Transcript Slide 1

New Opportunities for Cleaning &
Restoration Professionals In
Healthcare Facilities
Presented By Wonder Makers Environmental
Michael A. Pinto, CSP, CMP
CEO
2010 Business Mentors Summit – Chicago, Illinois
Your Speaker
Michael Pinto
•CEO, Wonder Makers
Environmental
•CSP, CMP
•Author of 5 books and 140+
articles
•Contributor to standards and
courses
ASTM, IICRC, RIA
Experience
•29 years2010
in safety,
health,
and
Business Mentors
Summit
– Chicago, Illinois
The Most Important Fact About
Your Speaker
•No financial tie to any of
the companies/products
mentioned in the
program
•Other than Wonder
Makers
2010 Business Mentors Summit – Chicago, Illinois
A Talk About Healthcare Facilities
Methodist Hospital In Chalmette,
Louisiana
Do You Really Want Hospital
Staff Tackling This?
Nor Is It A Job For A Regular Carpet
Cleaner!
Presentation Outline
• The unique nature of healthcare
environments
• Healthcare acquired infections
• Controlling hospital acquired
infections during restoration or
construction activities
• Practical tips on how to prepare your
organization to offer services to
healthcare facilities
2010 Business Mentors Summit – Chicago, Illinois
1. Healthcare Is A Different Type Of
Client
•Consolidation of ill and injured
individuals
•Priority of patient care
•Facility operation 24/7
•Security/traffic concerns
•Special building practices and systems
•Detailed regulatory restrictions
•High profile - Liability target
2010 Business Mentors Summit – Chicago, Illinois
Have You Ever Wondered From A
Business Perspective?
 Do we have critical skills and
experience that we can bring to:
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Hospitals
Out patient treatment facilities
Medical offices
Nursing homes
Have You Ever Done Work In A
Healthcare Facility?
 Water restoration
 Pump out, dry down, replacement of
finish materials
 Fire restoration
 Clean-up, deodorizing, blasting,
replacement
 Mold remediation
 Replace water stained ceiling tiles
 Duct cleaning
Have You
Seen A
Poster Like
This?
Does It Make You Wonder?
 About the safety of yourself &
your crew
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Exposure causing infection
 About the impact your activities
may have on the building &
occupants
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Activity increasing infection potential for
high risk groups such as sick, elderly,
recovering surgery patients, etc.
Bacterial and fungal contaminants
2. Healthcare Acquired Infections
 Are so common that they have their
own name – nosocomial infections
 Estimated two million hospitalacquired infections per year
 Estimated 100,000+ deaths every
year
 $5 billion spent on hospital-acquired
infections each year
Germs & Hygiene Practices
 Isn’t the problem “germs”
and personnel hygiene
practices?
 If 50% of the nosocomial
infections are caused by
improperly washed hands or
other touching
(staphylococcus), what is the
cause of the remaining 50%?
 Environmental cross
contamination
Common Construction Contaminants
 Bacterial
 Legionella, Pontiac fever
 Fungal
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Aspergillus: Aspergillosis
Penicillium: Penicilliosis
Fusarium: Fusariosis
Mucor: Mucomycosis
Trichoderma:
Trichosporonosis
Contractors’ Poor Work Kills People!
 2001 Canadian
Study
 32 cases, 154 deaths
 Basis for many
regulations and
guidelines
 CSA
 APIC
 Joint Commission
Was It The Construction?
 On January 25th, 2005,
a 29-week-old baby
"died of an infectious
disease''
 Montreal Hospital
moved premature
babies out of neonatal
wing as it scrambled to
locate the source of
infection
 Fourth floor infant
intensive care unit area
undergoing renovations
18 Avoidable Deaths
 Improper demolition
controls
 Removing false ceilings,
HVAC ductwork, window
frames and wall insulation
 Aspergillus fumigatus
exposure led to
aspergillosis
 22 critical care patients
sickened
 Poor isolation of the work
area identified as causing
the spread of spores
Bad Work in Hospitals Still Happens
 2/4/09 AP Story
Matthew J. Gliddon
 Florida lawsuit claims 3
kids died from hospital
mold
 St. Joseph's Hospital in
Tampa
 Pediatric cancer patients
 Fungal infections at the
facility
 Hospital failed to properly
seal off an area under
renovation
Is There A Pattern?
 Transplant HMO mortality rate in
liver patients
13% in health care facility undergoing
renovation
no documented cases where no renovation
was taking place
 A tertiary care center
Average 9% rate in aspergillosis
No documented cases after development
and enforcement of an extensive dust
containment policy
Lawyers Understand the Connection
 Spike in infection rates in
patient care areas adjacent
to a construction site
 A containment or an
impermeable barrier had
not been erected; windows
had not been properly
sealed
 Construction company was
held partially liable
2009 University Of South Florida Study
 Aspergillus infection deaths
associated with environmental:
hospital construction,
maintenance,
demolition and renovation;
 contaminated fireproofing;
air filters in hospital ventilation
systems, and
via contaminated carpeting.
3. Proactive Prevention of Infections
During Construction
 The American Institute of
Architects advocates the use of:
 Infection Control Risk Assessments
(ICRA)
 Infection Control Risk Mitigation
Recommendations (ICRMR)
 Plan your work, work your plan
Multiple Documents =
Standard of Care
 Rules for facilities and patients
 Center for Disease Control and Prevention (CDC)
 Healthcare Infection Control Practices Advisory
Commission (HICPAC)
 Joint Commission on Accreditation of Healthcare
Organizations (JCAHO)
 American Institute of Architects (AIA)
 Rules for Construction Workers
 OSHA
 Health Canada
Choosing Appropriate Safety Steps
 Association of Professionals for
Infection Control (APIC) Guidelines
 Consider risk groups impacted by
activities conducted in medical facilities
 Four groups
 Consider the type of work activity
 Four categories
 Matrix of procedures
Patient Risk Groups
Low Risk
 Office Areas
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Medium Risk
High Risk
Highest Risk
Cardiology
Echocardiography
Endoscopy
Nuclear Medicine
Physical Therapy
Radiology/MRI
Respiratory
Therapy
 CCU
 Emergency
Room
 Labor & Delivery
 Laboratories
(specimen)
 Newborn
Nursery
 Outpatient
Surgery
 Pediatrics
 Pharmacy
 Post Anesthesia
Care Unit
 Surgical Units
 Any area caring
for immunocompromised
patients
 Burn Unit
 Cardiac Cath Lab
 Central Sterile
Supply
 Intensive Care
Units
 Negative
pressure
isolation rooms
 Oncology
 Operating rooms
including Csection rooms
Categorizing Construction Activity
 Type A: Inspection, non-invasive activities
 Type B: Small scale, short duration,
minimal dust-generating activities
 Type C: Activities that generate moderate
to high levels of dust, require greater than
one work shift to complete
 Type D: Activities that generate high levels
of dust, major demolition and construction
activities requiring consecutive work shifts
to complete
– APIC definitions
Construction Activity
Risk Group
Group 1
Group 2
Group 3
Group 4
Type A
Type B
Type C
Type D
I
II
II
III / IV
I
II
III
IV
I
III
III / IV
IV
I-III
III / IV
III / IV
IV
Class I - Infection Control
 Minimize dust
 Replace ceiling tiles
 Clean work area
Class II - Infection Control
 Seal doors, vents, HVAC components
 Air scrubber or filter
 Dust control (mist or vacuum)
while working
 Dust mat at entry
 Covered waste during transport through
building
 Wet wipe with chemical
 Wet mop and/or HEPA vacuum floors
Class III - Infection Control
 Complete isolation of work area
(room enclosure or control cube)
 Negative pressure work via HEPA
equipment
 Waste in containers, then in covered
carts
 HEPA vacuum and wet wipe (HEPA
sandwich)
 Visual inspection by owner or third
party
 Controlled tear down
Class IV - Infection Control
 Extra effort to seal all
penetrations (do not rely on
negative pressure to prevent
dispersal of contaminants)
 Minimum 1 stage
decontamination chamber
 Use of shoe covers or
disposable suits (new
shoe/body covering every
time in/out)
4. Practical Tips
 Some important
points for
individuals and
organizations
working in, or
planning on
marketing to,
healthcare facilities
Your Experience Is Valuable
 There are many concepts,
procedures, and pieces of equipment
that restoration/remediation
contractors use daily that are critical
for infection control
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Many general contractors are years behind the
“dust control” curve
General contractors are often reluctant to use
appropriate personal protective equipment
Verification of project cleanliness is not typical for
construction but accepted for remediation and
necessary for infection control
Educate Your Staff
“Beth, I
Need To
Leave Early
Today, Let’s
Clean Just
The White
Squares!”
2010 Business Mentors Summit – Chicago, Illinois
90% Right Is Still 100% Wrong
 Understand and appreciate the
differences between restoration, mold
remediation, and infection control
 Similar approach and equipment
 More significant consequences for poor
performance – literally life and death
 Do your homework
 One 60 minute presentation does not
make you an expert
 Collect and read relevant resources
“Plus Up”
 Adapt an ASARA attitude
 As Safe As Reasonably Achievable
 Go beyond the minimums
 Substitute efficiency for higher
costs to bring better value to the
project
 Clear and detailed company policies for
work in healthcare facilities allows
standardization that creates efficiency
Begin Your Marketing Now
 Approach both contractors and
healthcare operators
 Explain that you understand the unique
aspects of infection control
 Become a pre-selected vendor for emergency
response
 Sell your expertise
 Set up and clean up while the contractor handles
demolition
 Post-construction cleaning for the facility if
their staff is stretched
 Specialized services such as duct cleaning
Remember: Keep Your Priorities
Straight
 Protect yourself and your crew
 Blood borne pathogen training and
medical protection
 Appropriate PPE every time
 Hand sanitizing emphasis
 Protect the occupants and patients
 Effective isolation
 Dust-free work, clean as you go
 Control costs
 Do it once, do it right!
Questions?
THANK YOU!
If you would like more information,
please contact:
Wonder Makers Environmental
P.O. Box 50209
Kalamazoo, Michigan 49005-0209
(888) 382-4154
fax (269) 382-4161
www.wondermakers.com
[email protected]
2010 Business Mentors Summit – Chicago, Illinois
Shocking Statistics
 Aspergillosis mortality rates have
been reported as high as:
 95% in bone marrow transplant patients
 13-80% in leukemia patients
 8-30% in kidney transplant patients
 Despite use of anti-fungal drugs,
the outcome of transplant patients
with aspergillosis continues to be
grim
They Deserve the Best
 Most susceptible people are those
with:
 Immunosuppressive conditions (e.g.,
bone marrow or solid organ transplants)
 Immunodeficiencies, AIDS
 Dialysis, renal failure
 Chronic pulmonary disease
 Surgery
 Diabetes
 Age (e.g., neonates and very old)
General Guidelines & Resources
 APIC and Health Canada use a
similar process to define minimum
infection control practices for
various types of
restoration/construction projects in
healthcare facilities:
 Categorize each construction activity (A
through D)
 Identify affected patient risk group for
each activity
 Follow minimum protocols
Don’t Get Caught With Your
Pants Down
Now I Know
Why They
Call It ICU!