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New Opportunities for Cleaning






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New Opportunities for Cleaning New Opportunities for Cleaning Presentation Transcript

  • 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 2010 Business Mentors Summit – Chicago, Illinois
    • 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
  • The Most Important Fact About Your Speaker 2010 Business Mentors Summit – Chicago, Illinois
    • No financial tie to any of the companies/products mentioned in the program
      • Other than Wonder Makers
  • 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 hospital-acquired 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 25 th , 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
      • 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
  • 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
    • Office Areas
    Low Risk
    • 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
    • CCU
    • Emergency Room
    • Labor & Delivery
    • Laboratories (specimen)
    • Newborn Nursery
    • Outpatient Surgery
    • Pediatrics
    • Pharmacy
    • Post Anesthesia Care Unit
    • Surgical Units
    • Cardiology
    • Echocardiography
    • Endoscopy
    • Nuclear Medicine
    • Physical Therapy
    • Radiology/MRI
    • Respiratory Therapy
    Highest Risk High Risk Medium Risk
  • 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
  • Risk Group Construction Activity Type A Type B Type C Type D Group 1 I II II III / IV Group 2 I II III IV Group 3 I III III / IV IV Group 4 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
      • A s S afe A s R easonably A chievable
      • 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_address] 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!