Most practices cannot close for months while their space is renovated or expanded. Patients still need care, staff still need to be paid, and a closed office loses patients to the practice down the street. So a lot of health care construction happens next door to an exam room that is still seeing patients. This guide covers how that work is planned for a medical, dental, or veterinary practice: phasing, infection control, barriers and negative air, exits and fire protection, noise, and talking with staff. It applies to a renovation or finish-out of existing space and to a new building going up beside one that stays in use.
Start with a phasing plan
Phasing means dividing the work into stages so part of the practice stays open while another part is built. The plan is drawn on the floor plan before the work is priced: which rooms close first, where patients enter during each stage, where staff park, and how many exam rooms or operatories are available at each point. A practice that needs eight rooms to keep its schedule should know before construction starts which weeks it will have six.
Phasing is possible on many projects, but not on every one, and it adds cost and time. Each stage has its own setup, its own temporary walls, and often its own inspection. Utility work is the hardest part to phase, because water, power, and the HVAC system usually serve the whole space. The schedule should show each shutdown, and when it is feasible the shutdown happens outside clinic hours.
Two of our projects show how phasing can work. At Holt Veterinary Clinic in Dallas, a zero-lot-line site, the new building went up behind the original 1946 clinic on the former kennel site, and only then was the old building abated and demolished to make room for a new approach and parking lot. The clinic kept serving clients through construction. At Eagle Ranch Vision Source in Fort Worth, a building addition and a remodel of the retail space and lab were phased while the office remained fully operational.
The infection control risk assessment
An infection control risk assessment, usually called an ICRA, is a short, structured look at two things: how much dust and disruption the work will create, and how vulnerable the patients nearby are. The CDC's guidelines for environmental infection control call for this kind of assessment before construction in health care spaces, and the American Society for Health Care Engineering publishes a widely used matrix, ICRA 2.0, that turns the answers into a class of precautions.
Painting in an office corridor is a low class. Demolition next to a procedure room or a surgery suite is a high class with much stricter measures. The practice's infection control lead, or the clinical leader who fills that role in a smaller office, sets the precautions with the design team. The contractor builds and maintains them every day the job is open. A dental office with aerosol-producing procedures and a veterinary hospital with a surgery room both deserve the same attention as a medical clinic.
Barriers and negative air
The barrier is the wall between the work and the patients. For light work it can be a plastic sheeting partition. For dusty work next to patient areas it is usually a hard, sealed temporary wall from floor to the deck above, with taped joints and a door, and a walk-off mat or sticky mat at the exit so dust does not track out on shoes.
Higher classes add negative air: a fan unit with a HEPA filter that pulls air out of the work area and exhausts it outside or through the filter, so air leaks into the construction zone rather than out of it. A simple pressure gauge on the barrier shows at a glance whether it is working. Return air grilles in the work area are sealed so the HVAC system does not carry dust to the rest of the practice. Someone checks the barrier and the gauge every day and writes it down.
Keeping exits and fire protection working
Temporary walls can block a path out of the building, and that is the risk owners overlook most. Every phase has to keep a clear, marked way out for patients and staff, with exit signs where they are needed. If an exit has to close, the alternate route is approved before the wall goes up. The fire code and the National Fire Protection Association's standard for construction operations, NFPA 241, both deal with fire safety during this kind of work.
Fire alarm devices and sprinkler heads in the work area may have to be covered or shut down for a time. When that happens, the fire marshal's requirements apply, which can include a fire watch, someone walking the space on a set schedule until the system is back in service. Hot work, such as welding or cutting, needs a permit and a watch of its own in an occupied building.
When a new suite is built next to an occupied neighbor, the separation between them matters as much as the barrier. At Fort Worth Plastic Surgery, the work included a fire-rated demising wall next to an occupied tenant and joining the new suite to an existing practice.
Noise, vibration, and after-hours work
Patients notice noise long before they notice dust. Core drilling, saw cutting concrete for plumbing, demolition, and powder-actuated fasteners can be heard and felt through a building. The usual answer is a schedule, not a promise: loud work is grouped into blocks set outside patient hours, or into the hours the practice says are quietest. An exam with a nervous patient, a hearing test, or a dental procedure all suffer from a sudden drill through the wall. Veterinary practices have to think about animals in boarding and recovery as well.
After-hours and weekend work is often feasible, and it adds cost and time because of overtime, slower production, and the extra setup and cleanup each day. Use it for the work that cannot happen during the day, such as shutdowns, the loudest demolition, and work inside rooms that are in use during clinic hours.
Telling staff and patients
A short weekly meeting between the contractor's superintendent and one person at the practice prevents most problems. That person hears what is coming next week, what will be loud, which door will close, and when water or power will be off. Staff should know who to call when dust appears on a counter or a barrier gets bumped.
Patients need less detail and more notice: a sign at the entrance, a note in appointment reminders if the entrance moves, and a front desk that can explain where to park. Keep the work area locked and out of sight. A clean, well-signed job site tells patients the practice is taking care of them while it improves the space. For more on what each kind of practice involves, see our medical, dental, and veterinary construction pages.
Common questions
Can my practice stay open during a renovation?
Often, yes, by phasing the work so part of the space stays open while another part is built. It is not feasible on every project, and phasing adds cost and time. A phasing plan drawn before pricing shows which rooms you will have at each stage.
What is an ICRA, and who prepares it?
An infection control risk assessment rates how much dust and disruption the work will create and how vulnerable nearby patients are, then sets the precautions. The practice's infection control lead sets them with the design team, and the contractor builds and maintains them.
Does after-hours work cost more?
Yes. Overtime, slower production, and the daily setup and cleanup all add cost and time. It is best used for shutdowns, the loudest work, and rooms that are in use during clinic hours.
What happens to fire alarms and sprinklers during construction?
Devices in the work area may be covered or shut down for a time. When that happens, the fire marshal's requirements apply, which can include a fire watch until the system is back in service.
Planning a new building, a finish-out, or a renovation? Tell us about it.