that increase the
risk of microbial transmission in the environment.
Note: An ICRA considers the facility’s patient population and clinical programs, and the potential effects
of disruptions to essential services (e.g., water, ventilation, electricity) that could affect patient placement
or necessitate relocation of patients.
Inpatient: an HCF patient who occupies a bed for at least one night in the course of treatment,
examination, or observation.
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October 2021 (Updated May 2022) Page 24 of 26
Inpatient area: an area in the HCF specifically intended for the accommodation of inpatients.
Note: Examples of inpatient areas: critical care, maternal and newborn, medical-surgical inpatient, mental
health services, pediatric and adolescent inpatient, and rehabilitation care.
Maintenance: a type of construction activity conducted to preserve the condition and functionality of a
physical element of a health care facility. See Construction
Note:
1) Maintenance can be performed by an equipment supplier, contractor, or facility-based
operation and maintenance staff.
2) The term “maintenance” also covers repairs.
Multidisciplinary team (MDT): a group comprising representatives from various disciplines in the health
care facility that works with the project management team and others to ensure that the appropriate
infection prevention and control measures are followed during construction activities.
New construction: a project intended to produce a complete health care facility, or a new section of an
existing facility, that did not exist prior to the project.
Patient: a person who is waiting for or undergoing medical investigation, care, or treatment.
Note: This Standard uses “patient” as a global term applying to all HCFs. Some HCFs prefer to use
alternative terms such as client, resident, or occupant.
Patient care area: an area used primarily for the provision of diagnosis, therapy, or treatment.
Personal protective equipment: items that when worn correctly form a barrier or shield against
hazardous materials.
Plumbing dead leg: a pipe or other plumbing component or system that has contained, contains, or
likely will contain stagnant water.
Plenum box: an air distribution box designed with the intent to baffle the air discharged from a CAHU,
reducing channeled air from turbulent to laminar flow, while providing additional HEPA filtration.
Preventive measure: a system involving precautionary actions, equipment, and barriers at each phase
of a project to decrease the spread of contaminants during construction, renovation, or maintenance of a
health care facility.
Preventive measures analysis: the process of evaluating construction-related risks to patients and staff
and determining the preventive measures that will be necessary to mitigate those risks.
Renovation: see Construction.
Return to Service Cleaning: the thorough cleaning of a clinical space following construction and before
the space is used for patient care, medical equipment, or the storage of clean or sterile supplies, in order
to remove contaminating micro-organisms that could be acquired by subsequent occupants or staff.
Unoccupied space: an area where there are no patients or patient-related activities and that is absent of
any medical supplies or equipment. Unoccupied spaces may include vacant wards, basements, shelled
spaces for future development, or spaces only accessed for equipment servicing. Patient care areas that
are intermittently unoccupied due to designated working hours are not considered unoccupied spaces.
User: person occupying or performing an activity in a building, area, or room intended for that purpose
(e.g., diagnosis, treatment, waiting, dining, etc.).
Infection Prevention and Control
Healthcare Facility Infection Control Risk Assessment and
Preventive Measures for Construction, Renovation and Maintenance Activities
October 2021 (Updated May 2022) Page 25 of 26
Walk-off mat: a specially designed mat that is placed outside a construction area or in an anteroom and
is intended for removal of contaminants from the footwear of workers.
Note: Walk-off mats include, for example:
a) mats for removal of sand and winter road salt;
b) mats with a sticky surface;
c) sections of carpet made with synthetic fibers; or
d) antibacterial mats that include a frame allowing for placement of antibacterial solutions.
Infection Prevention and Control
Healthcare Facility Infection Control Risk Assessment and
Preventive Measures for Construction, Renovation and Maintenance Activities
October 2021 (Updated May 2022) Page 26 of 26
References
Canadian Standards Association. Z317.1-16. Special requirements for plumbing installations in health
care facilities. 2016.
Canadian Standards Association. Z317.13-17. Infection control during construction, renovation and
maintenance of health care faciltiies. 2017.
Canadian Standards Association. Z317.2-15. Special requirements for heating, ventilation, air
conditioning (HVAC) systems in health care faciltites. 2015.Canadian Standards Association.
Z317.2-15. Special requirements for heating, ventilation, air conditioning (HVAC) systems in health
care faciltites. 2015.
Canadian Standards Association. Z8000-18. Canadian health care faciltities. 2018.
Facility Guidelines Institute. Guidelines for Design and Construction of Hospitals Chicago, IL.: American
Society for Health Care Engineering of the American Hospital Association; 2018. 411 p.
Johnson L. Construction and Renovation. In Grota P., et al, eds. APIC Text Online. 2015. Available at
http://text.apic.org/
. Accessed April 12, 2019.
