Fungi Mitigation During Construction

The Clean-up Process:

The most important components of fungi clean-up are physical removal of colonized materials; removal of settled dusts containing spores; prevention of spores and dusts generated during clean-up from entering clean areas and patient rooms; and the use of appropriate personal protective equipment (PPE) by knowledgeable clean-up personnel.

Healthcare facilities should have policies and procedures for fungi remediation and should include, at minimum, the following components:

• A description of the general mycological condition in the building
• General practices to be used for removing contaminated materials and control of construction or renovation dust
• Specific practices to be used in mold clean-up or during dust control
• Specific practices to be used for preventing cross contamination between contaminated or dusty areas, and clean areas and patient rooms • PPE and practices to be used by clean-up personnel
• Location of patient areas, notably those with patients who are most susceptible to infection
• Qualifications of clean-up personnel
• Guidelines to be followed by the occupational health professional who is monitoring clean-up activities

Specific actions to prevent cross contamination during construction or renovation activity include:

• Techniques required to prevent fugitive dust emissions from the activity area
• Monitoring procedures needed to verify that work areas are depressurized relative to areas immediately outside of containment
• Administrative controls designed to prevent tracking dust and other contaminants into patient areas Hansen says it is vital to keep construction personnel and healthcare workers from inadvertently tracking on the floor or dispersing through the air construction- or cleanup-related contaminants.

“Nurses are generally more aware of cross contamination than the doctors,” Hansen says. “When I talk to ICPs, of course, I am preaching to the choir. Nothing can be 100 percent foolproof. We’ve had some hospital administrators who have said, ‘I want my hospital to be totally contaminant free.’ Well, you can’t do that with construction. Given the best cooperation between the contractors and hospital personnel there’s always going to be breaches; sometimes they are caused by healthcare staff members.

They’ll say, ‘Oh, what’s going on in there, I’ll just move this yellow tape and walk in and see.’ I hate to throw stones, but the doctors are a bigger offender than nurses. You can tell a charge nurse, ‘Don’t go in here because it’s contaminated and it might put your patients at risk,’ and they’re not going to go in. But the doctor always wants to see what’s going on. You’re going to get someone who wants to take a shortcut and you’re going to have honest accidents. Those things do happen and there’s no way to make it 100 percent foolproof — but we can get close.”

Lack of Standards:

If it seems challenging to establish consensus among construction team stakeholders, consider that there is no consensus in the industry regarding indoor air quality (IAQ). The proposed IAQ rule from the Occupational Safety and Health Administration (OSHA), first introduced in 1994, is no closer to adoption almost a decade later.

“The IAQ was sandbagged by the tobacco industry and it didn’t finish its tour in the Clinton administration,” Hansen says. “And then the Bush administration just shut it down. The next thing that could happen is the introduction of an IAQ standard being worked on by the International Organization for Standardization for the last nine years. They are getting closer to releasing a document, but since the ISO is very slow and methodical, the standard won’t be bulletproof but awfully close. My guess is we might see a standard in late 2004 or 2005.”

The American Society of Heating, Refrigeration and Air Conditioning Engineers (ASHRAE) has its standards related to construction, renovation and infection control, as does the Centers for Disease Control and Prevention (CDC). The American Institute of Architects (AIA), whose Guidelines for Design and Construction of Hospitals and Healthcare Facilities, compiled with assistance from the Department of Health and Human Services, places new emphasis on designing out potential issues associated with above-ceiling contaminants and paying attention to ventilation rates in patient rooms. It’s an emphasis reflected in the Joint Commission on Accreditation of Healthcare Organizations (JCAHO)’s revised Environment of Care standard, but real-world pursuit of this standard is another thing altogether.