1. Challenges & Strategies During Healthcare Construction - Environmental Risk Assessments

2. 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

3. 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

4. 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

5. UNIQUE CHALLENGES OF THE HEALTHCARE ENVIRONMENT

6. 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

7. Challenges of the Healthcare Environment
Maintain Operations and Occupancy
Lead-Lined Walls in Radiation Areas
Additional Contaminants to Control
Bacteria
Radiation
ISO Standard – Cleanrooms and Associated Controlled Environments
Provides stringent classification levels and specifications of air cleanliness specific to cleanroom environments

8. CONSTRUCTION PROJECT STRATEGY

9. 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

10. 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

11. ENVIRONMENTAL RISK ASSESSMENTS

12. Hazardous Materials Assessments
Identify and inventory hazardous materials to mitigate risk and liability for renovation related conditions
Asbestos
Mold
Lead
PCB’s
Mercury
Fuel

13. 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

14. 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

15. 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

16. Indoor Air Quality Evaluation & Monitoring
Proactive Evaluation
Document Air Quality
Maintain Healthy Indoor Environments
Reduce Liability
Optimize Building Operations
HVAC System Inspection
Air Sampling

17. 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

18. 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

19. MOLD AWARENESS

20. 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

21. 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

22. 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)

23. 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

24. 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.

25. Water Loss Mitigation
Environmental Consultant performs an initial assessment and reviews environmental conditions
Remediation Contractor begins emergency response work to contain loss

26. 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

27. 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)

28. 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)

29. 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

30. ASBESTOS AWARENESS

31. Pre-Abatement Plan Sequence and Schedule
Prepare and issue abatement specifications and sketches
Select qualified abatement contractor
File with all applicable regulatory agencies
Pre-Abatement preparation

32. Abatement Filings The Filing Process takes approximately 2-3 weeks
Environmental Protection Agency (EPA)
State Department of Health and Department of Labor (DOH &DOL)
State Environmental Protection Agency
State Department of Community Affairs (DCA)
Local Municipalities

33. Notifications
Signs
Demarcation of work areas

34. Air Monitoring
Area Sampling
High Volume Pumps

35. Protection From Exposure-PPE
Asbestos Awareness
Protection From Exposure-PPE
Disposable Suits
Disposable Footwear
Disposable Gloves
© Hillmann Institute of Training

36. The Abatement Process Pre-Commencement Inspection Start of abatement
Tracking of waste
1st, 2nd & 3rd Cleaning Inspections
Final Aggressive Air Clearance Sampling
Break-down of containment

37. LEAD AWARENESS

38. Lead Paint Hazards Peeling or Chipping Paint Alligatoring Chalking
Paint on a Deteriorating Subsurface
Impact or Friction Surfaces
Blistering Paint
Water Damaged Surfaces 38

39. 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 39

40. 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
Describe lead hazards again- 2 slides back
show checklist again-fill out entirely for classroom
mention hallways, closets, bathrooms, common areas, etc.
kitchen cabinets not closing, doors unsquare, stuck windows 40

41. Exposure Monitoring Wipe Samples Air Samples Assessment Clearance
Area Samples
Personal Samples
Packet of sweet n low - Show Visual Aids
100 floor
500 sill
800 well
areas should be well less than 30
work areas less than 50
action level is 30
often less than 2 in “clean areas” 41

42. Correcting LBP Hazards
Wet Scraping
Wet Sanding
No Mechanical Equipment
Chemical Stripping
No Methylene Chloride Permitted
Additional PPE Required
Additional Disposal Fees
Odor Complaints
Mention enclosure and encapsulation.
Pull out equip. and demonstrate 42

43. 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
Clean-up must be thorough/detergent/HEPA
Visual verifies no loose paint,dust or related work debris
Final - Plastic removed all surfaces HEPA and wipe
Summarize sequence of activities 43

44. Determining Effectiveness
Collect Clearance Wipe Samples
Continued Quality Maintenance
Maintenance of Documentation
HECO will do
PB still remains..continued maint.
Records prove it was done...If it aint written...It aint been done!! 44

45. Question & Answer