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<br />PHYSICIST /RADIATION SHIELDING REPORT
<br />RADIATION SERVI, I
<br />Shielding Specifications
<br />for
<br />AdventHealth Zephyrhills
<br />7050 Gall Boulevard
<br />Zephyrhills, Florida 33541
<br />Radiology Room 6
<br />Completed on
<br />August 17, 2021
<br />,JJPerformed by
<br />rV` tJ"X�J
<br />Carly D. Williams, M.S., DABR
<br />Medical Physicist
<br />9320 McIntosh Road, Dover, Florida 33527
<br />(813) 685-3796 (800) 505-6828 Fax (813) 685-2448
<br />Page 1 of 3
<br />Shielding Calculation (RIF Room)
<br />Date: August 17, 2021
<br />Room: Radiology Room 6
<br />Calculated By Carly D. Williams. M.S.. DABR
<br />i^,
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<br />T
<br />KIP
<br />Kip
<br />ec
<br />Patients Per Wk.-
<br />(mGylpt)
<br />(mGy/pt)
<br />{mGy/pt)
<br />Side
<br />(mGy/pt)
<br />(mGy/pt)
<br />60
<br />Chest *
<br />2.3
<br />Other**'
<br />5.2
<br />Scatter**
<br />0.034
<br />Leakage-
<br />0.00053
<br />Backscatter-
<br />Rad Room
<br />Rad Tube
<br />5.9
<br />0.028
<br />0.00094
<br />(R&F Room)
<br />20
<br />Fluoroscopic Tube
<br />(R&F Room)
<br />0.012
<br />0.440
<br />Design Parameters
<br />A-B (Hallway)
<br />0.02
<br />625
<br />1.00
<br />Chest Image Receptor
<br />1,00
<br />B-C (Room 5)
<br />0.02
<br />9.96
<br />0.02
<br />Secondary Wall
<br />1.00
<br />C-D (Control Room)
<br />0.02
<br />9.87
<br />0.02
<br />Secondary Wall
<br />1.00
<br />E-F
<br />0.02
<br />13.75
<br />0.02
<br />Secondary Wall
<br />0.25
<br />(Tech Area, Room 6 Toilet)
<br />F-A
<br />0.02
<br />5.50
<br />0.2
<br />Secondary Wall
<br />1.00
<br />(Pulmonary Function Lab)
<br />Ceiling/Floor
<br />0.02
<br />1 3.93
<br />1 0.89
<br />1 Ceiling/Floor
<br />1 1.00
<br />Shielding Requirements
<br />A-B (Hallway)
<br />1.1
<br />1/16
<br />None,,e "
<br />B-C (Room 5)
<br />0.55
<br />1/16
<br />Noeie
<br />C-D (Control Room)
<br />0.55
<br />1/16
<br />None
<br />E-F
<br />(Tech Area, Room 6 Toilet)
<br />0.4
<br />1116
<br />None
<br />F-A
<br />(Pulmonary Function Lab)
<br />0.86
<br />1/16
<br />Npne
<br />Ceiling/Floor
<br />65 rum concrete
<br />Assumed 72 min concrete
<br />None
<br />Value provided by facility
<br />V211.le taken from NCRP Report No. 147
<br />Assumptions
<br />1. The recommended occupancy factors are conservatively high.
<br />2. The minimum distance to the occupied area from a shielded wall is assumed to be one foot.
<br />3. The minimum required thickness has been increased to nearest available 1/32" of lead.
<br />4. The shielding design goal of 0.02 mGy/wk. was chosen for all occupants to meet NCRP guidelines for declared pregnant workers.
<br />Recommendations:
<br />1. The shielding required for the control room window must be the lead equivalent of the rest of the barrier.
<br />2. The shielding in the walls must extend to a height of at least seven feet.
<br />3. Any joints in the shielding material should overlap to prevent leaks.
<br />4. Any penetrations to the shielding should be back shielded with equivalent material to the shield penetrated with sufficient
<br />overlap such that no direct line of sight between the radiation source and the outside of the barrier exists.
<br />5. The existing structural concrete in floor and ceiling meet the shielding requirement.
<br />6. A permanent placard should be mounted by the contractor in the room specifying the amount and type of shielding in each of the walls.
<br />I aU�UVi 1 .R.I Y es Inc.Page 2 of 3 w(813) 6 ser.co
<br />I (813)85-3796
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<br />Specific details relating to the above shielding requirements diagram can be found on the corresponding calculation pages included in this document.
<br />radseccomR1&RSpnkes, Inc,
<br />Page 3 of 3 (813) 685-3796
<br />INFECTION CONTROL RISK ASSESSMENT
<br />ADVENTHEALTH
<br />INFECTION CONTROL RISK ASSESSMENT
<br />Infection Control Construction Worksheet No:
<br />Location of Construction: Imaging Suite
<br />Project Start Date: TBD - Approx 9/15
<br />Project Coordinator: Jordan Smith
<br />Estimated Duration: Approx 30 days
<br />Contractor Performing Work: TBD
<br />Completion Date: 10/15/2021
<br />Supervisor: TBD
<br />Telephone: TBD
<br />YES
<br />NO
<br />CONSTRUCTION ACTIVITY
<br />YES
<br />NO
<br />INFECTION CONTROL RISK GROUP
<br />TYPE A: Inspection, non-invasive activity
<br />GROUP 1: Low Risk
<br />TYPE B: Small scale, short duration
<br />GROUP 2: Medium Risk
<br />moderate to high levels
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<br />TYPE D: Major duration and construction
<br />GROUP 4: Highest Risk
<br />activities requiring consecutive work shifts
<br />1. Execute work by methods to minimize raising dust
<br />3. Minor Demolition for Remodeling
<br />CLASS I
<br />2. Immediately replace a ceiling tile displaced for
<br />visual inspection
<br />1. Provide active means to prevent airborne dust from
<br />6. Contain construction waste before transport in
<br />dispersing into atmosphere.
<br />tightly covered containers
<br />2. Water mist work surfaces to control dust while
<br />7. Wet mop and/or vacuum with HEPA filtered
<br />CLASS II
<br />cutting.
<br />vacuum before leaving work area.
<br />3. Seal unused doors with duct tape.
<br />8. Place dust mat at entrance and exit of work area
<br />4. Block off and seal air vents.
<br />9. Isolate HVAC system in areas
<br />5. Wipe work surfaces with disinfectant.
<br />where work is being preformed.
<br />L Isolate HVAC system in area where work is being
<br />6. Vacuum work with HEPA filtered vacuums.
<br />CLASS III
<br />done to prevent contamination of ducts stem.
<br />p y
<br />7. We mop with disinfectant
<br />p
<br />Date:
<br />2. Complete all critical barriers or implement control
<br />8. Remove barrier materials carefully to minimize
<br />Cube method before construction begins.
<br />3. Contain construction waste before transport in
<br />spreading of dirt and debris associated with
<br />construction
<br />Initial
<br />tightly covered containers
<br />9. Cover transport receptacles or carts. Tape coverings
<br />4. Maintain negative air pressure within work site
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<br />10. Isolate HVAC system in areas where
<br />Y
<br />utilizing HEPA equipped air filtration units.
<br />5. Do not remove barriers from work area until
<br />work is being preformed
<br />completed project is thoroughly cleaned by the
<br />Environmental Services Department.
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<br />Architect: CJAE Group, Carla Harvey
<br />Engineering: Jordan Smith
<br />Infection Control:
<br />Safety Officer: Jordan Smith
<br />Contractor: TBD
<br />Date: 6/23/2021
<br />Exceptions/Additions to this inspection: Yes No
<br />Steps 1-3 Adapted with permission V Kennedy, B Barnard, St. Luke Episcopal Hospital, Houston TX; C Fine, CA
<br />Steps 4-14 Adapted with permission Fairview University Medical Center, Minneapolis MN
<br />ADVENTHEALTH
<br />INFECTION CONTROL RISK ASSESSMENT
<br />Step 3:
<br />Description of Required Infection Control Precautions by Class
<br />Uurmg Uonstructlon rroject
<br />1. Execute work by methods to minimize raising dust
<br />From construction operation.
<br />2. Immediately replace a ceiling tile displaced for
<br />visual inspection
<br />1. Provide active means to prevent airborne dust from
<br />dispersing into atmosphere.
<br />2. Water mist work surfaces to control dust while
<br />cutting.
<br />3. Seal unused doors with duct tape.
<br />4. Block off and seal air vents.
<br />5. Place dust mat at entrance and exit of work area
<br />6. Isolate the HVAC system in areas where
<br />work is beine nerformied.
<br />1. Isolate HVAC system in area where work is being
<br />done to prevent contamination of duct system.
<br />2. Complete all critical barriers I.e. sheetrock,
<br />plywood, plastic, to seal area from non work area
<br />or implement control cube method (cart with
<br />plastic covering and sealed connection to work site
<br />with 14EPA vacuum for vacuuming prior to exit)
<br />before construction begins.
<br />3. Maintain negative air pressure within work site
<br />utilizing HEPA equipped air filtration units.
<br />4. SeaI holes, pipes, conduits, and punctures.
<br />5. Construct anteroom and require all personnel to
<br />pass through this room so they can be vacuumed
<br />using a HEPA vacuum cleaner before leaving work
<br />site or they can wear cloth or paper coveralls that
<br />are removed each time they leave work site.
<br />6. All personnel entering work site are required to
<br />wear shoe covers. Shoe covers must be changed
<br />each time the worker exits the work area.
<br />7 Do not remove barriers from work area until
<br />completed project is inspected by the owner's
<br />Safety Department and Infection Control
<br />Department and thoroughly cleaned by the
<br />owner's Environmental Services Dept.
<br />Upon completion of rroject
<br />1. Wipe work surfaces with disinfectant.
<br />2. Contain construction waste before transport in
<br />tightly covered containers.
<br />3. Wet mop and/or vacuum with HEPA filtered
<br />vacuum before leaving work area.
<br />4. Remove isolation of HVAC system in areas
<br />where work is being performed.
<br />1. Remove barrier materials carefully to
<br />minimize spread of dirt and debris
<br />2. Contain construction waste before transport in
<br />Tightly covered containers.
<br />3. Cover transport receptacles or carts. Tape covering
<br />unless solid lid.
<br />4. Vacuum work area with HEPA filtered
<br />vacuums.
<br />5. Wet mop area with disinfectant.
<br />6. Remove isolation of HVAC system in areas
<br />where work is being performed.
<br />Steps 1-3 Adapted with permission V Kennedy, B Barnard, St. Luke Episcopal Hospital, Houston TX; C Fine, CA
<br />Steps 4-14 Adapted with permission Fairview University Medical Center, Minneapolis MN
<br />4
<br />I
<br />EXISTING SLAB ABOVE
<br />CLOSE CEILING SPACE WITH
<br />POLYTHENE MEMBRANE
<br />SEAL OPEN DUCTS
<br />SUSPENDED CEILING (TYP)
<br />E
<br />SEAL ALL OPEN JOINTS AND
<br />PIPE/DUCT CONDUIT PENETRATIONS;
<br />SECURE ALL TAPE W/ RAM -TACK
<br />IN THE PARTITION AND POLYTHENE
<br />BARRIER WITH DUCT TAPE
<br />SEAL PERIME
<br />DUCT TAPE
<br />RENOVATION SIDE
<br />NOTE: CONTRACTOR SHALL MAINTAIN
<br />A MINIMUM OF 6'-0" CLEAR WIDTH IN
<br />ALL CORRIDORS AND PASSAGES
<br />ALONG THE FULL LENGTH OF THE
<br />TEMPORARY CONSTRUCTION BARRIER
<br />ON THE OCCUPIED SIDE.
<br />PLASTER TAPE ALL JOINTS, HIGH
<br />TACK SPRAY OR EQUAL
<br />5/8" TYPE 'X' GWB ON 3 5/8"
<br />STUD FRAMING AT 16" O.C. (1-HR).
<br />PAINT OCCUPIED SIDE.
<br />OCCUPIED SIDE
<br />(MIN) SOUND ATTENUATION
<br />WET
<br />NT 3 5/8" SILL TRACK
<br />"URED TO FLOOR
<br />STING FLOORING
<br />ADVENTHEALTH
<br />INFECTION CONTROL RISK ASSESSMENT
<br />Infection Control Risk Assessment
<br />Matrix of Precautions for Construction & Renovation
<br />Step One:
<br />Using the following table, identify the Type of Construction Project Activity (Type A-D)
<br />h
<br />Inspection and Non -Invasive Activities.
<br />Includes, but is not limited to:
<br /># Removal of ceiling tiles for visual inspection limited to I tile per 50
<br />ar "
<br />square feet.
<br /># Painting (but not sanding)
<br /># Wall covering, electrical trim work, minor plumbing, and activities
<br />Which do not generate dust or require cutting of walls or access to
<br />Ceilings other than for visual inspection
<br />Small scale, short duration activities which create minimal dust.
<br />Includes, but is not limited to:
<br /># Installation of telephone and computer cabling
<br /># Access to chase spaces
<br /># Cutting of walls or ceiling,,where dust migration can be controlled.
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<br />Major demolition and construction projects.
<br />Includes, but is not limited to:
<br /># Activities which require consecutive work shifts
<br /># Requires heavy demolition or removal of a complete cabling system
<br /># New construction
<br />Step 1: TYPE C
<br />Steps 1-3 Adapted with permission V Kennedy, B Barnard, St. Luke Episcopal Hospital, Houston TX; C Fine, CA
<br />Steps 4-14 Adapted with permission Fairview University Medical Center, Minneapolis MN
<br />2
<br />ADVENTHEALTH
<br />INFECTION CONTROL RISK ASSESSMENT
<br />Step 4: Identify the areas surrounding the project area, assessing potential impact
<br />Unit Below
<br />Unit Above
<br />Lateral
<br />Lateral
<br />Behind
<br />Front
<br />N/A
<br />Cath/Locker
<br />(Risk Gr 4)
<br />Imaging
<br />Imaging
<br />Imaging
<br />Imaging
<br />Risk Grou
<br />Risk Grou
<br />Risk Grou
<br />Risk Gmu
<br />Risk Grou
<br />Risk Grou
<br />Step 5: Identify specific site of activity eg, patient rooms, medication room, etc.
<br />Replacement of existing x-ray equipment with new x-ray equipment.
<br />Step 6: Identify issues related to: ventilation, plumbing, electrical in terms of the occurrence of probable
<br />outages.
<br />There may be minor electrical shutdown required for new wiring connections. Will be coordinated with
<br />sraff/areas affected.
<br />Step 7: Identify containment measures, using prior assessment. What types of barriers? (Eg, solid wall
<br />barriers); Will HEPA filtration be required?
<br />Entry door protection, solid wall barrier or Edgeguard, with HEPA filtration negative air machines and
<br />entry vestibule.
<br />(Note: Renovation/construction area shall be isolated from the occupied areas during construction and
<br />shall be Negative with respect to surrounding areas)
<br />Step 8: Consider potential risk or water damage. Is there a risk due to compromising structural integrity?
<br />(eg, wall, ceiling, roof)
<br />None
<br />Step 9: Work hours: Can or will the work be done during non -patient care hours?
<br />Normal Hours
<br />Step 10: Do plans allow for the adequate number of isolation/negative air flow rooms?
<br />N/A
<br />Step 11: Do the plans allow for the required number & type of hand washing sinks?
<br />N/A - Already in the room.
<br />Step 12: Does the infection control staff agree with the minimum number of sinks for this project?
<br />N/A
<br />Step 13: Does the infection control staff agree with the plans relative to clean and soiled utility rooms?
<br />N/A
<br />Step 14: Plan to discuss the following containment issues with the project team.
<br />Eg, traffic flow, housekeeping, debris removal (how and when),
<br />Contractor to remove waste out the back of the building. Contractor to monitor housekeeping and sticky
<br />mats at all times.
<br />Steps 1-3 Adapted with permission V Kennedy, B Barnard, St. Luke Episcopal Hospital, Houston TX; C Fine, CA
<br />Steps 4-14 Adapted with permission Fairview University Medical Center, Minneapolis MN
<br />5
<br />ADVENTHEALTH
<br />INFECTION CONTROL RISK ASSESSMENT
<br />Step Two:
<br />Using the following table, identify the Patient Risk Groups that will be affected.
<br />If more than one risk group will be affected, select the higher risk group.
<br />Offices
<br />All patient care areas
<br />Emergency Department
<br />Operating Rooms
<br />Administration
<br />not mentioned in
<br />Ratltirlirv&1Vf
<br />Sterile Processing
<br />Public Areas
<br />groups 3 or 4
<br />PACU
<br />ICU
<br />Kitchen
<br />Nuc Med
<br />Cath Lab
<br />Admission
<br />Laboratories
<br />Outpatient Areas
<br />Echocardiography
<br />Dialysis
<br />Pharmacy
<br />Step 2: High
<br />Step Three: Match the
<br />Patient Risk Group (Low, Medium, High, Highest) with the planned...
<br />Construction Project Type (A, B, C, D) on the following matrix, to find the...
<br />Class of Precautions (1, H, III, IV) or level of infection control activities required.
<br />Class I -IV or Color -Coded Precautions are delineated on the following page.
<br />IC Matrix - Class of Precautions: Construction Project by Patient Risk
<br />Construction Project Type
<br />Note: Infection Control approval will be required when the Construction Activity and Risk Level indicate
<br />that _ or ® control procedures are necessary.
<br />Steps 1-3 Adapted with permission V Kennedy, B Barnard, St. Luke Episcopal Hospital, Houston TX; C Fine, CA
<br />Steps 4-14 Adapted with permission Fairview University Medical Center, Minneapolis MN
<br />ADVENTHEALTH
<br />INFECTION CONTROL RISK ASSESSMENT
<br />Appendix: Identify and communicate the responsibility for project monitoring that includes infection
<br />Control concerns and risks. The ICRA may be modified throughout the project.
<br />Revisions must be communicated to the Project Manager.
<br />Yes
<br />No
<br />N/A
<br />X
<br />Will there be Noise generated that will impact a department adjacent to, above or below the construction
<br />area?
<br />X
<br />A: If so, departments must be notified.
<br />X
<br />B: How are you going to reduce the noise to an acceptable level?
<br />Yes
<br />No
<br />N/A
<br />X
<br />Will Vibration be generated that will impact a department adjacent to, above, or below the construction area?
<br />X
<br />A: If so, departments must be notified.
<br />X
<br />B: How are you going to reduce the noise to an acceptable level?
<br />Yes
<br />No
<br />N/A
<br />X
<br />Are Emergency Procedures in place and posted on each job for accidental events that could greatly impact
<br />Patient Care or Life Safety to the facility? included in these procedures are such things as:
<br />Emergency telephone numbers of key departments
<br />A plan that describes where main valves, switches, and controls are for the area in case of an emergency.
<br />A plan for unexpected outages.
<br />Steps 1-3 Adapted with permission V Kennedy, B Barnard, St. Luke Episcopal Hospital, Houston TX; C Fine, CA
<br />Steps 4-14 Adapted with permission Fairview University Medical Center, Minneapolis MN
<br />6
<br />KEY PLAN N�
<br />106 WEST NORTH BAY STREET / TAMPA, FL 33603
<br />http:l/cjaegroup.com
<br />ENGINEERING
<br />STAMPS AND APPROVALS
<br />I HEREBY CERTIFY THAT THIS PLAN, SPECIFICATION OR REPORT WAS
<br />PREPARED BY ME OR UNDER MY DIRECT SUPERVISION, AND THAT I AM A
<br />DULY LICENSED ARCHITECT UNDER THE LAWS OF THE STATE OF FLORIDA-
<br />TO THE BEST OF MY KNOWLEDGE, THESE PLANS AND SPECIFICATIONS
<br />COMPLY WITH THE APPLICABLE BUILDING CODES.
<br />CARLA J. HARVEY, LICENSE NO: AR95088
<br />PROJECT NAME
<br />ADVENTHEALTH ZEPHYRHILLS
<br />ROOM 6 X-RAY REPLACEMENT
<br />PROJECT LOCATION
<br />7050 GALL BOULEVARD
<br />ZEPHYRHILLS, FL 33541
<br />PROJECT NUMBER
<br />2021-009
<br />PROJECT PHASE
<br />100%D CONSTRUCTION DOCUMENTS
<br />ISSUE DATE
<br />AUGUST 18, 2021
<br />REVISIONS LIST
<br />NO. DATE DESCRIPTION
<br />SHEET TITLE
<br />INFECTION CONTROL RISK
<br />ASSESSMENT AND INFORMATION,
<br />RADIATION SHIELDING REPORT
<br />SHEET NO.
<br />■
<br />TYPICAL TEMP CONSTRUCTION BARRIER
<br />
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