“expanding your infection prevention...
TRANSCRIPT
Three Rivers Association for Professionals in Infection Control & Epidemiology
TRAPIC 2016 Fall Conference Agenda October 7, 2016
Keystone+Mountain+Lakes Regional Council of Carpenters Training Center
“Expanding Your Infection Prevention Toolbox”
7:30-8:30 a.m. Registration / Breakfast and Vendor Display
8:30-8:45 a.m. Welcome / Conference Dedication
8:45-9:45 a.m. Session I: Clearing the Air: Reducing Fungal Infection Risk
Andrew Streifel, MPH, RS
9:45 – 10:45 a.m. Session II: Construction Management and Water Damage for Infection Prevention
Michael Buck, B.A. Biology, MDH Certified Hazardous Material Inspector, MDH Asbestos Site Supervisor
10:45-11:30 a.m. Break / Vendor Displays / Snack
11:30 – 12:30 p.m. Session III: The Design Professional and Infection Prevention for Healthcare Facilities
David Wells, AIA, Bachelor of Architecture
(Vendor Lunch at this time)
12:30 – 1:30 p.m. Attendee Lunch / Vendor Display
1:30-2:30 p.m. Session IV: Managing Construction-Related Risk from Legionella and Waterborne Pathogens
Janet Stout, Ph.D.
2:30-2:45 p.m. Break
2:45-3:45 p.m. Session V: Meet the Experts Panel Discussion
Andrew Streifel, Michael Buck, David Wells, and Janet Stout
3:45-4:00 p.m. Closing Remarks / Needs Assessment / CEU Certificate Distribution
TRAPIC gratefully acknowledges the following companies for their support of The Three Rivers APIC Annual Fall
Conference on October 7, 2016.
“Expanding Your Infection Prevention Toolbox”
Venue including breakfast, lunch, refreshments and handmade tool boxes sponsored in part by
the Keystone+Mountain+Lakes Regional Council of Carpenters.
Folders, notepads and pens provided by
Buckeye International.
Three Rivers APIC 2016 Fall Conference
Vendors / Sponsors
Name E‐mail Address Company Representatives1 3M ‐ Medical Division Cathy Janco [email protected] Cathy Janco, RN, BSN
Lynda Cook, MSN, RN, CRNI
2 Accelerate Diagnostics Matt Swider [email protected] Matt Swider
3 Access Scientific Jim Kuntz [email protected] Jim Kuntz
4 Aramark Uniform Services Kelly Sevachko sevachko‐[email protected] Kelly Sevachko
5 Bard Acess Systems Audra Sinclair [email protected] Audra Sinclair
6 Buckeye Cleaning Center ‐ Pittsburgh Scott Smith [email protected] Scott Smith, Grant Wolf, Mike Gordon
7 Centurion Medical Products Annette Sackett [email protected] Annette Sackett, Jane Kelley, Rhonda Chico
8 Clinical Technology, Inc. Brad Kinney [email protected] Gene Cuomo, Brad Kinney
9 Clorox Professional Scott Chrystal john@apex‐reps.com Scott Chrystal, Gary Hartman
10 Daylight Medical Gayle Harper [email protected] Greg Burrelli
11 Ecolab Healthcare William Committee [email protected] William Committee
12 Eloquest Healthcare Ralph DeStefano [email protected] Ralph DeStefano
13 Erzen Associates John Erzen [email protected] John Erzen, David Erzen, Ron Romano
14 Ethicon Mark Dunn [email protected] Mark Dunn, Sean Holleran
15 Genentech Mickey Bell [email protected] Mickey Bell, Tracy Rozzi
16 Global Life Technologies Corp. /
NOZIN
Ebony Grant [email protected] David Hanline
17 GOJO Industries Jenny Nichols [email protected]@gojo.com Patrick Robinette
18 ICU Medical Jenny Smith [email protected] Mike Bracken
19 KML Regional Council of Carpenters Ricky Okraszewski [email protected] Ricky Okraszewski
20 Medline ‐ Infection Prevention
Division
Brett Lucido [email protected] Brett Lucido
21 Medtronic Tara Valentine [email protected] Val Dedes, Tara Valentine, Ryan Presutti
22 Meiko, USA Jim Ward [email protected] Jim Ward
23 Molnlycke Healthcare, Inc. Kathy Caldwell kathy.conforti‐[email protected] Kathy Conforti‐Caldwell, Jody Feigel, RN,
Sam Grainger
24 Premier ‐ TheraDoc Jim Sianis [email protected] Jim Sianis, Trish Iovino
25 Professional Training Associates, Inc. Greg Ashman [email protected] Greg Ashman, Bill Tomlinson
26 Pursuit Healthcare Advisors Dean Boyd [email protected] Dean Boyd
27 Repco II Inc. Angel Casciato [email protected] Chris Krasny, Frank Gonzales, Graham Beaudry
28 Roche Diagnostics Ryan Connors [email protected] Ryan Connors, Greg Bammerlin
29 Sage Products Keith Kubit [email protected] Keith Kubit and Mark Vaselaney
30 Sealed Air / Diversey Madelyn Mastin [email protected] Madelyn Mastin
31 Seqirus Julie Zawrotuk [email protected] Julie Zawrotuk, Nick Zuzolo
32 Sherwin Williams Chris Sarkis [email protected] Chris Sarkis, Sharon Lee, Jim Geist
33 Special Pathogens Laboratory Jackie Lesjak [email protected] Jackie Lesjak
34 Stericycle, Inc. John Aldridge [email protected] John Aldridge
35 STERIS Corp. Allison Ross [email protected] Jamie Trainor, Allison Ross
36 Surfacide Mfg. Teri Kermendy [email protected] Tony Morocco
37 Teleflex Incorporated Casi Gorgas [email protected] Casi Gorgas, Chrissy Oravec
38 The Morel Company Erica Varble [email protected] Erica Varble
Company Name
10/8/2016 1 of 1
Last Name First Name Designation Company Name Email Address (if shared)
TRAPIC 2016 Fall Conference Attendees - October 7, 2016KML Regional Council of Carpenters Training Center, Pittsburgh PA
"Expanding Your Infection Prevention Toolbox"
Alcorn Tonya RN UPMC Seneca Place
Andaloro Katey Asst. Project Mgr. Jendoco Construction Corp.
Andrews Cindie RN Jefferson Hospital
Argyros Mary Ann RN The Surgery Center At Cranberry
Ballay Gregory RN UPMC
Bellush Mary Jo RN Excela Health Westmoreland Hospital [email protected]
Bender Jenny RN UPMC Presbyterian
Berback Jonathan Infection Preventionist UPMC Passavant
Brosious Steven Safety, IH Tech Geisinger Health System
Brytus Jeanne RN Children's Hospital of Pittsburgh - UPMC
Busalacchi Andy MBM Contracting, Inc.
Cloud-Woods Shelia RN VA Pittsburgh Healthcare System
Colaianne Bonnie RN UPMC [email protected]
Crawford Joan RN Allegheny General Hospital
Crowell Ray Excela Health Westmoreland Hospital [email protected]
Croyle Karen RN UPMC Presbyterian [email protected]
Dalton Claire Marie RN LifeCare Hospitals of Pgh. [email protected]
Dauberger Steve KML Carpenter Co-Sponsor
Dawson Audra RN Children's Hospital of Pittsburgh
Dentler Joe Facility Mgr. Heritage Valley Health System
DiNucci Susan RN UPMC Mercy
Dugan Nancy RN West Penn Hospital [email protected]
Fagan Julie RN UPMC St. Margaret, UPMC Passavant
Faidley Stephanie RN Somerset Hospital
Feigel Jody RN Molnlycke HC
Ferguson Melissa MT Grove City Medical Center [email protected]
Ferguson Patrick Safety Coordinator Rycon Construction,Inc.
Ferrelli Juliet MT UPMC Mercy [email protected]
Thursday, October 6, 2016 Page 1 of 4
Last Name First Name Designation Company Name Email Address (if shared)
TRAPIC 2016 Fall Conference Attendees - October 7, 2016KML Regional Council of Carpenters Training Center, Pittsburgh PA
"Expanding Your Infection Prevention Toolbox"
Fiddner Jennifer MPH Allegheny County Health Dept.
Fitzpatrick Julie RN St. Clair Hospital
Foster Diane RN UPMC Passavant
Franceschini Joseph VP-Safety PJ Dick Corporation
Fritz Jennifer RN Ceisinger Health System
Grote JoAnn MT Excela Health Latrobe Hospital [email protected]
Gwaley Kathleen RN UPMC McKeesport
Hathaway Lynette RN UPMC East [email protected]
Hawk Bill Sr. Project Mgr. Jendoco Construction Corp.
Heckman Ellen RN Washington Health System
Hepler Amy RN Allegheny Valley Hospital
Hildebrand Barbara RN Magee-Womens Hospital of UPMC
Hudnall Melissa RN Heritage Valley Health System - Sewickley
Jones Shawn Facility Mgr. Heritage Valley Health System
Joos Kristie RN St. Clair Hospital
Kalgren Terry RN Saint Vincent Hospital
Kirsch Christy Three Rivers APIC
Landau Jeffrey Construction Landau Building Company
LaPorte Robin RN North Shore Endoscopy Center
Leuch John Superintendent Mascaro Construction
Liberatore Kathy RN Monongahela Valley Hospital, Inc.
Magee Emily Infection Prevention UPMC Mercy
Mamrose-Hunt Suzanne MT Frick Hospital /Excela Health [email protected]
Marshall William Corporate Director Facilities Allegheny Health Network
Matters Paul VP Plant Operations Saint Vincent Hospital
McCallister Chad KML Carpenter Co-Sponsor
McNally Cheryl MT UPMC Passavant [email protected]
Mertz Kristen MD Allegheny County Health Department
Thursday, October 6, 2016 Page 2 of 4
Last Name First Name Designation Company Name Email Address (if shared)
TRAPIC 2016 Fall Conference Attendees - October 7, 2016KML Regional Council of Carpenters Training Center, Pittsburgh PA
"Expanding Your Infection Prevention Toolbox"
Messer Gwen MT UPMC Mercy
Metzger Scott Quality Mascaro Construction
Metzger Amy MT UPMC Presbyterian
Miladinova Vessela University of Pittsburgh
Minkel Barry MT John J. Kane Regional Centers [email protected]
Monaghan Patricia RN Spartan Health Surgi-Center [email protected]
Montgomery Thomas SM(ASCP), CIC UPMC St. Margaret
Morris Laura MT St. Clair Hospital [email protected]
Murillo Theresa RN UPMC Sherwoood Oaks
Nicola Tom KML Carpenter Co-Sponsor
Nolter Edward Senior Safety Coordinator Geisinger Health System
Novicki Stephen Director, Plant Operations St. Clair Hospital
Okraszewski Ricky KML Carpenter Co-Sponsor
Orr Fidelis RN St. Vincent Hospital
Ostrowski Michele RN, BSN West Penn Hospital
Parr Alyssa MPH UPMC Presbyterian
Peacock Natalie RN UPMC St. Margaret
Penrod Michael Corporate Safety Director Rycon Construction,Inc.
Peters Tammy RN Meadville Medical Center
Pethtel Lyn RN, BS, SM(ASCP),CIC Salem Regional Medical Center
Pettit Tammy RN Allegheny General Hospital
Pinter Brian MT John J. Kane Regional Centers
Plutt Dave KML Carpenter Co-Sponsor
Pokrywka Marian MT UPMC Mercy [email protected]
Price Cindy RN Ohio Valley Medical Center [email protected]
Reveille Kathryn RN Allegheny County Health Dept.
Roach Barry Facility Coordinator Saint Vincent Hospital
Roberts Terri Lee RN PA Patient Safety Authority
Thursday, October 6, 2016 Page 3 of 4
Last Name First Name Designation Company Name Email Address (if shared)
TRAPIC 2016 Fall Conference Attendees - October 7, 2016KML Regional Council of Carpenters Training Center, Pittsburgh PA
"Expanding Your Infection Prevention Toolbox"
Salopek Mike Superintendent Mascaro Construction
Sandusky Mickie RN Highlands Hospital [email protected]
Scabilloni James MT NIOSH
Schoeneman Mike Superintendent Mascaro Construction
Sedivy Judi RN PA Dept. of Health Epidemiology
Seltzer Ena RN Allegheny County Health Dept.
Shaw Mary RN Uniontown Hospital
Sheaffer Kimberly Student Holy Spirit, A Geisinger Affiliate
Sisler Lori RN West Virginia Univ. Hospitals - WVU Medicine
Squire Dan Engineering Director Heritage Valley Health System
Steen Barbara BSN, MPH, CICP Ohio Valley Hospital
Steimer Pamela RN ANH - Forbes Hospital
Stickley Kelly RN, BSN Kindred Hospital - Pittsburgh
Stieglitz Tracy RN Washington Health System
Sundermann Alexander MPH UPMC Presbyterian [email protected]
Swearingen, Jr. Frederick Project Manager A. Martini & Co, Inc.
Taylor Danielle RN UPMC Cranberry Place
Teachout Jocelin University of Pgh. Graduate School of Public Health
Torso Lauren Student Allegheny County Health Department
Toy Diana RN, BSN, CIC Dept. of Veterans Affairs
Vendeville Matthew Student University of Pittsburgh
Vivian Katie RN, BSN Conemaugh Memorial Medical Ctr.
Volpe Renee MT Heritage Valley Beaver
Waterkotte Bill KML Carpenter Co-Sponsor
Waudby James "JW" Servpro of Metro Pittsburgh
White Brad RN UPMC Hamot
Yantko Jane RN Southwestern Ambulatory Surgical Center [email protected]
Yassin Mohamed MD UPMC
Thursday, October 6, 2016 Page 4 of 4
TRAPIC 2016 Fall Conference Oct. 7, 2016
Construction Mgmt. and Infection Control, Andrew Streifel 1
Andrew Streifel
Hospital Environment Specialist
Construction Management and Infection Control
Objectives for Infection Control during Construction in Healthcare Facilities
•Respectful of patients
•Control aerosols
•Maintain a clean environment
•Prevent water damage
•Respond to emergencies
•Provide documentation
•Be trained & communicate
Levels of RiskHealthy person• Chronic obstructive pulmonary disease• Diabetes• Steroids• Cancer - solid tumor• HIV infection-end stage of spectrum• Organ transplant
– Kidney/heart– Lung/liver
• Malignancy - leukemia/lymphoma• Bone marrow transplant (BMT) allograftGreatest Risk
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No HEPA
HEPA
‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐ New Hospital‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐
Laundry:contaminated in transit
External Construction
Nosocomial Aspergillosis Prevention Measures
• Minimize non‐emergent infections patient admissions during heavy construction.
• Locate high‐risk patients as far away as possible from construction/demolition.
• Seal off patient care areas with impermeable barriers.
• Keep doors and windows closed.
• Verify HEPA filtration and air exchange rates.
• Assure proper air pressure relationships:
– Positive pressure in patient protective environment
– Negative pressure in adjoining construction areas
• Provide treatment in patient’s room when possible:
– If patient transport is necessary, schedule for periods of minimal construction activity
– Use appropriate patient face masks when transporting through potential contamination
• Wet‐clean wards thoroughly without raising dust.
• Surveillance of infections in high‐risk patients should be regularly performed.
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ICRA Matrix at www.ashe.org
Does Risk Vary during a Project
Master Specifications for UMMC
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• INFECTION CONTROL GENERAL OUTLINE NOTES
• ALL BALANCING REPORTS WILL BE MADE AVAILABLE TO UMMC INFECTION CONTROL PERSONNEL ON REQUEST. SUBMIT THESE REPORTS DIRECTLY AFTER BEING REVIEWED BY THE ENGINEER OF RECORD.
• ALL CONTRACTORS AND SUBCONTRACTORS SHALL FOLLOW THE FUMC INFECTION CONTROL RISK ASSESSMENT (IRCA) AND AIA GUIDELINES THROUGHOUT THE CONSTRUCTION PROCESS. ALL CONTRACTED WORKERS MUST RECEIVE INFORMATION/TRAINING ON INFECTION CONTROL RISKS AND PRACTICES PRIOR TO STARTING ANY ON SITE WORK.
• ALL WORK OUTSIDE THE PROTECTED PROJECT BOUNDARIES ABOVE EXISTING CEILING SHALL BE COMPLETED WITH CEILING REPLACED IN THE SAME DAY UNLESS FULLY COORDINATED THROUGH INFECTION CONTROL.
• CEILING TILES WITH VISIBLE WATER DAMAGE SHALL BE SPRAYED TO DISINFECT AND ENCAPSULATE POTENTIAL MOLD PRIOR TO REMOVAL.
• CONTRACTOR TO INSTALL TEMPORARY BARRIERS FOR EACH PROJECT PHASE AND/OR AREA. THESE BARRIERS SHALL BE FULLY COORDINATED WITH UMMC AND IN MOST CASES CONTAIN SOME FORM OF AIRLOCK VESTIBULE PRIOR TO ENTERING THE CONSTRUCTION AREA.
• FLUTTER STRIPS OR AIR PRESSURE GAUGES SHALL BE PROVIDED AT THE ENTRANCES TO EACH CONSTRUCTION AREA. ALL CONTRACTED WORKERS SHALL BE TRAINED TO VISUALLY MONITOR THESE DEVICES FOR ADEQUATE NEGATIVE PRESSURIZATION AS THEY ENTER/EXIT THE CONSTRUCTION AREA. DAILY LOGS SHALL BE KEPT BY THE MECHANICAL CONTRACTOR TO INSURE CONSTANT PRESSURIZATION HAS BEEN MAINTAINED.
• PORTABLE HEPA FILTER UNIT SHALL BE UTILIZED WITHIN EACH CONSTRUCTION AREA. THESE UNITS WILL BE PROVIDED BY FAIRVIEW UNIVERSITY AND MAINTAINED BY THE MECHANICAL CONTRACTOR.
• NEGATIVE PRESSURIZATION SHALL BE MAINTAINED IN EACH CONSTRUCTION AREA. IF LOCATED ON AN EXTERIOR WALL, FANS SHOULD BE UTILIZED TO EXHAUST AIR DIRECTLY OUT A NEARBY WINDOW, TAKING PRECAUTIONS TO NOT INTERFERE WITH EXISTING BUILDING AIR INTAKES, PUBLIC AREAS, ETC. IF NO EXTERIOR WALL IS AVAILABLE THEN NEGATIVE AIR MACHINES WITH INTERNAL FILTRATION SHALL BE PROVIDED AND CONNECTION TO THE NEAREST EXHAUST OR RETURN DUCT AVAILABLE (CONTACT ENGINEER TO VERIFY EXISTING DUCTWORK CAPACITY PRIOR TO CONNECTION).
• COORDINATE DEBRIS REMOVAL WITH UMMC. IF AN ACCEPTABLE EXIT PATH IS NOT AVAILABLE FROM THE PROJECT SITE THEN AFTER HOURS REMOVAL OF DEMOLISHED MATERIAL WILL BE PERFORMED. COVER ALL CARTS WITH SEALED COVERS TO MAINTAIN DUST CONTROL.
When we find mold what should we do?Have a planUse detergent and water sprayBe careful not to disturb until misted wet down Remove spray & backside of material wet downBag and be gone. Soap and water cleanup
Is containment necessary?Depends on riskPortable filters always help dilute
Aspergillus fumigatus• prolific spore production
Aerodynamic spore2‐4µm diameter
Mucor & Rhizopus canreproduce with mycelial fragmentsas well as with spores.Often associated with dust
Changing fungal agents.
TRAPIC 2016 Fall Conference Oct. 7, 2016
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Room 206
Door
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Patient Mock‐up Room Leakage Application Overview
Why should we seal rooms anyway??
AIA & ASHRAE DESIGN GUIDELINES FOR VENTILATION
CDC EIC MMWR JUNE 6, 2003
17
18
Ventilation: Patient RoomMock Up Testing
Blower doors allow for leakage testing by applying pressureand using smoke stick to find leaks for sealing
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Finding leakage points in rooms helps assure consistent pressure management
A sealed room has two advantages:-controlled sound movement-ventilation control for infectious disease management
Room Seal Necessary for Special Ventilation Management
• Cracks can result in room air leakage.
• Supply air volume differential allows for airflow direction control.
• Low pressure differential can result in airflow reversal.
• Substantial room pressure design should provide a sealed “vessel”.
• Design criteria are necessary for control.
Case Study‐ Barrier Management “Leakage”
Total Barrier Management
Infection control
Sound
Energy/ Movement
UL systems
Total Barrier Management practices increase build integrity beyond UL systems with additional secondary attributes
DISCLOSURE HILTI SPONSORED STUDY
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Staff/Housekeeping/Clean equipment in‐flow
Patient in‐flow
Patient/Staff/Housekeeping/Dirty Equipment out‐flow
HLIU FLOW
DirtyDecon
DirtyDecon
DirtyAnte
DirtyAnte
Clean Ante
Clean AnteDirty
Ante
DirtyAnte
PROPOSED AIR PRESSURE
‐5pa ‐5pa
‐7.5pa ‐7.5pa
‐7.5pa ‐7.5pa
‐10pa ‐10pa
‐2.5pa ‐2.5pa
‐2.5pa ‐2.5pa
‐5pa ‐5pa
Interlocking doors
Staff/Housekeeping/Clean equipment in‐flow
Patient in‐flow
Patient/Staff/Housekeeping/Dirty Equipment out‐flow
*Loss of corridor space and 2 x Nurse Alcoves
TRAPIC 2016 Fall Conference Oct. 7, 2016
Construction Mgmt. and Infection Control, Andrew Streifel 9
Barrier containment variation
Environmental Management Training
Training to mitigate hazards during construction in healthcare.
Training providesIC know howwith methodsto minimizeexposure.
Training needsconstant up‐dating to be relevant withhealthcareconstruction.
TRAPIC 2016 Fall Conference Oct. 7, 2016
Construction Mgmt. and Infection Control, Andrew Streifel 10
PRECAUTIONS DURING CONSTRUCTION
INDOOR PROJECTS (RENOVATION) OUTDOOR PROJECTS (NEW)
Employee training Employee training
Barrier management Dust control Water damage Noise and vibrationDemolition precautions Pest controlDust migration and control Building material storageDebris and material transport Water damage managementAccess routes to work area Sanitation and break areasOutages (electrical and plumbing) Tie in building issuesPortable filter usage Commissioning‐air & waterNoise and vibration Shell spaced‐build outSanitation and break areasCommissioning ‐air & water
Communication CommunicationEmergency response Emergency responseWater damage reporting Water damage reporting Changing work phases Material crane location
ICRA precautions during occupancy Changing ICRA precautions pre occupancy
Water Quality Water QualityStagnant water flushing Stagnant water flushingTesting water requirements Testing water requirementsPunch list Punch listCritical sinks drinking water Critical sinks drinking water
This procedure is paid for by as part of the project forthe mechanical contactorto properly maintain theportable filters during the interface of a tie in project.
AIHce 2004 ‐ Streifel & Wideman
Control Airborne‐Projects• Pressure management
– Barrier airflow control– > 0.01”wg (>2.5 Pascals)– Ideal (btwn 5 ‐ 8 Pascals)
• Transport– Personnel and materials– Track dirt
• Water damage protocols– Water resistant materials– Early detection
• Training– Supervisors and workers– Area tenants
TRAPIC 2016 Fall Conference Oct. 7, 2016
Construction Mgmt. and Infection Control, Andrew Streifel 11
What do you do when you discover mold?
Hidden behind object that are not movedVery often on the PCU
Pump with copper 8 quinolinolate
Dialysis cabinet in ICU
SOURCE MANAGEMENT
Cleanup Concerns
MOLD SOURCESARE COMMON
CONTROL PREVENTSINFECTION &OTHER ISSUES
IC CONSIDERATION EXAMPLES
TRAPIC 2016 Fall Conference Oct. 7, 2016
Construction Mgmt. and Infection Control, Andrew Streifel 12
Managing aerosol presentschallenges for constructionin hospitals.
Routine cleaning helpsmaintain aerosol controlnecessary for safepatient care duringconstruction.
HOW SHOULD A HOSPITAL MANAGE MOLD?
New York City Guidelines for levels of mold management and PPE requirements
Level Area type Example PPE requirements
1 Small isolated areas, 10 sq.ft. or less
Ceiling tiles,small areas on walls
N95 respirator, gloves, eye protection
2 Midsize isolated areas, 10-30 sq.ft.
Individual wallboard panels
N95 respirator, gloves, eye protection
3 Large isolated areas, 30-100 sq.ft.
Several wallboard panels
N95 respirator, gloves, eye protection
4 Extensive contamination, greater than 100 contiguous sq.ft. in an area
Faulty building designs, improper building material installation, condensation from high humidity environments, buildings affected by natural disaster
Full-face respirator with HEPA cartridges for mold, disposable protective clothing covering head, hands, and shoes
Portable containment on BMT unit
Portable HEPA unit
TRAPIC 2016 Fall Conference Oct. 7, 2016
Construction Mgmt. and Infection Control, Andrew Streifel 13
Protect floors and minimize track dirt
Moldy sink in pharmacy
Negative pressure indicator
PORTABLE FILTERS CAN BE FUN?!?!!
Employee training& understandingimportant to avoidexposure to airborneopportunistic microbes.
HOW NOT TO USE THE PORTABLE HEPA MACHINE
Criteria for Portable Filter Certification
•Policies and Procedures for usage
‐discharge of air modes
outside, inside adjacent & recirculate in room
•portable filters should be routinely evaluated
‐volume output should be determined
Q=VA
‐leak check for filter
16 locations over output area
‐criteria for filter change
pressure differential or volume of filter output
‐maintenance
storage, pre filter change & cleaning
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Construction Mgmt. and Infection Control, Andrew Streifel 14
ISOLATION OF A SUITE OF ROOMS FOR AIRBORNE ISOLATION
Parts of hospitalsare set aside forconstruction orinfectious patientswhen needed.
Ante Room usage isuseful when pressuresare hard to control dueto circumstances.
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Construction Mgmt. and Infection Control, Andrew Streifel 15
Managing aerosol presentschallenges for constructionin hospitals. Noise and vibration are also a major concern in healthcareconstruction.
Routine cleaning helpsimpress cleanlinessnecessary for safepatient care duringconstruction.
•Provide visual indicators‐pressure ‐signage‐flexible door
•Cover debris during transport
•Use portable HEPA filters
•Use walk off mats
Exhaust systems need to reinforceFlex duct to avoid pressure issues
TRAPIC 2016 Fall Conference Oct. 7, 2016
Construction Mgmt. and Infection Control, Andrew Streifel 16
What method is best forexhausting air from aconstruction zone.
The ducted exhaust advantages*controlThe direct exhaust advantages*no duct loses
DisadvantagesNo one is paying attention!
Have you seen this before?
•air handler door propped open•what does this do to the airsupply?•what might this indicate as a problem?
Lots of Puddles!!
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Construction Mgmt. and Infection Control, Andrew Streifel 17
Keep the rock off the slab!
Consider code and noise issueswith caulk under the gypsum board
Storage of gyp boardshould provide protectionfrom water damage
Best Practice
Specification:•Do not install wet GB•Protect GB from WD& Extreme climate
EXAMPLES
What is the differencein these shaft walls?
‐Luck?‐Better materials?‐Construction Implementation?‐All of the above?
IC CONSIDERATION EXAMPLES
Water Damage & Mold
Reactive Response
Proactive Response
Construction Management Proactive Issues
IC CONSIDERATION EXAMPLES
•Water & mold resistant gypsum board•Sanitation•Break areas
Proactive and reactive response to water damage.
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Construction Mgmt. and Infection Control, Andrew Streifel 18
What can happen with these conditions?
Each condition by itself and combined can cause infiltration.
Storage of Debris and Building Material a Challenge
Shrink wrapping protects theair handling system componentsduring transport to the jobsite.
When the wrappingis broken the materialshould be replaced to avoid dust buildup.
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Construction Mgmt. and Infection Control, Andrew Streifel 19
Best Practices for Duct Installation
Tin worker seals intermediate joints and after they complete this step, they wipe out the entire section with this mop and seal the ends of the duct just prior to hanging.
Specify Duct Cleanliness• Sheet Metal and Air Conditioning Contractors’ National Association (SMACNA) – Duct Cleanliness for New Construction Guidelines (2000)– A. Basic Level
– B. Intermediate Level
– C. Advanced Level
• Specify in contract
www.smacna.org
Protection of openings& storage of material.
These details should be partof the construction specificationto assure not installing waterdamaged material & preventionof water damage to susceptiblematerial.
Med gaspiping
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Construction Mgmt. and Infection Control, Andrew Streifel 20
Protect existing filters
Remove worn out fan
Demo cooling coils and drain pans
Process for of existing fan demolition
Temporary Ventilation for Fan OutageExchange—60 hour project
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Construction Mgmt. and Infection Control, Andrew Streifel 21
Fan wall allow redundancy and lesser foot print and addedCapacity.
Easy Assembly coils. Good to change outcoils because they plug
What do you do when you find mold?
Which side of filter is it located?
COOLING UNIT
HEPA UNITS
PATIENT READY ICU DURING PROJECT
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Construction Mgmt. and Infection Control, Andrew Streifel 22
Equipment placement during project
Particle count and pressure monitoringwere required for quality assurance
-Training for scope of work-What to look for in particle management of work-Stoppage guides for particle & noise/vibration
Interpretation of DataParticle Counters & Construction
• Particle counts compared to outside– Per cent reduction approximation
• 90% efficient filter @ 0.5µm • Result should be about 90% reduction of ambient BZ and supply air counts.
– Particle size and construction– Stop work guidance (1‐5µm particles‐5 to 10 times outside)
• Local controls when sampling– Set up levels of project expect high counts
• Know the aerosol• Sample more than once to be sure before reacting
– Critical to operation rooms, bone marrow transplant, oncology, neonates, burn unit
• Lowest levels before and after• % reduction from outside
– Ventilation management controlling dirty air• Exhaust ventilation out of space• Recirculation of HEPA filter• Negative pressure
NOTE: Do not use the particle counter in construction zone make affect optical lenses.
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Construction Mgmt. and Infection Control, Andrew Streifel 23
What does it take for success?
• Ventilation assurance– Pressure, filtration and air exchanges
• Construction management– Training
– Dust control
– Pressure management
– Water damage prevention
• Medical staff awareness– Patient confinement and treatment
Q & A
Q & AQuestions?
TRAPIC 2016 Fall Conference Oct. 7, 2016
Water Damage Management In Healthcare, Michael Buck 1
Water Damage Management in Healthcare
Michael Buck
University of Minnesota
Environmental Health and Safety
MOLD
Water Damage Management• Reactive
– respond to water incident– determine extent of water damage– cut out or dry
• Proactive– water resistant material– preservative application– proper installation– Collect Data
Water Damage Study
0
200,000
400,000
600,000
800,000
1,000,000
1,200,000
1,400,000
1,600,000
1,800,000
TRAPIC 2016 Fall Conference Oct. 7, 2016
Water Damage Management In Healthcare, Michael Buck 2
Loss Sources
% of Instances Mechanical Failure 18%
Domestic Failure 15%
Unknown 15%
Freeze 13%
Contractor Error 12%
Sprinkler Head 7%
Drain Failure 6%
Shell Failure 5%
Foundation 4%
Vandalism 3%
Sewer 2%
Loss Sources
% of Total $$$
Mechanical Failure 26%
Shell Failure 16%
Freeze 12%
Domestic Failure 9%
Contactor Error 8%
Drain Failure 8%
Vandalism 7%
Unknown 7%
Sprinkler Head 4%
Foundation 2%
Sewer 1%
26%
Water damaged infrastructure
Tell tale signs of problems
Hidden sources
Obvious problems can be noticed visually.However, the nose knows when the mold isgrowing in a source such as a fan coil. When theydry they fly.
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Water Damage Management In Healthcare, Michael Buck 3
Fungal source management
• Recognize fungal potential – Outward signs such as colonies on wall– Odors– Water damage
• Control methods –Source Control – Containment– HEPA filtration– Clean-up– Verification
Fungal Source Management
Interior HEPA Exhaust/IC Monitoring
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Water Damage Management In Healthcare, Michael Buck 4
Source Management ΔP/IC Monitoring
Airflow into the construction area
• Negative .02 to .03” water gauge
• Negative 5 to7.5 Pascals
• 566‐694 fpm
• Too much negative pressure? >1000 fpm
2014 Guidelines for Design and Construction of Hospitals and Outpatient Facilities
NYC guidelines for levels of mold contamination and PPE requirements
Level Area type Example PPE requirements
1 Small isolated areas, 10 sq.ft. or less
Ceiling tiles,small areas on walls
N95 respirator, gloves, eye protection
2 Midsize isolated areas, 10-30 sq.ft.
Individual wallboard panels
N95 respirator, gloves, eye protection
3 Large isolated areas, 30-100 sq.ft.
Several wallboard panels
N95 respirator, gloves, eye protection
4 Extensive contamination, greater than 100 contiguous sq.ft. in an area
Faulty building designs, improper building material installation, condensation from high humidity environments, buildings affected by natural disaster
Full-face respirator with HEPA cartridges for mold, disposable protective clothing covering head, hands, and shoes
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Water Damage Management In Healthcare, Michael Buck 5
APIC IP Manual for Construction and Renovation
Process for Mold Remediation & Mitigation-Recognize and identify mold by smell or sight
-Document the scope of the problem (How big is it?)
-Find and eliminate source of moisture (or control it)
-Dry and maintain an environment free of excess moisture
-Remove and replace saturated building materials (<72 hrs)
-Assess situation & evaluate if pesticide treatment is needed
-Wipe, scrape and clean visible mold from affected area
-Paint, coat or seal building material when conditions indicate
-Treat mold with labeled pesticide
-Consult an expert for best practice
Recognition, Evaluation, and Control of Indoor MoldAIHA 2008
Asbestos Material Survey
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Water Damage Management In Healthcare, Michael Buck 6
Mold Management Requires Control of Spore Release
When the source is dry the spores fly!
Mold growth should be expected with RH >90%with water content of material >25%
Sink passive eruption of sporesat 5.5x10^5 cfu/m^6 per hour.
With protective isolation 1/109 nasal swab positive for fungal isolate
Moldy sink
SEM wood surface
Contamination from a mold sourcecondensation pan in tissue culture lab
Incubator contamination
Humidification chamber
Condensation pan
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Water Damage Management In Healthcare, Michael Buck 7
‐Air diffuser growth due to high humid‐mold cancer clinic pharmacy‐60 bed hospital pharmacy
FUNGAL SOURCES
Construction‐Related Roof Leak
Construction schedules: difficult to coordinate
Roofer behind schedule while sheetrock ahead
Water damage requires immediate response
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Water Damage Management In Healthcare, Michael Buck 8
Healthcare Construction: Case Studies in Medical Facilities
Temporary Drying Unit
Medical records dried theold fashioned way
Quick drying withwarm dry air helps speed dry <20% water content<95% RH
Infection Prevention control issues
•What is your role?
•Assist in damage assessment?
•Do you have equipment to make assessment?
•ICRA for clean‐up activities
•Attend Construction Meetings?
•Require Environmental Sampling prior to turning area back to staff
Water damage response for leaking fixtures in UMMC
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Water Damage Management In Healthcare, Michael Buck 9
Moisture detectors are useful decision makers for water detection & drying
Keep moisture content <20% &<60%RHMaintain air movementRemove moisture physically or by evaporation
Infrared technology
IC CONSIDERATION EXAMPLES
NICU Case Study of water management
NICU – Case Study
TRAPIC 2016 Fall Conference Oct. 7, 2016
Water Damage Management In Healthcare, Michael Buck 10
NICU – Case Study
NICU – Case Study
NICU – Case Study
TRAPIC 2016 Fall Conference Oct. 7, 2016
Water Damage Management In Healthcare, Michael Buck 11
NICU – Case Study
NICU – Case Study
NICU – Case Study
TRAPIC 2016 Fall Conference Oct. 7, 2016
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NICU‐Case Study
NICU – Case Study
NICU –Case Study
TRAPIC 2016 Fall Conference Oct. 7, 2016
Water Damage Management In Healthcare, Michael Buck 13
NICU – Case Study
NICU – Case Study
NICU – Case Study
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Water Damage Management In Healthcare, Michael Buck 14
NICU – Case Study
Healthcare Construction: Case Studies in Medical Facilities
Patient Care Unit Air Samples, After Water Damage and Clean-up
58
3.7
101
7.3
731
78
260
7.1 5.4 0.35 19.2 0.1 5.3 0 6.2 0
0
100
200
300
400
500
600
700
800Total 25C FungiA. fumigatus
corridorrooms
Water damage
July ‘94
cfu
/m3
corridor rooms corridor rooms corridor rooms
Demolition Remediation Post cleaning
August ‘94 September ‘94 October ‘94
TRAPIC 2016 Fall Conference Oct. 7, 2016
Water Damage Management In Healthcare, Michael Buck 15
Key principal: get the water out of the building.
Mold grows quickly so removal is essential tominimize growth and sporulation.
-Germination in 4 hours-Sporulation in 96 hours
Flood day 72F RH 70%2 days later 72F RH 30%
When water intrusion occurs equipment must be gatheredthrough contingencies to respond to drying.
Water content of surface <20% & ambient RH <95%.
Brackytherapy room
Response after flooding:
-Stop water -remove wet material
1) to dry2) water damaged
-turn up temperature1) for 23F increase 2) air hold 50% more water vapor
-move air to decrease RH-dehumidify
1) depends on outside humidity2) inside humidity level
-reduce to RH 30%1) seasonal issues2) climate issues
-environmental conditions1)growth = surface <20% water content2) RH < 95%
TRAPIC 2016 Fall Conference Oct. 7, 2016
Water Damage Management In Healthcare, Michael Buck 16
Mold growth inhibitorsTransport gurney plus vacuum And extension cords in waiting
Being Prepared for Floods in Prudent Best Practice
Tools for quick response
Mold Sources are Abundant!!
Ceiling tile
MRI table support
Sink removal in ICU
Mold even likes antiseptics in a drippy shower
Using pesticide to mitigate mold growth
‐Water damage needs time to dry.‐Mold spores germinate in 4 hours under ideal conditions‐Applying a pesticide containing mold inhibiting chemicals will minimize growth‐This method provides mitigation without major disruption
TRAPIC 2016 Fall Conference Oct. 7, 2016
Water Damage Management In Healthcare, Michael Buck 17
Process for Mold Remediation & Mitigation-Recognize and identify mold by smell or sight
-Document the scope of the problem (How big is it?)
-Find and eliminate source of moisture (or control it)
-Dry and maintain an environment free of excess moisture
-Remove and replace saturated building materials (<72 hrs)
-Assess situation & evaluate if pesticide treatment is needed
-Wipe, scrape and clean visible mold from affected area
-Paint, coat or seal building material when conditions indicate
-Treat mold with labeled pesticide
-Consult an expert for best practice
Recognition, Evaluation, and Control of Indoor MoldAIHA 2008
Questions?
Mike = [email protected]
Janet Stout's presentation on Legionella can be viewed using the following link through Slidshare: https://www.slideshare.net/secret/aUmiVSHk1X8Vi7
The Design Professional andInfection Prevention for Healthcare Facilities
David J. Wells, AIA
October 7, 2016
TRAPIC 2016 Fall Conference Oct. 7, 2016
Design Professional & Infection Prevention in Healthcare Facilities, David Wells 1
Project Delivery and SchedulePersonal Background
David J. Wells, AIA
21 Years of Experience in Healthcare Design
Representative Clients:• Allegheny Health Network• Penn State Hershey Medical Center• Uniontown Hospital• University of Pittsburgh Medical Center• VA Healthcare System
TRAPIC 2016 Fall Conference Oct. 7, 2016
Design Professional & Infection Prevention in Healthcare Facilities, David Wells 2
Project Delivery and ScheduleDiscussion Topics
1. Design Professional Role
2. Approach to Infection Control
3. Hospital Guidelines and Codes
4. Construction Practices
5. Discussion
TRAPIC 2016 Fall Conference Oct. 7, 2016
Design Professional & Infection Prevention in Healthcare Facilities, David Wells 3
Project Delivery and ScheduleDesign Professional Role
Understanding Project Goals and Objectives• Working with all stakeholders• Involvement of Infection Control Officer• The patient population
Review of Hospital Guidelines and Codes• Governmental requirements• Impact on project program
Thoughtful Design• Patient and staff flow• Maximize infection control through design
Construction Observation• Assistance with coordination of infection control criteria• Construction process and infection control
TRAPIC 2016 Fall Conference Oct. 7, 2016
Design Professional & Infection Prevention in Healthcare Facilities, David Wells 4
Project Delivery and ScheduleApproach to Infection Control
Project Layout• Appropriateness within the facility• Reduce cross traffic – High Risk / Low Risk
Promoting Hand Washing through Design• Placement of sinks• Hands free controls• Wrist blades• Seamless sink design
Hand Sanitizers• Quantities• Placement
Airborne Infection Isolation Rooms• Anterooms• Special design features
TRAPIC 2016 Fall Conference Oct. 7, 2016
Design Professional & Infection Prevention in Healthcare Facilities, David Wells 5
Project Delivery and ScheduleApproach to Infection Control
Material Selection• Easily cleanable• Seamless products
Advancements• Vinyl like fabrics• Easier maintenance• Antimicrobial products
HVAC, Plumbing, and Electrical• Fresh air requirements• Air changes• Filtering• Flushing of plumbing systems• Hands free controls
TRAPIC 2016 Fall Conference Oct. 7, 2016
Design Professional & Infection Prevention in Healthcare Facilities, David Wells 6
Project Delivery and ScheduleHospital Guidelines and Codes
FGI Guidelines for Healthcare Facilities• Key objectives• Infection Control Risk Assessment (ICRA)• Infection Control Risk Mitigation (ICRM)• Patient Handling and Movement Assessment (PHAMA)
International Building Codes and NFPA• IBC and IEBC – Construction requirements• NFPA and Pennsylvania Department of Health
Other Codes• Americans with Disabilities Act (ADA)• Allegheny Co. Amendments to the Plumbing Code• Energy Codes
TRAPIC 2016 Fall Conference Oct. 7, 2016
Design Professional & Infection Prevention in Healthcare Facilities, David Wells 7
Project Delivery and ScheduleConstruction Practices
Maintain ICRA Barriers• Placement• Types of barrier construction• HEPA filtering and exhaust• Maintaining the ICRA barrier• Project phasing
Control Access to the construction site• Contractors, Hospital Staff, Visitors• Debris removal and material delivery
Mitigate Impact to adjacent spaces• Construction site access route• Elevators• Adjacent MEP Systems• Project close-out / final inspection
TRAPIC 2016 Fall Conference Oct. 7, 2016
Design Professional & Infection Prevention in Healthcare Facilities, David Wells 8
Project Delivery and ScheduleDiscussion
Photo Credits:Denmarsh PhotographyDuPontFacility Guidelines Institute
Mintie CorporationNiko SupplyRadelet McCarthy Polletta
TRAPIC 2016 Fall Conference Oct. 7, 2016
Design Professional & Infection Prevention in Healthcare Facilities, David Wells 9
Legionella and Construction by Janet E. Stout, PhD is not available to share electronically and
therefore not included in this file.
Three Rivers Association for Professionals in Infection Control & Epidemiology
1
Needs Assessment Evaluation - 2016 Annual TRAPIC Conference
“Expanding Your Infection Prevention Toolbox”
Please take the time to complete this short survey. Your answers will be used to help develop future conferences and educational programs.
1. Please indicate what subjects you would like to see presented at futureTRAPIC conferences?
2. Please indicate what your biggest challenges as an Infection Preventionist are?
3. Please indicate what subjects you would like to see presented at future TRAPICmeetings.
4. Please indicate what area of healthcare you are employed in. (i.e. Acute care,Long term Care, Home Care, etc.)
1
Three Rivers Association for Professionals in Infection Control and
Epidemiology:
Activity Title: “Expanding Your Infection Prevention Toolbox”
October 7, 2016
Please use this scale to rate the following: 5 = Excellent 4 = Very Good 3 = Good 2 = Fair 1 = Poor
Using the above scale, please rate the following Rating
1A. Degree to which you were able to meet the program objectives:
“Clearing the Air: Reducing Fungal Infection Risk”
a. To describe the process for evaluating your level of risk in healthcare facilities.
b. To discuss the challenges surrounding effective prevention measures for fungal infection risk
during construction in healthcare.
c. To list the critical steps that should be followed when mold is found.
1B. The teaching effectiveness of the presenter:
Andrew Streifel, MPH, RS
2A. Degree to which you were able to meet the program objectives:
“Construction Management and Water Damage for Infection Prevention”
a. To list the important steps in water damage management.
b. To define the role of infection prevention in water infiltration and mold remediation.
c. To be aware of tools available to make necessary assessments in water infiltration situations.
2B. The teaching effectiveness of the presenters:
Michael Buck, B.A. Biology, MDH
2
Using the scale below, please rate the following
5 = Excellent 4 = Very Good 3 = Good 2 = Fair 1 = Poor
Rating
3A. Degree to which you were able to meet the program objectives:
“The Design Professional and Infection Prevention for Healthcare Facilities”
a. To describe the role of the design professional as it relates to infection prevention.
b. To list the hospital guidelines and codes that are followed for healthcare facilities and design.
c. To review the construction practices that are taken into consideration when designs and
construction bids are made.
3B. The teaching effectiveness of the presenters:
David J. Wells, AIA, Bachelor of Architecture
4A. Degree to which you were able to meet the program objectives:
“Managing Construction-Related Risk from Legionella and Waterborne Pathogens”
a. Review Legionnaires disease and the risks associated with construction.
b. Identify specific components from the ASHRAE Standard 188 as it relates to design and
construction requirements.
c. Discuss when to consider supplemental water disinfection.
4B. The teaching effectiveness of the presenter:
Janet E. Stout, PHD
5A. Degree to which you were able to meet the program objectives:
“Meet the Experts Panel Discussion”
a. Describe the dynamics required for healthcare construction from the contracting, scientific,
and architectural perspectives of the panel.
b. Identify key concepts in planning, designing and carrying out construction in healthcare as
discussed by the panel.
c. Review potential problem areas in construction and renovation projects in healthcare as
discussed by the panel.
5B. The teaching effectiveness of the presenters:
Andrew Streifel, Michael Buck, David Wells, and Janet Stout
Thank you!
3
Please use this scale to rate the following:
5 = Excellent 4 = Very Good 3 = Good 2 = Fair 1 = Poor
a. Conference was well organized
b. Conference was stimulating and met my expectation
c. Overall rating of the conference
d. Location of conference was appropriated for learning
Please use the section below for additional comments:
Comments/ Suggestions
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TRAPIC 2016 Fall Conference October 7, 2016
Keystone+Mountain+Lakes Regional Council of Carpenters Training Center
“Expanding Your Infection Prevention Toolbox”
TRAPIC is an approved provider of continuing nursing education by PA State Nurses
Association, an accredited approver by the American Nurses Credentialing Center’s
Commission on Accreditation.
TRAPIC as a provider of CEUs, recognizes the educational activity only, and does
not imply TRAPIC or Pennsylvania State Nurses Association approval or
endorsement of any product.
For more information regarding contact hours, please call (Bonnie Colaianne, RN, MSN, CNL, CIC, 412-647-5675)
Three Rivers Association for Professionals
in Infection Control & Epidemiology