As a new hospital takes shape on the east edge of Portage la Prairie, Manitoba, steps are already being taken to keep future patients safe — even though they won’t be treated in the facility for several months.

While the importance of cleanliness in health care has been known for centuries, there is now increased awareness of the need to keep it clean while building health care facilities.

“We really focus on good housekeeping,” says Aidan McKay, project coordinator for PCL Construction. “Keeping the site clean and mitigating dust, dirt and debris within the building is critical.”

In the health care field, and in construction, that’s known as infection prevention and control (IPAC). During construction, the goal of IPAC is to prevent fungal, bacterial and viral material from construction activities from ending up in hospital settings, where they can lead to infections and illnesses.

One of the biggest concerns is legionnaires’ disease — a form of pneumonia caused by inhaling legionella bacteria, which can form in stagnant water left behind on construction sites.

Construction-related dust is another potential hazard. It can spread fungal spores that can lead to mold infections. The fungi species Aspergillus is most commonly associated with hospital-acquired mold infections.

“You might not think about it, but dangers are still there for patients in the future,” says Adam Taferner, senior project manager for PCL Winnipeg’s major projects. “Airborne spores, mold spores, and different pathogens can lay dormant. When the building is finished and turned over, patients are there, in compromised states and infections can happen quickly. That’s why this is such a critical area of attention and expertise.”

Other risks surface when construction is happening inside an operational health care facility. Often, those problems are found during demolition of existing building components.

“You’re pulling down a wall, and you don’t know what’s behind it,” says Shaun Blore, a district buildings systems manager in PCL’s Toronto office. “Asbestos could be one thing, there may have been water leaks in that space during or since its initial construction, you could have mold growth on the back of that drywall. It’s vital that we take steps to protect patients, and our own people, from those potential threats.”

While extra care has always been taken in hospital design and construction, a specific Canada-wide set of standards was developed in 2011 by the CSA (Canadian Standards Association) Group. It was most recently updated in 2022 (CSA Z317.13:22).

These standards currently require:

3.1 Negative pressure in all work areas. Essentially, this means machines are used to keep air pressure lower inside than outside, so air is flowing into the negative air zone, preventing contaminates from being introduced into clinical or clean areas.

3.2 HEPA filters on air exhaust vents to trap airborne particles.

3.3 Temperature and relative humidity to be kept within specific ranges to prevent moisture buildup, and to ensure there is enough moisture in the air to catch and weigh down airborne particulates.

3.4 Sealed work zones and airtight, physical barriers set up like walls or plastic sheeting — known as hoarding.

3.5 HVAC systems in construction areas to not be mixed with clean patient areas.

3.6 Ongoing documentation of inspections, air quality, pressure and humidity readings.

Hospitals and health authorities also supplement the CSA rules with their own policies and procedures.

“Our people take the time to understand those rules and then work with the hospitals to come up with solutions,” says Andre Bohren, senior construction manager for PCL’s major projects in Toronto. “We developed and continue to develop our own labour forces to build those temporary partitions, seal them up and ventilate them properly to create that negative air pressure. We build that skill set among our teams so they become experts.”

According to Bohren, that expertise has given PCL a competitive edge. When many other contractors start on a hospital project, they need to learn about the facility’s IPAC requirements and pivot to meet them. With 11 major hospital builds, expansions and redevelopment currently underway across Canada, and 13 completed over the last 10 years, PCL already has the knowledge and tools to meet and often exceed those requirements.

“We take pride and pay a great deal of attention to this, so our clients tend to develop a high degree of trust in us,” says Bohren. “We’re always looking for new means, methods and technologies to achieve elevated IPAC practices.”

For instance, the crew working on the Portage Regional Health Centre is using a simple but innovative unit on-site. It’s essentially a small, sealed chamber hooked up to a vacuum, that can be held against drywall while cutting it, to contain dust.

PCL also stays ahead of the curve by using industry-leading advanced technology, according to Taferner. The company has partnered with Latium Technologies, using a range of digital tools under its Job Sites Insights™ (JSI) platform: an Internet of Things (IoT) system that connects software, hardware and AI that was developed to help coordinate, communicate, plan, execute and improve safety on construction projects. On health care construction sites, the platform allows temperature, humidity and moisture — among other things — to be constantly monitored by smart sensors. All data, including alerts on unexpected changes, is instantly transmitted to web-based platforms on computers and phones.

“You can set alarms as well,” says Taferner. “So if any of those conditions fall out of a set range, if the temperature gets too low or if it gets too warm, it will send you a notification in real time.”

It’s sort of like the site is a patient and all its vitals are being constantly monitored.

“Having JSI in our back pocket, like a hammer or a screwdriver, is a huge advantage,” says Blore. “We believe that differentiates us from the competition.”

Of course, all the technology on the market isn’t of much use if the teams don’t know how to use it. PCL focuses heavily on ensuring its own teams, and its subcontractors, have proper training on all IPAC measures, equipment and processes.

“We hire experts to educate our people on the current standards and emerging regulations,” says Bohren. “And we're always looking at new and different means and methods to achieve and exceed those standards.”

On construction sites like the Portage Regional Health Centre, there are hundreds of trades workers on-site on any given day. PCL ensures every single person understands the IPAC measures and implements them.

“It starts with extensive orientation,” says McKay, from the work site in Portage la Prairie. “From there, we host eight or nine tailgate talks, covering everything from proper sweeping technique to correct HEPA vacuum use.”

For the people on the job site and in the offices, it comes down to a corporate culture of pride. Each person is reminded that they’re building the facilities they or someone they love may have to count on one day, where lives may hang in the balance.

“If you or your wife are on that operating table, you want that peace of mind that this facility is built to the highest standards,” says Taferner. “We’re confident our teams are doing the right thing, even when nobody's looking.”

IPAC is complex and evolving as knowledge improves around best practices. When it comes to hospitals, clients want the best teams building the best facilities that lead to the best health outcomes for patients. For PCL, success is a combination of factors — technology, experience, communication, expertise and passion are all part of the equation.

“Is any one of those a silver bullet?” asks Bohren. “I’d say, in the end, it’s our people that make the biggest difference. We have phenomenal leaders and teams who actually care and want to understand and learn the best practices. I feel our teams understand IPAC and show leadership, but we're also humble enough to listen and learn as IPAC evolves.”