Construction challenges are amplified when working in health care settings, and area construction pros say that two primary watchwords, safety and redundancy, define success.
Safety means managing the common denominators of dust, fumes, noise, vibration and disruption, which requires a “kid-glove” construction approach when renovating and expanding facilities while they remain occupied.
Redundancy means ensuring sure vital systems aren’t disturbed or interrupted during construction.
When frail, sick and infection-susceptible patients can’t be moved or relocated, a new level of diligence is required from start to finish, said Wendy Body, senior project manager at Alvin H. Butz Inc., Allentown.
And what might seem benign to a healthy person can have disastrous consequences to someone whose health is compromised.
To reduce the risk to patients, Body said, infection control risk assessment certifications, training and workshop courses are critical to controlling these factors for workers on the job.
“These people are so susceptible to fungus, which resides in construction dust, if you would walk through dust and had it on your jacket, you could kill somebody,” Body said.
Steven L. Daniels said a recent renovation to skilled and personal care units at Lutheran Home at Topton required careful coordination and management between the construction firm and his team.
“No one can afford to vacate a facility. It almost always means a number of rooms that need to be vacant and a lot of phasing,” said Daniels, executive director for facility planning and development at Diakon Lutheran Social Ministries in Middletown, Dauphin County.
Daniels said extra precautions and longer project times stretch completion schedules and typically hike costs. Enough time, additional materials and special accommodations such as tent enclosures, barriers or temporary walls and negative air machines to remove dust particles or fumes – as well as their setup and tear-down – affect the cost of the project, Daniels said.
“There is about 25 percent more cost to a renovation project that is occupied [over] the same space that is vacant,” Daniels said.
‘SAFE HAVEN’ AREAS
Body said a critical factor during health care construction, when patients or residents must remain in place, is system redundancy.
“You have to provide interim life-safety measures, because you can’t evacuate people easily,” Body said.
She said “safe haven” areas are important to preserve. Vibration from hammering or taking down walls is also a factor in areas near procedure or operation rooms.
“You don’t want to disrupt medical gas [lines] or be disruptive to medical procedures,” she said.
Daniels said system integrity and staffing are important to monitor patients in special wards, such as memory loss or Alzheimer care units.
“We have to be very careful not to cause systems to fail or that residents are ‘eloping,’ which means wandering or getting out,” of enclosed areas, Daniels said.
Stuart Smith, spokesman for Benchmark Construction Co. Inc. in West Earl Township, Lancaster County, said safety includes keeping track of tools and materials.
“We have to keep them out of the way,” Smith said.
Smith said a recent Benchmark job required extra precautions, such as building containment walls to protect patients in a memory care unit from construction activity.
Smith said his team tries to create vacant areas or blocks of time for noisy or disruptive construction activity by working with facility staff to move residents to other areas of the campus, such as a community room that isn’t near the worksite.
Another tactic is working when residents take off-site day trips.
With aging baby boomers set to swell care facility populations over the next decade-plus, planning involves demographic monitoring to ensure vital services, such as orthopedics, cardiology and neuroscience, will be within reach.
PLANNING IS PARAMOUNT
Mark McNash is vice president of support services for Reading Health System in West Reading. He said pre-planning, as well as engaging physicians and departments during planning, is important to an efficient project and a good outcome.
“A lot of our assumptions three years ago went into the Reading Healthplex – we looked at [those need] services and what would be the best location” for them, McNash said of the $354 million project that combined new construction and renovation. The facility opened in October.
However, government regulations still trump facility expansions, creating a numbers game for building new units for personal and skilled care.
“Future planning, we can’t control,” Daniels said. “We need a certificate of need [from the Pennsylvania Department of Health] in order to build, and the state determines where there is a surplus or a shortage,” of units and services.