Title: New Opportunities for Cleaning
1New 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
2Your 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
3The 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
4A Talk About Healthcare Facilities
5Methodist Hospital In Chalmette, Louisiana
6Do You Really Want Hospital Staff Tackling
This?Nor Is It A Job For A Regular Carpet
Cleaner!
7Presentation 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
81. 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
9Have 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
10Have 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
11Have You Seen A Poster Like This?
12Does 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
132. 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
14Germs 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
15Common Construction Contaminants
- Bacterial
- Legionella, Pontiac fever
- Fungal
- Aspergillus Aspergillosis
- Penicillium Penicilliosis
- Fusarium Fusariosis
- Mucor Mucomycosis
- Trichoderma Trichosporonosis
-
16Contractors Poor Work Kills People!
- 2001 Canadian Study
- 32 cases, 154 deaths
- Basis for many regulations and guidelines
- CSA
- APIC
- Joint Commission
17Was 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
1818 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 -
19Bad 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
20Is 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
21Lawyers 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
222009 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.
233. 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
24Multiple 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
25Choosing 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
26Patient 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
27Categorizing 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
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29Class I - Infection Control
- Minimize dust
- Replace ceiling tiles
- Clean work area
30Class 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
31Class 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
32Class 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)
334. Practical Tips
- Some important points for individuals and
organizations working in, or planning on
marketing to, healthcare facilities
34Your 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
35Educate Your Staff
Beth, I Need To Leave Early Today, Lets Clean
Just The White Squares!
2010 Business Mentors Summit Chicago, Illinois
3690 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
37Plus 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
38Begin 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
39Remember 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!
40Questions?
41THANK 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
42Shocking 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
43They 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)
44General 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
45Dont Get Caught With Your Pants Down
Now I Know Why They Call It ICU!
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