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Policies and Procedures on Infection Control Ministry of Health Malaysia 153

10.1.1 Introduction

Construction and renovation activities in the hospital may be associated with transmission of pathogens such as filamentous fungi , including Aspergillus spp, Candida spp , Fusarium and also bacteria such as Legionella and Nocardia. The most commonly reported hospital contruction-related infection is Aspergillus, which represent the greatest threat to neutropenic patients. Construction and renovation activities in the hospital facility are associated with variable levels of risks to the patients and it is important to understand what these risks are. Activities that are associated with significant generation of dusts create appreciable risks to mainly immune compromised patients such as oncology, bone marrow transplant, burns and intensive care units such as NICU and ICU. Examples of these construction activities include new construction projects and major demolition of buildings. These activities create a lot of dust which may carry aspergillus spores. Moderate levels of dust may be associated with activities such as sanding of walls prior to painting, construction of new walls and major cabling activities. Inspection and noninvasive activities such as removal of ceiling board for visual inspection, painting and minor plumbing works are low risk activities that generally cause minor generation of dusts. Patients who are at risk should be identified prior to the construction and renovation activities. Immunocompromised and ventilated patients are at high risks of construction-associated aspergillosis. These include cancer patients, transplant patients, neonatal intensive and adult intensive care patients and patients in the operating theater. Medium risk patients include endoscopy, cardiology, radiology and physiotherapy units. Office areas pose low risks to patients. Pre-construction and renovation consultation should be carried out in advance between all the stakeholders, including hospital management, infection control unit, microbiology unit, security unit, project architects and engineers and the contractor. This will help to identify the scope and nature of work and also to assess the degree of risks and potential patient groups that may be affected. Close monitoring of filamentous fungi isolation rates, especially aspergillus by the microbiology laboratory and prompt feedback to infection control units may be helpful to implement control measures. Procedures to contain or minimize dispersal of dust are necessary during construction activities. Examples include physical partitioning, rerouting of human traffic away from work areas, wet mopping and door mat placement at entrance, prompt debris removal, blocking and sealing of air vents where appropriate, and use of negative pressure at the construction sites. For specific containment measures, please refer to Facility Engineering Management Services Project Operational Guidelines.

10. ENVIRONMENT

10.1 Infection Control During Construction and Renovation