MISSISSIPPI HOSPITAL ASSOCIATION 15 NOVEMBER 2012

UNDERSTANDING THE DISASTER STAKEHOLDERS TYPES OF WATER INTRUSIONS CATEGORIES OF WATER MITIGATION RESTORATION/REMEDIATION PREPARATION LESSONS LEARNED

Earthquake: Sylmar, California.

Tornado: Joplin, Missouri.

Hurricane Katrina: New Orleans, Louisiana.

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

MISSISSIPPI HOSPITAL ASSOCIATION 15 NOVEMBER 2012

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

JACOB COLSON Principal/Catastrophe Response

Director SRP Environmental LLC 808.520.1062 colson@srpenvironmental.net JEFF GORDON Lead Project Manager LMS Restoration, Inc. 903.436.4059 jeff@lmsrestoration.com