The Joint Commission on
Accreditation of Healthcare Organizations (JCAHO)
addressed alcohol-based hand-rub dispensers with
foam in the April 2006 edition of the Environment of
Care News. Pending further review, JCAHO will allow
the use of foam dispensers as long as the same code
requirements outlined for the gel dispenser are
followed.
Horizontal Sliding Doors
The LSC has added new Section 7.2.1.4.1.6, which
addresses horizontal sliding doors for rooms of 10
or fewer healthcare occupants. These horizontal
sliding doors are no longer required to have a
swinging breakaway feature. This revision of the
code has been added to address critical care units
in hospital facilities that have specialty patient
care rooms with the use of support medical equipment
in and around the patient.
Horizontal sliding doors are used
throughout hospitals to address this critical
patient need. Previous editions of the LSC required
the horizontal sliding doors to have a breakaway
feature. Most of the horizontal sliding doors
require a track or guide for the doors to function
properly. The new revision will allow the smooth
transport of critical care patients.
Protective Plates on Smoke
Barrier Doors
Sections 18.3.7.7 and 19.3.7.7.1 have been revised
to allow non-rated, factory- or field-applied
protective plates to be unlimited in height when
added to smoke barrier doors. The previous editions
of the LSC set the height of protective plates
installed on smoke barrier doors at 48 inches. This
revision has been added because smoke barrier doors
are not required to carry a rating. As in previous
editions of the code, smoke barrier doors are
required to have a substantial core, such as
1.75-inch solid-bonded wood.
Interior Nonbearing Walls
Sections 18.1.6.7, 18.1.6.8, 19.1.6.7 and 19.1.6.8
have been revised to allow interior nonbearing walls
to be constructed using fire retardant-treated wood
enclosed within noncombustible or limited
combustible materials, provided that the walls are
not used for vertical shaft enclosure. This revision
was primarily made to follow building construction
standards and currently is allowed in model building
and fire codes.
Nursing Home Sprinkler
Protection
Section 19.3.5.1 has been revised to require
existing nursing homes to be protected throughout by
automatic sprinkler protection. This revision was
made in response to the 2003 nursing home fires that
occurred in Hartford, Conn., and Nashville, Tenn.,
where a total of 24 people died. Existing nursing
homes would require automatic sprinkler protection
upon adoption of the 2006 edition of the LSC in
their jurisdictions.
New and existing healthcare
facilities should verify if their local
jurisdictions have adopted the 2006 edition of the
LSC. The 2000 edition of the LSC is still being
enforced by both the Centers for Medicare & Medicaid
Services (CMS) and JCAHO. The 2000 edition of the
LSC was adopted by both CMS and JCAHO in March 2003.
However, if a facility believes that the revisions
in the 2006 edition will impact it in a positive
way, CMS and JCAHO will allow the facility to adopt
the 2006 edition of the code.
To adopt the 2006 LSC, CMS requires
that a facility complete and submit a formal waiver
request. JCAHO requires a facility to make a
notation on the Basic Building Information form,
which is part of the facilities Statement of
Conditions documentation, as well as notify the
survey team upon their arrival. CMS and JCAHO
require that a facility adopt the entire 2006
edition of the code and not just specific code
sections.
While the 2006 edition of the LSC
has been available for adoption, few authorities
having jurisdiction have done so. The LSC is
published on a three-year revision cycle. The NFPA
revision cycle for the 2009 edition of the LSC has
already begun. The first step in the revision cycle
is public comments, which are due to NFPA by Aug.
25, 2006.
To view the 2006 edition of the NFPA
101, Life Safety Code, visit the NFPA Web site at
nfpa.org, and click on the Codes & Standards tab.
Thus, environmental issues should be addressed in
the planning stages of a project, and it is
recommended that an in-house or contracted
environmental expert help with this assessment.
Adverse
impacts
During a construction and renovation project,
chemical contamination and improper hazardous
materials management can be the source of many
adverse environmental impacts. Historical
contamination in a health care facility or
mismanagement of C&D waste during a project can open
the door to penalties and fines from both state and
federal environmental agencies. Paperwork trails can
also cause significant compliance headaches, cost
overruns and project delays.
Many hospitals predate the existence of the
Environmental Protection Agency (EPA) or any of its
associated statutes. As a facilities manager, it can
be difficult to know how the laboratory and other
departments are handling hazardous materials now,
never mind how materials management practices were
controlled generations ago. Historical contamination
is extremely common in old hospital buildings and is
a potential budget buster, whether it be in soil,
infrastructures or a workspace targeted for
renovation.
Contamination in internal workspaces or
infrastructures could potentially come from many
more places than one might imagine. Many chemicals
used in the various departments of a hospital can
potentially be a source of historical or chronic
contamination in a health care facility.
If any laboratory space is being renovated
(clinical, pharmacy/oncology or research), for
instance, on-site contractors will often refuse to
work in that laboratory space without written
certification that all surfaces have been properly
decontaminated. The same may be true for any lab
equipment being relocated to new or temporary space.
This might mean bringing in a crew of environmental
specialists to decontaminate the space and provide
written documentation. These services can sometimes
be quite expensive if they are contracted at the
last minute.
Before large-scale demolition begins, it is
necessary to identify what lies in the building
infrastructure. For instance, one of the most
pervasive chemicals on old hospital sites is
mercury. Mercury’s harmful properties are
well-documented and most facilities strive to be
“mercury-free.” However, old cast-iron or glass
piping in buildings generally contain enough mercury
to raise serious concern about contamination unless
every line between the laboratories and the final
discharge has been replaced in recent years.
Mercury can be present not only from historical
use, but from current practices. Occasionally, there
is certain equipment for which staff do not want to
utilize mercury-free alternatives. Laboratory and/or
medical staff are sometimes reluctant to change
procedures for fear of impacting patient care.
Mercury thermometers, for example, are often still
used in laboratories to monitor temperatures in
water baths.
If contractors are surprised by the presence of
mercury, the project could be shut down until a
decontamination occurs. The associated costs of an
urgent decontamination and having contractors on
hold can be significant.
Do not repeat others’ mistakes by tearing down a
building without first removing contaminated piping,
draining cooling systems and removing all window air
conditioners. Damaging this equipment during
demolition can turn large amounts of debris into
hazardous waste. All thermostats, fluorescent lamps
and ballasts should also be removed before bringing
in the heavy equipment. Window casings from older
buildings have a high probability of lead paint and
may need to be removed separately and disposed of as
hazardous waste. Failure to do so can also create
contamination in ordinary construction debris waste.
External contamination may not only entail waste
disposal, but possible impacts to the environment.
This can lead to extensive cleanup costs and fees or
fines issued by state, local and federal agencies.
For instance, if a project includes any type of
excavation, it may impact storm drains. Storm drains
often contain evidence of automotive fluids and, if
not maintained routinely, a disturbed catch basin
can release contaminants into the groundwater and
sewer systems. Likewise, if a project entails
demolition work on or in a parking garage, oil/water
separators must be decontaminated before demolition
to avoid contaminating soil or debris.
Additionally, if any underground storage tank is
being removed, risk of having contaminated soil is
high. Tanks must be properly cleaned before removal
and, if being replaced, must be installed by a
licensed contractor. This will ensure compliance
with state and federal requirements for underground
chemical and oil storage.
Job site
decisions
A contractor is never responsible for any
hazardous wastes generated on a job site. The
contract agreement may indicate that waste disposal
is the contractor’s responsibility, and the
contractor may live up to the agreement, but any
waste created on-site at a health care facility is
linked to that property; therefore, it is tied to
the hospital’s EPA generator’s identification
number.
This means that it is the hospital’s
responsibility and liability, and any hazardous
waste generated during a project counts toward
monthly and annual waste generation. The hospital’s
name appears on the shipping papers, not the
contractor’s, so it is necessary to be certain that
only approved hospital personnel are signing the
papers.
It is also necessary to confirm that the waste is
being characterized and stored properly as well as
being shipped to a fully permitted disposal
facility. If the hospital is registered with the EPA
as a small quantity generator of hazardous waste,
the project can potentially cause limits to be
exceeded and subject the hospital to additional
fees, requirements and even fines on a state or
federal level.
Still, a project manager should fully understand
the contractor’s training, capabilities and
requirements for working in a potentially
contaminated area. If they require certificates of
decontamination, these procedures should be
appropriately planned. Typically, a plumbing
contractor will not be trained to manage hazardous
materials, and should not work with chemically
contaminated piping. Clear, concise communication
and proper planning will ensure that the appropriate
contractor is employed on each phase of the project.
If expectations and qualifications are clear, costly
delays can be avoided.
For example, a hospital in New England recently
removed an underground storage tank and, in turn,
had to ship several tons of contaminated soil to be
properly disposed. Although state contingency plans
require off-site shipment of the soil, the material
did not meet the definition of a hazardous waste in
this case. When the contractor arranged disposal
through its hazardous waste subcontractor, the soil
was improperly characterized as hazardous waste. The
improper characterization of the soil caught the
attention of the state agency, and caused the
additional requirement of completing and submitting
an EPA biennial report. Ultimately, the shipment
caused the hospital to exceed its generator limits
for the year and this waste management error became
the source of unbudgeted consulting services and
increased scrutiny by the state.
Many states perform their own on-site inspections
for environmental compliance. Events like this one
can put a facility under the microscope and increase
chances of a state inspection.
Regulatory
permitting
If a project involves adding or replacing
boilers, it will certainly have an effect on the air
emissions during and after the project. To avoid
Clean Air Act violations, it may be necessary to go
through a new source registration process and update
air emissions permits.
Permits also come into play under the Clean Water
Act. A project involving excavation will likely
require a storm water discharge permit. With
significant amounts of additional mobile equipment
on-site, storm water runoff can potentially be the
cause of groundwater contamination. Inside
buildings, engineering staff is responsible for
maintaining wastewater neutralization systems. These
systems were designed as a result of the Clean Water
Act regulations and associated permits. Project
managers should consider how the project may impact
current wastewater permits. Will there be flow
increases during or after the project? Is the
current system adequate to handle the changes? Will
there be new processes that require new treatment or
collection systems to be installed? Any significant
changes could potentially cause a violation of the
hospital’s wastewater discharge permit. Individual
state and local agencies may have other permit
requirements related to environmental issues. Be
sure to understand all local as well as federal
requirements.
Additionally, many states have a ban on certain
C&D materials from disposal at municipal landfills.
For example, Massachusetts will not allow municipal
landfill disposal of cathode ray tubes, lead-acid
batteries, asphalt, brick or concrete. Nor will wood
or metal waste be accepted in any significant
quantities at solid waste landfills. These materials
must be recycled and the list continues to grow,
including white goods such as stoves and
refrigerator units. It is a good idea to check
individual state requirements.
Potential
pitfalls
There are many potential pitfalls of a C&D
project, and any of the issues mentioned above could
result in compliance enforcement and fines as well
as project delays and cost overruns. Of course, it
all equates to bad publicity that does not go
unnoticed by potential customers, benefactors and
the Joint Commission.
Making the extra effort to identify and address
environmental issues prior to the project commencing
is highly recommended. A proactive approach can help
ensure that projects stay on time, on budget and
will minimize liability by foreseeing the potential
environmental impacts.