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:
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
Exposure causing infection
About the impact your activities
may have on the building &
occupants
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
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
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
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!