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Step Three : Match the construction activity type with the patient risk group on the Construction Class Matrix to establish the construction class.
Construction Class Matrix
Oncology Hematology Units Outpatient clinics for patients with cancer
All Operating Rooms NICU
ICU HDU
SCN All cardiac catheterization Angiography areas
Sterile processing rooms Pharmacy admixture rooms
All endoscopy areas
Group Four Highest Risk
Risk Group
Group One Group Two
Group Three Group Four
Construction Activity
Type A I
I I
I-III Construction
Activity Type B
II II
III IIIIV
Construction Activity
Type C II
II III
IIIIV Construction
Activity Type D
IIIIV IV
IV IV
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Step Four : Required Infection Control Precautions by Class During Construction Project
Execute work by methods to minimize raising dust. Immediately replace a ceiling board displaced
for visual inspection. Provide active means to prevent airborne dust
from dispersing into atmosphere. Water mist work surfaces to control dust while
cutting. Seal unused doors with duct tape.
Block seal air vents. Place dust matt at entrance exit of work area.
Remove or isolate HVAC system in areas where work is being performed.
Remove or isolate HVAC system where work is being done to prevent contamination of duct
system.
Complete all critical barriers i.e. plywood, plastic to seal area from non-work area.
Maintain negative pressure within work site using HEPA equipped air filtration units.
Contain construction waste before transport in tightly covered containers.
Cover transport carts. Isolate HVAC system.
Complete all critical areas. Maintain negative pressure within work site with
HEPA filters. All personnel entering work site are required to
wear shoe covers.Shoe covers must be removed upon exit.
Class I
Class II
Class III
Class IV Upon Completion of Project
Clean work area upon completion of task.
Clean work surfaces with hot water and detergent.
Contain construction waste before transport in tightly
covered containers.
Wet mop or vacuum with HEPA-filtered vacuum before
leaving work area.
Remove isolation of HVAC system in areas where work is
being performed.
Remove barriers only after work is completed site inspection
done by Project Consultant Engineer.
Remove barrier materials carefully to minimize spreading
of dirt debris.
Wet mop area with hot water detergent.
Remove isolation of HVAC system in areas where work is
being performed.
Remove barrier material carefully.
Contain construction waste. Cover transport carts.
Vacuum work areas with HEPA- filtered vacuums.
Wet mop area. Remove isolation of HVAC
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10.2.1 Introduction
The function of operating theater ventilation system is to prevent airborne microbial contaminants from entering surgical wounds. Under normal circumstances, source
of airborne microbial contaminants are skin fragments released by staffs working in the theater. A proportion of these skin scales are contaminated with the normal skin
flora 20 are Staphylococcus aureas The rate of dispersions is increased in movements and number of individuals present in the theater.
10.2.2. Types of Operating Theaters
• Conventionally ventilated theater
• Ultraclean ventilated Theaters
10.2.3 Indication for Air Sampling
• On completion of new OT building
• On completion of repair work done in the OT complex
• During investigation of Infectious Disease Outbreak
10.2.4 Planning for Infection Control Commissioning Re-commissioning
1. Receiver request to perform commissioning from authorized personnel 2. The following conditions have been met:
• All new and refurbished work has been completed
• All engineering commissioning procedures has been completed
• Full clean of all surfaces must be completed. x3
• Ventilation system has been running continuously for 24 hours must not in
setback setting •
The OT must not be use during this time and no one allowed to come in during the sampling process
3. Get information on OT conditions from Support Service Maintenance •
Temperatures in the OT and related adjacent rooms i.e Scrub room, anesthetic room, preparation room, disposal room corridor
• Humidity in OT room
• Pressure differentials between the rooms
• Air changes within each OT
4. Inform the OT Sister when the commissioning is to take place.
10.2 Operation Theatre Commissioning
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10.2.5 Air Sampling
10.2.5.1 Preparation
• Get the advice of Clinical Microbiologist Science officer prior to commissioning
owing to the large factors that affect microbial air sampling results. •
Prepare the air sampler
o Fully charge the battery o Get the sieve cap autoclaved a day before the process
o Order the required number of culture plates required for sampling process
Nutrient agar Blood agar •
Change into clean OT attire Sterile OT gown will have little effect on dispersions as the time gap between leaving the theatre and taking sample will cause
dilution of the air in the OT •
Prepare the sampling materials outside the OT. Clean the surface of a trolley with alcohol swabs, place a sterile wrapping paper. Place the sterile sieve
cap, sterile gloves and alcohol swabs on a sterile gallipot on the trolley. •
Set the timing of the Air sampler to 10 minutes to sample optimally a volume of 1,000 liters of air. A shorter time will be allowed but the number of colonies
isolated will be multiplied by a constant factor follow manufacturer’s instructions. The sample volume should not be less than 250 liters of air and
not more than 1,000 liters as it will cause the agar to dry off.
10.2.5.2 Sampling method
• The number of samples taken depends on consensus of the ICCT. A single
sample collected from each OT would be adequate if all the OT parameters are within normal range and there are no obvious defects seen.
• Only one staff shall set up the air sampler in the OT to minimize dispersion
contamination. •
The air sampler should be placed in the middle of the OT table or secured on a trolley where the theater table is usually located.
• Using aseptic technique, place the culture plate into the air sampler.
• Once the air sampler has been set, the staff should leave the OT and close
the door. •
Allow a few minutes gap to clear the air and using a remote or extension wire, start the air sampler.
• All doors must be closed and the theater empty until sampling is completed.
• Once the air sampler has stop, remove the plate and carefully place the cap,
lable the plate. OT namenumber, date, volume of air if not standardized •
Once completed immediately send all the plates in the closed carrier container to the Microbiology laboratory.
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10.2.5.3 Microbiology
• Check the plates label and the request form together with the ICN who perform
the sampling. •
Incubate the plates at 37 0 C for nutrient agar and place the blood agar in the CO2 incubator with temperature at 37 0 C.
• Inspect the plates after 24 hours and count the colonies grown on each plate,
note on the work sheet. 10.2.5.4
Results and Interpretation •
Reporting: ———— colonies m 3 •
Interpretation of results: Aerobic cultures on non selective medium should not exceed 35cfum3 ventilating air.
• Fungal cultures may be indicated in some circumstances where fungal
contamination were suspected. They are not done routinely for OT commissioning. Fungal cultures not exceed 35cfum3 ventilating air
• Agar used will be Sabaurouds plus chloramphenicol and gentamicin
• Interpretations will be the same as of bacterial counts.
10.2.6 Air Flow
1. The direction of air flow between rooms in a theater suite is used to ensure that there is no backflow of air from either dirty rooms or from contaminated areas in
the hospital. 2. The ICN should carry out airflow visualization smoke testing
• To observe for turbulent airflow particularly around the position of the OT table
• Any backflow from the OT to adjacent rooms anesthetic room, scrub room,
disposal room, corridor 3. Method: Smoke tube follow manufacturers recommendation
• Break one end of the tube and attached it to the rubber bulb, then break the
other end. •
Press the bulb to create a puff of smoke, observe the existence of the smoke, it should dissolve within seconds of its creation under the air curtains.
• Observe for any air turbulence under the air curtains, watch for the airflow at
each of the 4 quadrants. •
Near each door connecting to the adjacent room, press the bulb again to create a puff of smoke and watch for its direction with door closed and opened
slightly. 4. Particle count
• Charge the battery of the counter before the commissioning takes place
• Check whether it is functioning.
