By Shari L. Solomon

Healthcare settings are sensitive environments that house immunocompromised patients. Maintaining proper indoor air quality (IAQ) is vital to protecting patients with weakened immune systems who can develop infections after inhaling mold spores or having direct contact with mold.

During normal operations, building systems that function properly assist in the prevention of indoor mold growth, but they can be challenged during instances where water damage and high relative humidity occurs, or when renovations are conducted and building materials are disturbed. Immunocompromised patients can develop invasive mold infections days to weeks after exposure to indoor mold that grows as a result of water damage.

These infections typically are caused by Aspergillus molds, according to the Centers for Disease Control and Prevention (CDC), but they also can result from other types of mold, such as mucoromycetes. They can be difficult to diagnose and often are life-threatening. Aspergillus, the mold that causes Aspergillosis, is common indoors and outdoors.

But for immunocompromised patients, inhaling Aspergillus spores can cause an infection in the lungs or sinuses that can spread to other parts of the body. So preventive maintenance and quick response to water intrusion in healthcare settings is critical.

Assessing risks 

Healthcare facility managers need to take the necessary precautions to prevent patients from acquiring fungal infections. These precautions include increasing air filtration, directing air flow to reduce the chance of patient exposure, repairing water leaks promptly, and reducing dust during construction, according to the CDC.

One effective tool for risk management when addressing mold growth or water damage events is an operations and maintenance (O&M) plan for moisture and mold control. An O&M plan provides facility managers and their maintenance staff with guidelines for preventing, recognizing, and mitigating water intrusion events and subsequent mold growth on water-damaged building materials.

The plan establishes guidelines for responsibility, communications, documentation, training, and protocols essential to controlling moisture and protecting the facility and its occupants. Policies and procedures of the plan must be in accordance with the currently accepted governmental and industrial guidelines for mitigation of water intrusion and remediation of mold as dictated by all construction projects under the facility’s infection control risk assessment policy. 

Preventive maintenance is the most effective way to mitigate mold growth and moisture intrusion. Performing routine inspections of building exteriors to ensure intact roofing, sealed windows, and proper drainage can prevent structural leaks. Technicians also should routinely inspect utilities and appliances throughout the building to identify leaking pipes, faulty appliances, or running toilets that could cause water damage.

Technicians also need to inspect the facility’s HVAC system and perform routine maintenance. If filters are not changed or supply outtakes are contaminated, the HVAC system can become burdened and fail to function as designed. Proper ventilation and dehumidification are imperative to ensure proper IAQ and indoor conditions that prevent mold growth.

Inspection insights

The documentation resources contained in an O&M plan for moisture and mold control often include checklists for routine inspections and templates for work orders and communicating with patients and staff. Notably referenced in the CDC’s Guidelines for Environmental Infection Control in Health-Care Facilities, routine air sampling for mold is not recommended as a preventive measure, due to the variability and lack of standards.

The CDC also notes that air sampling in healthcare facilities might be conducted during periods of construction and periodically to determine IAQ, the efficacy of dust-control measures, and air-handling system performance via parametric monitoring.

The most important assessment tool remains a visual inspection of the impacted area to identify potential visible growth. Routine inspections cover building exteriors, drainage, plumbing, and HVAC systems in detail to ensure they are in good working order. Each checklist provides specific criteria to be thoroughly examined during walkthroughs of the building and components that need to be routinely addressed. Documentation templates also standardize the information needed for work orders and mitigate liability when communicating with patients and staff. 

Handling trouble

Every facility eventually will receive a complaint about building utilities or the indoor environment. The way managers respond to complaints can have legal ramifications and effects on patient relations. It might be the facilities department that is first to respond to mold growth or moisture intrusion, but managers also should consider consulting outside mold assessors, industrial hygienists, and health and safety professionals.

The initial investigation should include identifying the source of water intrusion, assessing the extent of the damage, and delegating who will perform any subsequent remediation. First responders must have the training and skill sets to perform the assessment. It is helpful to standardize these assessments using checklists and proper documentation to ensure a thorough inspection of all affected building systems. Managers can prepare for such events by creating operational policies and procedures to address mold growth, utility failures, and water damage.

Facilities that have an O&M plan developed by a mold professional can respond more efficiently to water damage events and signs of mold growth or moisture intrusion. If outside expertise is needed, it is beneficial to have two certified professionals listed in the O&M plan to perform the mold inspection and remediation. Mold professionals also can assist facilities with other environmental concerns surrounding IAQ, asbestos-containing building materials, lead-based paint, and environmental cleaning.   

While different roles need to work in unison to keep a facility running smoothly, it is ultimately the responsibility of the facilities department, along with the infection prevention team, to oversee routine maintenance, repairs, and custodial activities, as well as to train staff on operational procedures and policies concerning mold growth and moisture intrusion.

An O&M plan puts all the policies and procedures necessary for addressing these components in a written format that all staff can easily access. Facility operations run most effectively when an O&M plan to prevent and respond to mold growth and water intrusion is in place. Benjamin Franklin’s observation, “An ounce of prevention is worth a pound of cure,” holds true in the world of mold and moisture prevention.

Shari L. Solomon, Esq., is president and founder of CleanHealth Environmental, LLC. CleanHealth provides infection prevention and industrial hygiene training and consulting services geared toward facility personnel and vendors responsible for infection prevention, cleaning and disinfection, and facility operations and maintenance practices. Solomon possesses more than 20 years of environmental consulting and federal regulatory experience. An attorney by trade, combined with her experience in the industrial hygiene field with a focus on healthcare, Solomon has expertise and an understanding of liability prevention techniques, offering clients practical and valuable risk management solutions.