Www.hillmannconsulting.com Challenges & Strategies During Healthcare Construction - Environmental Risk Assessments

www.hillmannconsulting.com

Challenges & Strategies During Healthcare

Construction -

Environmental Risk Assessments


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


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


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


UNIQUE CHALLENGES OF THE

HEALTHCARE ENVIRONMENT


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


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


CONSTRUCTION PROJECT STRATEGY


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


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


ENVIRONMENTAL RISK ASSESSMENTS


Hazardous Materials Assessments

• Identify and inventory hazardous materials to mitigate risk and liability for renovation related conditions– Asbestos– Mold– Lead– PCB’s– Mercury– Fuel


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


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


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


Indoor Air Quality Evaluation & Monitoring

• Proactive Evaluation– Document Air Quality

• Maintain Healthy Indoor Environments• Reduce Liability• Optimize Building Operations

– HVAC System Inspection – Air Sampling


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


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


MOLD AWARENESS


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


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


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)


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


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.


Water Loss Mitigation

– Environmental Consultant performs an initial assessment and reviews environmental conditions

– Remediation Contractor begins emergency response work to contain loss


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


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)


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)


Role of the Environmental Consultant

• Verify contractor’s 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


ASBESTOS AWARENESS


Pre-Abatement Plan

A. Sequence and Schedule1. Prepare and issue abatement

specifications and sketches2. Select qualified abatement

contractor3. File with all applicable regulatory

agencies4. Pre-Abatement preparation


Abatement Filings

A. The Filing Process takes approximately 2-3 weeks 1. Environmental Protection Agency (EPA)2. State Department of Health and

Department of Labor (DOH &DOL)3. State Environmental Protection Agency4. State Department of Community Affairs

(DCA)5. Local Municipalities


Notifications

A. SignsB. Demarcation of work

areas


Air Monitoring

A. Area Sampling1. High Volume Pumps


Protection From Exposure-PPE

A. Disposable SuitsB. Disposable FootwearC. Disposable Gloves


The Abatement Process

A. Pre-Commencement Inspection B. Start of abatement C. Tracking of waste D. 1st, 2nd & 3rd Cleaning Inspections E. Final Aggressive Air Clearance Sampling F. Break-down of containment


LEAD AWARENESS


Lead Paint Hazards

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


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


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


Exposure Monitoring

• Wipe Samples– Assessment– Clearance

• Air Samples– Area Samples– Personal Samples


Correcting LBP Hazards

• Wet Scraping• Wet Sanding

– No Mechanical Equipment• Chemical Stripping

– No Methylene Chloride Permitted– Additional PPE Required– Additional Disposal Fees– Odor Complaints


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


Determining Effectiveness

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


Question & Answer

Documents

Www.hillmannconsulting.com Challenges & Strategies During Healthcare Construction - Environmental Risk Assessments