The arrival of the pandemic has brought urgency to infection control issues within the long-term care (LTC) community. Across the country, LTC facilities are consistently among the hardest hit by outbreaks and deaths, highlighting the longstanding need for redesign and refurbishment.

“There is a complete need for an overhaul within the long-term care system, not only in how nursing homes operate, but how they have been built and designed,” said Mike Yorke, President, Carpenters’ District Council of Ontario (CDCO). “Most importantly, it needs to be done to meet the highest of standards in terms of safety and infection control.”

The Carpenters’ Union has played an instrumental role in examining the issues around the age and structural integrity, overall design, and accountability throughout the system, including spearheading a recent study that reveals significant findings of concern.

It indicates that, for LTC’s reporting major outbreaks, the highest coronavirus infection rates occurred in homes built to 1972 or older provincial nursing home standards (classified as D- and C-level facilities), where the rate among residents averaged 60 per cent. These facilities account for more than 33 per cent of the entire province’s long-term beds.

By way of contrast, in facilities experiencing major outbreaks that meet or exceed the 1999 provincial long-term care manual standards, the infection rate is only 26 per cent of residents.

“COVID has really shone a light on the inadequacies of the physical environment in meeting the needs of long-term care residents,” said Rita Mezei, Executive Director, Canadian Centre for Healthcare Facilities (CCHF) in Abbotsford, BC. Her organization brings together engineers, architects, designers, builders and healthcare leaders to look at planning and construction within the sector. “The population in these homes is highly vulnerable, with complex health issues. Facility designs done over the last 50 years are wholly inadequate.”

An integral part of the plan that has been championed by the Carpenters’ Union for a number of years, is Infection Control Risk Assessment (ICRA) Best Practices in Health Care Construction training and certification.

“Working in healthcare facilities is vastly different than other spaces, because there are immune compromised individuals, who would be prone to lung infections,” said Adam Bridgman, provincial carpentry training coordinator for CDCO.

Retrofitting within medical settings is in fact ranked among the most dangerous work for construction workers, as contamination can exist in the ceilings, floors and walls. During construction contaminants can be transferred through HVAC systems, drafts, and foot traffic, leading to secondary infections.

The College of Carpenters and Allied Trades (CCAT), in Woodbridge, Ont. has been providing the only comprehensive union training course on ICRA Best Practices in the province. The two-part program includes 24 hours of hands-on training for contractors and construction workers that covers practical building practices and protocols. A second 8-hour awareness class has been added for anybody working in healthcare, from facility engineers to project managers to healthcare staff.

Interest in ICRA certification has increased with COVID, including estimators and project managers and others that may not be working on site, but need to understand the protocols for working in those environments, Bridgman said.

“In the U.S. contractors and workers are required to have ICRA certification. We have taken that model and adapted it to meet CSA construction guidelines in response to the fact that infections in healthcare facilities tend to go up during construction.”

Yorke and others strongly believe that mandating an ICRA officer on every job site should be a key part of the solution moving forward. “When the province does get to the retrofitting stage, they need to do it properly using best practices. The time will come soon, where facilities and builders will be demanding ICRA certification in tender documents. ICRA has been part of our bread and butter policy for years to the point where we now have thousands of trained carpenters who are ready and willing to do the work.”

Paula Randazzo, President of the Healthcare and Professional Employees Union (HOPE-Local 2220), which represents thousands of workers in multiple LTC’s across the province and that joined the Carpenters’ Union in 2011, said the need for infection control and ensuring staff safety is critical to managing crises in future. “A vast majority of workers are very concerned about infection control. You can have a perfectly built building, but still not have the proper staffing.”

“We can’t rectify that situation overnight. It has to be a long-term plan to make sure this problem gets fixed and doesn’t continually reoccur,” said Mark Lewis, General Counsel for CDCO, who worked with Yorke on the study. “One thing COVID-19 has brought home to everyone is how harmful and deadly these facilities can be and that any work being done moving forward has to be done to the highest standards available.”

This story was created by Postmedia Content Works, on behalf of Carpenters’ District Council of Ontario.