scope:

This Standard was developed in response to evidence of the serious health risks for patients, staff, and visitors from construction, renovation, and maintenance activities. Without the proper precautions, these activities can disperse dust particles contaminated with bacteria and fungi. The evidence led to the conclusion that early planning in construction and renovation projects must integrate infection prevention and control, engineering services, and facility design to prevent infections and minimize allergen load and other workplace hazards.

Precautionary measures during construction-related activities reduce the risk of infection (see Health Canada's Construction-related Nosocomial Infections in Patients in Health Care Facilities: Decreasing the Risk of Aspergillus, Legionella and Other Infections). In order to establish precautionary measures, health care facility personnel need to consider the type of construction, renovation, or maintenance work being undertaken and the proximity of such work to the occupants.

Construction-related infections caused by Aspergillus, Legionella, and other agents have led to serious infections and even deaths in health care facilities. Aspergillosis is acquired primarily by inhalation of fungal spores, which can lead to pneumonia following local lung tissue invasion. The fungus can also disseminate through the bloodstream to involve deep organs. Aspergillosis is difficult to diagnose and treat; consequently, there should be an emphasis on prevention and improved detection. The mortality rate for aspergillosis acquired in health care facilities (i.e., an Aspergillus infection) is between 65 and 100%, and the mortality rate for legionnaires' disease (pneumonia caused by Legionella) is between 24 and 80%, even when these infections are recognized and treated

Immunosuppressed patients, the elderly, and the very young are at greatest risk of acquiring a fungal or bacterial infection. The immunosuppressed group includes patients who have undergone bone marrow or solid organ transplants, patients receiving dialysis, patients taking immunosuppressive medications (including steroids), and oncology patients receiving chemotherapy. Appropriate mitigation measures focusing on patient safety are necessary before and throughout construction, renovation, and maintenance.

Assessing the risks to health care facility occupants and preventing and detecting fungal and bacterial infections requires a multidisciplinary team approach to

a) improve understanding of the issues;

b) identify responsibilities;

c) implement suitable avenues of communication between responsible parties; and

d) plan and implement measures to mitigate risks. 

An effective program of infection prevention and control will also work towards continual improvement by documenting the mitigation measures applied and any incidents that occur, and applying the lessons learned to future projects.