A strategy for mold clean-up and control
in a contaminated hospital

Prepared by: w. Curtis White, Director of R and D and
Mark Kuehl, Chief Operations Engineer
Aegis Environmental Management, Midland, MI USA

INTRODUCTION

The following thoughts cover the basic approach to dealing with a visibly mold contaminated hospital.  It covers the needed steps for the   analysis of the problem, the clean up of contaminated surfaces, the removal of spores, the containment of unreachable contamination, and the value of the Aegis Microbe Treatment as a preventative protective treatment for the cleaned surfaces.

Attacking problem mold in medical facilities requires that there are clear short and long-term strategies for the control of the moisture/water intrusion and how they relate to mold/mildew problems.  The moisture control always takes a significant amount of time.  This means that the mold will not be under control even if aggressive cleaning has been done.  Therefore, to occupy the hospital with minimal risk of mold exposure in the varied and high-risk service areas, the ĘGIS Microbe Shield Treatment is the only viable answer.  This is the exact problem that was faced at the Ohio State University Cancer Hospital after their flood and more recently at a dormitory and classroom building at a University in Washington D. C.  In the case of the DC University they wanted to use a damaged leaky building for one more year.  After surface cleaning and ĘGIS Treatment the building was used for four years without any microbial problems in the treated areas.  It was then decommissioned. 

The consequences of not doing a good job of cleaning, containment, and protective treatments is continuing problems with the operating systems, deterioration of materials of construction and furnishings, and exposure to microbial contaminants that affect the morbidity and mortality of staff and patients.

ANALYSIS

Air and surface samples should be taken to determine the types of molds present, the mix of types of fungi isolated, and the dominant species.  Testing should be done associated with problem areas, non-problem areas, outdoors (ground, air intake, and roof levels), and specific service areas of the hospital and/or air handler service areas and supply air.

In the case of most hospitals such testing helps establish clearance criteria but also should identify the presence of any pathogenic or toxigenic species.

Using hospital personnel and records and doing a walk-through with building and mold/mildew experts, areas of the hospital should be identified where water events have occurred, where structural elements allow water or condensation problems, where the operating systems (AC, air flow and turn-over rates, air circulation, filtration, system cleanliness and integrity, etc.) have water, dirt, or operating problems, and where furnishings and equipment are water or mold damaged.  From a preventative treatment point of view a good listing of the at-risk areas of the hospital should also be made.  A chart should then be made up defining actions appropriate for the problems found (tear out, clean, treat, etc.).

If available, an infrared scan of the building should be done to identify existing and historical water problems.

The hospital should use this to establish the scope of work for the repairs, clean up, and treatments needed on the project.

CLEAN UP

In the case of high levels of visible contamination, clean up needs to be done in a fashion most like the clean up of asbestos.  This includes worker protection, isolation, and bag-in bag-out of contaminated materials

Because, in a large facility, you can not do all of the clean up, repair, and treatment at one time it is advised to broadcast fog ĘGIS in all areas of the hospital including the above ceiling spaces and the duct systems.  This and efforts to maintain air circulation and lowering of humidity is essential to stop the further growth and proliferation of the fungus.  Two major consequences of not doing this are the further deterioration of contaminated materials and the growth of the fungus into hard to get at places. These problems and others are accelerated and magnified by the lack of occupancy and minimal housekeeping and maintenance.

For the clean up it is essential to clean all of the surfaces checking in drawers, under tables, and in all odd places.  Cleaning should be facilitated with a light surfactant mix to scour up the spores.  This is a tactic used for asbestos and works well for spores.  Soft goods need to be vacuumed with a HEPA filtered vacuum and light detergent spray.  The cleaning is best done with disposable one-use wipes to minimize any risks of cross contamination.  Once used these should be bagged for removal and burned or sent to land fill.

Depending on the testing and other determinations relating to the moisture problems, it might be called for to do serious desiccant or more standard refrigeration moisture removal.

CONTAINMENT

In almost every building there are areas where the mold is growing and spores are latent.  These areas cannot be reached for cleaning without tearing out walls, moving installed cabinets, or other destruction.  This is not needed except where the materials of construction have lost their integrity and usefulness.  What is needed is a good survey of where the at-risk places are and then implementation of sealing up such areas.  This can require the sealing with silicone caulk of wall cracks, the sealing of wall plug outlets with caulk or closed cell foam-in-place urethane foam like what is used for insulation.  If inner wall contamination is found or expected all wall penetrations need to be sealed.  Pipe and electrical chases need to be cleaned and treated with the ĘGIS Treatment and all penetrations to the occupied space need to be sealed.  The floor-to-floor penetrations need to be sealed with fire stop and other appropriate sealants.  The blow in place fire stop insulation needs to be carefully checked for contamination and sealed with a properly fire rated sealant.

TREATMENT

Treating with the ĘGIS Microbe Shield Treatment is essential and should be done in accordance with the Aegis Environments training manual and with ĘGIS qualified material.  In visibly contaminated areas using the ĘGIS before the cleaning as a broadcast fog is recommended.  After cleaning all surfaces and equipment should be treated.  All efforts to assure air movement and drying of the treatment should be done.

CONTINGENCY PLAN

Because of the containment strategy and the fact that everything will not be perfect, it is important to work with the housekeeping people, the maintenance people, the infection control people, and the management to set up cautions and re-treatment protocols for future construction activities, water events, and or as a response to sample results that indicate contamination.  This coupled with thorough clearance testing after the clean up and ĘGIS treatment will assure ongoing control of the mold and mildew while the water intrusion and relative humidity problems are being addressed and the building moves to occupancy. 

SUMMARY

Act now!!!  To delay is to set up conditions that are increasingly difficult to deal with.

Here in the USA, Canada, and Europe where we have experience with contaminated 9-12 story facilities such a problem is solved at a cost of 1.5 to 3.0 million dollars US and can take up to three months plus the costs associated with repairs and upgrades to the building and the operating systems.