Feb 5

Management of Construction and Renovation

Australasian Aged Care Facilities

Building or renovating in an aged care environment isn't just about noise and dust - it’s a significant clinical challenge. For residents in Australia and New Zealand, their "home" also doubles as a clinical setting where infection risk is high.

Under the strengthened Aged Care Quality Standards (effective 2024/2025) and joint AS/NZS guidelines, providers must adopt a proactive, risk-based approach to construction. Here is how building activities impact infection prevention and control (IPC) and what facilities need to do to stay compliant.

Why Construction is a Risk

Construction activities impact the environment in ways that enable invisible pathogens to thrive. The main risks include:

  • Aerosolisation of fungi: Dust from drywall or ceiling tiles often contains Aspergillus spores, which can cause fatal pneumonia in elderly residents. Bacteria can also be present in the demolition dust of walls or ceilings.

  • Airborne Contaminants: Increased risk of respiratory infections.

  • Water System Disturbance: Altering plumbing can cause water stagnation or release biofilms, raising the risk of Legionella infection.

  • Noise and Vibration: Indirectly affects resident well-being and staff workflow.

  • Access Control: Contractors moving through clinical areas can transmit pathogens.

  • Vulnerable Populations: Unlike a general hospital, aged care residents have "immunosenescence" (naturally weakened immunity), making standard construction dust a serious threat.

Governance Responsibilities

  • Risk Assessment Before Work Starts:
  • Identify high-risk zones (e.g., near resident rooms, kitchens, medication areas).
  • Consider immunocompromised residents and outbreak history.

  • Compliance with Standards:
  • NZ: Health and Disability Services Standards (NZS 8134).
  • AU: Aged Care Quality Standards and AS/NZS 4187 for reprocessing areas.

  • Contractor Management: Ensure contractors adhere to IPC protocols (hand hygiene, PPE, restricted access).

  • Communication Plan:
  • Notify residents, families, and staff about potential risks and ways to reduce them.


Alignment with New Aged Care Standards

The Australian Strengthened Quality Standard 4 (The Environment) and Standard 2 (The Organisation) specifically require that the environment is safe and effectively managed.

1. The Role of the IP Lead
  • Mandatory Oversight: Each facility must appoint a designated IP Lead (a nurse with specialist training).
  • Planning Authority: The IP Lead must be involved before any construction begins. They are responsible for approving construction risk assessments.
  • Continuous Monitoring: They must audit the site daily or weekly to ensure dust barriers and ventilation controls remain intact.

2. Risk Assessment Categories (The Matrix) 
Current Australasian guidelines (AusHFG Part D) require projects to be categorised to determine the level of precaution.
  • Type A: Inspection and non-invasive activities (e.g., painting without sanding).
  • Type B: Small-scale, short-duration tasks (e.g., demolition involving dust control).
  • Type C: Major demolition and construction (e.g., sanding, removing floor coverings).
  • Type D: Major new constructions or significant demolitions.

Essential Infection Control Measures

To safeguard residents and comply with New Zealand and Australian regulatory standards, the following "Hierarchy of Controls" should be implemented:

1. Dust & Air Quality Management
  • Physical Barriers: Use floor-to-ceiling plastic sheeting or solid "hoarding." These must be airtight and regularly checked for tears.

  • Negative Air Pressure: For major works, air should be drawn into the construction zone and exhausted outside through HEPA filters to prevent dust from leaking into resident areas.

  • Dust Control: Damp dusting and daily cleaning of adjacent areas. Adhesive "sticky mats" at exits to trap debris from workers’ boots.

  • HEPA Vacuuming: Standard vacuums simply blow spores back into the air; industrial HEPA-rated vacuums are essential for proper cleanup.

2. Water Safety & Plumbing
  • Stagnation Prevention: If a wing is closed for renovation, water outlets must be f lushed regularly to prevent Legionella growth in the dead legs of the plumbing.

  • Commissioning: New pipes must be hyper-chlorinated and tested for microbial safety before being connected to the resident supply. Flush systems before recommissioning and test for Legionella.

  • Waste Management: Secure removal of construction waste without contaminating care areas.

  • Monitoring: Daily IPC checks; air quality and water testing as needed.

3. Contractor Management
  • IPC Induction: All builders and plumbers are required to complete an IPC induction. They must understand that a "bit of dust" in this environment could be life-threatening.

  • Designated Routes: Workers should have dedicated entry/exit points and elevators that do not cross paths with residents or food service trolleys.

The "Terminal Clean" and Re-entry

Before residents return to a renovated space, the following must be completed:

  • The Builders Clean: Removal of heavy debris.
  • The Clinical Clean: A deep clean and disinfection by specialised environmental services.
  • Final Sign-off: The IP Lead must conduct a formal walkthrough and "Environmental Audit" before declaring the area safe for occupancy.

Conclusion

In Australia and New Zealand, construction in aged care is no longer just a facilities management task—it has become a clinical intervention. By involving IP Leads during the planning stage and following the enhanced Aged Care Quality Standards, providers can make sure that "improving the building" doesn't unintentionally "harm the resident."

You can find more information on the HUB (IPC’s) website. Contact EVE for a quick response in several languages or reach our specialised staff at  support@infectioncontrol.care

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