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Wednesday, December 19, 2007 Issue 19   VOLUME 1 ISSUE 19  
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A Creative Solution for Managing Institutional Biosafety Committee Research Requests
What You Need to Know about PCBs in Construction Materials
Responding to Indoor Air Quality Issues in Hospitals
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Responding to Indoor Air Quality Issues in Hospitals
An Incident Response Plan Model
by Steven B. Bloom, M.S.

The chapter on Environment of Care (EC) in The Joint Commission standards includes Elements of Performance (EPs) that directly address air quality. In section 8, which reviews the importance of maintaining a “healing and caring” environment, there are EPs on maintaining adequate ventilation and assessing the impacts of construction on air quality. In section 9, EPs specify that a hospital’s environment must be monitored and that environmental issues must be investigated and resolved.

While the EC chapter does not list standards or specifically require an Indoor Air Quality (IAQ) response plan, virtually all hospitals recognize the importance of maintaining such a plan. EH&E provides management support for the Environmental Health and Safety programs in several large healthcare institutions, and through necessity has developed a detailed Incident Response Plan for dealing with IAQ issues. This plan may be useful as a comparison to your existing program, or might serve as the basis for a new program, should your institution be planning significant construction projects.

Overview
A paging system is used as the primary mode of contact for urgent or emergent Indoor Air Quality related concerns. An employee from the Environmental Health and Safety (EH&S) Department carries the IAQ pager from 8:00 a.m. to 4:30 p.m., Monday through Friday. Nursing Administration carries and responds to IAQ pages between 4:30 p.m. and 8:00 a.m., Monday through Friday and all day on weekends and holidays. Nursing Administration will page an on-call EH&S person if the situation warrants. It is the role of the first responder, whether from the EH&S office or Nursing Administration, to gauge the severity of the situation and then to coordinate the response. Follow-up and resolution are also part of the role. Resolution applies not only to the immediate technical response, but also to addressing questions and concerns.

Investigation
1. Environmental Health and Safety Department (EH&S) is Contacted
The incident may be reported directly by paging the IAQ pager, or the call may come into the EH&S office and then be relayed to the pager. Alternatively, the call may come via the Occupational Health Department or the Engineering department. The four most common IAQ concerns are odors, symptoms believed to be IAQ-related, chemical spills, and uncomfortable temperature and/or humidity.

2. Information is Gathered
The EH&S responder calls the individual who paged and identifies him/herself by name “from EH&S, (or Nursing Administration, off-hours) responding to the IAQ page.” Locator information is gathered from the person calling in the page. This includes: who initiated the call, a contact phone number, and the department, building, floor and room number where the incident is occurring. In addition, the responder gathers basic information regarding the nature of the concern (e.g., whether it is an odor, chemical spill, thermal comfort issue, air-quality related symptoms, or another type of incident).

3. Prepare to Investigate
The responder next prepares the appropriate tools to investigate, if on-site analysis is warranted. If Nursing Administration received the initial page, the investigation falls to the EH&S on-call person. For most incidents where general poor air quality is reported, an IAQ monitor (such as a multi-channel monitor for measuring carbon dioxide, carbon monoxide, temperature, and relative humidity) will be brought to the site to assess ventilation and adherence to standards and guidelines (e.g., American Society of Heating, Refrigerating, and Air-Conditioning Engineers, Inc. [ASHRAE]). For more specific complaints, a particle monitor, chemical-specific monitoring tubes (e.g., Draeger), or a photoionization detector (PID) may be selected for use. In addition, the responder may contact the Engineering Department to assist, if deemed necessary.

4. Responder Goes to Incident Site
The EH&S responder reports to the site to investigate and conduct interviews with staff, if available. The responder will contact additional departments based on the information collected, if their assistance appears necessary. The initial response at the site will close with resolution of the issue, a plan for further investigation, or, if the condition has resolved with no intervention, by telling the occupants they should call again if the problem returns or persists. If follow-up is required, a tentative schedule should be conveyed before leaving.

5. Responder Returns to Office
Upon returning to the office, the appropriate reporting form should be completed. This includes a description of the incident and the actions taken to solve the problem, as well as locator information. Once this form is completed, it is faxed or emailed directly to the Engineering Department, the Occupational Health Department, and/or other departments as needed. If any of these departments need to act, they will now have documented information about the response.

6. The Response Report is Filed
Information from the report is then entered into an electronic database as well as stored on hardcopy. After the report has been entered electronically, a summary is emailed to the manager of the location involved. All handwritten and electronic documentation is stored in the EH&S office for reference as needed.

7. Follow-up
If follow-up is required, the responder does so according to the previously assigned date and time. When the follow-up is complete, the appropriate Air Quality Response Follow-Up Report is filled out and placed in the file along with the initial response report. This report is then faxed or emailed to the department manager at the site, as well as to any other departments the responder considers appropriate.

8. Reporting
Information on IAQ responses is compiled monthly and presented at the appropriate Safety Committee meeting.


Steven B. Bloom, M.S., is Associate Director of EH&S Compliance & Strategic Support at EH&E. He has approximately 25 years of experience in environmental, respiratory, and air quality issues. He also serves as full-time Director of Environmental Affairs at Brigham and Women’s Hospital, where he manages a comprehensive program that addresses air quality, environmental management, safety, and regulatory compliance.

For more information on EH&E’s web management of EH&S issues in healthcare settings, visit http://www.eheinc.com/solutions_healthcare.htm.


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