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New Opportunities for Cleaning

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New Opportunities for Cleaning & Restoration Professionals In Healthcare Facilities Presented By Wonder Makers Environmental Michael A. Pinto, CSP, CMP – PowerPoint PPT presentation

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Title: New Opportunities for Cleaning


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
2
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 years in safety, health, and environmental
    professions
  • MIOSHA, NSC, Consulting, FEMA MAT Team

2010 Business Mentors Summit Chicago, Illinois
3
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
4
A Talk About Healthcare Facilities
5
Methodist Hospital In Chalmette, Louisiana
6
Do You Really Want Hospital Staff Tackling
This?Nor Is It A Job For A Regular Carpet
Cleaner!
7
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
8
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
9
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

10
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

11
Have You Seen A Poster Like This?
12
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

13
2. Healthcare Acquired Infections
  • Are so common that they have their own name
    nosocomial infections
  • Estimated two million hospital-acquired
    infections per year
  • Estimated 100,000 deaths every year
  • 5 billion spent on hospital-acquired infections
    each year

14
Germs Hygiene Practices
  • Isnt 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

15
Common Construction Contaminants
  • Bacterial
  • Legionella, Pontiac fever
  • Fungal
  • Aspergillus Aspergillosis
  • Penicillium Penicilliosis
  • Fusarium Fusariosis
  • Mucor Mucomycosis
  • Trichoderma Trichosporonosis

16
Contractors Poor Work Kills People!
  • 2001 Canadian Study
  • 32 cases, 154 deaths
  • Basis for many regulations and guidelines
  • CSA
  • APIC
  • Joint Commission

17
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
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

19
Bad Work in Hospitals Still Happens
  • 2/4/09 AP Story
  • 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

Matthew J. Gliddon
20
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

21
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

22
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.

23
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

24
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

25
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

26
Patient Risk Groups
Low Risk Medium Risk High Risk Highest Risk
Office Areas 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 immuno-compromised patients Burn Unit Cardiac Cath Lab Central Sterile Supply Intensive Care Units Negative pressure isolation rooms Oncology Operating rooms including C-section rooms
27
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

28
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29
Class I - Infection Control
  • Minimize dust
  • Replace ceiling tiles
  • Clean work area

30
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

31
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

32
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)

33
4. Practical Tips
  • Some important points for individuals and
    organizations working in, or planning on
    marketing to, healthcare facilities

34
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

35
Educate Your Staff
Beth, I Need To Leave Early Today, Lets Clean
Just The White Squares!
2010 Business Mentors Summit Chicago, Illinois
36
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

37
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

38
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

39
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!

40
Questions?
41
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
map_at_wondermakers.com
2010 Business Mentors Summit Chicago, Illinois
42
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

43
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)

44
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

45
Dont Get Caught With Your Pants Down
Now I Know Why They Call It ICU!
46
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