Hospital Proactive IEQ Solutions...A Case Study
Shaping circumstances before circumstances dictate actions

Project: A Florida Hospital

Project Consultant: Pure Air Control Services
Project Microbiology Laboratory:  Environmental Diagnostics Laboratory 
Project HVAC Remediation Contractor:  Building Remediation Sciences
Project Background: 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 environmental 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 is a "medically disciplined, solution-oriented indoor environmental service company" with headquarters in Clearwater, Florida. 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 AIHA Accredited laboratory analyzes levels of IEQ constituents e.g. mold, bacteria, dustmite, mycotoxins, 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 Control Services 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."
• Limited Liability and Lawsuits. Performing a proactive IEQ due diligence will provide the assurity that the facility is following a IEQ standard of care.
• Energy conservation - up to 30 percent.
• Improved maintenance efficiency.
• Overall, a 20 percent annual payback on the investment in indoor air quality.

After remediation e.g. biological, allergen or chemical issues, air quality improvement can increase by as much as 80-90%.

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 environmental (IEQ) quality from a health, energy and comfort standpoint," he said. "We identify IEQ constituants that are not typically analyed by most consultants e.g. dustmite, endotoxins, mycotoxins, fiberglass fibers, building pressurization, mechanical hygiene conditions. 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 AIHA accredited microbiology lab can turn work around in days. "Our clients like the fact that we can turn their samples over if necessary in the same day the sample was received" stated Dr. Rajiv Sahay, Director of Laboratory Services. "As an AIHA accredited laboratory we pride ourselves on the quality of microbiology service by providing authentic, efficient and economical laboratory services."  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 and treat the difficiency, 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.

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 vs IEQ GUIDELINES:
While IEQ standards be years away, Wozniak says, the U.S. Occupational Safety and Hazard Administration is working on indoor air quality standards. IEQ, as it is known, continues to grow in prominence on the national health and regulatory agendas. Many state 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.
 
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 IEQ 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 wont get there."  
 
This falls true in any indoor air quality project.  If you don't know what your IEQ goals and objectives (where you are going?) then you will never know if you've achieved "acceptable" IEQ (did I get there?).  Without a quality baseline evaluation one will not be able to provide the critical clearance report or document stating that the facility meets an IEQ Standard of Care.  An IEQ project should be able to accomplish the following environmentally: Where are we now (present IEQ conditions)?  Where are we going (development of definitive project IEQ specifications, action plan with a CPM schedule)?  Will we know when we got there (post remediation evaluation to be compared to pre remediation and normal #'s)?  Can I enter the destination (provide a clearance for accomplishing a IEQ Standard of Care)?  Sound familiar?  Mom, Dad...are we there yet?

Development of indoor environmental quality guidelines is one reason many hospitals and other proactive companies are going to work on IEQ now.  With meaningful baseline laboratory analysis having been performed over the past 10 years, enough quaility information has been procured to develop IEQ Guidelines (a normal background #)  for a building indoor environment.  Dr. Rajiv Sahay, laboratory director with Environmental Diagnostics Laboratory will be presenting a paper entitled "IEQ: A 10 Year Case Study For IEQ Guidelines" at the American Industrial Hygiene Association (AIHA) annual conference in Sacramento, California, May of 2005. 

"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. Wozniak, a Sunday school teacher, enjoys citing the biblical book of Leviticus as a clear, if unlikely, source of remediation technique.
 
A passage often used in company presentations 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, "develop 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 IEQ issues can be real."

The number one indoor environmental quality culprit across the country, Wozniak added, is typically "deferred maintenance."

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

If you follow good, professional IEQ practices and develop a clear action plan you will reach your IEQ destination and you can succinctly tell your employees "Yes, we are here!".

For more information on Proactive IEQ Solutions, contact:

Alan Wozniak
Pure Air Control Services
(800) 422-7873, ext. 802
www.pureaircontrols.com
awozniak@pureaircontrols.com