Challenges

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Challenges Strategies During Healthcare
Construction -Environmental Risk Assessments
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Hillmann Consulting

• Full service Environmental Health Safety and
  Construction Engineering firm
• Nearly 30 years of experience working in
  healthcare facilities
• Headquartered in Union, NJ
• Over 60 Professionals Based in New Jersey
• 109 Professionals Nationwide

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The Hillmann Team

• Our expert staff is trained, certified and
  degreed in their respective fields
• Certified Industrial Hygienists
• Certified Safety Professionals
• Certified Hazardous Materials Managers
• Licensed Site Remediation Professionals
• Professional Engineers
• Registered Environmental Property Assessors
• LEED Accredited Professionals
• Experts in Asbestos, Lead, and Underground
  Storage Tank Management

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Presentation Overview

• Unique Challenges of the Healthcare Environment
• Construction Project Strategy
• Environmental Risk Assessment
• Hazardous Materials Assessments
• Abatement Management
• Chemical Environmental Compliance Management
• Indoor Air Water Quality Evaluation
  Monitoring
• Mold Awareness
• Asbestos Awareness
• Lead Awareness

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• UNIQUE CHALLENGES
• OF THE
• HEALTHCARE ENVIRONMENT

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Challenges of the Healthcare Environment

• Preserving a Contained Environment During
  Construction
• Maintain a Hard Barrier HVAC Balancing
• Track Pads
• Isolate Paths of Entry and Egress
• Protecting the Health of Susceptible Patient
  Populations from Dust and Fugitive Emissions
• Immune suppressed individuals
• Individuals with respiratory diseases
• Asthmatic or allergic individuals

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Challenges of the Healthcare Environment

• Maintain Operations and Occupancy
• Lead-Lined Walls in Radiation Areas
• Additional Contaminants to Control
• Bacteria
• Radiation
• ISO 14644 Standard Cleanrooms and Associated
  Controlled Environments
• Provides stringent classification levels and
  specifications of air cleanliness specific to
  cleanroom environments

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• CONSTRUCTION PROJECT STRATEGY

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Construction Project Strategy

• Complete Environmental Risk Assessment
• Identify Materials and Potential Contaminants
• Develop Mitigation Plan
• Reduce Risk and Liability
• Project Planning
• Ensure resulting environmental assessment issues
  are included in the work breakdown structure
• Allow adequate time in the project schedule to
  properly plan for environmental issues

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Construction Project Strategy

• Management of Project Work in Phases
• Maintain Facility Operation and Occupancy
• HVAC and Ventilation System Management
• Control of Critical Pathways
• Facilitate Patient Relocation
• Monitoring

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• ENVIRONMENTAL RISK ASSESSMENTS

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Hazardous Materials Assessments

• Identify and inventory hazardous materials to
  mitigate risk and liability for renovation
  related conditions
• Asbestos
• Mold
• Lead
• PCBs
• Mercury
• Fuel

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Abatement Management

• Confirm work is performed to applicable
  regulations and guidelines
• Verify appropriately trained and licensed
  personnel are providing clean-up and remediation
• Record-Keeping, Record-Keeping, Record-Keeping
• Maintain a safe environment for personnel and
  workers
• Ensure occupant/patient health and safety

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Chemical Environmental Compliance Management

• Hazard Communication
• Written Program
• Material Safety Data Sheets
• Training staff Initial, As hazards change
• Contractors
• Site Investigation
• Chemical Management
• Product Stewardship
• Regulatory Agency Liaison
• Regulatory Compliance
• RCRA, CERCLA, SARA, TCPA, CWA, NPDES

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Chemical Environmental Compliance Management

• Right-to-Know Programs
• Spill Prevention Clean-Up Countermeasures
• Required by EPA if facility can
• reasonably be expected to discharge harmful
  amounts of oil into navigable waters of the
  United States or adjoining shorelines
• Spills over 25 Gallons must be reported to the
  EPA

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Indoor Air Quality Evaluation Monitoring

• Proactive Evaluation
• Document Air Quality
• Maintain Healthy Indoor Environments
• Reduce Liability
• Optimize Building Operations
• HVAC System Inspection
• Air Sampling

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Indoor Air Quality Evaluation Monitoring

• Reactive Investigation
• Fire
• Major Leak or Spill
• Construction
• Renovation
• Occupant Complaints
• Occupant Complaint Survey
• Personal Interviews
• Building History
• Site Visit
• Environmental Monitoring

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Water Quality Testing

• EPA Primary and Secondary Contaminants
• Scheduled Facility Survey
• Legionella from Potable Water and Cooling Towers
• ASHRAE 188P Third Public Review (Jan 2013)
• Coliforms
• Priority Pollutant Metals
• Complaint Response

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• MOLD AWARENESS

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When to Initiate an Investigation

• Characteristic mold (musty) odor observed
• Water intrusion issue observed
• Occupants reporting health effects
• Allergy type symptoms i.e. itchy eyes, sneezing,
  etc
• Visible mold growth observed on exposed or hidden
  surfaces
• Elevated moisture content of delivered building
  materials

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Assessing the Situation

• Visual inspection is the primary investigation
  method to identify areas that require
  remediation.
• Be sure all contaminated areas are identified
• In wallboard material mold growth may extend up
  to 1 meter beyond what is visible
• Inaccessible areas may be your largest concern
  Behind wallboard, under wallpaper, below rugs,
  etc.
• A moisture meter can be useful in assessing
  porous materials that may be contaminated and
  should be disposed

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Assessing the Situation

• In a Healthcare facility, air sampling is highly
  recommended to identify the presence of mold
  spores
• Non-Viable air samples are run for 10 minutes
• Samples are analyzed for the presence of the
  Penicillium/Aspergillus, among others
• If the Penicillium/Aspergillus group of mold is
  identified in the samples, it is necessary to
  sample via viable (culturable) methods to
  determine the species present (Aspergillus
  species known to cause lung infection known as
  Aspergillosis)

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Nature of Mold Problems

• How extensive where
• Drywall cavity
• Carpet
• HVAC insulation near cooling coils
• Vinyl wall covering
• Crawl space
• Flood DRY OUT THE SPACE!!
• Cat I, II, III Water type will govern scope

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Water Loss Mitigation

• Loss Occurs
• Property Management may Initiate Insurance Claim
• Call your consultant and loss manager
• Source of water intrusion fixed (unless something
  major)
• Property Management contact hires Environmental
  Consultant and Remediation Contractor
• The consultant and contractor act as a third
  party and should not be hired by one another
• The consultant and contractor should be two
  separate entities.

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Water Loss Mitigation

• Environmental Consultant performs an initial
  assessment and reviews environmental conditions
• Remediation Contractor begins emergency response
  work to contain loss

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Water Loss Mitigation

• Complete Environmental Remediation Scope of Work
  Issued
• The Remediation Scope of Work includes
• Site observations
• Laboratory results
• Site diagram
• Recommendations
• Remediation guidelines for contractor to follow
• Insurance Criteria
• Sample Contract Form
• Clearance Criteria

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Loss Control Stage

• Remediation scope of work may be bid out
• Environmental Testing, Project Management and
  Cost analysis
• Cost Analysis can be conducted
• Environmental Consultant Performs Inspections and
  Clearance Testing
• Visual inspection
• Moisture Assessment
• Air sampling (if visual inspection and moisture
  assessment pass)

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Role of the Environmental Consultant

• Provide health and liability protection
• Furnish technical support and environmental
  expertise to limit the impact on-site and in the
  surrounding community
• Ensure the efficacy of environmental issues
  attributed to each specific loss
• Liaison with emergency management teams,
  adjusters, remediators, contractors, officials,
  and the insured (if related to an insurance claim)

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Role of the Environmental Consultant

• Verify contractors health safety program meets
  regulatory standards and applicable work
  practices
• Maintain efficient restoration schedule to
  pre-loss conditions
• Verify clean-up of effected areas is complete
• Provide record keeping functions in support of an
  insurance claim

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• ASBESTOS AWARENESS

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Pre-Abatement Plan

• Sequence and Schedule
• Prepare and issue abatement specifications and
  sketches
• Select qualified abatement contractor
• File with all applicable regulatory agencies
• Pre-Abatement preparation

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Abatement Filings

• The Filing Process takes approximately 2-3 weeks
• Environmental Protection Agency (EPA)
• State Department of Health and Department of
  Labor (DOH DOL)
• State Environmental Protection Agency
• State Department of Community Affairs (DCA)
• Local Municipalities

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Notifications

1. Signs
2. Demarcation of work areas

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Air Monitoring

• Area Sampling
• High Volume Pumps

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Protection From Exposure-PPE

• Disposable Suits
• Disposable Footwear
• Disposable Gloves

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The Abatement Process

• Pre-Commencement Inspection
• Start of abatement
• Tracking of waste
• 1st, 2nd 3rd Cleaning Inspections
• Final Aggressive Air Clearance Sampling
• Break-down of containment

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• LEAD AWARENESS

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Lead Paint Hazards

• Peeling or Chipping Paint
• Alligatoring
• Chalking
• Paint on a Deteriorating Subsurface
• Impact or Friction Surfaces
• Blistering Paint
• Water Damaged Surfaces

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Identifying LBP Hazards

• Lead-Lined Walls in Radiation Areas
• Friction Points
• Windows, Door Header, Jambs and Thresholds
• Stair Treads
• Impact Surfaces
• Doors, Stair Risers, Walls behind Door Knobs

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Visual Inspections

• All Potential Lead Hazards Must Be Identified
• Findings Are Recorded on a Prepared Checklist
• Room by Room Inspection
• Inspection of All Painted Surfaces and Components

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Exposure Monitoring

• Wipe Samples
• Assessment
• Clearance
• Air Samples
• Area Samples
• Personal Samples

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Correcting LBP Hazards

• Wet Scraping
• Wet Sanding
• No Mechanical Equipment
• Chemical Stripping
• No Methylene Chloride Permitted
• Additional PPE Required
• Additional Disposal Fees
• Odor Complaints

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Correcting LBP Hazards

• Component Replacement
• Component Adjustment
• Doors, Including Cabinet Doors
• Windows Must Be Adjusted and Squared
• Daily Cleanup
• Work Area Must Be HEPA Vac. Washed
• Daily Visual Examination
• Final Cleanup

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Determining Effectiveness

• Collect Clearance Wipe Samples
• Continued Quality Maintenance
• Maintenance of Documentation

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Question Answer