09-252-0056 5 4 3 2 j
South Wanii ISSUED FOR
y project Namo and Number:. Invasive Physicians Office PERMIT AND
klaSpiia� Location; 2 North tower
Vate Lag Number -- CONSTRUCTION
A (Part df 13apiiat iCcattb Systems project Manager Luis Ramudo
Date Proparod: 2 -5 -49 _
St Thirteen ,
L� Construction Infection Control Risk Assessment (ICRA) � �--" _
Does the infection control staff agree with the plans relative to CLEAN AND SOILED
--
Matrix of Precautions UTILITYROOMS?
- --
Project Name and Plumber: Invasive Physicians Office (16630 -8008) Yes. DATE:
Location: 2 North tower I
AHCA Log Number: Stan Fourteen:
Project Manager: Luis Ramudo Discuss the following CONTAINMENT ISSUES with the project team (comment as to how
Architect: Linea 5 these wll be addressed)
Engineer: Traffic flow -- The traffic flow will be kept to a minimum during the demolition process to avoid
Contractor: dust and possible debris dispersion,
n CLIENT CODE/FILE
Date Prepared: 2-5-04 / SCHEDULE I DR, BAQUERO I'. SCHEDULE
Housekeeping -Aroaa will be kept clean during construction ao ftlt"ad with disinfectant /` /,' �" NUMBER.
NOTE: The IGRA Matrix shall be completed during preconstruction and approved by SMH Facilities, after construction, a sticky mat will he pasted at the entrance'o`iTIIa�workoife and will be MANAGER ` 200 7 2004 ' 2007
Safety, and Infection Control, Controctor shall sign the ICRA Agreement as part of the construction (apiece as often as needed" O
contract documents. Prescribed precautions must be in place prior to work start and must be
maintained throughout the duration of the project, Debris. Removal - Covered carts using a designated route through the service elevator, / PROJECT ID- SUBMISSION
Step One:
129 SF ZIPPED ENTRANCE NUMBER:
; ' . ; '
K Using the following table, Identify the TYPE OF CONSTRUCTION PROJECT AC7IVITY (Type A -D). Step Fifteen:
Obtain required APPROVAL SIGNATURES of the ICRA team` Sign with Blue Ink Onl
T -- -T- -- 4 9 Y I I
Inspection and non- "rnvaslvt6activities
Includes, but is not limited to:
•. Removal of ceiling tiles for visual inspection limited to 1. the per 60zsquare feet
• Painting (but not standing)
• Wallcovering; {mstallabQn, but: not removal), electrical trim work, minor
plumbing; and activities which do not generate dust or require cutting of wails
or access to ceilings other than for visual inspechon
Small ace Is, short duration activities which create minimal dust
r Includes, but is not limited to;
• Installation of telephone and computer cabling
Access to chase spaces
• Cuttlnp of walls or ceiling where dust m grstion can be controlled
WQr-k that generates moderate to high level of dust or requires demolltton
or removal of any fixed building components or assemblies.
Includes, but not limited.to.
Sanding of walls for painting or waltcovering
e Removal of €ioorcovering ceiling tiles and casework
• New wall construction
y,' • Miner duct work or electrical work above oeilings
' • Major cabling activities
'Y' • An activi which cannot beompleted ' c Within a sin le workshift "
Major demolif,an and canstruchon projects
ncludes, but not limited to
• Activities which require consecutive work shifts
Requires heavy dernollbon or removal of a complete cabling system
• Removal of wallcovering
New construction _
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Project Manager Date CONSTRUCTION AlRaf' �.
PHASE 2 ICRA # AR92
6r 2 4
Architect ACCESS POINT
A& Fact 1.ri i s Date
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I XX
Plectron Co of PractdlonerJ hate o2 4 • Q y L - - - - - - Safety Officer Date � -129 -0 � �
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Step Sixteen: CONSTRUCTION
( �
Implement through the CONTRACTOR CONSTRU("rION ICRA AGREEMENT
ASSIST NT / fir '.. , " , , . • ? ° h.,.
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see A
t endix PP )
MAMA ER ACCESS POINT
Sup. We Pm m, e po[ Hospimt Hruswn TX. G Fn CA
Steps4A 4 Adapuwdwi 4h pamis.iomKalrvew Uhl ity Mr d i,* C. ner,
Mlnnoapniia MN
Forme modifad and PmvAad couri of Mehe [M *Y, I UI Irir- Severly Mils, MN I 20 : ' . -- %� ;
I %i/CI1IteCtlde
- / C lntedbr
- - - -- - - - - - - - - I ZIPPED ENT E
- -
j xx
This project has been identified as CONSTRUCTION PROJECT ACTIVITY TYPE C . I I i _ I 3
/ '` 3 -
/ CONST UCTION
sMHICRA - page, rovieed January 2006 MH )CRA- page4- revisedJanuary200b A C C E P OI N T DR, KRAUTHAMER
LINEA 5, ink
2002 420 LINCOLN ROAD, SUTE 258
MANAGER MAM BEACH, FLORIDA 33139
- - -- _ 002 FILES - 129 t:: 305- 673 -0004
SF
- 2 - FILES
0 F 2008 F 2008 FAX 305 - 673-0080
Protect Name and Number; Invasive Physicians Office project Name and Number: Invasive Physicians Office I I I N
I VAL
. Location: 2 North tower
Location. 2 North fewer AHCA Log Numberti
AHCA Log Number. � VA ` / CZ
Project Manager: Luis Ramudo Project Managuin Luis Ramudo I , �' _
Date Prepared: 25 -09 Date 2 -5-09 / I i ; ■ -
� ww
Stop Two. %_C_ Rai Matrix of Precautions - r4ppendin
Using the following table, identify the INFECTION CONTROL RiSK GROUP (Law to Highest) based O �j ' 1 '
on the location and type of service that will be affected. Circle the specific risk group below, A, REQUIRED INFECTION CONTROL PRECAUTIONS BY CLASS / - / `V ty� ■ . ■
- ' c.morria*eeag . :.. yamr?«R� FILM /PAPER _ LV
v / •�--�
Offs Cardiology CU ilmmuno-com romised Pts m 1. Execute work by methods to minimize raisin dust 1 teat me WORKROOM WORKROOM FILM /PAPER A 0
ogy p 9 plwhpe ezpoaedwrfacea wlih - [ ' M
Echocardiography Emergency Room 'Burn Unit `� from conshucbonoperation a disinfectant �� STORAGE STORAGE ins.■ cr)
Endowed Labor & Del Cardiac Cath Lab s 2.. Immediately replace a tailing file displaced for visual / _ W
G
Imaging Services Labnratorlas. Central 5tedle9upply I. provbeachvnmsanstopmvant airborne dustfrgm 1. Wet mop and7arvawam with HEPAfnered 2005 / .' � � 2009 � �� � / 2009 .�.J �r
Nuclear Medicine Newbom Nursery In?ensive Care Units d,spa-ing into atmosphere vacuum before releasing work area O 2005 ; O C: fin
I PTlOT Outpatient Surgery (Isolation Rooms 2. Remove or isolate HVAC system in areas where 2. Wipe work swNwe with dminfecant 1 - - - - -- C ® W
- "M
work is belny performed 3. Remove leatation of HVAC system in areas i
�`� ■
Respiratory Therapy Pediatrics : Medical / ;Surgical Unite a, flialntaln negative pressure In wotk site, conductanil where work Is being performed
Pharmacy NIGU d
Cardiac Rehab Phau Jment daily manttoring ® v
PACU . IVR 4. Seal urluaed doors and above telling penetrations in
'Oncologyi surrounding walls oaforo Poring roof -
-- _. -_ - -_ ----- ._.- - - -_ -- -- _ _.._.._____..
Radiation Oncology 5. Place track mat atentracceandexitofworkarea
' o. Cover transport receptacles or cads Tape covering
Operating Rooms / c) unless solidlid
G =5ectlon Rooms j 1. ComPlets all critical barriers 0 e. shaetrock p"oed, 1 0o not remove barriers from work are until -.___- _ ,/- -
-_ -- ctio .,. LAj
plasbcJ to seal area from Pan -work area of ,completed project is inspected by SMH / "' i . f.../ `�
This project has been identified as INFECTION CONTROL RISK GROUP
implement cpnbal cube method (cart w with to mtc Safety and Inte Non Control - - -- /i , .�, ■ .® _
co- er,'ng and sealed conne Lion to work ails w th 2. Remove barrier materials carefully to DM S / DNIS / / !
tIEPA vacuum prior t0 exit) before conRtrV°i*pn minimise spreeding of dirt and deeds
Step rh.8�.
W L
p ,.. begins associated wilh.cunstriiutipn :`�
Using the matrix below, match the CONSTRUCTION PROJECT ACTIVITY TYPE with the 2. sea] holes, pipe,,, wnduirs, and punctures 3, Vacuum work area with HEPA f tared
2001 2001 --
aPPr Patel / � C 0 CC
INFECTION CONTROL RISK GROUP to determine the CLASS OF PRECAt/TtONS required, a, Remove or Isolate HVAC system in area where work 4, wet mop area wrtn dlsinfettant
F
i :
w uuu y remove isoos", or r,vnc system m areas
system where work is being perho,meo -
4. trlafnfain negative preeeure.a vrork site of?0.01 wg 6, Final cleaning oy SMH Enmronmantal.
using HEpA air filtration. Exhaust air may not servides prior to occupancy
��` dlscnargefoceiling .Conductanddocumentdaily
mamtodng
5. Cover transport mcoptacAs Tape
_' _ / %
-
/
PAT. _
TOILET
%/-
%
'-
■®
P�
v�
0
-.
��
PAT,
_ _ -
TOILE r
1
CLASSt
CLASS If
CLASSiI
CtA$�
CLASS)
CLASS II
GLASS I//
CLASS IV-
...'. ,,: ^...
CLASS t
CLASS it
CLASS 1I "
/tLAS� - -
CLASS 11111V
CttAS
CLASS
CLASS TV
w carts. covering,
unless solid lid
6 Contain canstruct'on waste before tra
tlovered recept ocesA_ -` sport In tightly I
t
I-r
/
2011
-
-
2O
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//��� va C/�
F
_.... o,o t - loorr, Yrywwu, ;. ua nos emova oamare from werK are anbl '
piaatfc) to seal area tram non -Work area at completed project is inspected by SMH
This project has been determined to require CLASS PRECAUTIONS. implement control tuba method (Cad with plastic safely and Infaccton control / / -- / , ' ve
covering and sealed oerinectmt to worx alte with 2. Remove barrier material carefully to C
Note. SW Infection Control approval will be roquirod whan Cla" 11, 111, oriVPrecauflorts ore NEPA vacuum for vacuutriing prior to.axitj before min!miza apraading of dirt and dabru [0c / 1
required ICRA required t (s e Step i Class are i the Append x to this Matrix and included In the HEPA vacuum m for begins, miNnitatea with Ing of dirt an - x..6.6
2. Seal holes, pipes, conduit, and punctures 3.. Vacuum work area vAth HEPA filtered
/ --
L
required ICRR_Agraement {sea Slap Sixteen). appropttatelY, vabuumo,
4. Wet mop area w,ih disinfoctanl.
ya#nga 5. Remove ieolatlon of HVAC aya[ent in, areas ' -- - - ---- --
Step Four: 6r where work is being performed. ` _
Identify the AREAS SURROUNtNNG THE PROJECT, assessing the potential infection control t 6. Final cleaning by SMH Envirommntal , ' 7-
impact using the INFECTION CONTROL, RISK.GROUP designations from Step Two, Servimspnortoodwponcy ELECT / ELECT. �' ;'
4. Aerrwva or lsalate HVAC system ip aretwhe ±e_yy_tk - -, ROOM
- a 3cm pTaoct / ROOM /
iat3i -.. s tem. / /' ' /
_ s Ys
i (�/■ \/1
. 5. Msln Inn 1I
I
to negative raeat,ra n warkaE
Above Lobar and relive High e4 p site g.otw
delivery a s 2094 / / ' �/
using HEPAatrnitra4cn,Exheuatafrina no / `%' 2094
LHotaw Imaging Medium g Y f / /'''
discharge to calling Cond4ct and document dally
_ I N Lateral Invasive Heart Highest
monitoring
E Lateral Adminiatrativa offices Low g
L- 6. A31 personnel entering work sib are required to weal
�W t..affiral Corridor .Low ahae Defiers. $twe covnre most be changed each r E .
8 l atersi - ". CVCU _ Hi hest Z time the worker etdta the work area, / f
- - 7. Conain GenStfuCapn waste beloretrdnsPgrt in tightly
? covered cordalners.
What additionsl precautions should c ns 1e rid based on this assessmanf.
- B.: I;over tranaPOrt receptacles or calla. Tape doverinD
�.p. unless solid. lid.
�" !^�Riz.. !k/ --G_ (r,•�Ss} =$fir ---�.o j :
-- O
SN,'H rCRA:- page 2- revised January 2006 SMH ICRA- /page 5- •?avlgad January 2006 �e /`` / � � /
Ytr,fiL. � 1.1r,�,�T�iG?- Gy.e,.asi°•I.JC ' f /;:` / / /' ' /
Project Name and Number: Invasive Physicians Office B. CONTRACTOR CONSTRUCTION ICRA AGREEMENT o
--
Location; 2 North tower
AHCA Log Number: Project Name: Invasive Physicians Office: Project Number.,
Project Manager; Luis Ramudo Location of Work: 2 North tower Start Onto-, U
Date Prepared! 2.5 -09 Prefect Manager: Luis Ramudo Estimated Duration: INFECTION CONTROL PLAN -PHASE 1
General Contractor: Office Phoney n 1 r� INFECTION CONTROL PLAN - PHASE 2 'W ,_!
Step Five: Superintendent: Calf Phone/Pager: 'V/ 2 �■�.
Identify SPECIFIC SITE OFACTiWTIES (e g, patient rooms, medication rooms, etc.): TYPE OF CONSTRUCTION ACTIVITY 7NFEC770MCONTROL RAW GROUP SCALE: 1 /4 = V -10' D06
Invasive Heart Physician offices. Removal and installation of partition, relocation of light SCALE: 1/4' = f-0'
1 ) A Small Inspect ip l short duration, r activity ( ) &%D
fixturear electrical . outlets and . air supply vents, paint .and carpet replacement, : ( ) 8 Srnallscalesttonmoderatciehign ( ) MEDIUftt
Levels
C dust,mc.meratesterI atafshift vets °` " .HIGH DUTY TAPE EAVY -EXISTING STRUCTURE ICRA LEGEND ICRA GENERAL NOTES DURING CONSTRUCTION ICRA GENERAL NOTES . AFTER CONSTRUCTION
Step SIN;.. dust, requires greater i work;hlft
IdonbfylSSUES RELATED TO VENTILATION, PLUMBING, AND ELECTRICAL in terms of the I ) 1) Najorduranbn and wnatruchon acti'mes (x) HIGHEST
agwrng odneacubv work assts 1. Remove and isolate HVAC system in area where work is being done to prevent 1. Do not remove barriers for work area until tom leted project is inspected b the Owner's
occurrence ofprobab a outages: Low Y g p p
TEMP, VISQUEEN
cJlW
P 1 p Y
DENOTES LIMIT OF WORK LINE contamination of duct system. staff.
ac a Mo k by mnchuds W m,n m ip felons dust horn wa mopAr pe a p4aed au aa. wan dn,,reaant SEAL W/ HEAVY
$tap $BVen; 6Y.kc88 � conainubon opemtrans
Identify EONTAINAAgNT MEASURES using the pnorassessrnants: t z. m, emamyreclaee ni,,ngtivd3ancedrerva at DUTY TAPE 2. Complete all critical barriers i.e. sheet rock, plywood, plastic, to seal area from non work 2, Vacuum work area with HEPA filtered vacuums,
imipection
DENOTES EXISTING WALLS area or implement control cube method (cart with plastic covering and sealed co work site
IN?rot typo ofharrrers will be required. The wo+'k81fa will, have the door C(a5od and sealed during ,. Proridrr artivercl.ans to prevem aimome dust twm 1, wet rtropand7or vacuum war. HEpA filtered vacuum r- ,,l;;s,,,,�.. �a r
demol/Gonin addition to the plastic barriers wi th- sticky- MM- natside. The use ofdrywalt ai?perslneinenbno.pnera Uopreralce.ngwrorgaea SEAL W/ HEAVY with HEPA vacuum prior to exit) before construction begins. 3. Wet mop /wipe exposed surfaces with appropriately labeled and BHSF approved ho pit "ly or- sou "r MIAMI
2 Ma> nl4lnnegarnapressurepf _ >o,olwgtningHEPAalr z. wipework�arra� .. - - -__= DENOTES WORK TO BE DEMOLISHED disinfectant- I 4 "
barriers is not recommended beCBUSB it won't' be BflOdgh ClaafaRGO on fife corridor for staff/ .. etra cn: conduct a k dv umw t dewy manrwnng 3, W* worso•etWn pt HVAC ayalpm.n a ee w e e v a k
DUTY TAPE - - - -- 13'ILL13l I)'�4
C construcflontraf�cendd ebrisremoval, a a. sanhum, �ddoo rsandaboveeeningperwtrewn.;n ybe ;pypomy _ILINGASITOCCURS, 3. Maintain negative air pressure within work site utilizing HEPA equipped air filtration
`W-ft. "k meta b`'° e �" "`°" E CEILING PLAN GRIP DISK units. 4. Contain construction waste in tightly covered containers before transporting. _ t, r� , , w
GG �r_};yg4•
�'� 4. Ptaca hack metal entrance and exit afwolk crap. `�`�$�rfkJr a /•1t t.. .3��- ��,::r'f'�
'M1yh' NEPA fiNrahon. be required? You, the mnchfna will be connected thou an exterior exb &oaf '- s. Ramer. of Isolate HvAC system in areas wnerework fh
and the NEPA titters on the machine will be checked often to provlda a mexlmum afflclency. uaiop pedo,mad
5, Cov uanepoarereptaaesmcuy . Tzae cov»nng
, ur;Iw.anBd rat 4. Seal holes, pipes, conduits, and punctures appropriately. 5. Cover transport receptacles or carts. Tape covering unless solid lid. NQ DESCRPTION DATE
Note;. Renovatfon/COPOi UCtion Shall be 4014444 from Me DCCNpW amwr during construction t. Complete ail co" benfem (i.a, slwetrock, plywood. 1.. Do not remove handers from work, am unt icompI4.d
and shall be negative ()• 0.01 w9) with respect to .surrounding areas. tr,: Pisadc,) ,o seal arse from rwnwork area arfmpiement project )s inspected by SMH safety aril Infection Ceram'
W',trelaba method ioan with wa*f�covadngand 2. Remove best" oaterla.awiefaytomlnimue 5. All personnel entering work site are required to wear shoe covers. Shoe covers must be 6. Remove isolation of HVAC system in areas where work is being performed. j
jtl yi..W connoc ion to work woe with HEPAvacuvfii poor apresding of cid and dab. aseodate4 wMh an.buction
changed each time the worker exits the work area.
w e:iq before mnatrucion bagna - a. Vacuum work area with NEPA Blared vacuums g ����)�f `'. l) BY : _ =_= -�- ---- -•
SOR alght; ' 2. Seal kolas, pip., coodw%. wit punclurae appfpvetely 4. wet mop area with diainfecTaot
'°- 3, RYmnv9arl.piRWHVACsyVemisa ,rwherewckis S. RemoveiaolabonofHVAC iyisorn inarewwhomwick TEMP, VISQUEEN ZIPWALL 7. Remove barrier materials carefully to minimize spreading of dirt and debris associated 2
considarrwlpntial .RtsK,OFWA7+ERiJAa4ar3E:..Low. Na plumtrfngscope iscarrxit rddinuris being donewpreventcart roinapdantdeaaystem iabeingperrom,aa 6. Contain construction waste in tightly covered containers before transporting. with construction.
project 4, Melnlaln negative pmasursmwa knife o! >O.Mwa uHnq 6. Final cfawlnq by SMH&M,o mental. semcos Pn,, to
p 4
IiHPA.wfdbafpn E. ,a at ■. nq mmn!ll atg. pccupanoy ICRA KEYED NOTES --
ca I rig, Cnnd ct ar1Uf mart dauv monlorinq
Is them a dslc due to compromrsngstructurar pavers la.g. roof, axtenorwails, ate)? Na 5. eve anapodmropb daa «� a Tapacovennq 7. Cover transport receptacles or carts. Tape covering unless solid lid. 8. Final cleaning by Environmental Services prior to occupancy. _
mss said rid
ifao, piease explain e. contalnamstructlonwa.teWits usnapomm11gAby OCCUPANCY 8. Cover all carpet outside project area with rolled plastic to nearest vinyl floor - maintain
coveted mcepooso
r QaosP ate all apical barriers (I.e. meets&, plywood, L Do not remove awriara fnma work are umal comp ;ewd
Oa.tc)te.eatarea,mmuai,•workat orlmp,ament pwjwdNkN ci dby$MHsaletifDOlnfarcnc«IhW PATIENT AREA 1❑ TYPICAL VISQUEEN ZIPWALL ASSEMBLY with wet mop. C
Sft Nine: mntrvt 'be merhad (Can with Rlsatic _'1'Q are 2. Remove barer nne fW carakaly to m bli apco■skm tJ
. aabd�nr .�ontaworkrrlrrawrosr- lnUNIm,pr prdmanddab- thHFPAhr n�an, 2❑ WALK OFF MAT g
WORK HOURS -Can or will the work be done durfng non-patient care hours? No, the work waa con poor to o w rk bollory W cvnetn Plan vacuum for a, vawun work ar�;vith HEPA th erect tra nears.
g
schedule will be from. Seta 4pm. 2 seat bees, P1pea, QM'P k] s, and Punctures aPPropnstely 4 Wet nap amp wmh tfoltFe,ant.
'� 3 - 5. rumen aclatim of HVAC system In area whore work
` 19 flainq ptlr(trr,rlad,
rnkvile errenake e. Fineidanruna by SMH Emlronmental 5ervidoi pdarlu EXISTING DOOR TO BE RELOCATED 7 B
Ste en: huaouao Dead n«upancy
Do designplans aflowforan adequate number of ISOLA TIONINEGA 77VE AIR FLOW ROOMS? 4. Remo la sysfcmnaarattwham work ta RELOCATED DOOR 8
�t'ea: barnq done to prevent. 0O rNmirwtton of dud cystwn,
5. Maintain neaanve PraasPre Invvork site dr O.01wq wing
NEPA air fillmdon Erhaest air may not ditch rqa to
stoQElevan: : �;� I6"lark; �;oft m,,,m, -,,,�. CONSTRUCTION �5 COVER ALL CARPET OUTSIDE PROJECT AREA WITH � JOB NQ ��',
aoaasrynNransauDwfDrthe sg ;rednarn erantltyttltttANnWAStIiNClsftrKS? tea, ,wKa� 0,.anM EXTENSION POLES ROLLED PLASTIC TO NEAREST VINYL FLOOR
Yea 7. Cont■In oon■tud,pn wasin before transport In tighiry
- MAINTAIN WITH WET MOP DRAWN BY CFECKED BY
awereA rorddrrern.
,' Covet tronapaa rtx ro,a`�s< r warn. Tape Povel!nq uNeso
nalW lid: y�t�„
SteP Tweiye; Pa cues s0reeta mp,emonf mquTedpFel¢uP� noR(yVror Yt4 Taanr afnecessary chomps and it turn cv ndi ea SOn lmme @f.ry
Does the INFECTION CONTROL STAFF AGREE with the minimum number of sinks for this project? showd;aoldon of ii -xions be round, Contractor agrow N iffssorninate Ws lnformebm to subcwitnrcfa and assume mapon'Wity LASTIC SHEETING
Note design professional to ver a alnst AtA guidelines for hrrho;'- pi-ca. SIGN WITH BLUE INK ONLY ( g Py 9. g tyNesldl2cts) contractor pate RB
Yes Projact Mona or ,u19 Date. zJlofo9 - DATE SCALE
Facilities " -` Date
safety on Control rocdttane -..J pate . , o p AS D
Safety Officer f on: V oil Deco -CR Pe ]5q p
'SMH:7CRA - page J - ,revised January 2Q06 Atlapted with pe Ian: V edy, Barnard, evebped at St. Luxe's Episcopal Hespltal, Newston, TX ICRA per(nR GRIP DISK SN,H IcR4 -page 6- revised Jr anuary 2075 SHEET NO
SEAL W/ HEAVY
DUTY TAPE
PRE - CONSTRUCTION RISK ASSESSMENT FORM TEMP. VISQUEEN ZIPWALL INFECTION CONTROL PLAN NOTE Dool
A16 Al2 Q S
A08 NOT TO SCALE c copyright LINEA 5 NOT TO SCALE
SCALE: 3/4' =1' -0' O inc.
16 15 4 13 12 10 9 7 G 5 4 3 2 1