Digging Up Disease: Infection Prevention Strategies for Healthcare Construction Projects

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Digging Up Disease: Infection Prevention Strategies for Healthcare Construction Projects

By: Dr. Michael Berg
March 10, 2026
10:01 am
Tags: Asbestos, Construction, Crystalline Silica, Healthcare, Legionella, Mold and Fungi

Healthcare construction and remodeling projects can dramatically increase infection risks for vulnerable patients, staff, and visitors, but proactive environmental testing, planning, and rigorous infection control can keep your facility’s healing mission on track. In this post, we examine some of the primary infection risks in healthcare construction projects and offer risk mitigation strategies for each.

How Healthcare Construction Drives Infection Risk

Any time walls are opened, ceilings are disturbed, or soil is excavated around a hospital or long-term care facility, hidden contaminants can be released into the air and water systems. Patients in these environments often have weakened immune systems, which significantly increases their susceptibility to healthcare-associated infections (HAIs) triggered by construction-related disturbances. Furthermore, when construction activities are not tightly controlled, pathogens and particulates can travel far beyond the immediate work area, affecting units that may not appear to be directly connected to the project.

From an infection prevention and environmental health perspective, construction and renovation projects should be treated as part of a broader risk-management strategy. Embedding infection prevention into the project lifecycle—from planning and design through commissioning and occupancy—helps protect patients and staff, supports regulatory and accreditation requirements, and reduces the likelihood of costly delays or shutdowns. For healthcare leaders, this means working closely with facilities teams, project managers, and environmental laboratory partners to identify environmental hazards early and design the proper controls and testing protocols into every project.

Four Key Environmental Hazards in Healthcare Projects

In healthcare settings, construction and remodeling activities can elevate risk in four critical environmental hazard categories: waterborne pathogens (including Legionella), mold and fungi, respirable crystalline silica (RCS), and asbestos. Each of these hazards behaves differently, requires different sampling and control strategies, and carries different implications for patient safety and regulatory compliance. By understanding these risks, infection prevention and facilities teams can design a construction infection control risk assessment (ICRA) that is both thorough and practical.

Legionella and Other Waterborne Pathogens

Water systems are a critical focus area during healthcare construction and renovation. Shutting off or disrupting water lines can create pockets of warm, stagnant water where Legionella and other opportunistic waterborne pathogens can proliferate. When water service is restored, these pathogens can be flushed into the broader system and ultimately discharged through faucets, showers, and other fixtures where patients and staff may be exposed. In a population that includes immunocompromised patients, even relatively low levels of contamination can pose a significant risk.

Because Legionnaires’ disease carries a high mortality rate among vulnerable populations, regulators and accrediting bodies now expect robust water management programs that extend through the construction lifecycle. Standards and guidelines emphasize the importance of disinfection and flushing strategies, documentation of control measures, and close coordination with infection prevention. This includes more than just new tower construction or major expansions. Even modest remodeling or infrastructure upgrades can affect water pressure and flow conditions in ways that create new risk.

To reduce waterborne pathogen risk during healthcare projects, facilities should:

Disinfect building water systems prior to occupancy or re-occupancy and re-flush systems if more than a defined period (often around two weeks) passes between disinfection and commissioning.
Integrate planned construction and remodeling activities into the annual water management plan, including detailed standard operating procedures (SOPs) for safe water shutoff and return-to-service.
Train maintenance, engineering, and construction teams on infection-prevention-focused water practices so unplanned outages and emergency repairs are also managed in a risk-aware way.
Evaluate excavation and site work near the facility, since some Legionella species can reside in soil and may become aerosolized during digging, trenching, or utility work close to patient areas.

By addressing Legionella and other waterborne pathogen risks before construction begins, healthcare organizations can better align infection prevention, engineering, and environmental testing, maintain compliance with Legionella control requirements, and give their most vulnerable patients an added layer of protection. Learn more about Pace® testing services for Legionella and other waterborne pathogens.

Mold, Fungi, and Soil Disturbance in Healthcare Environments

Mold and fungi represent another potential infection hazard in healthcare construction and renovation. Dust generated by demolition, ceiling work, or wall removal can dislodge dormant mold spores and disperse them throughout the facility via air currents and ventilation systems. Exterior construction, including foundation work, utility trenching, and landscaping changes, can disturb soil that harbors additional fungal spores. Spores can travel long distances through the air or be carried on clothing, shoes, and equipment, eventually reaching units housing immunocompromised patients.

Organisms such as Aspergillus and mucormycetes are particularly concerning in hospitals and long-term care facilities because they can cause severe, sometimes fatal, infections in patients with weakened immune systems. For example, construction-associated Aspergillus exposure has been linked to invasive aspergillosis in oncology and transplant units, where patients are especially susceptible. Likewise, mucormycosis can progress rapidly, affecting sinuses, lungs, brain, and blood vessels, with high mortality rates in high-risk populations.

To control mold and fungal risks during healthcare construction, facilities should:

Conduct a pre-construction assessment of mold risk in both interior spaces (such as aging ceiling voids, old mechanical rooms, and water-damaged areas) and surrounding soil where excavation or trenching will occur.
Use robust containment strategies, including hard barriers, anterooms, and negative-pressure enclosures around work zones, combined with HEPA filtration to capture spores and dust.
Place high-risk patients in appropriately designed spaces—such as positive-pressure or HEPA-filtered rooms—when nearby construction activity cannot be avoided.
Control worker movement, PPE protocols, and material staging to prevent spores from being tracked from work zones into oncology, transplant, burn, or intensive-care units.

Embedding these fungal control measures into a construction Infection Control Risk Assessment (ICRA) ensures that mold and fungi are treated as central infection hazards, not just general “dust” or housekeeping issues. Learn more about Pace® mold and fungal testing services.

Managing Respirable Crystalline Silica (RCS) in Healthcare Construction

Respirable crystalline silica, a component of many construction materials such as concrete, brick, and stone, poses significant health risks when cut, drilled, or ground. The resulting fine dust particles are small enough to penetrate deep into the lungs, potentially causing silicosis, exacerbating chronic obstructive pulmonary disease (COPD), and increasing the risk of other respiratory conditions. While silicosis often develops after prolonged or high-level exposure, even short-term exposure to elevated silica dust can compromise breathing in patients with existing respiratory disease.

In a healthcare environment, RCS is not only a worker-safety issue but also a patient-safety and infection-prevention concern. Dust that migrates from construction zones into occupied areas can aggravate respiratory conditions, increase susceptibility to infections, and interfere with recovery. Therefore, controlling silica dust is an essential part of a comprehensive construction infection control program.

Best practices for controlling respirable crystalline silica in healthcare projects include:

Requiring wet methods (such as wet cutting and wet grinding) and local exhaust ventilation for activities that generate silica-containing dust.
Ensuring that workers use appropriate respiratory protection and other PPE, and that patient access is restricted near RCS-generating activities.
Implementing solid barriers and negative-pressure systems around construction zones to prevent dust migration into hallways, waiting rooms, and clinical areas.
Conducting targeted air monitoring to verify that silica levels remain within occupational exposure limits and that control measures are effective over time.

Including RCS in construction planning and documentation helps align safety, infection prevention, and facilities maintenance under a common framework. Learn more about Pace® testing services for respirable crystalline silica.

Asbestos Risk in Healthcare Remodeling and Infrastructure Work

Asbestos remains a serious consideration in many hospitals and healthcare facilities, particularly those constructed before 1980. Even if prior abatement projects have been completed, asbestos-containing materials (ACMs) may still be present in floor tiles, pipe insulation, ceiling materials, and other building components.

Many abatement efforts emphasize encapsulation or containment rather than full removal, meaning that modern renovation activities can unintentionally breach older containment solutions. For example, removing carpet installed atop older asbestos-containing floor tile, cutting into insulated piping, or modifying mechanical spaces can disturb asbestos that was previously considered safely contained. In healthcare environments, this poses a risk not only to workers but also to patients and visitors who may be exposed to airborne fibers that migrate beyond the immediate work zone.

In addition, asbestos risk extends beyond indoor spaces. Asbestos-cement (AC) pipes were widely used for municipal and facility-level water and sewer infrastructure in the mid-20th century. As these pipes age, they can degrade and release fibers into potable water systems. When these pipes are cut, drilled, or replaced during infrastructure projects near healthcare facilities, asbestos fibers can be released into the air and water, posing additional exposure pathways.

To manage asbestos risks during healthcare construction and infrastructure projects, organizations should:

Require comprehensive asbestos surveys and a thorough review of historical abatement records before disturbing walls, ceilings, flooring, or mechanical systems.
Develop detailed procedures for any anticipated asbestos disturbance, including engineering controls, waste handling, clearance criteria, and coordination with infection prevention and safety teams.
Consider both air and water pathways when nearby infrastructure work involves asbestos-cement water mains or sewer lines, particularly when these systems connect to or pass near patient care facilities.

By treating asbestos as an integral part of the construction infection control and environmental risk framework, healthcare organizations can better protect patients and staff. Learn more about Pace® asbestos testing services.

Build Infection Prevention into Every Project Phase

To effectively manage Legionella, mold and fungi, respirable crystalline silica, and asbestos during healthcare construction, infection prevention must be embedded into every phase of the project lifecycle. This goes beyond a single form or checklist; it requires a structured, collaborative approach that brings together infection prevention, facilities management, project management, safety, and environmental laboratory expertise.

Key elements of a robust construction infection control and environmental testing program include:

A hazard inventory that identifies which of the four major risk categories—waterborne pathogens, mold and fungi, RCS, and asbestos—are relevant to a specific project based on building age, materials, and project scope.
A construction infection control risk assessment (ICRA) that ties those hazards to specific controls, patient placement decisions, and monitoring strategies.
Baseline and follow-up environmental sampling, such as Legionella testing, mold spore counts, silica air monitoring, and asbestos air or bulk sampling, to verify that controls are functioning as intended.
Clear response protocols that define when work should be paused, what kinds of corrective actions are required, and how decisions are documented and communicated.
Ongoing communication with clinical leadership and frontline staff so that potential impacts on patient care areas are understood and managed in advance.
Targeted, timely training for construction workers, facilities staff, and other personnel who might inadvertently breach infection prevention barriers or protocols, including explicit instructions on when to stop work and whom to notify should a breach is suspected.

Healthcare construction and renovation projects do not have to put your patients, staff, or reputation at risk. Pace® combines healthcare-focused expertise with a nationwide laboratory network to help you identify risks early, validate controls, and respond quickly when conditions change. To discuss an upcoming construction or remodeling project or to review your current infection prevention strategy, contact us today.