2003 Issue No. 1     Inside: • Construction Related Nosocomial Infections • Changes to the Contaminated Sites Regulation • Insurance Exclusions • Staff Updates & News • Staff in the News • PHH Foundation Updates • Training Course Schedule Construction Related Nosocomial Infections by Jim Bagley MCIOB Mould contamination in hospitals (and indeed many other buildings) is ubiquitous, but often hidden from view in cavities, crawlspaces, voids and behind building finishes. Even relatively minor construction work has the potential for releasing dust and mould spores. Exposure to mould spores can present a serious health risk to susceptible patients and healthcare workers, and cause a wide range of non-specific irritant or allergic symptoms. Health Canada finalized guidelines in July 2001 (Construction-related Nosocomial Infections in Patients in Health Care Facilities) to "assist in developing policies, procedures and evaluative mechanisms to ensure an optimal level of care." These guidelines are currently being considered by the Canadian Standards Association (CSA) as the basis for a Canadian Standard which is expected to be produced in the next 18-24 months. A copy of these guidelines can be viewed from Health Canada's website at http://www.hc-sc.gc.ca/pphb-dgspsp/publicat/ccdr-rmtc/01pdf/27s2e.pdf. Mould contamination differs from other environmental pollutants in that, for most chemical pollutants there are well-established "safe" and "unsafe" airborne concentrations (often known as "threshold limit values" or "exposure limits"). Individual tendency to experience adverse health effects when exposed to moulds is highly variable. Some individuals would appear to be able to tolerate high concentrations of airborne fungal spores and fragments with no immediate noticeable adverse health effects (brewery workers and bakers for example are routinely exposed to very high yeast concentrations) whilst others are extremely sensitive to mould and other airborne biological particulate exposures. Construction projects and repair activities undertaken without consideration to mould contamination can be fatal to patients with weakened immune systems. Health Canada statistics show fatalities resulting from what at first sight might seem the most innocuous of circumstances. Repairs to a false ceiling due to a water leak in a store room housing intravenous supplies (i.e., not a patient care area) resulted in primary cutaneous aspergillosis and were cited as the cause of death to two leukemic children. Excavation work outside the hospital caused the death of five patients on a hematology unit and the demolition of false ceilings and ducts caused aspergillosis in 22 patients, 18 of whom died. The vulnerability of some patients including transplantees, those receiving chemotherapy, and premature infants necessitates great care and consideration when carrying out any construction and repair activity in Hospitals. Health Canada recommends that activities as simple as preparing walls for painting, removal of floor coverings and minor duct work or electrical work above ceilings in all patient areas should not be carried out without erecting impermeable dust barriers and maintaining the work area under negative pressure. Health Canada recommends that a risk assessment be carried out as a proactive measure to decrease the occurrence of construction-related infections. Preventive measures should be clearly outlined in the contract documents before any construction or renovation project is started. A multidisciplinary team is required to ensure that effective preventive measures are implemented. This team includes architects, engineers, infection control professionals (ICP) and health and safety professionals. PHH Environmental has already presented on this issue at a meeting of the Healthcare Safety Professionals Association of BC and we will also be presenting at the Canadian Healthcare Engineering Society on June 2 & 3, 2003. We proposed convening a panel discussion in Fall 2003 focussing on: Mould Ecology, Mould in Hospitals, Environmental Standards and Guidelines Workplace Health and Safety Regulations Nosocomial Infections and other Health Effects — Health Canada's Perspective Practical Implications of Rigorous Containment Procedures Delivering and Co-ordinating Safe Working Practices for Staff, Contractors and Patients Anyone seeking further information on this issue or wishing to with participate in the panel discussion should contact Jim Bagley at 250-499-0090 or jbagley@phhenv.com. Jim Bagley, M.C.I.O.B. Project Manager Jim Bagley is a Project Manager in our Kelowna office and has been employed with PHH since 1997. He is a Member of the Chartered Institute of Building. Jim undertakes environmental assessments, conducts hazardous building material surveys and assessments, conducts industrial hygiene related evaluations, and performs project management duties with respect to all these services.