By Gerry Rojewski/Special to Healthcare Facilities Today

With healthcare spending expected to outpace economic growth over the next decade, healthcare organizations may be looking to expand or to renovate existing facilities.* Whether a project is planned to meet the growing demand for health services or to keep pace with medical and building technology, environmental concerns should be at the forefront. Every construction project at a healthcare facility may involve environmental risks that need to be addressed to safeguard the health of patients, staff, workers and the public.

When it comes to construction and even routine operations, hospitals, clinics, senior living centers and other healthcare facilities need to meet a higher standard of care. Pollutants such as fugitive dust, fumes and mold that are caused by construction work may cause a life-threatening reaction for patients with weakened immune systems. For that reason, projects at healthcare facilities need to be carefully planned and managed to minimize the pollution risks. 

Healthcare facilities should not overlook the potentially significant financial and reputational risks that pollution problems can create. Environmental remediation costs are likely to be substantial, and it may be necessary to shut down part or all of a facility while the cleanup is underway. Financial costs are not the only consideration: Pollution incidents at healthcare facilities may draw media scrutiny and lead to negative headlines that can cause lasting damage to a facility’s reputation.

To manage these risks, healthcare facilities should consider working with environmental experts to plan and manage building projects and to review their insurance programs to make sure that they are specifically covered for environmental exposures and cleanup costs that are typically excluded from general liability policies.

'Green' buildings can pose environmental risks

While technology has made life easier in many areas, it is increasing the complexity of building projects at healthcare facilities, from both the medical and environmental standpoints. Complex medical equipment may require special considerations in the design, construction and upkeep of the facility. “Green” building designs can also ramp up the complexity of a project. Although the idea of “green” buildings may bring to mind the use of more environmentally friendly materials, typically the goal is to improve the building’s energy efficiency. That enhanced energy performance, however, can potentially increase the environmental exposures.

For instance, new coolants used in air conditioning systems may be more environmentally hazardous than older coolants and may require special training in installation, handling and disposal procedures. As another example, the exterior insulation finishing materials used to make buildings more energy efficient may lead to problems with moisture retention. If water seeps into a building through small openings around windows, doors and vents, it may become trapped in the building and lead to conditions that are conducive to mold growth.

Big environmental problems can start small

Environmental risks are not limited to large projects. Just cutting into a wall with a drywall saw can lead to significant problems if there is mold behind the wall. Mold spores may be taken up by the ventilation system and spread throughout the facility. Work involving a plumbing system can disturb areas where legionella pneumophila bacteria are present and spread it to showerheads and other fixtures, necessitating a thorough disinfection of the system. Any work with existing structures, from exterior facades to heating, cooling and ventilation and electrical systems, carries the risk of potential pollution conditions.

 Some common exposures that may be overlooked in construction and maintenance activities include fuel leaks and spills, fumes from adhesives, paint and solvents, drywall dust and silica dust from cutting concrete block or cement board. Even installing new carpet can cause problems due to the formaldehyde content in carpet fibers.

 If pollutants are spread outside a construction containment area, the remediation costs may be significant. The facility may have to hire environmental experts at short notice, and it may be necessary to shut down a portion of the building and to relocate patients. Special containment measures may be needed to limit further spread of the pollutants, and a large quantity of material may have to be removed and disposed of properly. In addition, the facility may be liable for environmental problems caused by hazardous materials that are not transported or disposed of in accordance with the applicable regulations.

Planning helps protect patients, staff - and the facility

While the environmental exposures may be complex, thorough planning combined with new technology can help to control many of the risks posed by construction or work. When considering work involving a water system, for example, the facility should follow the latest guidelines for controlling legionella pneumophila exposures established by the American Society of Heating, Refrigeration and Air Conditioning Engineers. The recommendations include identifying potential risks ahead of time, assessing infection controls and designing programs to isolate affected systems during renovation or construction. For work involving drywall or dropped ceilings, facilities managers should consider taking advantage of technology that enables them to identify areas behind walls and above ceilings where mold may be present and to take preventive measures before work begins. All project planning should involve consideration of necessary back-up systems, such as water or power, so that containment measures will not be interrupted by a power outage or even a natural disaster. 

Because of the complexity involved, healthcare facilities should consider working with environmental experts who are experienced in planning and managing projects at healthcare facilities to reduce the environmental risks. Such experts can help in identifying the exposures before work begins and develop strategies to address them and to monitor their effectiveness while the project is in progress.

Environmental incidents can be expensive

While thorough planning can help, it is unlikely to remove all the risks. Environmental incidents may not be frequent in nature, but they can be highly expensive to mitigate. To address the financial risks, healthcare facilities should review their insurance program to make sure that it provides appropriate coverage for pollution exposures. Although a general liability policy may offer limited coverage for a pollution incident, it is unlikely to suffice for problems stemming from a construction project at a healthcare facility.

Healthcare organizations should consider an owner-controlled insurance program that provides pollution coverage for all construction work at a particular facility or group of facilities. Because liability does not end at the property line, they should look for a policy that provides coverage for transportation and disposal of construction materials and waste. They should also consider coverage for out-of-pocket emergency response costs, decontamination costs and catastrophe management costs, including public relations advice to protect the facility’s reputation. To provide planning and management for construction projects, healthcare organizations should consider an insurer that can provide ancillary technical support services with environmental experts.

 Construction and maintenance projects are an indispensable part of the operations of any healthcare facility and help to make sure that patients receive the best, most up-to-date care. Yet, such projects pose environmental risks that must be addressed to protect patients as well as the facility. Thorough planning, expert management of construction projects and a comprehensive pollution policy can help to make these complex risks more manageable.

Gerry Rojewski is vice president and national product line manager, ACE Environmental Risk, a division of ACE USA and part of the ACE Group.

* National Health Spending Projections 2012-2022, Centers for Medicare and Medicaid Services