Step One: Using the following table, identify the Type of Construction Project Activity (Type A-D)

Step Two:  Using the following table, identify the Patient Risk Groups that will be affected. 
If more than one risk group will be affected, select the higher risk group:

Step Three:  Match the Patient Risk Group (Low, Medium, High, Highest) with the planned:
Construction Project Type (A, B, C, D) on the following matrix, to find the:
Class of Precautions (I, II, III or IV) or level of infection control activities required. 
Class I-IV or Color-Coded Precautions are delineated on the following page.

IC Matrix - Class of Precautions: Construction Project by Patient Risk

Construction Project Type

Note: Infection Control approval will be required when the Construction Activity and Risk Level indicate that Class III or Class IV control procedures are necessary.

III.B.3. Airborne Precautions Airborne Precautions prevent transmission of infectious agents that remain infectious over long distances when suspended in the air (e.g., rubeola virus [measles], varicella virus [chickenpox], Mycobacterium. tuberculosis, and possibly SARS-CoV) as described in I.B.3.c and Appendix A of the HICPAC/CDC Isolation Guideline . The preferred placement for patients who require
Airborne Precautions is in an airborne infection isolation room (AIIR). An AIIR is a single-patient room that is equipped with special air handling and ventilation capacity that meet the American Institute of Architects/Facility Guidelines Institute (AIA/FGI) standards for AIIRs (i.e., monitored negative pressure relative to the surrounding area, 12 air exchanges per hour for new construction and renovation and 6 air exchanges per hour for existing facilities, air exhausted directly to the outside or recirculated through HEPA filtration before return). Some states require the availability of such rooms in hospitals, emergency departments, and nursing homes that care for patients with M. tuberculosis. A respiratory protection program that includes education about use of respirators, fit-testing, and user seal checks is required in any facility with AIIRs. In settings where Airborne Precautions cannot be implemented due to limited engineering resources (e.g., physician offices), masking the patient, placing the patient in a private room (e.g., office examination room) with the door closed, and providing N95 or higher level respirators or masks if respirators are not available for healthcare personnel will reduce the likelihood of airborne transmission until the patient is either transferred to a facility with an AIIR or returned to the home environment, as deemed medically appropriate. Healthcare personnel caring for patients on Airborne Precautions wear a mask or respirator, depending on the disease-specific recommendations (Respiratory Protection II.E.4, and Appendix A of the HICPAC/CDC Isolation Guideline), that is donned prior to room entry. Whenever possible, non-immune HCWs should not care for patients with vaccine-preventable airborne diseases (e.g., measles, chickenpox, and smallpox).

V.D. Airborne Precautions
V.D.1. Use Airborne Precautions as recommended in Appendix A of the HICPAC/CDC
Isolation Guideline for patients known or suspected to be infected with infectious agents transmitted person-to-person by the airborne route (e.g., M tuberculosis, measles, chickenpox, disseminated herpes zoster.

V.D.2. Patient placement

V.D.2.a. In acute care hospitals and long-term care settings, place patients who require Airborne Precautions in an AIIR that has been constructed in accordance with current guidelines.

V.D.2.a.i. Provide at least six (existing facility) or (new construction/renovation) air changes per hour.

V.D.2.a.ii. Direct exhaust of air to the outside. If it is not possible to exhaust air from an AIIR directly to the outside, the air may be returned to the air-handling system or adjacent spaces if all air is directed through HEPA filters.

V.D.2.a.iii. Whenever an AIIR is in use for a patient on Airborne Precautions, monitor air pressure daily with visual indicators (e.g., smoke tubes, flutter strips), regardless of the presence of differential pressure sensing devices (e.g., manometers).

V.D.2.a.iv. Keep the AIIR door closed when not required for entry and exit.

V.D.5. Patient transport

V.D.5.a. In acute care hospitals and long-term care and other residential settings, limit transport and movement of patients outside of the room to medically-necessary purposes. Category II

V.D.5.b. If transport or movement outside an AIIR is necessary, instruct patients to wear a surgical mask, if possible, and observe Respiratory Hygiene/Cough Etiquette 12. Category II

V.D.5.c. For patients with skin lesions associated with varicella or smallpox or draining skin lesions caused by M. tuberculosis, cover the affected areas to prevent aerosolization or contact with the infectious agent in skin lesions 108, 1025, 1026, 1029-1031.
Category IB

V.D.5.d. Healthcare personnel transporting patients who are on Airborne Precautions do not need to wear a mask or respirator during transport if the patient is wearing a mask and infectious skin lesions are covered. Category II

VI.F. Use of Standard and Transmission-Based Precautions in a Protective Environment.

VI.F.1. Use Standard Precautions as recommended for all patient interactions. Category IA

VI.F.2. Implement Droplet and Contact Precautions as recommended for diseases listed in Appendix A. Transmission-Based precautions for viral infections may need to be prolonged because of the patient’s immunocompromised state and prolonged shedding of viruses

Category IB
VI.F.3. Barrier precautions, (e.g., masks, gowns, gloves) are not required for healthcare personnel in the absence of suspected or confirmed infection in the patient or if they are not indicated according to Standard Precautions

Category II
VI.F.4. Implement Airborne Precautions for patients who require a Protective Environment room and who also have an airborne infectious disease (e.g., pulmonary or laryngeal tuberculosis, acute varicella-zoster). Category IA

VI.C.1. Environmental controls

VI.C.1.a. Filtered incoming air using central or point-of-use high efficiency particulate (HEPA) filters capable of removing 99.97% of particles >0.3 μm in diameter 13. Category IB

VI.C.1.b. Directed room airflow with the air supply on one side of the room that moves air across the patient bed and out through an exhaust on the opposite side of the room 13. Category IB
VI.C.1.c. Positive air pressure in room relative to the corridor (pressure differential of >12.5 Pa [0.01-in water gauge]) 13. Category IB

VI.C.1.c.i. Monitor air pressure daily with visual indicators (e.g., smoke tubes, flutter strips) 11, 1024. Category IA

VI.C.1.d. Well-sealed rooms that prevent infiltration of outside air 13.
Category IB

VI.C.1.e. At least 12 air changes per hour 13. Category IB

III.F. Protective Environment A Protective Environment is designed for allogeneic HSCT patients to minimize fungal spore counts in the air and reduce the risk of invasive environmental fungal infections (see Table 5 for specifications) 11, 13-15. The need for such controls has been demonstrated in studies of aspergillus outbreaks associated with construction 11, 14, 15, 157, 158. As defined by the American Institute of Architecture 13 and presented in detail in the Guideline for Environmental Infection Control 2003 11, 861, air quality for HSCT patients is improved through a combination of environmental controls that include 1) HEPA filtration of incoming air; 2) directed room air flow; 3) positive room air pressure relative to the corridor; 4) well-sealed rooms (including sealed walls, floors, ceilings, windows, electrical outlets) to prevent flow of air from the outside; 5) ventilation to provide >12 air changes per hour; 6) strategies to minimize dust (e.g., scrubbable surfaces rather than upholstery 940 and carpet 941, and routinely cleaning crevices and sprinkler heads); and 7) prohibiting dried and fresh flowers and potted plants in the rooms of HSCT patients. The latter is based on molecular typing studies that have found indistinguishable strains of Aspergillus terreus in patients with hematologic malignancies and in potted plants in the vicinity of the patients 942-944. The desired quality of air may be achieved without incurring the inconvenience or expense of laminar airflow 15, 157. To prevent inhalation of fungal spores during periods when construction, renovation, or other dust-generating activities that may be ongoing in and around the health-care facility, it has been advised that severely immunocompromised patients wear a high-efficiency respiratory-protection device (e.g., an N95 respirator) when they leave the Protective Environment 11, 14, 945). The use of masks or respirators by HSCT patients when they are outside of the Protective Environment for prevention of environmental fungal infections in the absence of construction has not been evaluated. A Protective Environment does not include the use of barrier precautions beyond those indicated for Standard and Transmission-Based Precautions. No published reports support the benefit of placing solid organ transplants or other immunocompromised patients in a Protective Environment.

Standard IC.3.10
Based on risks, the hospital establishes priorities and sets goals for preventing the development of health care-associated infections within the hospital.

Standard IC.4.10
Once the hospital has prioritized its goals, strategies must be implemented to achieve those goals.
Elements of Performance for IC.4.10

1. Interventions are designed to incorporate relevant guidelines for infection prevention and control activities. Interventions are implemented which include the following (EPs 2 and 3)
2. A hospital-wide hand hygiene program that complies with current Centers for Disease Control and Prevention (CDC) hand hygiene guidelines
3. Methods to reduce the risks associated with procedures, medical equipment (Fixed and portable equipment used for the diagnosis, treatment, monitoring, and direct care of individuals) and medical devices, including the following:

• Appropriate storage, cleaning, disinfection, sterilization, and/or disposal of supplies and equipment
• Reuse of equipment designated by the manufacturer as disposable in a manner that is consistent with regulatory and professional standards
• The appropriate use of personal protective equipment

Standard IC.6.10 - As part of emergency management activities, the hospital prepares to respond to an influx, or the risk of an influx, of infectious patients.

Elements of Performance for IC.6.10        

1. The hospital plans its response to an influx or risk of an influx of infectious patients.
2. The hospital has a plan for managing an ongoing influx of potentially infectious patients over an extended period.
3. The hospital does the following:

• Determines how it will keep abreast of current information about the emergence of epidemics or new infections which may result in the hospital activating its response
• Determines how it will disseminate critical information to staff and other key practitioners

Identifies resources in the community (through local, state, and/or federal public health systems) for obtaining additional information

Standard IC.9.10
Hospital leaders allocate adequate resources for the infection control program.

Elements of Performance for IC.9.10

• The effectiveness of the hospital's infection prevention and control activities is reviewed on an ongoing basis, and findings are reported to the integrated patient safety program at least annually.
• Adequate systems to access information are provided to support infection prevention and control activities.
• Adequate laboratory support is provided to support infection prevention and control activities.
• Adequate equipment and supplies are provided to support infection prevention and control activities.