Transcript Slide 1

Challenges & Strategies During
Healthcare Construction Environmental Risk
Assessments
www.hillmannconsulting.com
Hillmann Consulting
• Full service Environmental Health & Safety
and Construction Engineering firm
• Nearly 30 years of experience working in
healthcare facilities
• Headquartered in Union, NJ
– Over 60 Professionals Based in New Jersey
– 109 Professionals Nationwide
www.hillmannconsulting.com
The Hillmann Team
• Our expert staff is trained, certified and degreed
in their respective fields:
• Certified Industrial Hygienists
• Certified Safety Professionals
• Certified Hazardous Materials Managers
• Licensed Site Remediation Professionals
• Professional Engineers
• Registered Environmental Property Assessors
• LEED Accredited Professionals
• Experts in Asbestos, Lead, and Underground Storage
Tank Management
www.hillmannconsulting.com
Presentation Overview
• Unique Challenges of the Healthcare
Environment
• Construction Project Strategy
• Environmental Risk Assessment
–
–
–
–
Hazardous Materials Assessments
Abatement Management
Chemical & Environmental Compliance Management
Indoor Air & Water Quality Evaluation & Monitoring
• Mold Awareness
• Asbestos Awareness
• Lead Awareness
www.hillmannconsulting.com
UNIQUE CHALLENGES
OF THE
HEALTHCARE
ENVIRONMENT
www.hillmannconsulting.com
Challenges of the Healthcare
Environment
• Preserving a Contained Environment During
Construction
– Maintain a Hard Barrier & HVAC Balancing
– Track Pads
– Isolate Paths of Entry and Egress
• Protecting the Health of Susceptible Patient
Populations from Dust and Fugitive Emissions
– Immune suppressed individuals
– Individuals with respiratory diseases
– Asthmatic or allergic individuals
www.hillmannconsulting.com
Challenges of the Healthcare
Environment
• Maintain Operations and Occupancy
• Lead-Lined Walls in Radiation Areas
• Additional Contaminants to Control
– Bacteria
– Radiation
• ISO 14644 Standard – Cleanrooms and
Associated Controlled Environments
– Provides stringent classification levels and
specifications of air cleanliness specific to
cleanroom environments
www.hillmannconsulting.com
CONSTRUCTION
PROJECT STRATEGY
www.hillmannconsulting.com
Construction Project Strategy
• Complete Environmental Risk Assessment
– Identify Materials and Potential Contaminants
– Develop Mitigation Plan
– Reduce Risk and Liability
• Project Planning
– Ensure resulting environmental assessment issues are
included in the work breakdown structure
– Allow adequate time in the project schedule to
properly plan for environmental issues
www.hillmannconsulting.com
Construction Project Strategy
• Management of Project Work in Phases
–
–
–
–
–
Maintain Facility Operation and Occupancy
HVAC and Ventilation System Management
Control of Critical Pathways
Facilitate Patient Relocation
Monitoring
www.hillmannconsulting.com
ENVIRONMENTAL RISK
ASSESSMENTS
www.hillmannconsulting.com
Hazardous Materials
Assessments
• Identify and inventory hazardous materials to
mitigate risk and liability for renovation related
conditions
–
–
–
–
–
–
Asbestos
Mold
Lead
PCB’s
Mercury
Fuel
www.hillmannconsulting.com
Abatement Management
• Confirm work is performed to applicable
regulations and guidelines
• Verify appropriately trained and licensed
personnel are providing clean-up and
remediation
• RECORD-KEEPING, RECORD-KEEPING,
RECORD-KEEPING
• Maintain a safe environment for personnel and
workers
• Ensure occupant/patient health and safety
www.hillmannconsulting.com
Chemical & Environmental
Compliance Management
• Hazard Communication
–
–
–
–
Written Program
Material Safety Data Sheets
Training staff – Initial, As hazards change
Contractors
• Site Investigation
–
–
–
–
Chemical Management
Product Stewardship
Regulatory Agency Liaison
Regulatory Compliance
•RCRA, CERCLA, SARA, TCPA, CWA, NPDES
www.hillmannconsulting.com
Chemical & Environmental
Compliance Management
• Right-to-Know Programs
• Spill Prevention Clean-Up & Countermeasures
• Required by EPA if facility can:
“reasonably be expected to discharge harmful
amounts of oil into navigable waters of the United
States or adjoining shorelines”
• Spills over 25 Gallons must be reported to the EPA
www.hillmannconsulting.com
Indoor Air Quality
Evaluation & Monitoring
• Proactive Evaluation
–
Document Air Quality
•
•
•
–
–
Maintain Healthy Indoor Environments
Reduce Liability
Optimize Building Operations
HVAC System Inspection
Air Sampling
www.hillmannconsulting.com
Indoor Air Quality
Evaluation & Monitoring
• Reactive Investigation
–
–
–
–
–
Fire
Major Leak or Spill
Construction
Renovation
Occupant Complaints
• Occupant Complaint Survey
–
–
–
–
Personal Interviews
Building History
Site Visit
Environmental Monitoring
www.hillmannconsulting.com
Water Quality Testing
• EPA Primary and Secondary Contaminants
• Scheduled Facility Survey
– Legionella from Potable Water and Cooling Towers
•ASHRAE 188P – Third Public Review (Jan 2013)
– Coliforms
– Priority Pollutant Metals
• Complaint Response
www.hillmannconsulting.com
MOLD AWARENESS
www.hillmannconsulting.com
When to Initiate an
Investigation
• Characteristic mold (musty) odor observed
• Water intrusion issue observed
• Occupants reporting health effects
•
Allergy type symptoms i.e. itchy eyes, sneezing, etc
• Visible mold growth observed on exposed or
hidden surfaces
• Elevated moisture content of delivered building
materials
www.hillmannconsulting.com
Assessing the Situation
• Visual inspection is the primary investigation
method to identify areas that require remediation.
– Be sure all contaminated areas are identified
– In wallboard material mold growth may extend up to 1
meter beyond what is visible
– Inaccessible areas may be your largest concern; Behind
wallboard, under wallpaper, below rugs, etc.
• A moisture meter can be useful in assessing porous
materials that may be contaminated and should be
disposed
www.hillmannconsulting.com
Assessing the Situation
• In a Healthcare facility, air sampling is highly
recommended to identify the presence of mold
spores
– Non-Viable air samples are run for 10 minutes
– Samples are analyzed for the presence of the
Penicillium/Aspergillus, among others
– If the Penicillium/Aspergillus group of mold is
identified in the samples, it is necessary to sample via
viable (culturable) methods to determine the species
present (Aspergillus species known to cause lung
infection known as Aspergillosis)
www.hillmannconsulting.com
Nature of Mold Problems
• How extensive & where
• Drywall cavity
• Carpet
• HVAC insulation near cooling coils
• Vinyl wall covering
• Crawl space
• Flood – DRY OUT THE SPACE!!
– Cat I, II, & III Water – type will govern scope
www.hillmannconsulting.com
Water Loss Mitigation
• Loss Occurs
– Property Management may Initiate Insurance Claim
– Call your consultant and loss manager
– Source of water intrusion fixed (unless something
major)
• Property Management contact hires Environmental
Consultant and Remediation Contractor
– The consultant and contractor act as a third party and
should not be hired by one another
– The consultant and contractor should be two separate
entities.
www.hillmannconsulting.com
Water Loss Mitigation
– Environmental Consultant
performs an initial assessment
and reviews environmental
conditions
– Remediation Contractor begins
emergency response work to
contain loss
www.hillmannconsulting.com
Water Loss Mitigation
– Complete Environmental Remediation Scope of Work
Issued
•The Remediation Scope of Work includes
–
–
–
–
–
–
–
–
Site observations
Laboratory results
Site diagram
Recommendations
Remediation guidelines for contractor to follow
Insurance Criteria
Sample Contract Form
Clearance Criteria
www.hillmannconsulting.com
Loss Control Stage
• Remediation scope of work may be bid out
• Environmental Testing, Project Management
and Cost analysis
• Cost Analysis can be conducted
• Environmental Consultant Performs
Inspections and Clearance Testing
•Visual inspection
•Moisture Assessment
•Air sampling (if visual inspection and moisture
assessment pass)
www.hillmannconsulting.com
Role of the Environmental
Consultant
• Provide health and liability protection
• Furnish technical support and environmental
expertise to limit the impact on-site and in the
surrounding community
• Ensure the efficacy of environmental issues
attributed to each specific loss
• Liaison with emergency management teams,
adjusters, remediators, contractors, officials, and
the insured (if related to an insurance claim)
www.hillmannconsulting.com
Role of the Environmental
Consultant
• Verify contractor’s health & safety program
meets regulatory standards and applicable work
practices
• Maintain efficient restoration schedule to preloss conditions
• Verify clean-up of effected areas is complete
• Provide record keeping functions in support of
an insurance claim
www.hillmannconsulting.com
ASBESTOS AWARENESS
www.hillmannconsulting.com
Pre-Abatement Plan
A. Sequence and Schedule
1. Prepare and issue abatement specifications and
sketches
2. Select qualified abatement contractor
3. File with all applicable regulatory agencies
4. Pre-Abatement preparation
www.hillmannconsulting.com
Abatement Filings
A. The Filing Process takes approximately 2-3
weeks
1. Environmental Protection Agency (EPA)
2. State Department of Health and Department
of Labor (DOH &DOL)
3. State Environmental Protection Agency
4. State Department of Community Affairs
(DCA)
5. Local Municipalities
www.hillmannconsulting.com
Notifications
A. Signs
B. Demarcation of work
areas
www.hillmannconsulting.com
Air Monitoring
A. Area Sampling
1. High Volume Pumps
www.hillmannconsulting.com
Protection From ExposurePPE
A. Disposable Suits
B. Disposable Footwear
C. Disposable Gloves
www.hillmannconsulting.com
The Abatement Process
A.
B.
C.
D.
E.
F.
Pre-Commencement Inspection
Start of abatement
Tracking of waste
1st, 2nd & 3rd Cleaning Inspections
Final Aggressive Air Clearance Sampling
Break-down of containment
www.hillmannconsulting.com
LEAD AWARENESS
www.hillmannconsulting.com
Lead Paint Hazards
• Peeling or Chipping Paint
• Alligatoring
• Chalking
• Paint on a Deteriorating Subsurface
• Impact or Friction Surfaces
• Blistering Paint
• Water Damaged Surfaces
www.hillmannconsulting.com
Identifying LBP Hazards
• Lead-Lined Walls in Radiation Areas
• Friction Points
– Windows, Door Header, Jambs and Thresholds
– Stair Treads
• Impact Surfaces
– Doors, Stair Risers, Walls behind Door Knobs
www.hillmannconsulting.com
Visual Inspections
• All Potential Lead Hazards Must Be Identified
• Findings Are Recorded on a Prepared Checklist
• Room by Room Inspection
• Inspection of All Painted Surfaces and
Components
www.hillmannconsulting.com
Exposure Monitoring
• Wipe Samples
– Assessment
– Clearance
• Air Samples
– Area Samples
– Personal Samples
www.hillmannconsulting.com
Correcting LBP Hazards
• Wet Scraping
• Wet Sanding
– No Mechanical Equipment
• Chemical Stripping
–
–
–
–
No Methylene Chloride Permitted
Additional PPE Required
Additional Disposal Fees
Odor Complaints
www.hillmannconsulting.com
Correcting LBP Hazards
• Component Replacement
• Component Adjustment
– Doors, Including Cabinet Doors
– Windows Must Be Adjusted and Squared
• Daily Cleanup
– Work Area Must Be HEPA Vac. & Washed
• Daily Visual Examination
• Final Cleanup
www.hillmannconsulting.com
Determining Effectiveness
• Collect Clearance Wipe Samples
• Continued Quality Maintenance
• Maintenance of Documentation
www.hillmannconsulting.com
Question & Answer
www.hillmannconsulting.com