put in perspective, the average human hair is 150 microns in diameter while dust
Some common names for a negative air machine include:
Red Baron® - brand name
The different names depend on geographic location, local area preference and
How to ensure negative air pressure is being
Because it is critical to keep dust
construction area, the negative air
machine must be kept running for as
long as the containment is up.
Everyone on the jobsite needs to pay
attention to the negative air
machines. There may be specific people assigned to walk through the job area
checking the function of the machines but everyone needs to be able to
recognize when a negative air machine is not operating properly. The most
obvious condition all workers need to be aware of is if the machines are not on. If
you find a machine not working, notify a supervisor immediately.
Many hospitals allow the negative air machines to be plugged into their
emergency power because they recognize the importance of maintaining a clean
work environment. If the machines are plugged into emergency power those
outlets will be coded red or orange. If you find a negative air machine unplugged,
do not assume it always goes into the emergency power. Check with your
Checking the air flow, air pressure or particle count in the air, are other methods
of determining the effectiveness of the negative air machines. These methods
will help identify if dust is escaping from the work area and entering into the clean
hospital areas. Additional training is needed if you are going to be responsible for
using one of these methods.
To keep the negative air machine functioning properly, the prefilters and filters
changed depends on the activities being performed and the contaminants in the
air. Changing the filters is the most common maintenance activity to be done on
a negative air machine. The procedures for changing the filters varies between
manufacturers, therefore, the individual manufacturer instructions should always
Good housekeeping is essential to minimizing the
spread of dust.
NOTES FOR SLIDE 55
The appearance of dust outside of
for the hospital staff. Seeing dust
outside of the work area will lead
hospital staff to think that you are not
following the ICRA Plan. It is vital
that you keep clean any visual
indicators that dust has spread.
In most cases, you will not be allowed to leave your equipment or materials
outside of the work area. This will require you to plan how you are going to have
the appropriate tools and materials in place to do your job. This may not be a
problem when you have a large work area but in cases where space is limited
you will need to coordinate your work activities with those around you.
There are a number of methods to use to keep the hospital area clean;
Sticky mats/tacky mats
Covering all trash carts when they entering/leave the work area
Covering or wrapping all equipment and construction materials
Use of HEPA vacuums
We will look at each of these in the following slide.
Sticky mats/walk off mats are used to remove dust.
The ICRA plan will often require the
use of sticky mats at the entrance
and exit of the work area. The placement of the mats depends on site specific
and preference. There is no “correct” way to have the mats at the
entrance/exit of the work area. Contractors and hospital protocols differ on their
The mats can be secured to the floor with spray adhesive (if allowed), to help
hardboard to protect the floor, and then secure the sticky mat to the hardboard
instead. Taping the sticky and walk-off mats to a hardboard or using the self-
adhesive strips on the back of the sticky mats is a common practice.
Walk-off mats are typically used in areas of high traffic to remove the gross
Walk-off mats are usually used inside the work area before you enter the
Sticky mats should be cleaned regularly. If hospital personnel see a sticky mat
common on ICRA jobs to use a lot of sticky mats.
Trash/debris removal requires special handling.
NOTES FOR SLIDE 57
When transporting trash or other
construction debris through the
hospital, the cart must have a solid
lid or be tightly covered with taped
down plastic. This prevents the dust
from escaping into the clean areas of
If materials do not fit into the trash cart, they must be cut into smaller pieces so
trash/debris in plastic and tightly tape all the seams.
The ICRA plan typically requires the wiping down of the trash cart at each end of
the trip, before it leaves the work area, and before it comes back into the hospital
from the loading dock or wherever the dumpster is located.
Try to use cleaner or disinfectant supplied by the hospit
al, so you know it’s
acceptable, and so a new or strange smell isn’t brought into the hospital from
different cleaning products.
The movement of equipment, tools and materials
Just like trash and debris carts,
equipment carts, hand trucks and other
methods for moving tools, equipment
and materials throughout the hospital
have to handled properly to prevent the
spread of dust.
Workers have to remember that the
tools they bring with them onto the job must be wiped down and cleaned before entering
the hospital. You may be required to clean your tools before you enter the job and must
definitely before you leave the work area. And don’t forget to wipe down the tool bag,
cart or container you use to carry your tools. If you use an open container to carry your
tools, it might be worth the investment to purchase a closed container. This will save you
clean before they can be brought into the hospital. Everything brought into and out of the
hospital must be cleaned before it can enter the clean area of the hospital.
Hospitals contain hazards that could affect a worker’s
health and safety.
NOTES FOR SLIDE 59
Only show the first bullet of the
PowerPoint slide. Discuss with
the class the information below.
One goal when working in a hospital is to not make the patients sick by exposing them to
What unique hazards can be found in a hospital that could affect them?
has stopped providing examples, advance the PowerPoint slide to reveal the
examples from the participant manual.
Compare the list generated by the participants with the information below.
Lead and Asbestos
Explain to the class that we are now going to look at each of these topics in more
Used needles and scalpel (surgical knife) blades are a biohazard for exposure to
bloodborne pathogens, such as hepatitis A or B (a liver disease) or HIV
There are special red plastic or metal boxes, called sharps containers, to safely
work begins. If you find a sharps
container, contact the hospital staff
to have it removed before you begin
Soiled linen such as bed sheets,
contaminated with blood or other
Some hospital laundry may be in red plastic bags or carts as a warning that it
biohazard materials or containers. That is the responsibility of hospital staff.
Do not touch wheelchairs, beds, or the like in a hospital.
You should always assume that surfaces that have been in contact with patients
might be contaminated. Spores from bacterial pathogens, such as Methicillin-
resistant Staphylococcus Aureus (MRSA) and Clostridium difficile (C. diff.), can
live for months on contaminated surfaces.
Lead and asbestos hazards may also affect workers in
Older hospitals, those built before
1980, may still contain asbestos
materials and/or lead paint, lead
solder or lead pipes.
If you believe there is lead or
asbestos in your work, notify your
Only trained and certified abatement workers can remove asbestos or lead.
It is not uncommon to find mold during hospital
NOTES FOR SLIDE 62
Does anyone know what ingredients
are needed for mold to grow?
Moisture: Mold spores need moist or damp areas to grow and reproduce.
Food: Mold spores need food
organic materials such as: carpet, fabric,
wood, and wood products, dust, paints, and wallpaper
Optimum Temperatures: Mold spores thrive in temperatures 32 and 120
90 degrees are the
Now show the second bullet of the PowerPoint slide.
Where else can mold grow?
Any answer is ok as long as the conditions for mold growth feature the three
conditions above. Remember, mold can grow on dust! Anywhere there is dust
and you have the conditions above, there can be mold growth.
The concern with mold is inhaling airborne mold spores. Exposure to mold can cause
What types of PPE would you need to wear if you were working around mold?
Any PPE example is ok as long as it falls within these categories:
Skin and Eye Protection
Radiation exposure is a concern
Nuclear medicine is also a branch of
medical imaging that uses small
diagnose and determine the severity
of or treat a variety of diseases, including many types of cancers, heart disease
and other abnormalities within the body. Hospitals have become a major source
of nuclear waste, producing and storing millions of radioactive materials each
year with no long-term disposal plan. Experts fear that such waste could pose
health hazards. Experts also fear that poor storage and disposal practices place
radioactive materials at risk of being lost or stolen, with potentially grave health
MRI scanners create extremely strong magnetic fields that can disrupt implanted
medical devices like pacemakers, cochlear implants, or insulin pumps. Workers
who have any of these devices must use extreme caution if they need to work in
areas where there are MRI scanners.
When an MRI scanner is running, the magnetic force can pull metal materials
into the magnet. Get too close, and an MRI’s magnet can pull a watch off your
arm, rip a tool out of your hand, or even pull something as big as a vacuum
cleaner or floor buffer across the room.
Remember, an MRI machine usually runs continuously, including after hours and
weekends, so extreme caution must be taken when you are working near them.
Pay attention to your surrounding inside the hospital.
NOTES FOR SLIDE 64
Wheelchairs, beds, and gurneys
hospital hallways. So are
housekeeping and maintenance
the hall with a patient on a gurney or
with emergency medical equipment such as crash carts or isolation carts, so you
need to pay attention to your surroundings.
Prior to and during work on roofs,
proper steps shall be taken to
ensure that workers are not exposed
to chemical, biological or radiological
materials. All exhaust systems on a
roof with potentially hazardous
exhaust should be identified with
signage/labeling or other identifying
A common system used to warn workers of hazards from roof top exhaust
they can approach an exhaust vent.
For example, level 1 would indicate it is safe to approach and safe to work on
system at any time. No hazardous constituents exhausted. An example would be
general building exhaust
Level 2 notification may indicate a potentially hazardous exhaust system meeting
minimum safety requirements. Exhaust systems meeting these requirements
have sufficient exhaust stack height and velocity to eject potential hazards
outside the building envelope. These systems are safe to approach and work
around. Actual work on the system or over the exhaust stream may require a
Level 3 indicates a potentially hazardous exhaust system that must be shut down
in order to approach the exhaust stack.
ILSM are put in place to protect the safety of patients,
visitors, and staff who work in the hospital.
NOTES FOR SLIDE 66
A hospital may decide what Interim
Life Safety Measures (ILSM) are
required for a project. ILSM usually
appear as a checklist and may
include things like exits, fire alarm
and suppression equipment and fire
safety, general safety hazards, and
ICRA precautions. This checklist
needs to be reviewed daily in most worksites.
The ILSM is one of the topics that is generally covered at a daily work safety
briefing at an ICRA worksite. Other topics include: infection control precautions
from the ICRA document, emergency plans in case of injury/fire/utility breaks,
hospital policies such as using designated areas for breaks, and proper
The hospital or your construction company may use a daily inspection checklist
to monitor Interim Life Safety Measures (ILSM) and ICRA precautions. The
checklist could include items such as: exits, fire equipment and fire safety,
general safety hazards, and ICRA precautions.
Another method for catching potential hazards before they become big problems
is to quickly scan the work area from top to bottom, from the ceiling to the floor,
looking for hazards like new holes or penetrations in a barrier, water leaks, dust
If you see something that doesn’t look right, report it to your supervisor or t
hospital ICRA supervisor. This informal method can be done by everyone on the
Ask participants to complete the handout individually, and then check their
answers with a partner. Encourage them to try and answer as many of the items
as possible without referring to the manual. If participants need help with the
answers, instruct them to use the Daily ILSM Checklist in the manual.