A cure for water damage in hospitals and healthcare facilities Risk Engineering: Understanding risk across your business
Focused on helping our customers At Zurich Services Corporation, we are focused on helping customers mitigate losses and get back to business quickly. This is particularly true in the healthcare industry, where a loss at a hospital can affect not only revenues, but more importantly, the health and safety of patients, visitors and staff. That is why we developed this brochure/kit, which helps identify water damage exposures, the leading cause of property losses in hospitals. It helps risk managers, safety managers and other key hospital professionals gain control over the primary exposures that cause potentially paralyzing losses. This program kit also provides important loss control information, tips and checklists to help prepare for a common and potentially devastating type of loss. Use the program s steps and recommendations to develop a loss control plan to help protect your hospital from disruptive and potential expensive losses, keeping facilities running smoothly and efficiently. Work with your Zurich Services Corporation risk engineering professional to determine the most effective ways to apply the tools included here to reduce your exposure to water damage. 1
The Problem The leading cause of property losses in hospitals and other healthcare facilities is from liquid damage. A review of Zurich claims data* highlights the problem. *Claims data is based on a review of water damage claims from 2002-2011. Hospital claims by number Hospital claims by loss dollars 43% 43% 37% 37% 57% 57% 63% 63% Liquid damage Liquid damage claims claims All others All others This means there is nearly a 50 percent chance that the next property claim will be water-related and if it is, it will cost, on average, three times as much as a claim that doesn t involve water damage. The high dollar amounts can result from payment for cleaning high valued and critical electronic diagnostic and treatment machines such as MRIs, accelerators, simulators and cardiac monitors. Patient services can be delayed or scheduled with other providers until the equipment is properly cleaned and tested. Preventing these losses and taking quick and effective action when leaks occur can help to drastically reduce the number and size of losses. Reducing the likelihood of such incidents also minimizes the disruption to hospital operations and its critical human resources. Water damage can originate from a number of sources: Domestic water lines and systems Drains and drain lines Sewage systems Cooling and heating piping and radiators Sprinkler piping Flooding Piping and other systems in older hospitals are more prone to failure, and greater maintenance and testing is needed to assure the integrity of the pipe, fittings and equipment. Some areas of the country have public or private water supplies containing certain minerals that increase the corrosion rate of water. Proper water treatment, system maintenance and testing the integrity of systems must be practiced in such areas. Pipe breaks often occur during earthquakes. Hospitals in earthquake-prone areas should be prepared for leaks and breaks. When leaks do occur, immediate and proper action is vital to preventing further damage and assuring a faster return to normal services. There is nearly a 50 percent chance that the next property claim will be water-related and if it is, it will cost, on average, three times as much as a claim that doesn t involve water damage. 2
Loss examples A major leak from a hot water pipe damaged clinical and outpatient service areas on the first and second floor of a hospital. The 22-year-old pipe had corroded near a coupling. Prior evidence of staining indicated that a small leak was present for some time. Although responding maintenance staff was quick to locate and isolate the leak, damage in excess of $1,500,000 still occurred. A frozen pipe burst and water leaked down four floors. The pipe was located just inside an exterior wall. A contractor working in December on the exterior wall did not provide protection to the pipe during the period the wall was opened up. A wellequipped cleanup and restoration company was notified immediately, limiting damage to $65,000. Water leaking from a corroded underground water main leaked into the basement radiology labs. The hole in the pipe was located upstream of the main valve. Water flowed along the outside of the pipe and through the wall opening for the water main. It took more than four hours to locate and shut off the water supply valve. During that time, five feet of water collected in the labs. Damaged equipment included three accelerators, a simulator, ultrasound and other diagnostic and treatment equipment. This radiology lab was not returned to full service for almost three months resulting in significant business interruption. The total loss was approximately $14,000,000. Diesel fuel from an overfilled tank in a mechanical penthouse flowed down two floors and interrupted a surgery in progress. The tank was located next to an emergency generator in the penthouse. The overfill device was inoperative, and the room was not attended during the filling operation. About 50 gallons of diesel fuel overflowed onto the floor and down through cracks and unsealed pipe openings to patient areas on the third floor and then into the surgical room on the second floor. The tank was not diked and spaces around conduit and pipes passing though the floors were not sealed as required for fire-rated floors. A newly soldered joint on a two-inch copper water line came apart, spilling water into a radiology area. Water damaged ceiling tiles, carpeting, walls and an MRI machine. The contractor was pressure testing the line when the fitting let go. The line was located above the equipment area. The MRI was down for 11 days. A two-inch diameter sprinkler pipe separated from its coupling in the ceiling of the 8th floor. Water from the failed coupling caused damage to all the floors beneath the 8th floor. Contents, non-structural building components, as well as electrical and mechanical equipment were damaged. Patients were relocated to accommodate repairs. The business interruption and extra expense loss was substantial. The approximate total loss was $7,000,000. Although responding maintenance staff was quick to locate and isolate the leak, damage in excess of $1,500,000 still occurred. 3
Reducing the damage from water, sewage and other types of liquids Complete the following checklists as indicated. Use them to help identify the risk for liquid damage, detect problems, check for preparedness and help in the response to any leaks that occur. The forms are also available on the enclosed CD-ROM. Hospital self-assessment for prevention of liquid damage and for mitigating liquid damage 1. Complete for each hospital or other major complex. 2. Prepare a written plan that details what to do in the event of a leak or liquid damage. Assign overall responsibility to a person in authority to oversee the process. 3. Review this plan at least once a year. Several items should be checked quarterly, such as the list of responders and the inventory check of materials and equipment needed for leak response and cleanup. Item Yes No Action/Comments 1. Is there a written plan detailing what to do in the event of a leak and liquid damage? 2. Is the plan reviewed for changes and discussed at staff meetings at least quarterly? 3. Has the Checklist for Valuable Equipment Areas been completed for all areas containing critical diagnostic and treatment equipment, main telephone rooms, computer centers, etc.? 4. Is the Checklist for Valuable Equipment Areas reviewed during the planning or design stage for new construction, renovation or relocation projects? 5. Is someone immediately available at all times with authorization (24 hours, 7 days) to call and bring in the professional cleanup and restoration companies? 6. Are the names and phone numbers for professional cleanup and restoration companies readily available? See preferred provider list stored on the enclosed CD-ROM. 7. Is a trained person available on all shifts to respond immediately to any leak? 8. Is this list of responders checked at least quarterly for turnover? 4
Item Yes No Action/Comments 9. Are all those responding to a leak aware of the location of valves? 10. Does the staff have immediate access to a spill response cart or supplies and emergency pipe repair supplies? 11. Is the supply of spill response and pipe repair materials complete, readily accessible and checked at least quarterly? 12. Are pipe diagrams or prints up-to-date and showing the location of valves for all liquid-carrying systems? Isometric drawings are very beneficial. (Note 1) 13. Are valves placarded or tagged for easy identification? 14. Are shutoff valves exercised (closed and reopened, lubricated as needed) at least annually to verify they can be quickly closed during an emergency?. 15. Are small leaks promptly repaired? A small leak may be a sign of hidden corrosion or other problem with potential for growing into a catastrophic leak. 16. Is the cause of any leak analyzed to determine if it was an isolated occurrence or a symptom of a system wide problem? 17. Are housekeeping personnel instructed to immediately notify maintenance when any type of dripping, leakage or clogged drains are found? 18. Is there a lockout/tagout procedure in place when valves are shut on liquid-carrying systems under repair or modification? 19. Is there close monitoring of third-party work that may affect piping systems (sprinklers, water, etc.)? 20. Are there any liquid storage tanks or vessels (hot water, condensate, boilers, fuel oil, etc.) inside the building, mechanical penthouse or on the roof? (sprinklers, water, etc.)? 21. If so, is there a dike around the tank or vessel, and/or drains to contain or effectively carry away leaking fluids? Dikes are required around fuel tanks.? 22. Are there any floor openings or cracks through which a leaking fluid may pass through and damage areas below? (Note 2) 5
Item Yes No Action/Comments 23. For basement areas, are there any water mains, sprinkler mains or liquid utility piping entering through the walls or floor? 24. Is there any evidence of leakage or seepage through the wall or floor openings? If so, indicate repair schedule. 25 Is an underground plan of these mains immediately available, showing the location of shutoff valves? (in case an underground leak occurs and water flows through the wall or floor opening) (Note 3)? 26. If any part of the property is exposed to potential flood, is there a formal flood emergency plan or similar flood preparation plan? 27. If your hospital is in an earthquake-prone area, has your automatic sprinkler system been surveyed by a sprinkler system professional to determine extent of vulnerability for leaks? (Note 4) 28. Are roofs inspected regularly (minimum of every 6 months or after severe storms) to check for damage or deterioration such as cracking, splitting, blistering, separation, holes or other potential source of leaks? 29. Are there any roof leaks or evidence of ponding on the roof? If so, indicate reasons and the repair schedule. 30. Are roof-mounted cooling towers inspected regularly, and are cooling tower basins watertight? (Note 2) 31. Are there any areas directly adjacent to the building where rainwater can accumulate during heavy rains? Large landscaping planters built next to grade wall and windows are an example where water can pond and find its way into the building. Notes: 1. Liquid-carrying systems may include sprinkler systems, hot and cold water piping, chilled water lines for cooling, hot water lines for heating, condensate piping, sewer lines, drain lines, fuel oil piping, etc. 2. Floor openings often occur around penetrations made for pipe and conduit. Seal the open space around the pipe or conduit to prevent passage of a liquid. Often, these are penetrations in concrete floors that are required to be fire-stopped anyway. Use a W-Rated fire-stop product that produces a tight liquid seal. A fire-stop is a UL-listed fire-resistive material used to fill holes in fire-rated floors and walls. Some types resemble caulk. 3. Accurate drawings of the underground water mains are important in a large complex with private mains. A leak may occur in an underground pipe near a building. There may be a control valve in the basement or just outside the building. Closing this valve may not stop the leak if the break is upstream of the valve and the water is flowing along the outside of the pipe, then into the building. A plan showing the location of all valves in the system will be needed to quickly locate another valve to shut and stop the leak. 4. Sprinkler pipes and heads often break during earthquakes as a result of swaying fixtures or ceiling tile systems. Breaks or leaks also occur if the sprinkler pipes are not adequately braced per the latest code. In these situations, breaks or leaks occur from excessive pipe swaying or when pipe movement is not in sync with the building s movement. 6
Checklist for valuable equipment areas (MRI, CT scan, electron microscope, linear accelerator, simulator, main telephone room, EDP Center, etc.) Building: Floor: Area evaluated (department, room number or equipment name) Instructions: 1. Complete for each valuable equipment area. 2. Prevent potential problems by reviewing while planning/designing new construction, renovation projects or relocation. Even a small amount of water or other liquid falling on valuable equipment may result in total shutdown until it has been cleaned, tested and recertified. It s critical to identify sources of water or other liquids located immediately above valuable equipment areas. Once identified, analyze the potential for leakage and wetting. Take measures to eliminate, reduce or protect against possible leaks. Basements are the least desirable locations for valuable equipment. Item Yes No Action/Comments 1. Are there any water lines, drains or other liquid piping in the ceiling directly above the valuable equipment? 2. Do these lines contain fittings, valves or other devices with connections above the equipment? 3. If they cannot be removed or relocated, what can be done to determine their integrity? 4. Is there any evidence of leakage? If yes, indicate repair schedule. 5. On the floor directly above the valuable equipment room, are there any bathrooms, slop sinks or other rooms with fixtures or equipment containing water, steam or other liquids? 6. Is there any evidence of leakage? If so, indicate repair schedule. 7. Are locations of shutoff valves noted by fixtures or on a floor diagram?. 8. Are shutoff valves marked and easily accessible? 7
Item Yes No Action/Comments 9. Does the floor directly above the valuable equipment area contain any poke-throughs (penetrations) for conduit, pipe, cabling etc., through which water can flow down onto the equipment? 10. If yes, are the open spaces well sealed to prevent water penetration? If not, indicate repair schedule. 11. Is a spill response kit or cart, including plastic sheeting to cover and protect equipment, readily available? 12. Has the entire staff of operators, maintenance and housekeeping been trained to report any type of liquid leak to the maintenance department for immediate attention?. 13. If leakage onto or potentially onto the equipment occurs, are attendees instructed to immediately shut off power (if safe to do so) to electrical equipment and protect equipment with plastic sheets? 14. For a valuable equipment area located in the basement, are there any water mains, sprinkler mains, liquid utility piping entering through the walls or floor? 15. Is there any evidence of leakage through the wall or floor openings? If so, indicate repair schedule. 16. Is an underground plan of these mains immediately available, showing the location of shutoff valves? (in case an underground leak occurs and leakage occurs through the wall or floor opening) 17. For areas that are unoccupied periodically, are there any water sensors on the floor or excess humidity sensors available to provide an alarm to a constantly attended position? 8
New construction or renovation When adding or moving valuable equipment, use the Checklist for Valuable Equipment Areas to reduce the chances of potential problems. Locate valuable equipment on floors at or above grade. This includes diagnostic and treatment equipment, telephone equipment rooms and computer centers. Designers should route all liquid-carrying systems away from ceilings over critical and valuable equipment. Locate valves in readily accessible areas. Consider adding valves if needed to improve response time in isolating a leak. Label valves to identify purpose and the zones or areas each controls. Waterproof the floors above areas containing critical and valuable equipment. Completely seal all openings around floor penetrations made for conduit and ducts and other utilities. Pressure test pipe per code, witnessed by owner s representative, with all leaks properly repaired and the pipe retested. Do not seal off pipe in walls until tested and signed off. Provide secondary containment and drains in rooms containing fuel tanks, hot water tanks, other liquidcontaining equipment and vessels. Consider installing water sensors on the floor for areas containing valuable equipment or under raised floors of computer rooms. Identify new construction/landscaping on adjacent properties, especially those being conducted at slightly higher elevations. Storm water runoff can be a major problem when natural water diverting means, such as grass, are temporarily removed during a project. Debris from construction projects and landscaping can also clog storm drains in the area during exceptionally heavy rain events. 9
Helping mitigate damage when leaks occur Turn off power immediately! Do not energize wet equipment! Track down and shut off the cause of leakage. Cover up equipment if leaking continues from above. Begin removing the liquid. Remove, as much as possible, all wet items (anything that holds moisture). Begin cleanup and drying procedures immediately. Apply proper preservatives to equipment (note material should not promote corrosion, conduct electricity or create a fire hazard). Call the Zurich Claim Care Center at 800-987-3373. Call professional cleaners and restorers immediately. Fire/water cleanup: Name Phone Equipment restoration: Name Phone Call the Zurich Claim Care Center at 800-987-3373 to speak with a professional about the situation. 10
First 24-hour checklist Building Remove wet items such as carpeting, padding and ceiling tile, anything that holds moisture to an exterior location or cutoff dock area. Use all available and rentable vacuum equipment to eliminate water on floors as soon as possible. Also use squeegees and mops. Set up any available dehumidifiers (if outside temperature is greater than 60 F). Open any doors and windows to help reduce humidity (if weather is appropriate). Use fans to help circulate the air and assist drying. Open drawers and closet doors to enhance drying. Blot hard surface furniture dry. Place nonstaining blocks or aluminum foil under furniture legs. Lift draperies off carpet and suspend. Move photos, paintings and art objects to a safe, dry location. Remove damp books from shelves and spread in a stable, dry environment. Leave the heat on if damage occurs during a cool season. Utilize air conditioning if it occurs during a warm season. Equipment Turn off power immediately! Do not energize wet equipment! Do not reenergize equipment until authorized by qualified restoration personnel or manufacturer s technical representative. Open cabinet doors/sidepanels/covers/chassis drawers drain all water. Remove equipment to a cool, dry area after wiping down and eliminate as much moisture and contaminants as possible. Set up fans to move ambient air through equipment. Blow water out with clean compressed air (or preferably liquid nitrogen) and/or hair dryers or a PowerCat. Spray water displacement solvent on electronic components (such as contact cleaner, LPS 1 or alcohol/freon mixture). Wipe down and dry metal surfaces as soon as possible use protective surface treatments to slow corrosion (CRC, LPS 1). Follow up with professional restoration services. X-Ray or other film Relocate to a dry environment. Separate and dry off. Call professional restorers as these steps are being done. Professional equipment restorers bring the experience and resources to effectively clean and repair electronic equipment and get it recertified if necessary. 11
First 24-hour checklist (continued) Recording equipment (disk and tape drives) Do not operate if wet or dirty. Clean tape transport mechanism with alcohol solvents dry out if wet. Wipe off surface contamination before drive system use. Treat electronics as detailed above. Do not reenergize equipment until authorized by qualified restoration personnel or manufacturer s technical representative. Magnetic media Do not use if wet or dirty. Clean and dry dirty tapes/disks/cassettes with alcoholbased solvents for one time data recovery. Send wet head disk assemblies (HDAs) to a specialist for data recovery. Save the data not the media. Follow up with professional restoration service. Follow up with professional restoration service. Spill response cart and pipe repair supplies A spill kit or cart and emergency pipe repair supplies should be available for quick accessibility and use anywhere in the hospital. The following list contains suggestions for a spill response kit. The maintenance and/or engineering departments should participate in selecting the contents and locations of the kits. Make plastic sheets to cover electronic equipment readily available in the applicable areas for use by operators. Note The materials may be needed in several areas if the hospital is large or involves multiple buildings. Quick accessibility is the goal. Plastic sheets to throw over and protect equipment (should be immediately available in every valuable equipment area) Plastic bags to dispose of wet material Wet vacuums or other water removal equipment (commercial grade with effective GFIs, squeegees, mops, buckets) Portable pump(s) and hose Water displacing solvents for applying to electrical equipment (examples: contact cleaner, LPS 1) Preservatives for metal (examples: CRC, LPS 1) Towels for wiping up (assumed to be available from housekeeping) Alcohol for computer tapes and disks (ISA99 for purity) Pipe clamps to place around and stop a leak (pipe repair kit) Diagrams of piping systems with valve locations highlighted Dehumidifiers (or ready rental source) Boots Portable dikes for diverting surface water away from below grade doorways and possible points of water entry. This would be necessary during unusually heavy rains, and especially if the hospital has a history of water accumulating near certain doorways, loading docks, parking ramps, etc. Absorbent socks, to contain and absorb spills Clean and dry dirty tapes/disks/cassettes with alcohol-based solvents for one time data recovery. 12
Phone numbers Make emergency phone numbers readily available to management and the personnel responding to or overseeing the incident (see sample list on enclosed CD-ROM). Examples of phone numbers that should be available include the professional clean-up company, professional equipment restoration company(s), Zurich Claim Care Center (800-987-3373), servicing companies for the critical and valuable equipment (especially the technical representatives) and sources for renting additional wet vacuums and dehumidifiers. CD Case goes here. Do not print magenta box. 13
A1-13131-E (02/13) 112000921 Zurich Services Corporation Risk Engineering 1400 American Lane, Schaumburg, Illinois 60196-1056 800 982 5964 www.zurichservices.com The information in this publication was compiled by Zurich Services Corporation from sources believed to be reliable for informational purposes only. All sample policies and procedures herein should serve as a guideline, which you can use to create your own policies and procedures. We trust that you will customize these samples to reflect your own operations and believe that these samples may serve as a helpful platform for this endeavor. Any and all information contained herein is not intended to constitute legal advice and accordingly, you should consult with your own attorneys when developing programs and policies. We do not guarantee the accuracy of this information or any results and further assume no liability in connection with this publication and sample policies and procedures, including any information, methods or safety suggestions contained herein. Moreover, Zurich reminds you that this cannot be assumed to contain every acceptable safety and compliance procedure or that additional procedures might not be appropriate under the circumstances. The subject matter of this publication is not tied to any specific insurance product nor will adopting these policies and procedures ensure coverage under any insurance policy. 2013 Zurich Services Corporation