A series of recent patient deaths at Pittsburgh hospitals directs a glaring spotlight on the deadly effects of mold and other airborne pathogens in healthcare facilities. In a more recent hospital mold outbreak, the facility was forced to cancel patient surgeries until mold could be eradicated. These situations underscore the critical challenges facing hospital administrators and facility managers when trying to prevent and remediate outbreaks of mold and bacteria in their high-risk environments.
In the most recent case, the patient contracted an infection when spores of rhizopus – a particularly deadly form of mold – reached her sinus cavity. The contamination wasn’t surface-based, but airborne. Remediation for surface pathogens in these environments requires highly specialized efforts, but eliminating their airborne counterparts presents even greater dangers – for at-risk patients, facility staff, and even the remediation experts themselves.
5 Challenges of Mold Remediation in a Healthcare Environment
“Mold remediation in a healthcare facility is far more complex than in a typical residential or commercial property scenario,” says Tom Peter, Certified Industrial Hygienist (CIH), of Infection Control Technologies, a firm specializing in mold remediation in high-risk environments. “The overriding concern, of course, is patient safety. Most patients in care are already, by definition, at risk for infection. The design, planning, scheduling, and execution of a remediation plan is driven by ensuring that patients and staff are protected during all stages of the project from potential surface, and especially airborne, contamination.”
With that in mind, the coordination of efforts reaches all areas of the hospital or healthcare facility operation. “The planning and scheduling stage is critical,” says Thomas Licker, Certified Environmental Infection Control Remediator (CEICR). “Typically a mold remediation team would include a Certified Environmental Infection Control Remediator or Certified Industrial Hygienist, experts from the building’s Engineering Department, the Facilities staff, and most importantly, the Infection Control department.” Each will take part in the design and approval of a comprehensive plan that considers the following:
- Identification. What is the source of the mold outbreak? What steps are necessary to eliminate the source and ensure that the outbreak will not reoccur? What type of mold is present? How physically extensive is the contamination, both in terms of square footage as well as the manner(s) of contamination (surface type(s), air, etc.)?
- Containment. What physical and systematic controls mechanisms will be in place to ensure that the outbreak is limited to the smallest area possible, and prevent further spread?
- Relocation. Safely coordinating the relocation of patients and staff can be the most crucial factor of a healthcare remediation effort. How, where and when can they be moved to ensure their safety and to eliminate potential cross-contamination to other areas of the facility in the process?
- Remediation. What remediation methods, equipment, and materials will be necessary to contain, clean, disinfect, sanitize and safely dispose of all affected equipment, furnishings, building materials and other contents? How will biohazards and contaminated medical supplies be properly packaged and removed?
- Cleanup and Reconstruction. What efforts and resources will be needed to return the facility to pre-existing and full operating condition in the safest, most efficient and least disruptive way possible, while ensuring the safety of all patients and staff?
Peter says, “It’s challenging. The controls and coordination that need to be in place require full cooperation of all stakeholders, and these steps all need to be thoughtfully designed, confirmed and approved before any work can begin. But at the same time, it needs to be done rapidly. It’s a delicate balance. The right expertise and the right foundation need to be in place before events occur. Because they will.”
Vital Elements of Proper Mold Remediation in Hospitals and Healthcare Facilities
“The hospital’s or healthcare facility’s Infection Control Risk Assessment (ICRA) dictates the standards that must be met before work can begin,” says Peter. “It’s all about the details, the safety, the process and the staff involved. Having highly-trained, qualified professionals in place is essential.”
The most important step in a hospital mold remediation effort, according to Peter, is containment and dust control. “We call this ‘engineering controls’. It’s the creation of a sealed work area, or containment system, that fully encompasses the contaminated space, with safe passage areas for remediation technicians,” says Peter.
- Physical barriers. Containment with plastic or hard barriers can be complicated. The objective isn’t merely to prevent people from coming into the area; it’s necessary to keep microscopic mold spores from leaving. Dividing hallways and sealing off above and below ceilings must be done properly.
- HVAC system barriers. The process of remediation – removing furnishings, possibly walls and flooring, will release more mold spores into the air. Prior to any work, the ventilation system must be fully isolated to prevent contamination throughout the entire facility, as well as the HVAC ducts and components.
- HEPA air filtration devices. Dust and contaminants must be captured during remediation using HEPA air filtration devices. Optimum air flow and negative pressure should be monitored at all times with a manometer.
- Decontamination Area. The containment system must accommodate a decontamination area, or anteroom. This room at the entrance of the contained area is used as a staging and cleaning area for technicians. They will use the space to change in and out of protective clothing and respirators, and to clean equipment as it goes in and out of the work area.
- Fully Executed Remediation, Cleaning and Inspection. After the remediation work is completed, all of the affected areas should be left “white glove clean”. A thorough process includes HEPA vacuuming all surfaces, hand cleaning with disinfectant, additional HEPA vacuuming, and high-level disinfection with validation the technology used. Many are starting to use spore inoculated Biological Indicators. Before the area can be released, it should be inspected and tested by an independent company or the hospital’s infection control staff.
The Key to Successful Healthcare Facility Mold Remediation: Planning Ahead
The complexities of mold outbreaks in hospital and healthcare facilities illustrate the need for administrators to have comprehensive mitigation guidelines in place. All internal members of the remediation team should be identified in advance. External contractors, environmental consultants and industrial hygienists should be vetted and in place well before of any contamination event to avoid unnecessary or dangerous delays.
“There is no margin for error when a hospital experiences mold contamination,” says Peter. “Having a current, comprehensive emergency response plan in place that includes mold remediation is the key to successfully and quickly containing and eliminating the danger to the patients and staff.”
Insurance Restoration Specialists, Inc. (IRS) is a premier provider of disaster recovery mitigation, environmental remediation, biohazard emergency response and HVAC inspection and cleaning in the New Jersey-Philadelphia-New York City area. IRS is certified by NADCA and have Certified Air Systems Cleaning Technicians and a Certified Ventilation System Inspector on staff. For businesses and property managers, an IRS Emergency Response Plan ensures having a pre-qualified contractor with a master services agreement, pricing and insurance in place before a disaster occurs.
ICT: First in Infection Control and Biological Decontamination. Infection Control Technologies, (ICT) a division of Insurance Restoration Specialists, Inc. (IRS) is one of the nation’s leading Building Hygiene contractors. ICT provides Facility Hygiene Services and Emergency Decontamination for some of the nation’s most respected real estate and Risk Management Professionals, Health Care, Municipalities, Institutions, Food Safety, Transportation, and government organizations.
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