There is a current shift in practice when it comes to providing transparent reporting in the healthcare space. Reports are being utilized by both government entities (Medicare/Medicaid) and patients for reimbursement purposes and to determine where they will receive their care. The world is becoming more data driven. Access to data points, being disseminated by third party entities, affects the bottom line of your facility. Today, the data is heavily focused on the clinical aspect of facilities and systems. However, a holistic approach to the maintaining a “healthy” facility should include all aspects; services provided, level of care, and, building services. There should be a focus on “preventative medicine” for a facility’s brick and mortar components, mechanical workings, and general conditions.
A common example is the HVAC system that provides thermal comfort and ideal indoor air quality to your facility. These systems affect every person that walks in the door whether they are a patient or not. Neglect of your HVAC system can create significant issues that can resonate throughout the patient care spectrum.
A reoccurring issue that Rolyn has addressed is mold growth in air handlers, or air handling units (AHU). The level of severity has ranged from almost benign to extreme cases where the growth has taken over the components and ruined their functionality. But mostly, the level of growth is extreme due to prolonged neglect of a preventative maintenance program.
The easiest thing to do at this stage is to point fingers amongst responsible parties; this however, does not get you any closer to rectifying the situation. These scenarios are rarely simple and most likely involve AHUs that serve critical spaces and patient populations. So what do you do when you find an AHU that serves a transplant operating room (OR) that has patients highly susceptible to infection? What information do you have? What information needs to be shared, and with whom?
In our experience, fact gathering prior to notification is worth its weight in gold. For example, let’s take unit serving the OR’s. First, an Industrial Hygienist (IH) should be consulted to provide a report and scope of work to ensure proper remediation. The hygienist should also do some indoor air quality testing (IAQ) downstream to ensure that the filters are performing as they should. Indoor mold levels should lower in comparison to outside readings. Mold remediation should take place as soon as possible. If circumstances dictate that the HVAC unit is inaccessible for an extended amount of time; routine (weekly) downstream testing should be implemented.
Typically an IH’s scope of work calls for specific containment measures and HEPA filtration requirements in the limited space of a mechanical room. You must enlist an experienced, resourceful, and inventive remediation contractor to ensure that the infection prevention standards are met and maintained. The remediation contractor and IH should be independent of each other. The mold remediation itself will likely be the most expedient part of the process. It should include not only a form of mechanical cleaning but also a removal and replacement of interior insulation components. Finally, all filters in the loop should be replaced so clearance testing can take place.
Such scenarios are easily corrected if they are approached in an appropriate manner and mitigated fully. Overlooking a mold problem may jeopardize your patient population and put you in legal cross hairs, as the responsible party for neglect. For healthy facilities, always adopt a proactive, as opposed to, a reactive ideology.