Managing construction projects can be difficult at the best of times, however, within the confines of an operational hospital - impacting critical areas such as the operating rooms, catheterization (cath) labs, and Neonatal Intensive Care units - brings a whole new challenge.
The replacement of the clean steam system – which provides humidification throughout the John H. Stroger Jr. hospital – required the installation of more than five miles of piping and 83 humidifiers above the ceiling in some of the most critical areas of a hospital. The following describes the challenges faced and how our team successfully completed the project due to proper coordination, planning and communication.
The coordination of this work had to be planned months ahead of time with regular meetings that included the department heads, physicians, nurses and other administrative staff to phase and schedule the shutdown of large segments of the 19 departments that were impacted.
According to the Center for Disease Control (CDC), "in 2011, there were an estimated 722,000 healthcare associated infections (HAIs) in U.S. acute care hospitals. Additionally, about 75,000 patients with HAIs died during their hospitalizations." According to an article published by Jeffrey D. Clair (PDF,2.2MB), RN, 5,000 HAI deaths are from construction related activities; thus conducting construction work while maintaining patient care is and always will be paramount.
We planned with the department heads to have the areas vacated with equipment removed and protected, then ensured the construction spaces were sealed appropriately...
Faithful+Gould worked closely with the infectious control department to outline the scope of work, the areas that were to be affected and the protective measures and procedures that needed to be in place, maintained and monitored diligently throughout the installation.
The installation of the new system directly impacted departments that treat immune compromised patients. We planned with the department heads to have the areas vacated with equipment removed and protected, then ensured the construction spaces were sealed appropriately, kept under negative air pressure to prevent dust migration, and properly filtered with High Efficiency Particle Arrestance (HEPA) filters to avoid dangerous spores from escaping as a result from disturbing dust or construction debris. Construction spaces had to be equipped with changes of protective clothing – for construction personnel both entering and exiting a work space, as well have defined egress paths for the contractors to the areas of work.
The team were required to replace a humidifier in each of the 38 air handling units (AHUs) that supply airflow to every space in the hospital. Keeping these spaces under positive or negative air pressures is critical in areas such as labs, operating rooms and sterile processing departments, among others. To complete the replacement of the humidifiers to these units, the team proposed shutting down each AHU, with the durations varying from eight to over 24 hours. The loss of air pressure for this duration was not acceptable by the hospital, which led our team to come up with an innovative way of completing these replacements.
The loss of air pressure for this duration was not acceptable by the hospital, which led our team to come up with an innovative way of completing these replacements.
To overcome the replacement challenge, our team designed and manufactured a custom bypass unit to attach to one air handler, then with four foot diameter flexible piping, we connected the bypass to the ductwork downstream of the AHU we planned to shut down. With this method, we were able to steal air from one AHU to feed two units. This allowed our team to have the AHU under construction, shutdown for multiple hours, with minimum disruption to airflow throughout the hospital.
In project management, it is critical to have a plan for an environment that requires flexibility. To complete the installation of the six humidifiers plus piping in the Neonatal Intensive Care unit required the shutdown of two large and two small nurseries, one at a time, for approximately two weeks. Extensive planning with the department head and charge nurses was required to relocate the infants to the unaffected nurseries that remained open.
...when we approached the nursery to start work, we were informed they had an influx of newborns and we could not begin.
It is not possible to predict the number of new born babies and when we approached the nursery to start work, we were informed they had an influx of newborns and we could not begin. Fortunately with good planning we were able to allocate the resources to another area within the hospital requiring work and were able to keep the momentum of the project moving forward.
To manage a project within a hospital, communication is vital. Keeping all key individuals informed of the scope and involved in every step of the planning process helped the progress of construction move much more smoothly. Like every other construction project, unexpected events may arise that could potentially impact the project schedule; however, if you have developed a good relationship with the various entities within the hospital and a history of keeping people informed, when an unexpected event does occur people are far more forgiving and willing to help you resolve and reschedule as necessary.
Faithful+Gould was able to deliver a very complex project, in an environment with many critical obstacles. The team were able to generate good relationships with the client and with the departments, physicians and nurses at the hospital. We met the challenge of orchestrating the progress of construction through the many areas of the hospital in a timely fashion, delivering quality, and perhaps most importantly, safety, minimizing the impact to patient care.
This is a project that proved to be greatly challenging, but a very interesting and exciting one to be a part of.
Our team was able to demonstrate to the client the value added from our services. Using our process of reviewing construction documents, identifying credits for work not required, reviewing invoices, change orders and tracking work completed, we were able to save the client approximately $3 million, which greatly surpassed our overall fee for the project.
This is a project that proved to be greatly challenging, but a very interesting and exciting one to be a part of. We demonstrated how we can provide a great service to the healthcare industry and, that in future opportunities with healthcare institutions, we can bring the added experience of the Clean Steam Replacement project at John H. Stroger Hospital with us.