10.5 PCRA, the Cleaning Responsibility Matrix & Projecting EVS Cost for New Construction

10.5 PCRA, the Cleaning Responsibility Matrix & Projecting EVS Cost for New Construction

Three Planning, Design, and Construction tasks complete the eight-item content area and are frequently missed:

• Task 2.B — Risk Assessment: ICRA, PCRA. The outline names both.
• Task 2.I — "Interpret and apply manufacturers IFUs for medical equipment and identify responsibility matrix."
• Task 2.H — "Calculate EVS departmental costs for new building or expansion of facility."

Tasks 2.C, 2.D, 2.E, and 2.G — collaborating on institutional design standards, evaluating cleaning maintenance recommendations before purchase, participating in planning and design, and maintaining facility appearance — set the governance context and are covered at the end.

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1. PCRA vs. ICRA: Two Different Assessments

Section 10.1 covered the Infection Control Risk Assessment in detail. The Pre-Construction Risk Assessment is broader, and confusing them is a reliable exam trap.

[!IMPORTANT] Memorize the PCRA's six named domains: air quality, infection control, utility requirements, noise, vibration, and other hazards affecting care, treatment, and services. An item that lists five of these plus a fabricated sixth is a common distractor pattern.

What EVS Owns in the PCRA

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2. Manufacturer IFUs and the Cleaning Responsibility Matrix

Task 2.I pairs two ideas because they solve the same problem: shared medical equipment that nobody cleans.

The IFU is binding. Every medical device carries manufacturer Instructions for Use specifying which cleaning and disinfection products are validated for its surfaces, the contact time, and any prohibited chemistries. Using an unapproved product can void the warranty, degrade the housing, and — most importantly — fail to achieve disinfection. When a device IFU and the facility's standard disinfectant conflict, the conflict is resolved before purchase, not by a technician at the bedside.

[!WARNING] The purchasing-cycle failure. A capital committee approves a new infusion pump fleet, and only after delivery does anyone read the IFU and discover the housing is not compatible with the facility's standard quaternary disinfectant. The department is now choosing between voiding warranties and stocking a second chemical. This is precisely why Task 2.D requires the CHESP to evaluate cleaning maintenance recommendations prior to purchase — and why EVS belongs on the product evaluation committee (Section 9.6).

Building the Cleaning Responsibility Matrix

A responsibility matrix is a simple table with one row per item and one owner per row. It is one of the highest-value documents an EVS director produces, and its absence is a recurring accreditation finding because uncleaned shared equipment is a documented transmission route.

Rules for making the matrix stick: build it multidisciplinarily and get it approved by the Infection Control committee; state the product and the contact time, not just the owner; review it whenever new equipment arrives; and post the relevant excerpt at the point of use rather than filing it centrally. The moment an item has no owner, the correct answer during a survey is that it went uncleaned.

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3. Calculating EVS Cost for a New Building or Expansion

Task 2.H asks for a number, and the method is a straight application of the workload and FTE mathematics in Chapter 8.

+-----------------------------------------------------------------------------+
|        SIX STEPS: FROM CONSTRUCTION DRAWINGS TO A BUDGET REQUEST            |
|                                                                             |
|  1. TAKEOFF      Cleanable square footage from the drawings, BY AREA TYPE   |
|                  (patient room, clinical support, public, administrative)   |
|                  - Cleanable sq ft is NOT gross building sq ft: exclude     |
|                    shafts, chases, and non-serviced space                   |
|  2. WORKLOAD     Apply task frequencies and time standards to each area     |
|                  type; add projected discharge/terminal cleaning volume     |
|  3. CONVERT      Annual productive hours -> NET FTEs -> GROSS FTEs using    |
|                  the non-productive factor                                  |
|  4. PRICE        Gross FTEs x FULLY LOADED cost (wage x benefit load)       |
|  5. NON-LABOR    Chemicals, liners, linen, equipment operating cost         |
|  6. CAPITAL      One-time equipment package + infrastructure that must be   |
|                  in the CONSTRUCTION budget (closets, floor sinks,          |
|                  dispensing stations, trash/linen chute or holding rooms)   |
+-----------------------------------------------------------------------------+

Worked Example: A New 36-Bed Inpatient Floor

Step 1 — Takeoff (24,000 cleanable square feet):

Step 2 — Workload:

• Daily occupied room cleaning: 36 rooms × 28 minutes = 1,008 min/day = 16.8 hr/day × 365 = 6,132 hr/yr (28 minutes sits inside AHE's published 25–30 minute occupied-room band — do not model a new building at a time the certifying body's own guidance calls too short)
• Discharge/terminal cleaning: projected annual discharges = (36 beds × 80% occupancy × 365) ÷ 4.2-day average length of stay = 10,512 patient days ÷ 4.2 = 2,503 discharges; at 45 minutes each = 112,635 min ÷ 60 = 1,877 hr/yr
• All other space: 12,480 sq ft at a 3,000 sq ft/hour production rate = 4.16 hr/day × 365 = 1,518 hr/yr
• Total annual productive workload = 6,132 + 1,877 + 1,518 = 9,527 hours

Step 3 — Convert to FTEs (2,080 paid hours, 15% non-productive, 1,768 productive hours per FTE):

$\text{Gross Budgeted FTEs} = \frac{9{,}527}{1{,}768 \text{ productive hours/FTE}} = 5.39 \approx \textbf{5.4 gross FTEs}$

Cross-check by the two-step route: $9{,}527 \div 2{,}080 = 4.58$ Net Worked FTEs, and $4.58 \times \frac{1}{0.85} = 5.39$. Dividing 5.39 by 0.85 a second time to reach 6.3 would charge the project for non-productive time twice.

Step 4 — Price at fully loaded cost (illustrative $19.50/hr average wage, 28% benefit load):

• Fully loaded hourly rate = $19.50 × 1.28 = $24.96
• Annual fully loaded cost per FTE = $24.96 × 2,080 = $51,916.80
• Labor = 5.4 × $51,916.80 = $280,350.72 ≈ $280,400 per year

Steps 5 and 6 — Non-labor and capital:

[!TIP] Two errors that cost departments real money. First, using gross building square footage instead of cleanable square footage inflates the request and destroys credibility. Second, pricing at base wage instead of fully loaded cost understates the request by roughly the benefit load — here 28% — and the department absorbs the gap all year. Also insist that closets, floor sinks, and dispensing stations be funded in the construction budget; if they are missed, the operating budget will be asked to retrofit them at several times the cost (Section 10.4).

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4. Design Standards Governance and Facility Appearance

The remaining PDC tasks describe an ongoing seat at the table, not a one-time review:

• Task 2.C — Institutional design standards. Collaborate with internal or external designers on standards for floor coverings, wall coverings, furnishings, and finishes so each project does not re-litigate them. A written standards document is what stops the fourteenth flooring type from entering the building.
• Task 2.D — Pre-purchase evaluation. Evaluate cleaning maintenance recommendations for every new floor covering, wall covering, furnishing, and finish before purchase — required chemistry, restricted chemistry, maintenance cycle, and expected labor (Section 10.3).
• Task 2.E — Participate in planning, design, and construction plans. Attend design reviews. EVS input at drawing stage is free; the same input after occupancy is a change order.
• Task 2.F — Infection control collaboration. Co-own the ICRA and the PCRA with Infection Prevention.
• Task 2.G — Facility appearance. Maintain a rolling plan for appearance: floor restoration cycles, wall and corner-guard repair, furniture replacement triggers, and exterior entry presentation — the first and last thing every patient sees.

[!TIP] The unifying PDC principle for the exam: every decision made before the building opens is either an operating cost or an operating saving for the next twenty years. The CHESP's job in PDC is to convert design choices into their labor, chemical, and life-cycle consequences (Section 8.6) and to put that number in front of the people making the decision — while it is still a drawing.