Water Damage Remediation Part I. Introduction

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1 Water Damage Remediation Part I Montana Hospital Association September 25, 2014 Larry Lee, CIH Pacific Industrial Hygiene LLC Copyright Larry Lee 2014 Larry Lee, CIH Certified Industrial Hygienist Indoor air quality Group Health Flood 96 Specialize in healthcare construction & infection control Introduction 1

2 Sewage changed my life My introduction to healthcare 48 sewage main backs up Floods ground level Nuclear medicine, Radiology & Records Rains down on Central Sterilization & Supply Pools and flows down ½ level into HVAC unit Sewage clean up is straightforward but slow Fuzz appears in some areas Is this a problem? 2

3 My introduction to healthcare I dunno I ll check it out Water Building materials + Time Mold growth Fundamental equation 3

4 Irritation Allergic type Potential health effects Sneezing Skin rashes Exacerbation of asthma Infection Opportunistic fungal infections Aspergillus species Fusarium species Scedosporium species Rhizopus species Zygomycetes Others 4

5 Epidemiology Aspergillus species & aspergillosis Aspergillus fumigatus (~90% invasive illness worldwide) A. flavus A. niger A. terreus A. ustus A. nidulans A. lentulus (drug resistant) Aspergillus species Epidemiology Ubiquitous Can grow at 35 to 37⁰C Small spores (2 3 microns) readily inhaled Prolific & spores dispersed in air Grows on wet building materials Spores in settled dust Photo courtesy of Aspergillus website 5

6 Who s at risk from infection? Patients with Barrier defects Skin & mucosa Immune defects Cellular Neutrophils & macrophages Acquired Allergies & asthma Who s at risk from infection? Transplantation Hematopoietic stem cells Allogeneic Autologous Solid organ Burns Cystic fibrosis COPD Neonates Chronic granulomatous disease Oncology Leukemia Chemotherapy & radiation High dose corticosteriods TB Diabetes mellitus (dialysis) Late stage AIDS/HIV Surgical 6

7 Water Water is the precipitating event Excess moisture + time + food (carbon) = growth Time is typically 5 to 15+ days Less than 5 is unusual An ounce of prevention is worth gallons and gallons of cure Construction & water Construction water sources Large scale construction projects average 3 water events Weather rain & flooding Pipe & hose leaks/breaks Mechanical failures (e.g. sump pump) Draining/charging sprinklers & hydronic systems Building envelope & roof failure Discovery of pre existing condition Cove base failure (e.g. OR floor) Floor or wall panel failure (e.g. scullery) 7

8 Construction & water prevention Prevention Ounce of prevention gallons of cure Protect the structure Weather barriers Seal penetrations Cover the roof Raise supplies off of the floor (e.g. sheet rock) Mold resistant sheet rock Required throughout before shell is completed Monitor work Shut off procedure checklist All water system work Water control cart Just plain silly 8

9 Construction & water response planning Construction water response plan Recommended for the general contractor Daily & weekend monitoring Owner notification immediate/2 hours Pre qualified drying contractor Immediate response Equipment and manpower needs assessment Insurance Approved/set up in accounting system Action plan for small, medium, large responses Spills, floods, catastrophic events Institutional water response plan Hospital response plan Notify Infection Prevention immediately/2 hours Action plan for small, medium, large responses Spills, floods, catastrophic events In house, local drying contractor, national drying contractor Pre qualified drying contractor Immediate response Equipment and manpower needs assessment Insurance Approved/set up in accounting system Action plan for small, medium, large responses 9

10 Water response plan The Art & Science of Drying Drying, how hard can it be? Basics Remove bulk water Determine the water footprint Use the air to dry Turn water to vapor Remove vapor from air Air circulation Water response All hospitals leak They have leaked, are leaking, & will leak Water + time + food = mold growth Gypsum wallboard, ceiling tile, etc. Dust and dust accumulations Prevention is best Anticipate & plan for the worst 10

11 d Step 1. Remove the bulk water Step 2. Temp the structure 11

12 Step 2. Determine the water footprint Pin type moisture meters Insert pins/probe See s the material only Pad type moisture meters Place on surface See s through and behind the material Use both in tandem Step 3. Determine the water footprint Infrared cameras 12

13 Step 3. Determine the water footprint Water hides Step 3. Determine the water footprint Water hides 13

14 Step 3. Determine the water footprint Water hides Drying simplified 1. Drying the air Refrigerant dehumidifiers 2. Providing dry air High temperature, low % r.h. air Dessicant dryers Supplemental air circulation Increases contact of dry air with wet surfaces Step 4. Drying 14

15 Step 4. Drying Using the air to dry Heat breaks H2O bonds Drying the air Lowering % relative humidity draws water to the air Refrigerant dehumidifiers Providing dry air High temperature, low % r.h. air Dessicant dryers Air circulation Increases contact of dry air with wet surfaces Step 4. Drying Refrigerant dehumidification Portable Air passes by cooling coils Water vapor condenses on coils Water pumped to drain Air often HEPA filtered 15

16 Step 4. Drying Large scale dessicant drying Closed loop 90 to 95 F air at 10 to 20% r.h. Remove water & return Step 4. Drying In line dessicant with HVAC system 16

17 Step 4. Drying Impediments to drying Vinyl wall covering Vinyl flooring Step 4. Drying Case work is an impediment to drying 17

18 Impediments Cove base Insulation Step 4. Drying Step 4. Drying Drying impediments Wall coverings Vinyl, wood or melamine panels, 2X sheetrock Insulation Casework Integral cove base Raised flooring Materials Sheer walls (metal & wood) Remove impediments or go around in order to dry 18

19 Step 4. Drying Infection prevention concerns Isolate footprint Barriers & negative pressure Air circulation 1,000 cfm fans aerosolize dust No Air scrubbers HEPA filtered, 2,000 cfm fans Suspend more dust than they capture Drying contractors do not understand hospitals They need coaching and watching Step 5. Not dry in time Not identified in the water footprint 19

20 Step 5. Not dry in time What is your policy? Most have adopted EPA Guidelines > 48 hours wet remove and replace Overly cautious Based on growth in pure culture media But is it your policy? Step 6. Mold growth present Visible mold growth appears 5 to 15 days later Odors can occur in the same time frame Mold cleaning & removal is a standard construction activity Conduct PCRA/ICRA Barriers, depressurization & standard controls Emphasis on worker hygiene & clothing Control spread of dust Household bleach (10 water: 1 bleach) HEPA filtered vacuum cleaners Bag or seal waste 20

21 Standard ICRA Control Measures Patient relocation/protection Physical barriers Negative pressure HEPA filtered negative air machines Personal hygiene Tacky walk off mats HVAC system protection Clean waste containers Infection prevention commissioning Questions? Thank you Copyright Larry Lee

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