New Opportunities for Cleaning & New Opportunities for Cleaning & Restoration Professionals In Restoration Professionals In
Healthcare FacilitiesHealthcare Facilities
Presented By Wonder Makers EnvironmentalPresented By Wonder Makers EnvironmentalMichael A. Pinto, CSP, CMPMichael A. Pinto, CSP, CMP
CEOCEO
2010 Business Mentors Summit –2010 Business Mentors Summit – Chicago, IllinoisChicago, Illinois
Your SpeakerYour Speaker
2010 Business Mentors Summit –2010 Business Mentors Summit – Chicago, IllinoisChicago, Illinois
Michael PintoMichael Pinto•CEO, Wonder Makers Environmental•CSP, CMP•Author of 5 books and 140+ articles•Contributor to standards and courses
ASTM, IICRC, RIAASTM, IICRC, RIAExperience
•29 years in safety, health, and 29 years in safety, health, and environmental professionsenvironmental professions
MIOSHA, NSC, Consulting, FEMA MIOSHA, NSC, Consulting, FEMA MAT TeamMAT Team
The Most Important Fact About The Most Important Fact About Your SpeakerYour Speaker
2010 Business Mentors Summit –2010 Business Mentors Summit – Chicago, IllinoisChicago, Illinois
•No financial tie to any of the companies/products mentioned in the program
•Other than Wonder Makers
A Talk About Healthcare FacilitiesA Talk About Healthcare Facilities
Methodist Hospital In Chalmette, Methodist Hospital In Chalmette, LouisianaLouisiana
Do You Really Want Hospital Do You Really Want Hospital Staff Tackling This?Staff Tackling This?
Nor Is It A Job For A Regular Carpet Nor Is It A Job For A Regular Carpet Cleaner!Cleaner!
Presentation OutlinePresentation Outline• The unique nature of healthcare The unique nature of healthcare
environmentsenvironments• Healthcare acquired infectionsHealthcare acquired infections• Controlling hospital acquired Controlling hospital acquired
infections during restoration or infections during restoration or construction activitiesconstruction activities
• Practical tips on how to prepare your Practical tips on how to prepare your organization to offer services to organization to offer services to healthcare facilitieshealthcare facilities
2010 Business Mentors Summit –2010 Business Mentors Summit – Chicago, IllinoisChicago, Illinois
1. Healthcare Is A Different Type 1. Healthcare Is A Different Type Of ClientOf Client
•Consolidation of ill and injured Consolidation of ill and injured individualsindividuals•Priority of patient carePriority of patient care•Facility operation 24/7Facility operation 24/7•Security/traffic concernsSecurity/traffic concerns•Special building practices and systemsSpecial building practices and systems•Detailed regulatory restrictionsDetailed regulatory restrictions•High profile - Liability targetHigh profile - Liability target
2010 Business Mentors Summit –2010 Business Mentors Summit – Chicago, IllinoisChicago, Illinois
Have You Ever Wondered From A Have You Ever Wondered From A Business Perspective?Business Perspective?
Do we have critical skills and Do we have critical skills and experience that we can bring to:experience that we can bring to: HospitalsHospitals Out patient treatment facilitiesOut patient treatment facilities Medical officesMedical offices Nursing homesNursing homes
Have You Ever Done Work In A Have You Ever Done Work In A Healthcare Facility?Healthcare Facility?
Water restorationWater restoration Pump out, dry down, replacement of Pump out, dry down, replacement of
finish materialsfinish materials Fire restorationFire restoration
Clean-up, deodorizing, blasting, Clean-up, deodorizing, blasting, replacement replacement
Mold remediationMold remediation Replace water stained ceiling tilesReplace water stained ceiling tiles
Duct cleaning Duct cleaning
Have You Have You Seen A Seen A
Poster Like Poster Like This?This?
Does It Make You Wonder?Does It Make You Wonder? About the safety of yourself & About the safety of yourself &
your crewyour crew Exposure causing infectionExposure causing infection
About the impact your activities About the impact your activities may have on the building & may have on the building & occupantsoccupants
Activity increasing infection potential Activity increasing infection potential for high risk groups such as sick, for high risk groups such as sick, elderly, recovering surgery patients, elderly, recovering surgery patients, etc.etc.
Bacterial and fungal contaminantsBacterial and fungal contaminants
2. Healthcare Acquired Infections2. Healthcare Acquired Infections
Are so common that they have their Are so common that they have their own name – own name – nosocomial nosocomial infectionsinfections
Estimated two million hospital-Estimated two million hospital-acquired infections per yearacquired infections per year
Estimated 100,000+ deaths every Estimated 100,000+ deaths every yearyear
$5 billion spent on hospital-$5 billion spent on hospital-acquired infections each yearacquired infections each year
Germs & Hygiene PracticesGerms & Hygiene Practices Isn’t the problem “germs” Isn’t the problem “germs”
and personnel hygiene and personnel hygiene practices?practices? If 50% of the nosocomial If 50% of the nosocomial
infections are caused by infections are caused by improperly washed hands or improperly washed hands or other touching other touching (staphylococcus), what is the (staphylococcus), what is the cause of the remaining 50%?cause of the remaining 50%?
Environmental cross Environmental cross contaminationcontamination
Common Construction Common Construction ContaminantsContaminants
BacterialBacterial LegionellaLegionella, Pontiac fever, Pontiac fever
FungalFungal Aspergillus: Aspergillus: AspergillosisAspergillosis Penicillium: Penicillium: PenicilliosisPenicilliosis Fusarium: Fusarium: FusariosisFusariosis Mucor: Mucor: MucomycosisMucomycosis Trichoderma: Trichoderma:
TrichosporonosisTrichosporonosis
Contractors’ Poor Work Kills Contractors’ Poor Work Kills People!People! 2001 Canadian 2001 Canadian StudyStudy 32 cases, 154 deaths32 cases, 154 deaths
Basis for many Basis for many regulations and regulations and guidelinesguidelines CSACSA APICAPIC Joint CommissionJoint Commission
Was It The Construction?Was It The Construction? On January 25On January 25thth, 2005, , 2005,
a 29-week-old baby a 29-week-old baby "died of an infectious "died of an infectious disease'' disease''
Montreal Hospital Montreal Hospital moved premature moved premature babies out of neonatal babies out of neonatal wing as it scrambled wing as it scrambled to locate the source of to locate the source of infection infection
Fourth floor infant Fourth floor infant intensive care unit intensive care unit area undergoing area undergoing renovationsrenovations
18 Avoidable Deaths18 Avoidable Deaths Improper demolition Improper demolition
controlscontrols Removing false ceilings, Removing false ceilings,
HVAC ductwork, window HVAC ductwork, window frames and wall insulation frames and wall insulation
Aspergillus fumigatus Aspergillus fumigatus exposure led to exposure led to aspergillosisaspergillosis
22 critical care patients 22 critical care patients sickenedsickened
Poor isolation of the work Poor isolation of the work area identified as causing area identified as causing the spread of sporesthe spread of spores
Bad Work in Hospitals Still HappensBad Work in Hospitals Still Happens 2/4/09 AP Story2/4/09 AP Story
Florida lawsuit claims 3 Florida lawsuit claims 3 kids died from hospital kids died from hospital moldmold
St. Joseph's Hospital in St. Joseph's Hospital in Tampa Tampa
Pediatric cancer patients Pediatric cancer patients Fungal infections at the Fungal infections at the
facility facility Hospital failed to properly Hospital failed to properly
seal off an area under seal off an area under renovationrenovation Matthew J. Gliddon
Is There A Pattern?Is There A Pattern? Transplant HMO mortality rate in Transplant HMO mortality rate in
liver patientsliver patients13% in health care facility undergoing 13% in health care facility undergoing renovation renovation no documented cases where no renovation no documented cases where no renovation was taking placewas taking place
A tertiary care center A tertiary care center Average 9% rate in aspergillosis Average 9% rate in aspergillosis No documented cases after development No documented cases after development and enforcement of an extensive dust and enforcement of an extensive dust containment policycontainment policy
Lawyers Understand the Lawyers Understand the ConnectionConnection
Spike in infection rates in Spike in infection rates in patient care areas patient care areas adjacent to a construction adjacent to a construction sitesite
A containment or an A containment or an impermeable barrier had impermeable barrier had not been erected; not been erected; windows had not been windows had not been properly sealedproperly sealed
Construction company Construction company was held partially liablewas held partially liable
2009 University Of South Florida Study2009 University Of South Florida Study Aspergillus infection deaths Aspergillus infection deaths
associated with associated with environmental:environmental:hospital construction, hospital construction, maintenance, maintenance, demolition and renovation;demolition and renovation; contaminated fireproofing; contaminated fireproofing; air filters in hospital ventilation air filters in hospital ventilation systems, and systems, and via contaminated carpeting. via contaminated carpeting.
3. Proactive Prevention of 3. Proactive Prevention of Infections During ConstructionInfections During Construction
The American Institute of The American Institute of Architects advocates the use of:Architects advocates the use of: Infection Control Risk Assessments Infection Control Risk Assessments
(ICRA)(ICRA) Infection Control Risk Mitigation Infection Control Risk Mitigation
Recommendations (ICRMR)Recommendations (ICRMR) Plan your work, work your planPlan your work, work your plan
Multiple DocumentsMultiple Documents = = Standard of CareStandard of Care
Rules for facilities and patientsRules for facilities and patients Center for Disease Control and Prevention (CDC)Center for Disease Control and Prevention (CDC) Healthcare Infection Control Practices Advisory Healthcare Infection Control Practices Advisory
Commission (HICPAC)Commission (HICPAC) Joint Commission on Accreditation of Healthcare Joint Commission on Accreditation of Healthcare
Organizations (JCAHO)Organizations (JCAHO) American Institute of Architects (AIA)American Institute of Architects (AIA)
Rules for Construction WorkersRules for Construction Workers OSHAOSHA Health CanadaHealth Canada
Choosing Appropriate Safety StepsChoosing Appropriate Safety Steps Association of Professionals for Association of Professionals for
Infection Control (APIC) GuidelinesInfection Control (APIC) Guidelines Consider risk groups impacted by Consider risk groups impacted by
activities conducted in medical facilitiesactivities conducted in medical facilities Four groupsFour groups
Consider the type of work activityConsider the type of work activity Four categoriesFour categories
Matrix of proceduresMatrix of procedures
Patient Risk GroupsPatient Risk Groups Low RiskLow Risk Medium RiskMedium Risk High RiskHigh Risk Highest Highest
RiskRisk Office AreasOffice Areas CardiologyCardiology
EchocardiographyEchocardiography EndoscopyEndoscopy Nuclear MedicineNuclear Medicine Physical TherapyPhysical Therapy Radiology/MRIRadiology/MRI Respiratory Respiratory
TherapyTherapy
CCUCCU Emergency Emergency
RoomRoom Labor & Labor &
DeliveryDelivery Laboratories Laboratories
(specimen)(specimen) Newborn Newborn
NurseryNursery Outpatient Outpatient
SurgerySurgery PediatricsPediatrics PharmacyPharmacy Post Anesthesia Post Anesthesia
Care UnitCare Unit Surgical UnitsSurgical Units
Any area caring Any area caring for immuno-for immuno-compromised compromised patientspatients
Burn UnitBurn Unit Cardiac Cath Cardiac Cath
LabLab Central Sterile Central Sterile
SupplySupply Intensive Care Intensive Care
UnitsUnits Negative Negative
pressure pressure isolation roomsisolation rooms
OncologyOncology Operating Operating
rooms including rooms including C-section rooms C-section rooms
Categorizing Construction ActivityCategorizing Construction Activity Type A:Type A: Inspection, non-invasive Inspection, non-invasive
activitiesactivities Type B:Type B: Small scale, short duration, Small scale, short duration,
minimal dust-generating activitiesminimal dust-generating activities Type C:Type C: Activities that generate Activities that generate
moderate to high levels of dust, require moderate to high levels of dust, require greater than one work shift to completegreater than one work shift to complete
Type D:Type D: Activities that generate high Activities that generate high levels of dust, major demolition and levels of dust, major demolition and construction activities requiring construction activities requiring consecutive work shifts to completeconsecutive work shifts to complete– APIC definitions
Risk Group Construction Activity
Type A Type B Type C Type D
Group 1 I II II III / IV
Group 2 I II III IV
Group 3 I III III / IV IV
Group 4 I-III III / IV III / IV IV
Class I - Infection ControlClass I - Infection Control
Minimize dustMinimize dust Replace ceiling tilesReplace ceiling tiles Clean work areaClean work area
Class II - Infection ControlClass II - Infection Control
Seal doors, vents, HVAC componentsSeal doors, vents, HVAC components Air scrubber or filterAir scrubber or filter Dust control (mist or vacuum) Dust control (mist or vacuum)
while workingwhile working Dust mat at entryDust mat at entry Covered waste during transport Covered waste during transport
through buildingthrough building Wet wipe with chemicalWet wipe with chemical Wet mop and/or HEPA vacuum floorsWet mop and/or HEPA vacuum floors
Class III - Infection ControlClass III - Infection Control Complete isolation of work area Complete isolation of work area
(room enclosure or control cube)(room enclosure or control cube) Negative pressure work via HEPA Negative pressure work via HEPA
equipmentequipment Waste in containers, then in Waste in containers, then in
covered cartscovered carts HEPA vacuum and wet wipe (HEPA HEPA vacuum and wet wipe (HEPA
sandwich)sandwich) Visual inspection by owner or third Visual inspection by owner or third
partyparty Controlled tear downControlled tear down
Class IV - Infection ControlClass IV - Infection Control Extra effort to seal all Extra effort to seal all
penetrations (do not rely on penetrations (do not rely on negative pressure to negative pressure to prevent dispersal of prevent dispersal of contaminants)contaminants)
Minimum 1 stage Minimum 1 stage decontamination chamberdecontamination chamber
Use of shoe covers or Use of shoe covers or disposable suits (new disposable suits (new shoe/body covering every shoe/body covering every time in/out)time in/out)
4. Practical Tips4. Practical Tips
Some important Some important points for points for individuals and individuals and organizations organizations working in, or working in, or planning on planning on marketing to, marketing to, healthcare facilitieshealthcare facilities
Your Experience Is ValuableYour Experience Is Valuable There are many concepts, There are many concepts,
procedures, and pieces of procedures, and pieces of equipment that equipment that restoration/remediation contractors restoration/remediation contractors use daily that are critical for use daily that are critical for infection controlinfection control Many general contractors are years behind the Many general contractors are years behind the
“dust control” curve“dust control” curve General contractors are often reluctant to use General contractors are often reluctant to use
appropriate personal protective equipmentappropriate personal protective equipment Verification of project cleanliness is not typical for Verification of project cleanliness is not typical for
construction but accepted for remediation and construction but accepted for remediation and necessary for infection controlnecessary for infection control
Educate Your StaffEducate Your Staff
““Beth, I Beth, I Need To Need To
Leave Early Leave Early Today, Let’s Today, Let’s Clean Just Clean Just The White The White Squares!”Squares!”
2010 Business Mentors Summit –2010 Business Mentors Summit – Chicago, IllinoisChicago, Illinois
90% Right Is Still 100% 90% Right Is Still 100% WrongWrong
Understand and appreciate the Understand and appreciate the differences between restoration, mold differences between restoration, mold remediation, and infection controlremediation, and infection control Similar approach and equipmentSimilar approach and equipment More significant consequences for poor More significant consequences for poor
performance – literally life and deathperformance – literally life and death Do your homeworkDo your homework
One 60 minute presentation does not One 60 minute presentation does not make you an expertmake you an expert
Collect and read relevant resourcesCollect and read relevant resources
““Plus Up”Plus Up”
Adapt an Adapt an ASARAASARA attitudeattitude AAs s SSafe afe AAs s RReasonably easonably AAchievablechievable Go beyond the minimumsGo beyond the minimums
Substitute efficiency for higher Substitute efficiency for higher costs to bring better value to the costs to bring better value to the projectproject Clear and detailed company policies for Clear and detailed company policies for
work in healthcare facilities allows work in healthcare facilities allows standardization that creates efficiencystandardization that creates efficiency
Begin Your Marketing NowBegin Your Marketing Now Approach both contractors and Approach both contractors and
healthcare operatorshealthcare operators Explain that you understand the unique Explain that you understand the unique
aspects of infection controlaspects of infection control Become a pre-selected vendor for Become a pre-selected vendor for
emergency responseemergency response Sell your expertiseSell your expertise
Set up and clean up while the contractor handles Set up and clean up while the contractor handles demolitiondemolition
Post-construction cleaning for the facility if Post-construction cleaning for the facility if their staff is stretchedtheir staff is stretched
Specialized services such as duct cleaningSpecialized services such as duct cleaning
Remember: Keep Your Priorities Remember: Keep Your Priorities StraightStraight
Protect yourself and your crewProtect yourself and your crew Blood borne pathogen training and Blood borne pathogen training and
medical protectionmedical protection Appropriate PPE every timeAppropriate PPE every time Hand sanitizing emphasisHand sanitizing emphasis
Protect the occupants and Protect the occupants and patientspatients Effective isolationEffective isolation Dust-free work, clean as you goDust-free work, clean as you go
Control costsControl costs Do it once, do it right!Do it once, do it right!
Questions?Questions?
THANK YOU!THANK YOU!If you would like more information,If you would like more information,
please contact:please contact:
Wonder Makers Environmental Wonder Makers Environmental P.O. Box 50209P.O. Box 50209
Kalamazoo, Michigan 49005-0209Kalamazoo, Michigan 49005-0209(888) 382-4154 (888) 382-4154
fax (269) 382-4161 fax (269) 382-4161 [email protected]@wondermakers.com
2010 Business Mentors Summit –2010 Business Mentors Summit – Chicago, IllinoisChicago, Illinois
Shocking StatisticsShocking Statistics Aspergillosis mortality rates have Aspergillosis mortality rates have
been reported as high as:been reported as high as: 95% in bone marrow transplant patients95% in bone marrow transplant patients 13-80% in leukemia patients 13-80% in leukemia patients 8-30% in kidney transplant patients8-30% in kidney transplant patients
Despite use of anti-fungal drugs, Despite use of anti-fungal drugs, the outcome of transplant the outcome of transplant patients with aspergillosis patients with aspergillosis continues to be grimcontinues to be grim
They Deserve the BestThey Deserve the Best Most susceptible people are Most susceptible people are
those with:those with: Immunosuppressive conditions (Immunosuppressive conditions (e.g.,e.g.,
bone marrow or solid organ bone marrow or solid organ transplants)transplants)
Immunodeficiencies, AIDSImmunodeficiencies, AIDS Dialysis, renal failureDialysis, renal failure Chronic pulmonary diseaseChronic pulmonary disease SurgerySurgery DiabetesDiabetes Age (Age (e.g.,e.g., neonates and very old) neonates and very old)
General Guidelines & General Guidelines & ResourcesResources
APIC and Health Canada use a APIC and Health Canada use a similar process to define minimum similar process to define minimum infection control practices for infection control practices for various types of various types of restoration/construction projects restoration/construction projects in healthcare facilities:in healthcare facilities: Categorize each construction activity (A Categorize each construction activity (A
through D)through D) Identify affected patient risk group for Identify affected patient risk group for
each activityeach activity Follow minimum protocolsFollow minimum protocols
Don’t Get Caught With Your Don’t Get Caught With Your Pants DownPants Down
Now I Know Now I Know Why They Why They Call ItCall It ICU! ICU!