MOULDS

1
MOULDS MASKS MOISTURE MAYHEM

• Jim Gauthier, MLT, CIC
• Infection Control Practitioner
• February 2005

2
What are Fungi?

• A diverse Kingdom of organisms that includes
  yeasts, moulds and mushrooms.
• Found in soil, water, and air.
• Derive their nourishment by breaking down organic
  matter.
• Many species reproduce by means of spores.

3
What is Mould?

• Fuzzy coating of fungus that grows on food and
  other surfaces that contain sufficient moisture.
• Spores readily dispersed during excavation,
  demolition and construction.

4
Spores

• Need temperature, substrate, and moisture
• Wide range of temperatures gt 4o to 40o C
• Drywall, wood and wood products, ceiling tiles,
  wallpaper and carpets, dirt crawl spaces
• Masonry, fiberglass wont support if not soiled
  with other nutrients.
• High humidity, flood, leaks, HVAC
• Range in size from 1-50 µm

5
Spores

• Root like structure in hours
• Visible colonization and masses of spores within
  3-5 days.
• Black, green or grey spotty circular growth or as
  masses of fine, white, fluffy growth.

6
Mould Growth

• Musty, earthy odour, which is the release of
  metabolic by-products, often present as mould
  grows

7
So What?

• Mould spores can be put into the air when we
  remove ceiling tiles, renovate, or create dust
• Spores less than 10µm can enter alveoli
• Residents/patients can get sick
• Staff can get sick
• Now an issue in Health Care

8
False Ceiling Repair

• Done after a leak.
• Above IV supplies
• Contaminated adhesive tape and arm boards
• 6 infected, 2 died

9
Demolition

• Ducts, false ceiling, glass fibre insulation
• Work on roller-blind casings
• 22 cancer patients infected, 18 died.

10
Outside Construction

• Road construction
• Air conditioner heavily contaminated with
  Aspergillus spores
• 10 cancer patients infected, all 10 died

11
During Construction

• Wet fireproofing material installed.
• Spores dispersed when the dry fireproofing was
  disturbed during maintenance or renovation
• 8 cancer patients infected, 3 died

12
What Can They Do?

• Produce potent mycotoxins
• Metabolites that have been identified as toxic
  agents
• Aspergillus, Penicillium, Fusarium, Trichoderma,
  Memnoniella, and Stachybotrys

13
Stachybotrys chartarum

• Greenish-black mould
• Likes high cellulose and low nitrogen content
  (fibreboard, paper, dust, lint)
• Currently NO association between it and health
  symptoms (CDC 2004)

14
Stachybotrys chartarum

• Even when hundreds of conidia (asexual spores)
  seen on direct examination, only 2-3 will be
  viable
• Dead conidia apparently remain toxic for some
  time, as do conidial fragments

15
Canadian Construction Association (CCA) - 2004

• Legal Overview
• Compared to the Asbestos crises of several years
  ago
• Employers must take all reasonable measures to
  protect the health and safety of workers
• Includes a duty to protect against exposure to
  potentially harmful substances such as mould.
• These measures require the immediate and safe
  removal of any mould growth in buildings
• While protecting workers, occupants and
  surrounding environment.

16
Exposure to Indoor Fungi

• Symptoms are vague
• Runny nose, eye irritation, cough, congestion,
  aggravation of asthma, headache, flu-like
  symptoms, fatigue, skin rash.
• Symptoms may be caused by bacterial or viral
  pathogens or other allergies.
• People with suppressed immune systems may be
  susceptible to fungal infections as a result of
  exposure to indoor moulds.

17
Exposure to Indoor Fungi

• Current reviews in latest Health Canada document
  find some relationship between indoor mould and
  respiratory, allergic or irritation symptoms
• There is a published study that found an
  association between mould exposure at school and
  childhood asthma

18
Assessment for Mould Visual, Intrusive, Surface

• Visual inspection
• Great checklist in Appendix A
• Concentrate on areas of known water damage, or
  where odours are noted.
• Intrusive Inspection
• Peel back baseboards or wallpaper, remove
  sections of carpet or ceiling tiles, cut holes in
  walls

19
Assessment for Mould

• Intrusive Inspections (Continued)
• Remove occupants if possible (esp. infants,
  asthmatics, compromised immune systems, etc.)
• Will need to consider isolated conditions and
  perhaps negative air enclosures
• Investigator wear PPE

20
Assessment for Mould

• Surface Testing
• Where contamination is evident, it is seldom
  necessary to test mould-suspect materials (MSM)
• 3 types of testing
• Bulk or Substrate samples
• Tape-lift samples
• swabs

21
Assessment for Mould

• Bulk or Substrate
• Send a sample of MSM
• Use a sturdy zip-lock bag.
• Clean sampling tool between samples.
• Tape-Lift
• Clear adhesive tape pressed lightly against MSM
• Stick onto clear plastic (zip lock bag works)

22
Assessment for Mould

• Swab
• Use standard clinical swab
• Roll swab against the MSM surface.
• Best to check with Laboratory first
• Need to make sure they are certified, accredited,
  and can handle environmental samples.

23
Assessment for Mould

• Air Sampling
• Not typically required in investigations
• Sometimes performed after abatement procedures
• Need outside background, pre and post tests.

24
Canadian Standards Association

• Z317.13-03. Infection control during construction
  or renovation of health care facilities
• Section 7 Remedial Measures
• 7.2 Report water leaks and flooding immediately
  to the managers of the affected area. They shall
  be responsible for
• Protecting or removing patients
• Defining, locating and controlling leaks
• Recording the extent of damage to structures,
  materials and furniture
• Implement and monitor remedial measures.

25
Assessment for Mould

• Health Canadas Fungal contamination in public
  buildings Health effects and investigation
  methods
• Steps to follow that reiterate other documents
  commented upon.

26
Z317.13-03

• 7.3.1 Investigate by trained maintenance staff
  or accredited consultants.
• 7.3.2 Inspect all concealed spaces, use
  moisture meter
• 7.3.3 Determine if lt 48 hours or gt 48 hours.

27
Remediation Levels (7.3.4)

• Level 1 small area, less than 1 m2
• Level 2 medium, 1 to 3 m2
• Level 3 large area, gt3 m2 to 10 m2
• Level 4 extensive contamination gt10 m2
• Level 5 HVAC or domestic water systems
  contaminated in any affected area.

28
Remediation Levels

• CCA 82 3 Levels
• Level 1 - lt 1 m2
• Level 2 1-10 m2
• Level 3 - gt10 m2

29
Containment of Contaminants

• 7.4.1 Do not create dust or disperse spores
• 7.4.2 Mist surfaces
• 7.4.3 Seal duct work, diffusers and openings,
  maintain negative pressure
• 7.4.4 Close and seal doors, windows, and
  impermeable dust barrier required.
• 7.4.5 Personal Protective Equipment (PPE)
  required.

30
Abatement

• 7.6.2 Performed by a qualified abatement
  contractor or by maintenance staff trained in
  abatement protocols.
• 7.6.3 Remove contaminated materials in a manner
  to limit dust generation.
• 7.6.4 Wrap in 0.15 mm (6 mil) polyethylene, and
  seal with tape

31
Abatement

• 7.6.5 Non-removable materials need to be
  vacuumed with HEPA-filtered vacuum, then scrubbed
  with detergent solution.
• 7.6.6 All surfaces and materials adjacent to
  the affected area shall be vacuumed and wet wiped
  with a mild detergent.
• 7.6.7 If risk of contamination, air ductwork to
  and from the affected area shall also be vacuumed
  and wet wiped. All downline filters to be
  replaced.

32
Level 1 AbatementCCA

• Regular building staff
• Must be trained in use of PPE and proper clean-up
  methods
• Well informed about the hazards of mould
  abatement
• If history of significant allergic disease (hay
  fever, asthma, hives) consult with Occupational
  Physician

33
Level 1 Abatement

• Limit access of patients
• Especially patients recovering from surgery,
  infants, elderly, suppressed immune systems, etc.
• Use half face piece air purifying respirator
  fitted with N95 filters as a minimum OR filtering
  facepiece respiratory (N95 minimum) and suitable
  eye protection
• Fit tested prior to initial use and annually

34
Level 1 Abatement

• Disposable coveralls and dust impermeable gloves
  appropriate for initial work
• Water impermeable gloves when applying detergent
  or disinfectant.
• May wear disposable boot covers or clean boots
  off before leaving the area.
• Turn off HVAC and cover openings

35
Level 1 Abatement

• Moveable non-porous items within work area shall
  be cleaned with HEPA vacuum, then cleaning
  solution, then removed.
• Fixed non-porous items shall be HEPA vacuumed,
  wet wiped, then sealed under polyethylene
  sheeting, taped in place during remediation.

36
Level 1 Abatement

• Place drop sheet if possible.
• Dust suppression tape plastic or duct tape over
  mouldy material, or lightly mist the material
  with water. DO NOT dry sweep or dry whisk.
• Remove porous materials well beyond the areas of
  visible contamination minimum distance is 30 cm.

37
Level 1 Abatement

• After bulk removal, HEPA vacuum.
• If HEPA vacuum not available, wet wiping is
  adequate for Level 1 work (CCA 82, pg 24, 11)
• Seal waste into 6 mil disposable bags. Wet wipe
  or clean the bags with a HEPA vacuum and then
  double bag in a second clean 6 mil nominal bag or
  suitable sealed container.

38
Level 1 Abatement

• Clean equipment (HEPA vacuum and wet wipe).
• Waste is good for landfill, if not breaking
  applicable local or provincial laws (?)!
• Wash face and hands, clean half-face resp.
• Leave areas dry and free from contamination and
  debris
• Ensure adequately dry before installing new
  materials.

39
Level II Abatement

• Need a health and safety professional experienced
  in performing microbial investigations as
  consultant
• Competent supervisor must be present during all
  decontamination work.
• USE OUTSIDE AGENCY!!

40
Householders Guide

• Focuses on reducing moisture in residences
• Renters report all plumbing leaks and moisture
  problems immediately to your building owner,
  manager, or superintendent. In cases where
  persistent water problems are not addressed, you
  may want to contact local or provincial health or
  housing authorities.

41
Tenants

• HOWEVER I could not find language in the Tenant
  Protection Act on mould, mold, spores, fungus or
  water damage clean up.
• nor in AB, BC, MB, SK, NB, NF, NS, PEI, PQ
• very interesting!

42
Suggestions and Discussion

• This could very well be an expensive venture that
  we must undertake in public buildings
• Mould audit similar to the asbestos audits of a
  few years ago
• Mark vacant areas where mould is present, slate
  for remediation when necessary
• Mould in occupied areas needs to be addressed ASAP

43
Suggestions and Discussion

• In healthcare, train our maintenance and
  housekeeping staff to recognize mould, and how to
  remediate Level 1 volumes
• Establish when to culture, and where to send
  cultures for analysis
• Cost of remediation you want to make sure it is
  mould!
• Need to involve Infection Control and
  Occupational Health

44
Suggestions and Discussion

• Health Canada comments on a safe workplace as
  being mandated (Hazardous Products Act, the
  Canada Labour code, Transportation of Dangerous
  Goods Act), and that we need to look at our
  legislation, with the input of the designated
  Medical Officer of Health or Public Health
  Directors for the area concerned, as there is not
  good language for air contaminants.

45
Suggestions and Discussion

• Train someone regionally as an expert
• Center for Disaster Recovery in Barrie is
  certified training school
• Have very clear policy and procedure on water
  clean up, within 48 hours
• See Wheel of Fungus!

46
Questions?
47
Resources

• Health Canada. Construction-related Nosocomial
  Infections in Patients in Health Care Facilities
  can be found at
• http//www.phac-aspc.gc.ca/publicat/ccdr-rmtc/01vo
  l27/27s2/index.html
• Canadian Standards Association. Z317.13-03.
  Infection control during construction or
  renovation of health care facilities. 2003
• Canadian Construction Association. CCA 82-2004.
  Mould guidelines for the Canadian construction
  industry.2004
• http//www.cca-acc.com/documents/electronic/cca82/
  cca82.pdf
• www.cdc.gov/nceh/airpollution/mold/stachy.htm

48
Resources

• Center for Disaster Recovery, Barrie, ON
• www.centerfordisasterrecovery.com
• Fungal contamination in Public Buildings A guide
  to recognition and management 1995
• www.hc-sc.gc.ca/hecs-sesc/air_quality/pdf/fungal.p
  df
• Fungal contamination in Public Buildings Health
  effects and investigation methods 2004
• www.hc-sc.gc.ca/hecs-sesc/air_quality/pdf/fungal_c
  ontamination.pdf
• New York City Department of Health Guidelines on
  assessment and remediation of fungi in indoor
  environments
• http//www.nyc.gov/html/doh/html/epi/moldrpt1.html
  

49
Resources

• Canada Mortgage and Housing. Moisture and air,
  problems and remedies. Pamphlet 61033.
• EPA. A brief guide to mold, moisture and your
  home.
• http//www.epa.gov/iaq/molds/images/moldguide.pdf
• Tenant Protection Act 1997
• http//192.75.156.68/DBLaws/Statutes/English/97t24
  _e.htm