IAQ/Mold Solutions for Healthcare Facilities

A Florida hospital believes in proactively—that is, in acting to shape circumstances before circumstances end up dictating the actions.

That approach extends to their management of indoor air quality. About three years ago, the Florida hospital reacted to air quality concerns by recruiting expertise, in the form of Pure Air Control Services, Inc. "It's a big issue these days," hospital Director of Engineering said of indoor air quality. "Our approach has been, instead of waiting until we have a problem, of going out and making sure our equipment works well—to avoid problems."

SOLUTIONS-ORIENTED:

Pure Air Control Services is a "medically disciplined, solution-oriented indoor environmental service company" with headquarters in Clearwater, Florida and branches in Atlanta, GA, Houston, TX, West Palm Beach, FL, and Washington, DC. The Director of Engineering with the hospital considers Pure Air Control Service's staff first-rate, and adds: "They've done very well when it comes to responding to our needs."

Overall, Pure Air Control Services begins with inspections, followed by air quality diagnosis. Then its laboratory analyzes levels of mold, fungi, airborne chemicals or other contaminants. If contaminants are found, mitigation procedures are recommended. "Remediation" steps such as HVAC mitigation, replacing insulation or application of an anti-microbial agent come next. Pure Air Control Services then continues to monitor the situation and report to the client.

At the hospital, marginal counts of molds, fungi and particulates turned up occasionally. While these counts were "not dramatic," the facilities management added that Pure Air Control Services and their building sciences team "can tell when you get into areas where action is needed. They make recommendations, and we OK them."

The hospital project posed unique challenges. One is the area's humid climate. Another is the variety of special ventilation needs—and not just the low temperature requirements of computer rooms. Patients particularly susceptible to infection need rooms with positive pressure, essentially an outflow of air that prevents outside air from being "pulled in" to the patient's room and increasing the risk of infection.
Patients with medical conditions that could infect others often need rooms with negative pressure, which draws in clean air.

There's more. Surgical suites, cardiovascular suites and other specialize in hospital operations have particular ventilation needs.

POTENTIAL OUTCOMES:

What benefits might justify an air-quality project on this scale? Speaking of clients in general, Pure Air President and CEO Alan L. Wozniak lists these potential outcomes:

• Reduced absenteeism. In "worst case buildings" the improvement has been as great as 80 percent.
• Reduced workers compensation claims, as much as 40 percent in at least one case.
• Reduced medical costs.
• Fewer union grievances.
• Improved productivity and morale. "If people see you're doing something to help the environment," Wozniak said, "they're going to help the employer."
• Fewer lawsuits. Wozniak expects indoor air quality lawsuits to become more common.
• Energy conservation - up to 30 percent.
• Improved maintenance efficiency.
• Overall, a 20 percent annual payback on the investment in indoor air quality.

After remediation that deals with biological, allergic or chemical issues, air quality improvement typically is in the 80-90 percent range.

When a building's air quality comes under assault, often the real issue is unclear at first. Other causes might be involved or perhaps psychosomatic symptoms. Regardless, Wozniak says Pure Air Control Services multi-disciplinary approach will pinpoint whether the quality of indoor air deserves the blame.

The company's diagnostic skills, medical skills, and availability of its own lab are key elements. "We look at indoor air quality from the standpoint of all the issues," he said. "We sample things other people wouldn't dream of sampling. We get to the root of the problem if there is one."

While most laboratories need from one to two months, the Environmental Diagnostics Laboratory (www.EDLab.org), Pure Air Control Services internal lab can turn work around in days. "Our clients like that," Dr. Rajiv Sahay, Director of Laboratory Services said. When addressing air quality problems, it's generally not enough to simply increase the efficiency of a building's air filtration— even, say, from 15-20 percent to 80 percent.

Changing filtration efficiency alone doesn't necessarily change the problem. In extreme cases, buildings can accumulate up to an inch of dust in their ventilation systems. Fungi as large as mushrooms have turned up, thriving amid warm, moist conditions.

And to be brief, pigeons can leave their mark. Environmentally clean the system out, Wozniak said, and then proper filtration can do its job.
 Another, more recent event, is probably the best-known source of air quality concern: In 1976, more than 30 people died after an outbreak of what later became known as Legionnaires' disease. The common bacterium that caused the epidemic, Legionella pneumophila, was traced to bacteria in the cooling towers that circulated in the building that housed Legion members.

ONE OUT OF THREE:

The U.S. Environmental Protection Agency estimates that one of every three buildings in this country has major air-quality issues. And while that doesn't necessarily mean another outbreak like the one in Philadelphia is on the way, it underscores why IEQ issues are receiving more and more attention.

As the Legionnaires' disease epidemic demonstrated, Wozniak said, poor air quality has the potential to put people's lives at risk. "A lot of these issues are psychosomatic," he added, and paused: "And a lot of them are not." This is why it is imperative to develop baseline conditions to know where you are, where you want to be and where you may want to go with IEQ. Yogi Berra put it quit succinctly "if you don't know where you are going, you probably won’t get there."

The air we breathe may present the ultimate example of deceptive appearances. Apart from Los Angeles and a few other areas notorious for smog, the air we breathe usually looks like it's clean. The truth, as set forth by Dr. Rajiv Sahay, goes more like this: "The Environmental Protection Agency has postulated that in buildings with limited outdoor air makeup capacity i.e., limited ventilation, the indoor air maybe as much as 10 times more contaminated as the building's associated outdoor air."

"The indoor air contains a collection of contaminants. Biological contaminants include microbial agents...fungi (mold and yeasts), bacteria, viruses, protozoa, algae, and parasites (mites)."

"Nonmicrobial, biological allergens include insects, rodents, dander, feces, etc. Chemical agents of biological origin include carbon dioxide, volatile organic compounds..., and toxins."

IEQ STANDARDS:

While IEQ standards are years away, Wozniak says, the U.S. Occupational Safety and Hazard Administration are working on indoor air quality standards. IEQ, as it is known, continues to grow in prominence on the national health and regulatory agendas. Many states are developing their very own standards for toxic mold constituents. As of present there are over 64 state initiated toxic mold bills have sprung up.

Development of air quality standards is one reason many hospitals and other proactive companies are going to work on IEQ now.

"The worst thing we can do as facilities managers is to take the 'ostrich approach,”‘declares Skip Camp. He is director of facilities management for another Pure Air client, the Board of County Commissioners in Collier County, Florida. "IEQ won't go away," Camp added, "unless we address it."

 ANCIENT ORIGINS:

This is not an entirely new idea. The biblical book of Leviticus is a clear, if unlikely, source of remediation technique.

The passage includes: "He (a priest) shall examine the disease; if the disease is in the walls of the house with greenish or reddish spots, and if it appears to be deeper than the surface, the priest shall go outside to the door of the house and shut up the house seven days. The priest shall come again on the seventh day and make an inspection; if the disease has spread in the walls of the house, the priest shall command that the stones in which the disease appears to be taken out and thrown into an unclean place outside the city. He shall have the inside of the house scraped thoroughly, and the plaster that is scraped off shall be dumped in an unclean place outside the city ..."

Wozniak's own, more current professional advice echoes the Director of Engineering comments on proactively at the hospital. "Form an indoor environmental quality committee," Wozniak suggested, "a proactive, IEQ building program. Get employees on an IEQ committee. Don't hide (the issue), or put it on a shelf. It just makes sense to be proactive, to communicate openly... because these issues may be real."
The number one indoor environmental quality culprit across the country, Wozniak added, is "deferred maintenance."

Does it all work? The hospital Director of Engineering is clear and brief: "It's been well worth it."

For more information on Proactive IEQ Solutions, contact:

Ed Ziegler, VP Business Development
Pure Air Control Services
(800) 422-7873, ext. 804
awozniak@pureaircontrols.com