With demands on the American healthcare system growing, construction projects to expand capacity or update services are a common sight in facilities across the country. However, construction and renovation projects can inadvertently pose significant health risks if not managed properly. Among the various hazards, microbiological dangers such as Legionella, molds, and other waterborne or airborne pathogens present serious concerns. Additionally, disturbances to older structures can release contaminants such as asbestos, adding to the dangers to patients, healthcare workers, and construction personnel.
Understanding these risks is the first step in mitigating their potential impact. In this post, we look at three risk categories and share best practices for ensuring the safety of all who enter your facility.
Legionella in Water Systems
Construction and renovation can greatly exacerbate risk from waterborne pathogens. Legionella is the bacterium primarily responsible for Legionnaires' disease, a flu-like illness with a mortality rate of around 10% in healthy individuals. Mortality rates for healthcare-associated cases of Legionnaires’ disease are reported to be significantly higher, with historic case fatality rates (CFRs) reaching as high as 46%.
Legionella thrives in warm, stagnant water—an environment that often exists in older water pipes. During construction and renovation, water flow through these lines is often disrupted, creating even more growth opportunities for bacteria. When water service is restored, the increased pressure can disrupt the biofilm inside the pipes, releasing colonies of microorganisms into the potable water systems. Even the vibrations created by nearby construction can disrupt bacterial colonies, releasing them into the water systems of buildings or wings of a facility that aren’t being renovated.
Read: Getting Rid of Lead and Copper in Drinking Water. Introducing Legionella?
Another case from 1978 was reported in which 81 patients suffering from psychiatric illness were infected. In this instance, 14 of these patients died from the infection. This incident happened only a couple of years after the Legionella bacteria was identified as the source of Legionellosis, and the strain of bacteria was not identified. However, the CDC found serological evidence of Legionnaires’ disease.
A more recent CDC investigation of Legionnaires’ disease cases between 2000 and 2014 uncovered 407 cases linked to soil-intensive activities, resulting in 48 deaths. This report also cites an earlier outbreak at a hospital in Washington D.C. associated with the excavation of an underground landscape irrigation system.
Proactive planning and prevention are essential safeguards during construction and renovations of any scale. Several organizations provide guidance for how to reduce the risk of Legionella-related infections. In particular, the CDC offers guidance for minimizing Legionella risk when reopening a building. The National Institute for Occupational Safety and Health (NIOSH), a division of the CDC, also offers a fact sheet for preventing occupational exposure to Legionella. In particular, they suggest watching out for “dead legs” (a length of pipe within a water system that has little to no flow because it leads to a fitting or outlet that is rarely used) in the water system.
An Infection Control Risk Assessment (ICRA) is a systematic process used to identify potential risks during construction or renovation projects. Pace® offers this type of assessment for water systems (WICRA) to help infection risk prevention teams identify potential risks from construction and renovation projects. Learn more.
Molds and Fungi
Construction and renovation projects mobilize mold spores through excavation of soil or other activities that create dust, releasing spores into the air. While relatively harmless in otherwise healthy individuals, some spores can be deadly to immunocompromised individuals. Aspergillus is one of the most concerning, with mortality rates ranging from 30% to 95%, depending on the patient population and specificities of the infection, such as which organs are affected.
Read: Top 4 High-Risk Molds in Healthcare Facilities and How to Address Them
The broader category of fungi can also cause Healthcare-Associated Infections (HAIs, and some of the cases cited in the Canada Communicable Disease Report have disturbingly high mortality rates. In one, loose wallpaper and building design issues allowed fungal spores to be released into a bone marrow transplant unit. Seven patients were infected and six died. Additional cases cited in the report implicate both Aspergillus and various other fungi.
Testing, air sampling in particular, can help identify the presence of mold and fungi. In healthcare, sample culturing is often recommended to determine the genus of mold present as well. If mold is an issue, mitigation strategies, such as using HEPA filters, setting up containment barriers, and maintaining negative air pressure in construction zones, should be employed to prevent the spread of mold spores into occupied areas. Foot traffic through construction and into occupied areas of the building should also be minimized.
Asbestos
Depending on the age of the building and the type of renovation, asbestos can still be an issue during construction and renovation events. This cancer-causing material was widely used until the early 1970s. Even after many manufacturers discontinued using it, stockpiles of building materials containing asbestos remained. In addition, it wasn’t until March of 2024 that the U.S. EPA prohibited the on-going use of chrysotile asbestos, the last known form of asbestos distributed in the U.S.
Construction or renovation projects can disturb asbestos-containing materials and dust, releasing fibers into the air. Inhalation of asbestos fibers can lead to serious lung conditions, including asbestosis and mesothelioma. For patients with pre-existing health conditions, the presence of asbestos can significantly elevate the risk of adverse health outcomes.
The Occupational Safety and Health Administration (OSHA) outlines specific regulations and guidelines for managing asbestos exposure in the workplace, emphasizing the need for training, exposure control plans, and protective measures to safeguard workers and occupants from asbestos risks during construction. Our recent webinar on asbestos in settled dust offers numerous insights into how to assess a site for asbestos contamination before construction begins.
Watch: Asbestos in Settled Dust
Progress Shouldn’t be Hazardous to Staff or Patient Health
The construction and renovation of healthcare facilities allow providers to offer the highest quality, most advanced patient care. However, the microbiological and environmental dangers associated with these activities require careful attention and management. By understanding the risks and implementing robust safety measures, you can ensure that healthcare facilities remain places of healing, even amidst construction and change. If you have questions on analyzing any of these hazards in your facility, please reach out to us.