36E77619R0085-016.pdf

DEPARTMENT OF VETERANS AFFAIRS

NORTH TEXAS HEALTH CARE SYSTEM

July 31, 2012 549/007

VANTHCS MEMORANDUM NO. 007-19

MOLD AND MOISTURE CONTROL PROGRAM

1. PURPOSE:

The purpose of this memorandum is to provide guidance for the establishment and implementation of a comprehensive Indoor Air Quality (IAQ) Mold and Moisture Control Program at VA North Texas Health Care System (VANTHCS).

2. POLICY:

It is the policy of VANTHCS to protect employees by ensuring the environment of care is maintained to provide a safe environment for employees, visitors, and patients.

3. PROCEDURES:

The most effective way to control mold is to solve moisture problems before mold growth starts. The first step in preventing mold growth is to identify the source of the water infiltration. When occupants of a building notice a water infiltration (a wet ceiling tile, leaking equipment, water seeping into and under walls or ceilings, etc.) contact should be made to Engineering Service through the electronic work order system. If the infiltration is significant and continuous, Engineering Service should be contacted immediately by phone. Leased buildings should notify their Building Management Authorities or appropriate personnel specified in the lease, as soon as possible.

General mold prevention measures should include the following (but results will depend on specific site conditions):

a. General Prevention Strategy:

(1) Being alert for condensation and wet spots and making sure sources of moisture are fixed as soon as possible after they are discovered.

(2) Increasing surface temperature by better insulating or increasing air circulation, reducing the humidity by repairing leaks, increasing ventilation or by dehumidifying the area.

(3) Keeping heating, ventilation, air conditioning (HVAC) drip pans clean, flowing properly, and unobstructed.

(4) Venting moisture-generating equipment to the outside, where possible.

(5) Maintaining low indoor humidity, ideally 30-50%, but at least below 60% relative humidity.

(6) Repairing plumbing leaks in the building as soon as possible.

(7) Performing regular building/HVAC inspections and maintenance as scheduled.

(8) Cleaning and drying wet or damp areas immediately, within 48 hours, so that mold does not have time to grow.

(9) Providing adequate drainage and sloping the ground away from building foundations so they do not stay wet.

(10) Inspecting areas which are normally wet (e.g. shower rooms), to ensure adequate drainage and ventilation.

(11) Ensuring construction and/or renovation activities comply with the Construction and Renovation Infection Control Guideline.

b. Clean-Up and Remediation Initial Steps: Prevention of mold growth is best achieved by removal of moisture within the first 48 hours. If water is removed and materials are dried within that time, then the chance of mold growth is greatly reduced.

(1) A preliminary inspection must be conducted by qualified individuals from Infection Prevention and Control (for patient care areas), Safety Service, and/or Engineering Service, to assess the extent of damage and source of damage. The inspection must occur within 24 to 48 hours of the incident, including weekends. The inspection should include an assessment of the size of the mold and/or moisture problem and the type of damaged materials. If an Engineering Service employee performs a preliminary inspection and starts measures to fix a moisture problem before Safety Service and/or Infection Prevention and Control arrive, they must report the extent and source of damage to Safety Service and Infection Prevention and Control.

(2) American Federation of Government Employees (AFGE) must be notified before any mold remediation is initiated that involves shifting of employee work locations or work stoppage, but water removal and emergency operations should proceed immediately with appropriate protections.

(3) The HVAC system should be shut down if mold contamination within the system is known or suspected. The HVAC system may also help to remediate the problem; however, this decision will be made by Engineering Service, Safety Service, and Infection Prevention and Control.

(4) Location of immunocompromised or other high-risk patients must be addressed, prior to any clean up or remediation procedures, to reduce possible transmission of molds. The VHA Moisture and Mold Management Program (M3P) contains an Infection Control Risk Assessment for water intrusion and mold responses. This program may be accessed at the following link:

http://vaww.ceosh.med.va.gov/01IH/02IH_SpecificTopics/03IH_IndoorAirQ ualityMold/04IH_OtherReferences/M3P.pdf

(5) The water or moisture problem must be repaired immediately by Engineering Service. The designated/expected initial responders must have the proper training, Personal Protective Equipment (PPE) and supplies to handle all types of water intrusion occurrences: clean water, gray water, or black water.

(6) The remediation team performing demolition procedures should wear respirators, eye protection, and gloves appropriate for mold remediation work. The VHA M3P at the link above details PPE and containment requirements depending on the type and extent of contamination.

(7) Safety Service, Infection Prevention and Control, and Engineering Service are responsible for monitoring cleanup or remediation procedures.

(8) Air, bulk or surface samples may need to be collected to identify specific fungal contaminants, as determined by the Industrial Hygienist.

Sampling is not recommended for visible mold with areas of contamination less than 10 square feet near low to medium risk patient groups.

Guidance for sampling is included in M3P. Cleanup of wet areas should not wait for sampling results.

(9) If surface or air sampling indicates that airborne concentrations of mold exceeds levels in the control sample, exposed employees will be notified in writing of the exposure within five days. Employees in the contaminated area will be referred to the Occupational Health Unit (OHU) for completion of Office of Worker’s Compensation Program (OWCP) forms as appropriate. All sampling results will be provided to AFGE and Safety Service. Per the AFGE Master Agreement, areas with documented mold exposure significantly above outdoor levels should have repeated monitoring every three months to document exposure until effective cleanup is achieved.

http://vaww.ceosh.med.va.gov/01IH/02IH_SpecificTopics/03IH_IndoorAirQualityMold/04IH_OtherReferences/M3P.pdf http://vaww.ceosh.med.va.gov/01IH/02IH_SpecificTopics/03IH_IndoorAirQualityMold/04IH_OtherReferences/M3P.pdf

(10) The use of gaseous, vapor-phase, or aerosolized biocides for remedial purposes is not recommended, in other than extreme situations.

The use of biocides in this manner can pose health concerns for people in occupied spaces of the building and for people returning to the treated space, if used improperly. Furthermore, the effectiveness of these treatments does not address the possible health concerns from non-viable spores or toxic metabolic byproducts.

c. Further Steps In Remediation:

(1) If water infiltrating the building is clean (no chemical, biological or sewage contamination), and the faster the repair, cleanup, and drying are accomplished, the greater the chances will be of preventing mold growth.

(2) If water infiltrating the building is polluted, then mold growth could be accelerated and further cleaning may be necessary. The Industrial Hygienist (IH) will assist with further remediation requirements, which are described in M3P.

(3) If water infiltration necessitates the replacement of any portion of interior walls, ceiling tiles, floor and floor finishes, carpet, etc., then Engineering Service and Environmental Management Service (EMS) will provide these repairs/services.

(4) If the moisture/mold problem has gone undetected and has existed over a period of time (greater than 48 hours), consult Safety Service for further instructions on remediation.

(5) Ceiling tiles: Tiles must be discarded and replaced if they become wet. Stained ceiling tiles must be removed and discarded and replaced as soon as possible. Staff should report any ceiling tile with wet or stained spots to Engineering Service, via the electronic work order system, immediately upon discovery.

(6) Wallboard: If excessive moisture is detected, then efforts should be made to make sure moisture has not collected behind the wall.

Wallboard should be replaced if excessive moisture is present and the area behind the wall must be cleaned/disinfected/dried, encapsulated or painted to trap and prevent further growth. Remove the base molding to inspect the wallboard. If the wallboard cannot be dried within 48 hours, measure 12 inches above the water mark/damage and remove and discard wallboard below that point. Remove and discard any damp insulation inside the wall and ventilate the wall cavity, until it is completely dry. If infiltrating water was contaminated, further disinfection may be required. Consult the IH for guidance.

(7) Carpet and backing: First, fix the source of the moisture problem and dry and clean the carpeted area. Remove all furniture/cabinets sitting on the wet carpet. Remove water with a water extraction vacuum; reduce ambient humidity levels with de-humidifiers; and speed drying by using fans, if available. If moisture cannot be removed from carpet, the carpet must be replaced as soon as possible. Carpet must be replaced in case of sewer leaks.

(8) Cellulose or fiberglass insulation: Discard and replace.

(9) Electrical: Consider all wet wiring, light fixtures, and electrical outlets to be a shock hazard. Turn power off in the area until these have been checked by Engineering Service Electric Shop. All electrical circuit breakers, ground fault circuit interrupter (GFCI’s) and fuses, that become wet, need to be replaced. All electric motors, fixtures, etc. that were wet must be opened, cleaned, air-dried and inspected by a qualified electrician prior to reuse. All damaged computer equipment must be evaluated by the Office of Information & Technology, prior to reuse.

(10) Books/paper products: Non-valuable materials should be discarded. Valuable papers and information should be dried, copied, and then discarded.

(11) Concrete or cinder block surfaces: Remove water with extraction vacuum. Speed dry with de-humidifiers and fans/heaters. Use caution when applying any heat source.

(12) Hard surfaces, porous flooring (linoleum, ceramic tile, and vinyl): Vacuum or damp wipe with water and mild detergent and allow to air dry.

(13) Non-porous, hard surfaces (plastic/metal): Vacuum or damp wipe with water and mild detergent and air dry.

(14) Upholstered furniture: Remove water with extraction vacuum.

Use fans/heaters to accelerate drying within 48 hours to impede mold growth.

(15) Wood surfaces: Remove moisture immediately and use de-humidifiers, gentle heat and fans for drying. Use caution when applying any heat source. Treated or finished wood surfaces may be cleaned with mild detergent and clean water and allowed to dry. Wet paneling should be pried away from the wall for complete drying.

d. Clean-up Methods: Clean-up methods should be specified according to the type and size of incident as described in M3P, including these possibilities:

(1) Wet vacuum (in the case of porous materials, some mold spores/fragments will remain in the material but will not grow if material is completely dried). Steam cleaning may be an alternative for carpets and some upholstered furniture.

(2) Damp-wipe surfaces with plain water or with water and detergent solution (except wood - use wood floor cleaner); scrub as needed. A bleach solution (1:9), germicidal disinfectants, or other solutions will be used as necessary.

(3) High-efficiency particulate air (HEPA) vacuum after material has been thoroughly dried. Dispose of contents of the HEPA vacuum in well-sealed plastic bags, as non-regulated waste.

(4) Discard/remove water-damaged materials and seal in plastic bags while inside of containment, if present. Dispose of as non-regulated waste. HEPA vacuum area after it is dried.

e. Containment is also discussed in M3P and varies by contaminated area:

(1) Minimum: No containment is necessary. Examples would include a single stained tile with no visible growth, or growth in less than ten (10) square feet of total surface affected.

(2) Limited: Use polyethylene sheeting, ceiling to floor, around affected area with a slit entry and covering flap; block supply and return air vents within containment area. This would apply to areas with total surface area 10 to 100 square feet.

(3) Full: Use two layers of fire-retardant polyethylene sheeting with one airlock chamber. Maintain area under negative pressure with a HEPA filtered fan exhausted to the outside of the building. Block supply and return air vents within the containment area. This would apply to areas with greater than 100 square feet of contamination.

NOTE: If negative air pressure is accomplished by venting directly to the outside, Engineering Service will determine whether additional HEPA filters are to be utilized.

f. Personal Protective Equipment (PPE): PPE and containment for medium to large areas, use professional judgment to determine prudent levels of PPE and containment for each situation, particularly as the remediation site size increases and the potential for exposure and health effects increases.

(1) Minimum: Gloves, goggles/eye protection.

(2) Limited: Gloves, respirator with HEPA filter, disposable overalls or jumpsuit, goggles/eye protection.

(3) Full: Gloves, disposable full body clothing (jumpsuit), head protective covering, foot coverings, full-face respirator with HEPA filter.

g. Remediation of Contaminated HVAC Systems: Guidance on removal of contamination in the HVAC system comes from M3P and the EPA website.

The Industrial Hygienist can help to specify methods. Remediation inside HVAC systems must be performed by qualified contractors or fully trained staff.

h. Hazard Communications: When fungal growth, requiring large-scale remediation, is found, VANTHCS should notify occupants in the affected area(s) of its presence. Notification should include a description of the remedial measures to be taken and a timetable for completion. Group meetings held before and after remediation, with full disclosure of plans and results, can be an effective communication mechanism. Staff conducting remedial operations should also be fully informed of all potential hazards.

i. Training:

(1) Employees and contractors will be educated on required infection control prevention and other safety measures during construction and renovation by using various training mechanisms (i.e., handouts, videos, and one-on-one). Details of training requirements can be found in M3P.

(2) Employees who will participate in mold remediation or initial response to water intrusion must be trained in advance, including methods of protecting themselves and surrounding employees or patients from exposure. AFGE representatives must be invited to training for staff who will participate in mold remediation so that they can safely monitor operations.

j. Close-Out Investigation: As described in M3P, any restoration activity after a water intrusion or mold remediation event must be followed up by a close-out inspection to ensure the area is clean, restored, and ready for us. This should be connected to a hazard communication meeting with the staff. The process of response, planning, and restoration should be reviewed at this time to evaluate ways to improve future responses.

4. RESPONSIBILITIES:

a. The Director is responsible for providing a healthy and hazard-free environment that supports our patients, families, visitors and staff.

b. The Chief, Engineering Service, is responsible for:

(1) Ensuring VA buildings are maintained to ensure a safe environment regarding air quality for patient, staff, and visitors.

(2) Ensuring that the proper temperature, humidity, and ventilation are maintained in order to provide the proper mixture of fresh air resulting in odor control, infection control, proper air movement and the prevention of mold growth.

(3) Inspecting, maintaining and repairing HVAC systems, utility systems, Bio-Medical equipment and building structural materials to ensure proper indoor air quality for all buildings through visual inspection and preventive maintenance procedures.

(4) Inspecting systems to ensure proper operation and to eliminate leaks and water infiltrations to prevent sources of mold growth.

(5) Providing in-house remediation as necessary.

(6) Replacing furnishings that become water damaged beyond repair.

(7) Supervising remediation contracts to ensure that cleanup and containment are conducted in a manner that protects the health of the workers and any employees, patients, or visitors in the area.

c. EMS is responsible for coordinating the cleanup of water infiltrations and disposal of damaged materials.

d. Service Chiefs are responsible for immediately reporting water infiltrations, leaks, wet ceiling tiles, and other potential sources via the Electronic Work Order System, or in emergencies, calling Engineering Service immediately. During off duty hours and weekends, contact the Administrative Officer of the Day (AOD) or Energy Center.

e. The Infection Prevention and Control Coordinator, or designee, is responsible for addressing specific infection control concerns to the Project Engineer/Manager, or Contracting Officer Representative (COR).

f. The IH is responsible for:

(1) Making recommendations in relation to indoor issues based on Environmental Protection Agency (EPA) or other applicable recommendations. This includes determining the level of sampling needed, in cooperation with the Occupational Health Unit physician when symptoms are presented and recommending requirements for contractors conducting this sampling.

(2) Providing results of sampling to AFGE.

(3) Notifying employees in a work area where airborne concentrations of mold exceed levels in control samples.

(4) Referring employees to OHU for completion of OWCP forms as appropriate.

g. Employees are responsible for notifying their supervisor of mold concerns in their work areas when identified.

5. REFERENCES: VA Directive 7700, “Occupational Safety and Health”, February 11, 2009; and VHA Directive 7701, “Occupational Safety and Health (OSH), August 9, 2010; VHA Moisture and Mold Management Program (M3P); VA Pamphlet 05-08, Master Agreement between the Department of Veterans Affairs and the American Federation of Government Employees, 2011; EPA, “Mold Remediation in Commercial Schools and Buildings”, Part I, September 30, 2010, and Part II, September 20, 2010; EPA, “Building Air Quality: A Guide for Building Owners and Facility Managers – Appendix C: Moisture, Mold and Mildew”, October 24, 2006; Occupational Safety and Health Administration (OSHA) 29 Code of Federal Regulations (CFR) 1910, “Occupational Safety and Health Standards”, February 28, 2006, and 1960, “Basic Program Elements for Federal Employees OSHA”, July 5, 1995; Joint Commission Manual, Environment of Care Standards, current edition; Centers for Disease Control (CDC) and Prevention, website www.cdc.gov/mold/faqs.htm , “Molds in the Environment”, webpage updated last on February 8, 2010.

6. RESCISSION: None.

Jeffery L. Milligan Director

Distribution “B” http://www.cdc.gov/mold/faqs.htm