Fighting Fungi

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Fighting Fungi

• Environmental Contaminants in Healthcare
• Kirsten M. Buck
• Ecolab, Inc.
• ? 2002 Ecolab, Inc.

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Fungus Terminology

• Fungus
• Mold
• Mildew
• Fungicide
• Fungistat

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Know Your Enemy

• Fungi Friends
• antibiotics
• enzymes
• pest control
• oil spill clean-up

• Fungi Foes
• building material destruction
• unsightly stains
• allergies
• skin infections
• lung infections

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Fungi Drawing Attention

• Aspergillus
• Trichophyton
• Stachybotrys
• Histoplasma

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Fungal Disease Vectors
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Conditions for Mildew
Moisture
Food
MILDEW!
Spores
Temperature
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Fungi Control

• Get rid of the water!
• Get rid of the food!
• Dont forget the air!
• Kill, then control!

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Excess Moisture

• Construction Site Moisture Absorption
• Concrete block, slabs
• Wall boards
• Ceiling tile
• Induced Humid Air Infiltration
• air conditioning vs. de-humidifying
• Leaky Building Envelopes
• joints
• concrete seal

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Water in Buildings
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Eliminating Water

• Identify infiltration points
• Fix air and water leaks
• Dry or replace moist material

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Fungus Food

• Anything organic (contains the element carbon)
• Cardboard
• Wallpaper glue
• Soap and body oil
• Carpet fibers

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Fungi Control

• You can clean without disinfecting
• You can NOT disinfect without cleaning

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Fungicides/Fungistats

• Sodium Hypochlorite (Bleach)
• Phenols
• Quaternary Ammonium Compounds
• Acids
• Copper-8-Quinolinate

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Sodium Hypochorite(Bleach)

• Advantages
• Cheap
• Effective
• Removes discoloration from white surfaces

• Disadvantages
• Not compatible with all surfaces
• Safety issues
• Not a cleaner
• Inactivated by heavy organic soil
• Unstable

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Phenol

• Advantages
• Very Effective
• Good Cleaner
• Not affected by organic soil

• Disadvantages
• Expensive
• Safety/Toxicity
• Surface Compatibility

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Quaternary Ammonium Compounds

• Advantages
• Excellent Cleaner
• Effective in organic soil
• Mildewstatic properties
• Safe

• Disadvantages
• Need to keep using until the molds food source
  or water is eliminated

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Acids

• Advantages
• Excellent cleaner
• Effective mildewcide

• Disadvantages
• Surface compatibility
• Safety
• High concentrations needed

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Copper-8-Quinolinolate

• Advantages
• Effective mildewstat
• Low toxicity

• Disadvantages
• More studies needed on efficacy
• Need to keep using until the molds food source
  or water is eliminated
• Not soluble in water
• Not a cleaner (not compatible with surfactants)

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Follow Manufacturers Directions

• Use the right dilution
• Use the right application
• Change solution when recommended
• Avoid cross-contamination

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Pre-Design and Programming Phase

• Establish an IC committee
• Identify high risk patients
• Review existing ventilation, distances
• Take air quality baseline samples
• Determine methods to monitor air quality
• Identify potential contaminants

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Design Phase - General

• Determine location of partitions
• Select access route for delivery
• Select area for mechanical/electrical work
• Determine areas for special protection
• Specify after hours construction activities

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Design Phase - Mechanical/Electrical Concerns

• Verify capacity
• Provide exhaust systems, alarms
• Check integrity of air filters
• Determine shut-down times
• Decide need for duct cleaning/treatment
• Define post-construction clean-up

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Design Phase - Hospital Responsibilities

• Develop plans to relocate high-risk patients
• Make a specification section to address infection
  control requirements for contractor

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Construction Phase

• Pre-construction meeting
• Worker infection control education
• Weekly project team meetings
• Monitor infection control compliance

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Infection Control IssuesDuring Construction

• Relocate high-risk patients, issue
  high-efficiency masks
• Decrease high-risk admissions
• Close patient room and unit doors
• Damp-mop or HEPA-vacuum vicinity
• Check air filters regularly
• Monitor air quality

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Fungal Abatement Procedures

• Communication
• define areas of removal
• determine timeline
• Training
• Haz-mat
• Right-to-know

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Fungal Abatement Procedures

• Proper PPE
• negative pressure respirators
• coveralls
• gloves
• Hygiene
• hand hygiene
• decontamination
• respirator disinfection

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Fungal Abatement Procedures

• Containment
• plastic sheeting, duct tape
• exhaust fan with HEPA filter
• allow for decontamination, staging areas
• Control of Exposure
• vacate adjacent areas as appropriate
• Treatment
• mildewcide/stat
• antimicrobial paint

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Fungal Abatement Procedures

• Removal of Containment Materials
• bags, drums
• disposal requirements
• Cleaning Contaminated Area
• Final Inspection

Moldy Stuff
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Post-Construction Phase

• Thoroughly clean renovated patient areas
• Pay special attention to air ducts
• Obtain cultures, particle counts
• Verify integrity of ventilation system

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Final Points to Remember

• Eliminating water is the best way to eliminate
  fungi
• You cannot disinfect and kill fungi without
  cleaning first
• Choose the right chemicals for the job and follow
  manufacturers directions

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Final Points to Remember

• Understand risks for construction projects
• Educate contractor, workers in infection control
• Monitor compliance to IC procedures

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QUESTIONS?
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• www.aia.org/publications/guidelines.asp
• www.apic.org/pdf/srconst.pdf
• www.dehs.umn.edu/iaq
• www.doctorfungus.org
• www.aspergillus.man.ac.uk/patients

Resources For More Information