4/24/2012 1 Matthew L. Berkheiser, DrPH, CIH, CSP Executive Director & Chief Safety Officer Environmental Health & Safety May 2012 Indoor Air Quality: Mold, Patients and…Elevators? Background • Cost of hospital-acquired infections • History on decision to investigate the elevator shaft Other Regulatory Requirements • American Institute of Architects – Created in 1996. Expanded in 2001 edition of The Guidelines for Design and Construction of Hospital and Healthcare Facilities. Created the Infection Control Risk Assessment (ICRA). – Revised in 2003 and 2006 and 2010 • An ICRA is multidisciplinary, organizational, documented process that considers the facility's patient population and program. • Focuses on reduction of risk from infection • Acts through phases of facility planning, design, construction, renovation, facility maintenance. • Coordinates and weighs knowledge about infection, infectious agents, permitting the organization to anticipate potential impact.
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Indoor Air Quality: Mold, Patients and…Elevators? · 2018. 4. 16. · evaluating the indoor quality compared to outside levels. • A significant correlation existed between parameters
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4/24/2012
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Matthew L. Berkheiser, DrPH, CIH, CSP
Executive Director & Chief Safety Officer
Environmental Health & Safety
May 2012
Indoor Air Quality:
Mold, Patients
and…Elevators?
Background
• Cost of hospital-acquired infections
• History on decision to
investigate the elevator shaft
Other Regulatory Requirements
• American Institute of Architects – Created in 1996. Expanded in 2001 edition of The
Guidelines for Design and Construction of Hospital and Healthcare Facilities. Created the Infection Control Risk Assessment (ICRA).
– Revised in 2003 and 2006 and 2010• An ICRA is multidisciplinary, organizational, documented
process that considers the facility's patient population and program.
• Focuses on reduction of risk from infection • Acts through phases of facility planning, design,
construction, renovation, facility maintenance.• Coordinates and weighs knowledge about infection,
infectious agents, permitting the organization to anticipate potential impact.
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Other Regulatory Requirements
• Joint Commission– Adopted AIA guidelines 2002
– Environment of Care (EC.02.06.05)• When planning for demolition, construction, or
renovation, the hospital conducts a preconstruction risk assessment for air quality requirements, infection control, utility requirements, noise, vibration, and other hazards that affect care, treatment, and services.
MD Anderson Cancer Center
• Because we are a cancer hospital, the majority of our population is immuno-compromised and therefore are susceptible to opportunistic infections that can be caused by exposure to mold spores.
• Very important that we contain mold spores to protect our patients from opportunistic infections.
• Valuable research that can be invalidated by contamination.
Minimum Precautions
• Some type of containment: surface, double flap of poly on door, zip wall, containment cube, or full containment.
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Minimum Precautions
• Room air supply should be covered and exhaust should be filtered or covered completely
• Trash must be double bagged and removed in a covered trash cart
• Terminal cleaning
once work is
complete
Minimum Precautions
• Clearance: visual, surface sampling, air sampling.
• Personal protective equipment: safety glasses, gloves, tyvek, respirator.
• Do not leave containment
wearing PPE!!!
Mold Prevention
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Mold needs 3 things to grow…
Spore
WaterFood
Eliminate any one of the three and mold cannot grow…
• Spores are ubiquitous-impossible to eliminate all of them
• Food sources exist everywhere-its impossible to eliminate all paper based products.
• So that leaves WATER!
All that effort
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Visualization of air leaving shaft
While difficult to see in the pictures… the air is leaving the shaft through the gap between the door and the floor and entering the hospital lobby and elevator car.
The Theoretical Path
Spores enter vents on roof
Into elevator shaft
Air travels through vent to
top of shaft
Vent terminates into
shaft
Elevators travel up
and down
Air escapes from shaft into
hospital around gaps b/t car
and bldg
Elevator Vulnerability Assessment
??
In Houston Cladosporium
98% frequency on spore
traps, penicillium/
aspergillus spores 91% and
basidiospores 96%
frequency
Air entering elevator
shaft
Air/spores
Enter through first
floor
HVAC air enters
On 8th floor
HEPA filtered
? = what are the frequencies and concentrations
?
?
?
?
?
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Hypothesis
• There is a positive correlation between the number of Penicillium/Aspergillus-like spores, cladosporium, ascospores, basidiospores in spores/m3 found in the hoistway vent of an elevator shaft and the levels of the same spores, sampled near simultaneously and near the outdoor intake of the elevator shaft.
• There is a positive correlation between the number of Penicillium/Aspergillus-like spores, cladosporium, ascospores, basidiospores in spores/m3 found in the hoistway vent of an elevator shaft and the levels of the same spores, sampled near simultaneously in elevator lobbies of the study location.
Hypothesis
• There is a positive correlation between the number of Penicillium/Aspergillus-like spores, cladosporium, ascospores, basidiospores in spores/m3 found in the 5th floor elevator lobby and the levels of the same spores, sampled in the 5th floor surgery recovery area collected on the same day within the same time frame.
Hypothesis
• Compare hoistway vent to outdoor environment for 0.3, 0.5, 1.0, 2.5, 5.0, 10.0 µm particle concentrations.
• Are the two areas similar or different?
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Hypothesis
• There is a positive correlation between the concentration of particles at 0.3 um, 0.5 um, 1.0 um, 2.5 um, 5.0 um, 10.0 um sizes air found in the hoistway vent of an elevator shaft and the levels of the same collection of particles found in
the elevator lobbies and other sampling locations.
Specific Aims
Aim 1: To determine if external Penicillium/Aspergillus-like spores are entering
the healthcare facility via the elevator shaft and hoistway vents.
Aim 2: To determine levels of Penicillium/Aspergillus-like spores outdoors, in
the elevator shafts, and indoors in areas possibly affected by elevator shaft air.
Aim 3: To determine if Aspergillus spores (niger, flavus, fumigatus, terreus,
versicolor) identified indoors are the same as spores found outside the healthcare facility.
Aim 4: To determine if there is a direct correlation between Aspergillus
spores/m3 of air, species occurrence and particle counts for the locations
sampled.
Aim 5: To obtain air velocity in the elevator shaft during controlled situations and calculate air flows to provide additional data that addresses the
• Ascospores and basidiospores did not provide enough positive samples inside the building to be useful as a tracer during this study.
• Particle count correlations supported the hypothesis between outside and the hoistway and other floors to hoistway comparisons.
• Relative humidity inside the duct decreased from 49.3 to 37.8 following the damper installation.
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Conclusions (continued)
• Hospital areas studied were clean in relation to the outside Aspergillus species levels, particle levels and other mold spores collected
• The use of Penicillium/Aspergillus-like and Cladosporium(>5.0 um) spores and particle counts were the most effective measures for evaluating the indoor quality compared to outside levels.
• A significant correlation existed between parameters for the environment outside and inside the hoistway.
Conclusions (continued)
• Consider elevator shafts as potential spore sources.
• Evaluate and understand how the air flows through the shafts and into the buildings. The findings may prompt consideration of retrofits of similar dampers.
• Design criteria should be updated for future hospital buildings.
• The new criteria should include consideration for protecting the elevator shaft from exterior air utilizing a damper similar to the one in this study, or alternate solutions achieving the same results.
• Sharing this information with building code organizations in future comment sessions when updating elevator and building ventilation code sections may be helpful. No existing recommendations or building code requirements specifically address this issue.
QUESTIONS / COMMENTS
Matthew L. Berkheiser, DrPH, CIH, CSPExecutive Director & Chief Safety Officer