(6) Healthcare and Operational Issues in Relation to Mold Problems (Bpkj)

8/14/2019 (6) Healthcare and Operational Issues in Relation to Mold Problems (Bpkj)

1/65


2/65

Contents

1. Importance of Indoor Air Quality

2. Health Related IAQ Problems

3. Fungal Biology

4. Effects to Human Health5. Moisture Sources and Problems

6. Sources of Building Humidity and Dehumidification Load

7. Key Variables to Consider for Fungal Remediation

8. Case Study Health Facilities

9. References

2esd_conference2011_kak


3/65

For prevention of cross-contamination, reduction

and controlling infection to occupants

For the promotion of comfort

A factor in patient recovery

In some instances, a major treatment

Indoor Air Quality (IAQ)

in Healthcare Facilities

Critical in healthcare environment/hospitals



4/65


5/65

Symptoms

Eye Irritation Mildest

Dry Throat

Rhinitis, Runny NoseHeadache

Fatigue

Sinus Congestion

Skin Irritation

Shortness of Breath

Cough

Dizziness & Nausea

Health Related IAQ Problems

Sick Building Syndrome (SBS)



6/65

Carbon dioxide, carbon monoxide,

formaldehyde and tobacco smoke.

Air temperature, air velocity, humidity.

Mites, virus, bacteria and spores.

Radon.

Health Related IAQ Problems

IAQ Parameters



7/65

The Key Factors That Influence The MetabolismAnd Survival Of Fungi/Mold

Temperature Spores NutrientType andConcentration

Water(Moisture)

Fungal iology


8/65

Time for Spore Germination UnderIdeal Conditions:

Aspergillus & Penicillium,

48 72 hours

Stachybotrys,

812 days

Fungal iology



9/65

Aspergillus niger

Fungal iology



10/65

Stachybotrys

Fungal iology



11/65


12/65


13/65


14/65


15/65


16/65

WeatherRain, fog and snow, enter the building structure through

roof and wall leaks

Outdoor intake louvers may entrain rain droplets or

snowflakes

Ground water

May seep into building through small cracks in basement

walls and floors

Leaking pipes and equipment

Leaking appliances, valves and pipes can wet large interioror concealed areas

Wet cleaning processes

Floor mopping and carpet shampooing

Liquid Water Sources



17/65

Evaporation from peopleOccupants produce water vapor at different rates, depending

upon their activity level via respiration (ASHRAE Handbook)

Vapor-pressure diffusion from outside

Water vapor moves through wall materials

Resulting moisture load is based on vapor pressure difference,

surface area and material.

Wet surfaces and processes

Planned, as from pools, aquariums and fountains

Unplanned, as from leaky pipes and dislocated condensationCooking

Occupants carry a significant amount of moisture into the building

on their shoes and clothing during raining days




18/65

Infiltration from outsideOutdoor and indoor airs exchange through little openings on

building envelope, and through large openings such as doors

and windows

Driven by mechanical ventilation, wind and stack effect

Introduction via ventilation airflow

VAC equipment draws in outdoor air for ventilation and to

replace indoor air removed by fans for exhaust and processes

Ventilation air contain considerable moisture, especially in

hot, humid climatesWater vapor in the ventilation air often represents the single

largest source of moisture in a building




19/65

Condensation

Condensate forms whenever moist air contacts a surface ata temperature below the dew point

If concrete beneath flooring is much cooler than room

temperature

Uninsulated or misinsulated supply ducts and chilled water

pipes above ceiling or inside unconditioned areas

In unconditioned equipment-room, uninsulated surfaces of

AHU, supply ducts, chillers, chilled water pipes, etc.


When moist air is cooled below its dewpoint (i.e. cooled to a temperature at which itcannot contain all the water originally present), and if the cooling is caused by

contact with a colder surface, the vapour changes to liquid droplets on that surface.

This phenomenon is called condensation.



20/65

Condensation Occurs

on the Surface When ACold Surface Contacts

Humid Air

Drink Can Phenomena



21/65


22/65


23/65

Key Variables to Consider for

Mold Remediation

Maintenance Focus

Identify total surface

area affected

Identify materials &furnishings affected

Propose cleanup

methods

Bring proper personalprotective equipment

Propose proper

containment methods

Engineering Focus

Locate source of the

moisture to eliminate the

mold agentsIdentify the root causes in

engineering aspects

Propose techniques to

ENSURE NO potential formold and fungal

reoccurrence



24/65

Case Study



25/65


26/65


27/65

GAMBAR-GAMBAR KEADAAN INFESTASI KULAT KLINIK AIR KEROH

Bil ik Pemeriksaan Mata:

Blackish mold is in germinating status.

Ruang Menunggu/Pendaftaran:

Outpatients crowd at waiting area. All air supply grills are spraying Mold sporesinto the hall.



28/65

Kl inik Warga Sejahtera

Mold is all over the walls and ceiling.

Bi lik Rawatan Pesakit luar:

Mold is obvious on walls, column and ceiling.



29/65

Bi l ik Pemeriksaan 7 (Aras Bawah)

Mold is in active grow stage. Musty odor persisted.

Bi l ik Pemeriksaan 5 & 8 (Aras Bawah)

ir is stagnant, but mold spreads all over ceiling. The Ceiling air return grill is heavily

contaminated. Patches of fluffy mold grows from behind wall paint and from cracks.



30/65

AHU of AIR-COND SYSTEM

System lacks control on temperature, air flow and humidity. The existing appearance

suggested a poor house keeping and maintenance practice.



31/65

Exam Room (PAP Smear), Poliklinik

Heavy colony of mold all over the wall & ceiling



32/65

Hospital Sultan Ismail, JB



33/65


34/65

Ventilation louvre with surface condensation

Hospital Umum Sarawak East Wing Ward



35/65

Lokasi Persampelan Kulat yang dikenalpasti

Pintu bilik kebal Cladosporium sp.

Bilik Mesyuarat Cladosporium sp.

In-house playground Confluent growth of non-sporulating fungi.

Bilik Temubual Confluent growth of non-sporulating fungi.

Depan Bilik Temubual Confluent growth of non-sporulating fungi.

Air handling Unit Farmasi Clasdosporium sp.,

Aspergillus niger

Penicillium sp.

Klinik Ayer Keroh: Type of Mold Identified



36/65

Purpose :

To asses problems and to identify root causes of moldinfestation and to enable decisions to be made onappropriate remediation and repairs, control measures, theprovision of information, and the necessity for airmonitoring as may be required to protect the health ofemployees and occupants who may be exposed to air

contaminants at the place of work.

Assessment of Indoor Air Quality

Case Study

Klinik Ayer Keroh



37/65


38/65


39/65

Identified Risks

Patients are exposed to high immunological risk

Physicians and administrative staffs are exposed inhazardous environment for long hours.

Medical equipment is contaminated.

Pharmacy medicine dispatching under pollutant

exposure environment. Technical speaking, evacuation necessary.

esd_conference2011_kak 39

Case Study


40/65

Recommendation

Immediate remediation of VAC

Clean up and decontamination Review the adequacy of VAC design,

upgrade, modify and improve

Rectify infiltration of moisture sources

Control, maintain, monitor and provide goodhousekeeping


Case Study


41/65

Location -- KUALA LUMPUR - MYS

{N 3 7'} {E 101 33'} {GMT +8.0 Hours}

Elevation -- 22m above sea level

Standard Pressure at Elevation -- 101061Pa

Data Source -- IWEC Data / WMO Station 486470 : Kuala Lumpur/Subang (2006)

- Monthly Statistics for Relative Humidity %

Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

Maximum 100 98 99 100 98 99 100 98 98 100 100 97

Day:Hour 29:07 23:07 3:05 6:09 4:17 28:08 17:02 2:08 9:17 7:03 18:02 24:05

Minimum 42 44 47 44 54 44 36 53 46 52 55 54

Day:Hour 7:17 7:14 2:14 20:14 1:14 24:17 3:17 11:14 2:17 23:14 17:14 16:14

- Monthly Statistics for Dry Bulb temperatures C


Maximum 33.3 33.5 34.8 34.7 34.0 5.0 35.8 33.3 34.0 34.0 33.0 33.0

Day:Hour 18:14 11:14 31:17 20:17 1:14 28:17 6:17 30:14 8:14 6:17 6:14 1:14

Minimum 21.0 22.8 23.0 20.9 23.0 22.2 22.8 22.7 22.9 22.0 22.6 21.9

Day:Hour 7:08 22:05 24:08 6:11 19:08 29:08 11:08 27:0812:08 18:07 7:05 31:05

Daily Avg 26.9 27.0 27.4 27.6 27.6 27.9 27.3 27.1 27.2 26.7 26.7 26.4

- Maximum Dry Bulb temperature of 35.8C on Jul 6

- Minimum Dry Bulb temperature of 20.9C on Apr 6

- Monthly Statistics for Dew Point temperatures C


Maximum 25.6 25.9 26.5 25.6 26.6 26.0 26.1 28.8 25.0 26.0 25.7 29.9

Day:Hour 14:17 9:17 1:23 23:17 2:11 17:13 13:20 7:17 10:11 6:18 26:20 31:14

Minimum 17.2 19.4 20.9 20.2 21.3 20.0 15.0 20.9 20.3 21.4 21.5 20.7

Day:Hour 7:11 5:16 28:14 19:14 11:17 18:20 3:17 1:20 17:05 23:14 6:11 31:10

Daily Avg 23.1 23.0 24.2 23.6 24.0 23.7 23.8 23.7 23.2 23.6 23.5 23.1

- Maximum Dew Point temperature of 29.9C on Dec 31

- Minimum Dew Point temperature of 15.0C on Jul 3

41


42/65

Klinik Ayer Keroh: Temperature and RH% Data

Jadual 1: Suhu dan kelembapan relatif di kawasan

kaunter utama semasa pendingin udara beroperasi

Jadual 1

Jadual 3

Jadual 2


kaunter utama beberapa ketika setelah pendingin

udara dihentikan


kaunter utama beberapa ketika sebelum pendingin

udara dihidupkan

42

Lokasi: Aras 1 Masa: 1.00 pm

Suhu Purata %RHTRM (C) TSUR (C) TDP (C) RHRM

Depan Farmasi 19.72 15.5 13.6 69.4

Depan Lif 19.66 15.7 14.9 75.7

Bilik rekod 22.2 18.6 15.5 63.6

Bilik perancang

keluarga

21.5 15.4 13.5 59.8

Purata Suhu / Kelembapan di Luar bangunan: 28

C / 85%

Lokasi: Aras 1 Masa: 5.45 pm

Suhu Purata %RHTRM (C) TSUR (C) TDP (C) RHRM

Depan Farmasi 26 13.16 21.3 76.8

Depan Lif 26 12.06 20.6 73

Bilik rekod 24.26 14.34 19 74

Bilik perancang

keluarga

25 14.5 19.8 74

Purata Suhu / Kelembapan di Luar bangunan: 28C / 86%

Lokasi: Aras 1 Masa: 7.20 am

Suhu Purata %RH

TRM (C) TSUR (C) TDP (C) RHRM

Depan Farmasi 23.8 20.3 22.7 95

Depan Lif 23 20.3 22.9 99

Bilik rekod 24 19.8 22.5 92

Bilik perancang

keluarga

24 16.8 21.3 86

Purata Suhu / Kelembapan di Luar bangunan: 23C / 100%

42


43/65


44/65


45/65

Monthly Temperature Data For Ruang Menunggu Farmasi KK Ayer Keroh


46/65

Monthly % RH Data For Ruang Menunggu Farmasi KK Ayer Keroh


47/65


48/65

Example of Applicable Strategies

for Condensation/Mold Prevention

48


49/65


50/65

Desiccant Wheel Dehumidification



51/65

Building Enclosure for Humid Climate -

Wall Analysis



52/65

Wall Construction Type



53/65

Wall Construction Type



54/65

Thermal Insulating Coating / Painting

54


55/65

For good insulation properties, the paint layer should

have low conductivity values.

Cool paints should exhibit high reflectivity so that lightwaves in the IR region may be reflected.

Material with low emissivity indicate that the radiation

of heat energy back to the surroundings is low.

Hence, for cool paints, it is desirable to have highemissivity

Conductivity, Reflectivity and Emissitivity



56/65


57/65

Typical Equipment

Mold Remediation Respirator

Mask Kit

Bio- Aerosol

Impactor

Protimeter Moisture

Measurement

Non-destructively Concrete

Moisture Meter , Data logger with

Infrared Thermometer

Moisture Meter for

wood, plaster/concrete,and sum



58/65

New Technology/Product

Hygenic Coating/Paint with active bacterial

inhibiting properties and less VOC

Non Chemical Metal based bacteria inhibitortechnology surface coatings

UVGI

Thermal and vapor insulating panel/paint Radiant barriers and duct insulators



59/65

The regulator: EPA

Government enforcement:ACGIH

The Remediator standard: IICRC The Property standard: ASHRAE

Third party verification:Academic

Lab.



60/65


61/65


62/65

Guidelines on the Control of Hospital Acquired Infection by Medical Services

Division of MOH

Code of Practice for the Prevention of Infection & Accidents in

Hospital, Laboratories & Post-mortem Rooms, 1987

Guidelines on Monitoring of Airborne Contaminant for Chemicals Hazardous to

Health, DOSH, Min of Human Resources, Msia, 2002

Code of Practice on Indoor Air Quality, DOSH, Min of Human

Resources, Msia, 2005

OSHA 1994 / JKR Arahan Teknik / Local Building Codes

JKR Design Guidelines: 1)Garispanduan bagi Mencegah Pembentukan Kulat

didalam Bangunan, 2) Arahan Teknik untuk mencegah Kulat Dalam Bangunan

Kesihatan

Local Guidelines & References



63/65


64/65


Root Causes to be looked at mostly in combination, for

surface condensation and mold growth problems:

1.Moisture Ingress and Infiltration

2.Temperature and %RH

3.Thermal Transmission

4.Vapour pressure

Conclusion


65/65

Documents

(6) Healthcare and Operational Issues in Relation to Mold Problems (Bpkj)