The term “healthcare facility” describes many settings. Medical centers, acute-care hospitals, surgery centers, long-term care facilities, urgent-care centers, medical office buildings, doctors’ offices, hospice care, outpatient clinics—each of these structures has a distinct construction, use, and occupancy, and each generates its share of IEQ complaints. This article discusses the unique challenges industrial hygienists face when they conduct IEQ investigations in healthcare facilities. These challenges include a wide range of affected populations and a variety of possible sources for IEQ problems. In addition, many of the hazards in these facilities may be unfamiliar to investigators used to working in environments more traditionally frequented by IHs. THE INVESTIGATION As with all industrial hygiene assessments, the investigation of an IEQ complaint in a healthcare facility generally includes the following steps:
  • characterizing the complaint through questionnaires, incident logs, employee interviews, medical evaluations, review of prior environmental reports or sampling data
  • visually inspecting the site: evaluating the space and/or HVAC system
  • identifying potential indoor and outdoor sources: chemical (for example, formaldehyde or xylene), biological (mold, bacteria), and physical (noise/vibration, lighting, ergonomics)
  • sampling or monitoring of potential sources and interpretation of results
  • developing solutions: elimination, substitution, engineering and administrative controls
Each step can increase in complexity depending on the nature of the complaint and phase of the investigation. POPULATIONS In any IEQ investigation, it is important to understand the affected population when designing an assessment strategy. Different populations will have different sensitivities and risk tolerances. They may have language barriers, and they may respond differently to certain communication styles. Participation from the following populations is often critical to the success of an investigation in a healthcare facility:
 
Medical/clinical staff. The educational backgrounds within this group, which includes physicians, nurses, and medical assistants, can vary widely. These professionals can be hard to meet with or to engage in the investigation due to scheduling and the nature of their work. Communicating with those who are knowledgeable about health effects may be difficult for IH investigators used to dealing with the general public.
 
Engineering/facilities staff. These individuals are the most knowledgeable about the general mechanics of the building. They can help the investigator identify source pathways and HVAC system deficiencies.
 
Environmental services staff (EVS). Responsible for disposal of waste (including bio-hazardous waste) and the cleaning and disinfection of surfaces, EVS staff are usually the most knowledgeable about the types of cleaning products used on site.
 
Administrative staff. These staff typically work in office settings and on the business side of the medical center. They may provide valuable information in the early stages of the investigation regarding the nature of the IEQ concerns, including the locations, times, and dates of complaints.
 
Patients. This group includes individuals of all ages, races, and educational backgrounds. Some sensitive populations may be included in this group, such as infants, the elderly, immunocompromised individuals, and cancer patients. Occupational exposure limits and guidelines are not appropriate for evaluating risk to patients. While they may not be directly involved in the investigation, it’s important to understand the potential effects on patients when drawing conclusions or making recommendations.
 
Vendors, consultants, and contractors. Although this group might lack proper training and understanding of unique healthcare issues, they are often knowledgeable about the use of chemicals, sources of noise, or building performance characteristics.
 
Communication is often a key component to resolving IEQ complaints, and this is especially true in healthcare settings. Although these groups typically work within the same facility, communication between them is often inconsistent, inaccurate, or incomplete.
IEQ Investigations in Healthcare Facilities
BY DAVID BRINKERHOFF AND MICHELLE ROSALES
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