Construction, redevelopment and the built environment

Construction, redevelopment, and the built environment – Integration of Infection Prevention and Control (IPC) principles guideline

Extensive planning and consultation are required for redevelopment activities, including new builds to include features that support good IPC practices and remove IPC risks that may cause harm. Infection Prevention and Control Professional (IPCP) input is fundamental in all stages of redevelopment within a healthcare facility. It is vital IPCP input is not overlooked or compromised throughout the lifecycle of the project. Failure to assess IPC risks properly can lead to expensive redesign and exposes patients, staff, visitors, and other users of the healthcare system to infection-related harm.

Guideline for construction, redevelopment and the built environment (PDF 572 kB)

Building and refurbishment works Infection Prevention and Control (IPC) checklist

IPC is a key priority in Australian hospitals. All building, refurbishment, and maintenance activities within and around a healthcare facility should incorporate a formal approach to risk management. It is important to include building and refurbishment works undertaken adjacent to health services that are likely to impact patients, other users of health services, or staff.  Construction project staff MUST formally engage the services of infection prevention and control for all building and refurbishment and related activities within clinical buildings or a hospital and its grounds.

The building team responsible for construction or redevelopment should submit a formal Construction and Redevelopment Infection Control Management plan (CR-ICMP), which includes a detailed summary of IPC risk mitigation strategies to be utilised throughout the project.

It is recommended infection prevention and control services or designated person/s:

  • Complete the Infection Prevention and Control (IPC) Building and refurbishment works checklist (PDF 277 kB) for all building and refurbishment work to monitor the application of IPC recommendations.
  • Ensure relevant authorised personnel sign IPC Building and refurbishment works checklist and file appropriately with the builders Construction and Redevelopment Infection Control Management plan (CR-ICMP).
  • Monitor IPC recommendations for the duration of project and update as required.

Construction action plan compliance audit

The Construction action plan compliance audit (PDF 1061 kB) can be used to document site inspections.

Information regarding construction and redevelopment

  • Infection risks associated with construction and redevelopment

    Many types of fungi and bacteria can be disturbed during demolition and construction in healthcare facilities. This increases the risk that immune compromised patients will develop invasive infections such as Aspergillosis.

    Organisms that can be implicated in human disease during demolition and construction (list not exhaustive)

    Aspergillus species (A. fumigatus,
    A. flavus, A. niger, A. terreus,
    and A. nidulans)

    Bacillus species

    Legionellae
    Scedosporium
    Histoplasma capsulatum

    Coccidioides immitis
    Pneumocystis carinii
    Mucorales     (e.g., Rhizopus)
    Fusarium species

    Patient risk

    Most people are exposed to fungus such as Aspergillus at some time during their lives, but never develop an infection. Aspergillus spores are often present in the air and carried on wind currents from environmental sources. Healthy people usually inhale these spores without becoming sick. However, for patients who are immunocompromised, increased concentrations of Aspergillus spores in the air because of construction works may lead to severe invasive fungal infection. Such infections pose an increased risk of mortality for these patients.

    Patients at highest risk are:

    • neonates and infants,
    • receiving immunosuppressive or cytotoxic therapy,
    • transplant recipients,
    • HIV infection, and
    • those with granulomatous disease.

    The incubation period can be a few days to months. Common clinical presentations include pneumonia, sinusitis, or invasive aspergillosis or other invasive fungal infection. Aspergillus is not spread person to person.

    Preventing infection risks with construction and redevelopment

    While all steps will be taken to reduce environmental risks posed by construction activities, dust may still be generated during this work. Please report any concerns you identify with dust to your line manager and the Infection Prevention and Control team.

    Staff should never enter construction zones unless authorised.

    Refer to Table 1 for information regarding individual risk factors to consider. All patients in categories 2-4 should wear a surgical mask when travelling in or out of the facility through any external zone impacted by construction.

    Additionally, patients at increased risk of invasive fungal infections as per Table 1 (Category 2-4), where practicable, may need to be moved to an area well away from the works. Patients at the highest risk (Category 4), may need to be placed into a HEPA filtered positive pressure room or unit.

    A high index of suspicion for the diagnosis of fungal infections such as Aspergillosis should be maintained for those persons identified as being at risk (Category 2-4) and ongoing surveillance through clinical and microbiological/histological specimen.

    Individual risk factors to consider for invasive fungal infection

    Category 1

    • Staff members, service providers and contractors.
    • All patients not listed in Groups 2 - 4 below.

    Category 2

    • Patients on prolonged courses of high dose steroids particularly those hospitalised for prolonged periods.
    • Severely immuno-suppressed patients living with HIV.
    • Patients undergoing mechanical ventilation.
    • Patients having chemotherapy who are not neutropenic.*
    • Dialysis patients.

    *Neutropenia defined as absolute neutrophil count (ANC), <1x109/l

    Category 3

    • Neutropenia* for less than 14 days following chemotherapy.
    • Solid organ transplantation.
    • Neonates in intensive care units (ICU).

    *Neutropenia defined as absolute neutrophil count (ANC), <1x109/l

    Category 4

    • Allogenic bone marrow transplantation: within 12 months of transplant; if >12 months, consult with haematologist.
    • Autologous peripheral blood stem cell transplantation, i.e., during the neutropenic period.
    • Prolonged neutropenia for greater than 14 days following chemotherapy or immunosuppressive therapy: e.g., acute myeloid leukaemia (AML), acute lymphoblastic leukaemia (ALL), Burkitt’s lymphoma, lymphoblastic lymphoma, primary CNS lymphoma.
    • Aplastic anaemia patients.
    • Children with:
      • Severe Combined Immunodeficiency Syndrome (SCIDS).
      • Chronic Granulomatous Disease of Childhood (CGDC).

    *Neutropenia defined as absolute neutrophil count (ANC), <1x109/l

  • Infection risks associated with construction and redevelopment

    Any demolition or construction activities in hospitals and healthcare services can increase the risk of infections to patients or visitors. Organisms that may cause harm to patients, such as fungi, are usually found in soil, water, the natural environment and within the fabric and spaces of buildings. These organisms are disturbed during construction activities.

    Healthy people who come into contact with these organisms usually do not develop an infection, but patients who have poor immune function can become very unwell. Many people that receive care in hospitals and healthcare services are at high risk of developing an infection.

    Preventing infection risks with construction and redevelopment

    Everyone has a role in preventing infections in hospital and healthcare services.

    Actions to prevent infection include:

    • Perform hand hygiene on entry and exit to healthcare services.
    • Avoid spreading dust and debris from the construction zone. Do not wear dusty clothes and shoes from construction zones in the healthcare facility. Boot covers may be useful.
    • Use water misting during demolition and excavation.
    • Regularly clean the worksite, particularly when within a healthcare facility to stop dust from spreading. Always use damp mops/cloths and vacuum cleaners with a HEPA filter when cleaning.
    • Always clean construction hoarding prior to removal to reduce spread of dust.
    • Repair any faults with construction hoarding as soon as they are identified.
    • Replace sticky mats regularly.
    • Securely cover waste prior to removal.
    • Ensure appropriate signage and security to prevent unauthorised entry to construction zones.
    • Report difficult to contain dust to your supervisor.
    • Be fully vaccinated.

    Contact your site Infection Prevention and Control team if you have any questions.

Queensland capital infrastructure requirements (CIR)

Queensland Capital Infrastructure Requirements have been moved to Queensland Health Capital Infrastructure (CI) requirements (internal Queensland Health link)

A number of other documents may be useful when assessing and planning IPC mitigation strategies.

Queensland development code

Queensland Development Code: Private Health Facilities Part MP 5.5 outlines the building requirements for private health facilities. The purpose of this standard is to facilitate the safety and care of patients and the safety of staff and the public in private health facilities.

Interstate and national guidelines

International guidelines

Water risk management

Refer to the requirements for water risk management in healthcare facilities.

Last updated: 14 November 2024