Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.

New Opportunities for Cleaning


Published on

  • Be the first to comment

  • Be the first to like this

New Opportunities for Cleaning

  1. 1. New Opportunities for Cleaning &New Opportunities for Cleaning & Restoration Professionals InRestoration Professionals In Healthcare FacilitiesHealthcare Facilities Presented By Wonder Makers EnvironmentalPresented By Wonder Makers Environmental Michael A. Pinto, CSP, CMPMichael A. Pinto, CSP, CMP CEOCEO 2010 Business Mentors Summit –2010 Business Mentors Summit – Chicago, IllinoisChicago, Illinois
  2. 2. Your SpeakerYour Speaker 2010 Business Mentors Summit –2010 Business Mentors Summit – Chicago, IllinoisChicago, Illinois 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, RIA Experience •29 years in safety, health, and29 years in safety, health, and
  3. 3. The Most Important Fact AboutThe Most Important Fact About Your SpeakerYour Speaker 2010 Business Mentors Summit –2010 Business Mentors Summit – Chicago, IllinoisChicago, Illinois •No financial tie to any of the companies/products mentioned in the program •Other than Wonder Makers
  4. 4. A Talk About Healthcare FacilitiesA Talk About Healthcare Facilities
  5. 5. Methodist Hospital In Chalmette,Methodist Hospital In Chalmette, LouisianaLouisiana
  6. 6. Do You Really Want HospitalDo You Really Want Hospital Staff Tackling This?Staff Tackling This? Nor Is It A Job For A Regular CarpetNor Is It A Job For A Regular Carpet Cleaner!Cleaner!
  7. 7. Presentation OutlinePresentation Outline • The unique nature of healthcareThe unique nature of healthcare environmentsenvironments • Healthcare acquired infectionsHealthcare acquired infections • Controlling hospital acquiredControlling hospital acquired infections during restoration orinfections during restoration or construction activitiesconstruction activities • Practical tips on how to prepare yourPractical tips on how to prepare your organization to offer services toorganization to offer services to healthcare facilitieshealthcare facilities 2010 Business Mentors Summit –2010 Business Mentors Summit – Chicago, IllinoisChicago, Illinois
  8. 8. 1. Healthcare Is A Different Type Of1. Healthcare Is A Different Type Of ClientClient •Consolidation of ill and injuredConsolidation 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 2010 Business Mentors Summit –2010 Business Mentors Summit – Chicago, IllinoisChicago, Illinois
  9. 9. Have You Ever Wondered From AHave You Ever Wondered From A Business Perspective?Business Perspective?  Do we have critical skills andDo 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
  10. 10. Have You Ever Done Work In AHave You Ever Done Work In A Healthcare Facility?Healthcare Facility?  Water restorationWater restoration  Pump out, dry down, replacement ofPump out, dry down, replacement of finish materialsfinish materials  Fire restorationFire restoration  Clean-up, deodorizing, blasting,Clean-up, deodorizing, blasting, replacementreplacement  Mold remediationMold remediation  Replace water stained ceiling tilesReplace water stained ceiling tiles  Duct cleaningDuct cleaning
  11. 11. Have YouHave You Seen ASeen A Poster LikePoster Like This?This?
  12. 12. 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 activitiesAbout the impact your activities may have on the building &may have on the building & occupantsoccupants  Activity increasing infection potential forActivity increasing infection potential for high risk groups such as sick, elderly,high risk groups such as sick, elderly, recovering surgery patients, etc.recovering surgery patients, etc.  Bacterial and fungal contaminantsBacterial and fungal contaminants
  13. 13. 2. Healthcare Acquired Infections2. Healthcare Acquired Infections  Are so common that they have theirAre so common that they have their own name –own name – nosocomial infectionsnosocomial infections  Estimated two million hospital-Estimated two million hospital- acquired infections per yearacquired infections per year  Estimated 100,000+ deaths everyEstimated 100,000+ deaths every yearyear  $5 billion spent on hospital-acquired$5 billion spent on hospital-acquired infections each yearinfections each year
  14. 14. Germs & Hygiene PracticesGerms & Hygiene Practices  Isn’t the problem “germs”Isn’t the problem “germs” and personnel hygieneand personnel hygiene practices?practices?  If 50% of the nosocomialIf 50% of the nosocomial infections are caused byinfections are caused by improperly washed hands orimproperly washed hands or other touchingother touching (staphylococcus), what is the(staphylococcus), what is the cause of the remaining 50%?cause of the remaining 50%?  Environmental crossEnvironmental cross contaminationcontamination
  15. 15. Common Construction ContaminantsCommon Construction Contaminants  BacterialBacterial  LegionellaLegionella, Pontiac fever, Pontiac fever  FungalFungal  Aspergillus:Aspergillus: AspergillosisAspergillosis  Penicillium:Penicillium: PenicilliosisPenicilliosis  Fusarium:Fusarium: FusariosisFusariosis  Mucor:Mucor: MucomycosisMucomycosis  Trichoderma:Trichoderma: TrichosporonosisTrichosporonosis
  16. 16. Contractors’ Poor Work Kills People!Contractors’ Poor Work Kills People!  2001 Canadian2001 Canadian StudyStudy  32 cases, 154 deaths32 cases, 154 deaths  Basis for manyBasis for many regulations andregulations and guidelinesguidelines  CSACSA  APICAPIC  Joint CommissionJoint Commission
  17. 17. Was It The Construction?Was It The Construction?  On January 25On January 25thth , 2005,, 2005, a 29-week-old babya 29-week-old baby "died of an infectious"died of an infectious disease''disease''  Montreal HospitalMontreal Hospital moved prematuremoved premature babies out of neonatalbabies out of neonatal wing as it scrambled towing as it scrambled to locate the source oflocate the source of infectioninfection  Fourth floor infantFourth floor infant intensive care unit areaintensive care unit area undergoingundergoing renovationsrenovations
  18. 18. 18 Avoidable Deaths18 Avoidable Deaths  Improper demolitionImproper demolition controlscontrols  Removing false ceilings,Removing false ceilings, HVAC ductwork, windowHVAC ductwork, window frames and wall insulationframes and wall insulation  Aspergillus fumigatusAspergillus fumigatus exposure led toexposure led to aspergillosisaspergillosis  22 critical care patients22 critical care patients sickenedsickened  Poor isolation of the workPoor isolation of the work area identified as causingarea identified as causing the spread of sporesthe spread of spores
  19. 19. Bad Work in Hospitals Still HappensBad Work in Hospitals Still Happens  2/4/09 AP Story2/4/09 AP Story  Florida lawsuit claims 3Florida lawsuit claims 3 kids died from hospitalkids died from hospital moldmold  St. Joseph's Hospital inSt. Joseph's Hospital in TampaTampa  Pediatric cancer patientsPediatric cancer patients  Fungal infections at theFungal infections at the facilityfacility  Hospital failed to properlyHospital failed to properly seal off an area underseal off an area under renovationrenovation Matthew J. Gliddon
  20. 20. Is There A Pattern?Is There A Pattern?  Transplant HMO mortality rate inTransplant HMO mortality rate in liver patientsliver patients 13% in health care facility undergoing13% in health care facility undergoing renovationrenovation no documented cases where no renovationno documented cases where no renovation was taking placewas taking place  A tertiary care centerA tertiary care center Average 9% rate in aspergillosisAverage 9% rate in aspergillosis No documented cases after developmentNo documented cases after development and enforcement of an extensive dustand enforcement of an extensive dust containment policycontainment policy
  21. 21. Lawyers Understand the ConnectionLawyers Understand the Connection  Spike in infection rates inSpike in infection rates in patient care areas adjacentpatient care areas adjacent to a construction siteto a construction site  A containment or anA containment or an impermeable barrier hadimpermeable barrier had not been erected; windowsnot been erected; windows had not been properlyhad not been properly sealedsealed  Construction company wasConstruction company was held partially liableheld partially liable
  22. 22. 2009 University Of South Florida Study2009 University Of South Florida Study  Aspergillus infection deathsAspergillus infection deaths associated with environmental:associated with environmental: hospital construction,hospital construction, maintenance,maintenance, demolition and renovation;demolition and renovation;  contaminated fireproofing;contaminated fireproofing; air filters in hospital ventilationair filters in hospital ventilation systems, andsystems, and via contaminated carpeting.via contaminated carpeting.
  23. 23. 3. Proactive Prevention of Infections3. Proactive Prevention of Infections During ConstructionDuring Construction  The American Institute ofThe American Institute of Architects advocates the use of:Architects advocates the use of:  Infection Control Risk AssessmentsInfection Control Risk Assessments (ICRA)(ICRA)  Infection Control Risk MitigationInfection Control Risk Mitigation Recommendations (ICRMR)Recommendations (ICRMR)  Plan your work, work your planPlan your work, work your plan
  24. 24. 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 AdvisoryHealthcare Infection Control Practices Advisory Commission (HICPAC)Commission (HICPAC)  Joint Commission on Accreditation of HealthcareJoint 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
  25. 25. Choosing Appropriate Safety StepsChoosing Appropriate Safety Steps  Association of Professionals forAssociation of Professionals for Infection Control (APIC) GuidelinesInfection Control (APIC) Guidelines  Consider risk groups impacted byConsider 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
  26. 26. Patient Risk GroupsPatient Risk Groups Low RiskLow Risk Medium RiskMedium Risk High RiskHigh Risk Highest RiskHighest Risk  Office AreasOffice Areas  CardiologyCardiology  EchocardiographyEchocardiography  EndoscopyEndoscopy  Nuclear MedicineNuclear Medicine  Physical TherapyPhysical Therapy  Radiology/MRIRadiology/MRI  RespiratoryRespiratory TherapyTherapy  CCUCCU  EmergencyEmergency RoomRoom  Labor & DeliveryLabor & Delivery  LaboratoriesLaboratories (specimen)(specimen)  NewbornNewborn NurseryNursery  OutpatientOutpatient SurgerySurgery  PediatricsPediatrics  PharmacyPharmacy  Post AnesthesiaPost Anesthesia Care UnitCare Unit  Surgical UnitsSurgical Units  Any area caringAny area caring for immuno-for immuno- compromisedcompromised patientspatients  Burn UnitBurn Unit  Cardiac Cath LabCardiac Cath Lab  Central SterileCentral Sterile SupplySupply  Intensive CareIntensive Care UnitsUnits  NegativeNegative pressurepressure isolation roomsisolation rooms  OncologyOncology  Operating roomsOperating rooms including C-including C- section roomssection rooms
  27. 27. Categorizing Construction ActivityCategorizing Construction Activity  Type A:Type A: Inspection, non-invasive activitiesInspection, non-invasive activities  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 moderateActivities that generate moderate to high levels of dust, require greater thanto high levels of dust, require greater than one work shift to completeone work shift to complete  Type D:Type D: Activities that generate high levelsActivities that generate high levels of dust, major demolition and constructionof dust, major demolition and construction activities requiring consecutive work shiftsactivities requiring consecutive work shifts to completeto complete – APIC definitions
  28. 28. 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
  29. 29. Class I - Infection ControlClass I - Infection Control  Minimize dustMinimize dust  Replace ceiling tilesReplace ceiling tiles  Clean work areaClean work area
  30. 30. 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 throughCovered waste during transport through buildingbuilding  Wet wipe with chemicalWet wipe with chemical  Wet mop and/or HEPA vacuum floorsWet mop and/or HEPA vacuum floors
  31. 31. Class III - Infection ControlClass III - Infection Control  Complete isolation of work areaComplete isolation of work area (room enclosure or control cube)(room enclosure or control cube)  Negative pressure work via HEPANegative pressure work via HEPA equipmentequipment  Waste in containers, then in coveredWaste in containers, then in covered cartscarts  HEPA vacuum and wet wipe (HEPAHEPA vacuum and wet wipe (HEPA sandwich)sandwich)  Visual inspection by owner or thirdVisual inspection by owner or third partyparty  Controlled tear downControlled tear down
  32. 32. Class IV - Infection ControlClass IV - Infection Control  Extra effort to seal allExtra effort to seal all penetrations (do not rely onpenetrations (do not rely on negative pressure to preventnegative pressure to prevent dispersal of contaminants)dispersal of contaminants)  Minimum 1 stageMinimum 1 stage decontamination chamberdecontamination chamber  Use of shoe covers orUse of shoe covers or disposable suits (newdisposable suits (new shoe/body covering everyshoe/body covering every time in/out)time in/out)
  33. 33. 4. Practical Tips4. Practical Tips  Some importantSome important points forpoints for individuals andindividuals and organizationsorganizations working in, orworking in, or planning onplanning on marketing to,marketing to, healthcare facilitieshealthcare facilities
  34. 34. Your Experience Is ValuableYour Experience Is Valuable  There are many concepts,There are many concepts, procedures, and pieces of equipmentprocedures, and pieces of equipment that restoration/remediationthat restoration/remediation contractors use daily that are criticalcontractors use daily that are critical for infection controlfor infection control  Many general contractors are years behind theMany general contractors are years behind the “dust control” curve“dust control” curve  General contractors are often reluctant to useGeneral contractors are often reluctant to use appropriate personal protective equipmentappropriate personal protective equipment  Verification of project cleanliness is not typical forVerification of project cleanliness is not typical for construction but accepted for remediation andconstruction but accepted for remediation and necessary for infection controlnecessary for infection control
  35. 35. Educate Your StaffEducate Your Staff ““Beth, IBeth, I Need ToNeed To Leave EarlyLeave Early Today, Let’sToday, Let’s Clean JustClean Just The WhiteThe White Squares!”Squares!” 2010 Business Mentors Summit –2010 Business Mentors Summit – Chicago, IllinoisChicago, Illinois
  36. 36. 90% Right Is Still 100% Wrong90% Right Is Still 100% Wrong  Understand and appreciate theUnderstand and appreciate the differences between restoration, molddifferences between restoration, mold remediation, and infection controlremediation, and infection control  Similar approach and equipmentSimilar approach and equipment  More significant consequences for poorMore significant consequences for poor performance – literally life and deathperformance – literally life and death  Do your homeworkDo your homework  One 60 minute presentation does notOne 60 minute presentation does not make you an expertmake you an expert  Collect and read relevant resourcesCollect and read relevant resources
  37. 37. ““Plus Up”Plus Up”  Adapt anAdapt an ASARAASARA attitudeattitude  AAss SSafeafe AAss RReasonablyeasonably AAchievablechievable  Go beyond the minimumsGo beyond the minimums  Substitute efficiency for higherSubstitute efficiency for higher costs to bring better value to thecosts to bring better value to the projectproject  Clear and detailed company policies forClear and detailed company policies for work in healthcare facilities allowswork in healthcare facilities allows standardization that creates efficiencystandardization that creates efficiency
  38. 38. Begin Your Marketing NowBegin Your Marketing Now  Approach both contractors andApproach both contractors and healthcare operatorshealthcare operators  Explain that you understand the uniqueExplain that you understand the unique aspects of infection controlaspects of infection control  Become a pre-selected vendor for emergencyBecome a pre-selected vendor for emergency responseresponse  Sell your expertiseSell your expertise  Set up and clean up while the contractor handlesSet up and clean up while the contractor handles demolitiondemolition  Post-construction cleaning for the facility ifPost-construction cleaning for the facility if their staff is stretchedtheir staff is stretched  Specialized services such as duct cleaningSpecialized services such as duct cleaning
  39. 39. Remember: Keep Your PrioritiesRemember: Keep Your Priorities StraightStraight  Protect yourself and your crewProtect yourself and your crew  Blood borne pathogen training andBlood borne pathogen training and medical protectionmedical protection  Appropriate PPE every timeAppropriate PPE every time  Hand sanitizing emphasisHand sanitizing emphasis  Protect the occupants and patientsProtect the occupants and patients  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!
  40. 40. Questions?Questions?
  41. 41. THANK YOU!THANK YOU! If you would like more information,If you would like more information, please contact:please contact: Wonder Makers EnvironmentalWonder Makers Environmental P.O. Box 50209P.O. Box 50209 Kalamazoo, Michigan 49005-0209Kalamazoo, Michigan 49005-0209 (888) 382-4154(888) 382-4154 fax (269) 382-4161fax (269) 382-4161 2010 Business Mentors Summit –2010 Business Mentors Summit – Chicago, IllinoisChicago, Illinois
  42. 42. Shocking StatisticsShocking Statistics  Aspergillosis mortality rates haveAspergillosis 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 patientsthe outcome of transplant patients with aspergillosis continues to bewith aspergillosis continues to be grimgrim
  43. 43. They Deserve the BestThey Deserve the Best  Most susceptible people are thoseMost susceptible people are those with:with:  Immunosuppressive conditions (Immunosuppressive conditions (e.g.,e.g., bone marrow or solid organ transplants)bone marrow or solid organ 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)
  44. 44. General Guidelines & ResourcesGeneral Guidelines & Resources  APIC and Health Canada use aAPIC and Health Canada use a similar process to define minimumsimilar process to define minimum infection control practices forinfection control practices for various types ofvarious types of restoration/construction projectsrestoration/construction projects in healthcare facilities:in healthcare facilities:  Categorize each construction activity (ACategorize each construction activity (A through D)through D)  Identify affected patient risk group forIdentify affected patient risk group for each activityeach activity  Follow minimum protocolsFollow minimum protocols
  45. 45. Don’t Get Caught With YourDon’t Get Caught With Your Pants DownPants Down Now I KnowNow I Know Why TheyWhy They Call ItCall It ICU!ICU!