Moisture Management Infection Prevention and Corporate Safety This self-directed learning module contains information you are expected to know to protect yourself, our patients, and our guests. Target Audience: Teammates involved in response and/or evaluation of moisture and water issues. Contents Plant Operations & Maintenance Project & Construction Management Technical Services Group Lincoln Harris Property Managers Real Estate Infection Prevention Corporate Safety & Facility Safety Officers Environmental Services Managers Instructions... 2 Learning Objectives... 2 Job Aid... 11 Posttest... 12 Carolinas HealthCare System
Moisture Management Instructions: The material in this module is an introduction to important information and procedures regarding moisture management and mold. After completing this module, contact your immediate supervisor to obtain additional information specific to your department or work responsibilities. Read this module. If you have any questions about the material, ask your supervisor. Complete the online post-test for this module. Once you pass the post-test, print it or a copy of your transcript and give it to your manager. The Job Aid on page 11 should be customized to fit your department s policies and procedures and then used as a quick reference guide. Completion of this module will be recorded under My Learning in PeopleLink. Learning Objectives: When you finish this module, you will be able to: 1. Understand moisture and mold growth. 2. Describe possible health effects of mold. 3. List ways to prevent or limit mold growth. 4. Describe how to detect a mold problem. 5. Report water, moisture, and mold problems. 6. Describe the Moisture Management Process flow. 7. Use the Water Release/Mold Reporting Tool. 8. List appropriate water cleanup actions for common building materials.
Moisture Management Mold Basics Molds (fungi) are part of the natural environment. Many types of mold grow in moisture, warmth and darkness. Outdoors, molds play an important role by breaking down organic matter such as toppled trees, fallen leaves, and dead animals. Indoors, mold growth should be avoided. Molds grow anywhere you find moisture or water, air, and a food source (organic material). Molds can grow on wood, paper, carpet, and foods. Molds produce tiny spores (seeds) that easily float through indoor and outdoor air. Also people carry spores on their shoes, clothes, skin, and hair into a space. When mold spores find a damp indoor spot, they may begin growing. You can not get rid of all molds indoors. But you can prevent its growth by controlling moisture. Health Effects Most people experience no problems from molds. But some molds may adversely affect people in three ways: Allergy Infection Toxicity Allergy Some people may develop allergies to certain molds. Some people have specific antibodies to mold and may develop allergic rhinitis ( hay fever ) with symptoms such as sneezing, congestion, or runny nose. Asthma may also be triggered by molds. Deleted: Infection Most molds will not infect healthy people. Some fungi (mold) may cause local skin infections such as athlete s foot. However, weakened patients may become infected and seriously ill from other molds not harmful to normal persons. Toxicity Some molds produce toxic substances (mycotoxins), some of which have valuable use (penicillin). Some mycotoxins have caused illness in animals and people eating moldy foods. But illness from breathing mycotoxins has occurred only with farmers exposed to large amounts of moldy hay. You may have seen or heard media reports of breathing toxic mold in homes or buildings. However, there is no scientific evidence supporting those claims. The American College of Occupational and Environmental Medicine states: The present alarm over human exposures to molds in the indoor environment derives from a belief that inhalation exposures to mycotoxins cause numerous and varied, but generally nonspecific, symptoms. Current scientific evidence does not support the proposition that human health has been affected by inhaled mycotoxins in the home, school, or office environment. --Evidence Based Statements: Adverse Human Health Effects Associated with Molds in the Indoor Environment, American College of Occupational and Environmental Medicine, 2002. 3
Prevention Control moisture and you will control mold. When water leaks or spills occur - act quickly. Any water seepage should be stopped and cleaned quickly. A prompt response (within 24-48 hours), thorough clean-up, rapid drying, and/or removal of water-damaged materials will prevent or limit mold growth. A flowchart on the next page shows how to report moisture, water or mold problems. Mold prevention tips include: Report plumbing leaks and request repairs as soon as possible. Look for condensation and wet spots. Report problems as soon as possible. Pinpoint areas where leaks have occurred and report quickly. Mold Problem? Mold occurs normally in all places, including buildings. This is normal, not a hazard. Problems occur from excessive growth. When excessive growth occurs, it s usually obvious. You see it or smell it. If there is an earthy or musty odor, you probably have mold growing. Moisture and water usually provide the right conditions for excessive growth. Look for water damage. Look for discoloration and leaching from plaster, walls, or ceilings. Promptly report all findings. Testing for mold is not a routine step in an investigation. This is because decisions about fixing the problem can usually be made by visual inspection. No governmental, scientific or medical organization recommends testing as an initial step. Also, there are no standards for an acceptable quantity of mold. The best approach is to find the problem and fix it. If you don t fix the moisture problem, clean and disinfect the area, then mold growth will reoccur. Remediation Remediation includes both finding and fixing conditions allowing mold growth. Also it includes steps to safely remove mold and water damaged materials. Carolinas HealthCare System s policy on Moisture Management (CHS 7.10) outlines actions and responsibilities for these projects. The policy also contains the Moisture Management Tool Kit with more specific guidance for individuals involved in evaluation or remediation of moisture and mold. The Tool Kit consists of: 1. Moisture Management Process Flow 2. Water Release/Mold Reporting Tool 3. Water Damage Cleanup Guidelines 4. Mold Remediation Risk Assessment Guidelines (matrix) 5. Abatement Project Guidelines 4
Moisture Management Process Flow This simple process flow diagram shows the expected steps and sequence of actions. The diagram is self-navigating and begins with the Call Center notifying POM/Property Manager. Using supporting references in the Tool Kit, decisions by POM/Property Manager lead to other actions and notifications. Moisture Management Process Call Center receives report of discovery of water leak or mold Call Center notifies POM or Prop. Mgr. POM, Project Manager, or Property Manager: 1. Arranges site visit 2. Completes Water Release/Mold Reporting Tool, forwards as designated 3. Refers to Water Damage Cleanup Guidelines as needed 4. Refers to Mold Remediation Risk Assessment Guidelines as needed 5. Consults, as needed, with Infection Prevention, Safety, Nurse Supervisor, Admin and others. YES Mold Remediation Risk Assessment needed? NO Infection Prevention and/or Corporate Safety: 1. Performs Mold Remediation Risk Assessment 2. Determines control measures 3. Consults with POM/Prop Mgr, Admin, notifies Employee Health, or others as needed POM/Prop Mgr: 1. Repairs leak 2. Arranges cleanup following Water Damage Cleanup Guidelines 3. Documents incident and corrective actions POM/Prop Mgrcoordinates abatement project following:: 1. Mold Remediation Risk Assessment Guidelines 2. Water Damage Cleanup Guidelines 3. Abatement Project Guidelines 5
Water Release/Mold Reporting Tool This is a self-explanatory form to gather initial information and report to appropriate departments. Either POM or the Property Manager completes this tool and forwards as directed. Information needed to complete the form includes: Basic address, location, and contact information Building occupancy (risk groups) Description of leak or mold problem Planned corrective action 6
Water Damage Cleanup Guidelines This one-page reference provides simple and straightforward guidance for water damage to common building materials. Should they be dried and saved or discarded? 7
Mold Remediation Risk Assessment Guidelines (matrix) This risk assessment is a chart or matrix that uses information about Risk Groups and Activity to determine Interim Infection Control Measure Guidelines. The risk assessment is conducted by Infection Prevention or Corporate Safety. They will work with POM/Property Manager and others on the team as needed. Risk Groups The chart or matrix lists four groups: low, medium, high, sensitive. Also, the matrix shows typical examples within each group. Activity The matrix includes three categories of activity based on the estimated size of area involved: Small Isolated Area (< 30 ft 2 ) Large Isolated Area (30-100 ft 2 ) Extensive Involvement ( > 100 ft 2 ) Combining the Risk Group and Activity on the matrix specifies the level (I, II, III, IV) of Interim Infection Control Measures Guidelines. Level I is the least restrictive. Containment of work areas begins at Level II. Level IV is the most restrictive. An example is shown below: 8
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Abatement Project Guidelines Once a mold remediation project is necessary, two documents in the Tool Kit guide controls and work practices. The Risk Assessment provides guidance for the protection of employees, patients, and visitors to our facilities by designating the Level (I, II, III, or IV) of protection. Additional guidance is listed in the Abatement Project Guidelines. This 2-page reference provides work practice guidance for removing and treating common materials. 10
JOB AID 1 If these three conditions are present, mold can virtually grow on any substance: Moisture or water Air Food 2 Possible health effects due to the exposure to mold may include: Hay fever-type symptoms Skin infections Asthma attacks Infection in immune impaired patients 3 To prevent mold from growing you should: Report leaks and request repairs as soon as possible Look for condensation and wet spots. Request repairs ASAP Pinpoint areas where leaks have occurred and report quickly 4 If you think a mold problem may exist, ask yourself: Is moisture damage visible? Are there musty or moldy odors? Are there ongoing moisture problems? Have any materials or furnishings been wet for more than 48 hours? 5 If materials have mold or remain wet more than 48 hours: Water Release/Mold Reporting Tool completed Risk Assessment Project follows designated Interim Infection Control Measures Materials removed following guidelines Remember to notify the Call Center if there is a water leak or mold is discovered! 11
Posttest Name: Date: Circle the correct answer. 1. The three conditions that need to be present in order for mold to grow are: a. Dry air, oxygen, inorganic source b. Moisture/water, air, organic source c. Moisture/water, air, inorganic source d. Moisture/water, carbon dioxide, organic source 2. Mold can have what kind of health effect on humans: a. No adverse effect b. Asthma attack c. Hay fever-type symptoms d. Skin infections e. All of the above 3. When water leaks or spills occur indoors, a thorough clean-up, drying, and/or removal of water-damaged materials should take place: a. Within 5-10 hours b. Within 24-48 hours c. Within 48-72 hours d. None of the above 4. Questions that may assist you in detecting a mold problem: a. Does the building have a musty odor? b. Are there visible signs of mold? c. Have building materials remained wet for more than 2 days? d. Are there water stains on materials? e. All of the above 5. If you notice a leak or discover mold, you should: a. Take care of it yourself b. Ignore the problem c. Notify the Call Center d. None of the above 12
6. Following the Water Damage Cleanup Guidelines, carpet affected by a toilet overflow may be left in place, cleaned and dried within 48 hours, if a. The toilet overflow affects only a small, isolated area (< 30 ft 2 ) b. Carpet has been installed within 2 years c. Water Release/Mold Reporting Tool completed and faxed within 12 hours d. All of the above. 7. According to the Abatement Project Guidelines for wallboard, plan to remove visible mold areas and wet areas that can not be dried in 48 hours, a. And wallboard in rooms above the leak b. Plus a margin of at least 12 inches c. Unless you can paint them before anyone notices d. And ceramic tile floors in the same area 8. Which of the following is NOT required under Level III IICM Guidelines? a. Ante chamber/decon room for trash bag/container cleanup before removal b. Enclosure under negative pressure using HEPA filtered units exhausted outside. c. Turn off and/or seal HVAC vents d. Need for special clearance procedures determined by Hospital Epidemiologist. 9. Following IICM Guidelines, if HEPA filtered exhaust units can NOT be discharged outside, a. Consult with Maintenance to problem solve b. Consult with Infection Prevention c. Consult with Corporate Safety d. Direct discharge into space above ceiling 10. Heavy rain on Friday evening and a roof leak show up as a wet mess Monday morning when clinic employees report for work. The property manager determines at least 70 ft 2 of carpet are wet and more than 40 ft 2 of wallboard is wet. From the Mold Remediation Risk Assessment Guidelines, the appropriate Interim Infection Control Measures would be: a. Level II b. Level III c. Level IV d. Not needed, if they can now dry materials by Wednesday morning. Score: Manager s Initials: 13