Post on 29-Jul-2019
UNDERSTANDING THE DISASTER STAKEHOLDERS TYPES OF WATER INTRUSIONS CATEGORIES OF WATER MITIGATION RESTORATION/REMEDIATION PREPARATION LESSONS LEARNED
Earthquake: Sylmar, California.
Fire: Taunton, Georgia.
September 6, 2010: 0400 HRS – 3 Inch pressurized fire suppression line burst on the second floor bed tower. Approximately 20 minutes pass before the water main is isolated. An estimated 300,000 gallons of Category 3 water is released affecting approximately 80% of the hospital.
Man Made: Sulphur Springs, Texas.
• Facility was unprepared with no contingency • Shut-Down and diversion was not feasible • Administrators chose to remain operational • Mitigation, Restoration and Construction would
take 9 months to complete from the date of the release (24/7/365)
• Total loss: 9.5 million
The Affected Facility Insurance Company Restoration Contractor Industrial Hygiene Firm Construction Company Regulatory Agencies
AFFECTED FACILITY
Insurance Company
Restoration Contractor
Industrial Hygiene
Firm Construction
Company
Regulatory Agencies
1. RISING WATER – Torrential Rain, Groundwater
2. INTERNAL RELEASE - (Sprinkler Lines,
Sprinkler Heads, Pipe-Breaks, etc.) – Structural
3. EXTERNAL (Wind/Rain) – Super-Cell Storms, Straight-Line Wind, Tornados, Hurricanes
Category 1 (Clean Water) – Sanitary water source with no substantial risk.
Category 2 (Grey Water) – Significantly contaminated water with potential to cause sickness.
Category 3 (Black Water) – Grossly contaminated water containing pathogenic, toxigenic or other harmful agents.
Water Supply Lines Tub, Toilet, Sink Overflows (No Contaminants) Equipment Malfunctions – Water Supply Lines Melting Ice & Snow Falling Rainwater Note: If Category 1 water comes in contact with a contaminant or
remains following a release for 48 hours, it is considered Category 3 water.
Discharge from dishwashers, sterilizers, etc. Toilet overflows containing urine (no fecal) Release from water features Note: In medical facilities, Category 2 water is
considered Category 3 water in all patient-care areas. In all common areas, Category 2 water is considered Category 3 water if not immediately extracted.
Sewage Toilet Backflows (beyond the trap) All Seawater All rising water from rivers, streams,
groundwater Storm Surge (Hurricanes, Tornados, etc.) Sprinkler Lines!! (Always Category 3)
Release was from a 3 inch fire suppression line – Category 3 Water
All affected porous building materials would be removed correctly (demolished)
Contents would be individually assessed Industrial Hygiene: ICRA, Scope of Work,
Demo Specifications would be developed.
This is the “Response” in Disaster Response Think about sensitive receptors Should start immediately following an
intrusion Includes:
1. Extraction 2. Controlling Indoor Environment 3. Industrial Hygiene Services
Physically removing as much water as possible from indoor environment
Requires massive amount of man power/resources
Use of truck-mounted & portable water extraction units
Documentation of affected areas
Goal is to minimize wicking, prevent microbial growth, reduce overall
loss. Establish a drying chamber
Air Scrubbers only, No Fans Create drying conditions
Control Temperature & RH Dehumidification
Desiccants LGR Portables.
Immediate Baseline sampling for Mold & Bacteria
Rapid development of Remediation Specifications
Rapid development of an ICRA
Moisture mapping/identification of affected areas
Monitoring of atmosphere
Extraction and Control of Environment: 38 hours Standing water removed Generators/external power installed Desiccants, air scrubbers & portable dehumidifiers
in-place and operational Industrial Hygiene Support
Risk Assessment ICRA Development Remediation Specifications Development
Prior to remediation complete agreement and understanding must be achieved quickly between all stakeholders and the affected facility:
Facility Coordination Scope of Work Approval Prioritization Infection Control Regulatory Concerns
One Accessible Point of Contact: Facility Director/Engineer, COO, CEO, etc.
Cooperation of Staff Contractor Regulations and Safety Relocation of services, offices, contents Regular updates
Facility, Insurance, Industrial Hygienist & Restoration Contractor must Agree on Expectations and Desired Outcome
Fluid Document/Open to Change and Evolve Unforeseen Conditions/Pre-existing
damage/conditions
Business Units Addressed First: Emergency Room Patient Rooms PACU, Surgery, ICU, etc.
Offices & Common Areas addressed after income producing units restored
Contents were all individually assessed, either discarded or cleaned prior to re-use
Infection Control Risk Assessment Identify High Risk areas (NICU, ICP, etc.) Containment Design & Specifications Negative Pressure Ventilation (Particle Counts) ACH
Post-Remediation Verification Sampling Bacterial – Primary Concern Fungal
City Permits NFPA Fire Standards
Fire Watch Temporary Code Permit
Asbestos & Lead Containing Materials Samples required prior to Demo Notification if positive = delay
Fungal Growth (Mold) Reportable and regulated in some states
Never had a direct point of contact Remediation called for relocation of: Medical
Records, Day Surgery, PACU, 32 patient rooms, Admin, Radiology, Cafeteria, etc.
Scope of work took 10 days for approval Infection Control was left to contractor Reportable: Lead, Asbestos, Fungal Growth
82 Total Containments
4200 Mold & Bacterial Samples
9 Asbestos Abatement Projects/Areas
2 Lead Abatement Projects/Areas
8 Mold Remediation Areas (Reportable)
What can YOU do to prepare your facility for a catastrophic water release or flood?
1. Standard Operating Procedures 2. Facility Training 3. Know who to call and when to call 4. Understand the liability and risk
Know and understand your EAP Create or update your SOP for water losses Distribute this plan to all employees Continuity of business is paramount Think worst-case-scenario
Know and understand your EAP Create or update your SOP for water losses Distribute this plan to all employees Continuity of business is paramount Think worst-case-scenario
Practice relocation and diversion Create a water extraction team
Emphasize protection of expansion joints, business units, electrical components, etc.
Diversion, diking, damming
Good relationship with Insurance Agency Place yourself on an Emergency Response Plan
with a Restoration Contractor and Industrial Hygiene Firm that can handle a complete loss of your facility
Always call immediately following a loss. A quick response minimizes the overall loss.
Patient safety is the key concern, contact a professional when internal resources could present a liability.
Pass liability to contractors Protect patients and employees Ensure that your facility is restored properly
UNDERSTANDING THE PROBLEM ASSESSING THE DISASTER INFECTION CONTROL RISK
ASSESSMENT ENGINEERING CONTROLS INDUSTRIAL HYGIENE CONTROLS
Approximately 13% of high-risk adult patients develop HAIs annually
Cost each facility approximately $21,000 / patient
Increase patient stay 6-10 days Direct national cost of HAIs is approximately
$28 - $34 billion each year Surge of MRSA and other resistant infections
increases expenditures each year 48,000 deaths each year attributed to HAIs
Nature of the disaster affecting the hospital Flood Fire Smoke Flood/Fire/Smoke
Assessing critical functions of facility Surgery Suites PACU ICU Support (IV Rooms, Clean Rooms, Bed Towers)
Microbiological effects of disaster Baseline sampling (air and surface Bacterial and fungal
Determining affected vs. non-affected area/s Visual Analytical
Identifying sensitive receptors Immune-compromised patients NICU / Maternity Infectious Patients
Designed to assess infection risk based on planned activities and location of activities Type of Construction/Renovation/Restoration Identification of Patient Risk Groups Determination of Required Infection Control
Precautions Identification of Adjacent Units Engineering: Containment Design / Mechanical
Systems Establish Working Permit
Must be rapidly developed during mitigation Hospital staff, IH Company, Restoration
Contractor must all agree on permit Must be scientifically verified and monitored
Purpose is to isolate affected areas from patients and staff
Use of negative-pressure, hard-containments Recommend 0.02” negative pressure Hard construction (Critical) must be fire-resistant,
anti-static Limited Access
Must not affect HVAC zones and internal pressure systems.
Must create vertical and horizontal separation
Dust Mitigation Includes fungal spores, debris,
fibers, bacteria, etc. Accomplished through work
practices & special equipment Minimizing use of heavy
equipment Utilization of air scrubbers Reducing vibration Hose-exhausting power tools
Use of specially trained personnel Clean work environment
Restricted Access Only restoration workers and support staff Proper personal protective equipment must be
worn Access must be isolated from patient/staff/visitors
Demolition changes structure and containment Expose floor to floor voids/penetrations Ceiling spaces become connected Preexisting conditions often discovered which
affect containment integrity
Scientific verification that ICRA is successful
Includes collection of viable/non-viable samples Fungal Bacterial
Compared to baseline and scientific guidelines
Third-party analytical data verifies restoration is successful
Provides facility with data
Monitor Non-Affected Areas Particle Counting Air sampling Surface sampling
Coordinate with Facility Management Track HAIs, respond, adapt As work moves, layout
changes Report analytical results