New Opportunities for Cleaning & Restoration Professionals In Healthcare Facilities

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. 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 Your Speaker 2010 Business Mentors Summit –Chicago, Illinois

3. No financial tie to any of the companies/products mentioned in the program • Other than Wonder Makers The Most Important Fact About Your Speaker 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. 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 Presentation Outline 2010 Business Mentors Summit –Chicago, Illinois

8. 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 1. Healthcare Is A Different Type Of Client 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 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

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

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. 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. 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. “Beth, I Need To Leave Early Today, Let’s Clean Just The White Squares!” Educate Your Staff 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 ASARAattitude 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. 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@wondermakers.com THANK YOU! 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. Don’t Get Caught With Your Pants Down Now I Know Why They Call It ICU!