New Opportunities for Cleaning

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


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


•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


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


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 1I II II III / IV

Group 2I II III IV

Group 3I III III / IV IV

Group 4I-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!”


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


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!