A simple online search for mold in hospitals will return decades old articles and posts covering the increased focus on preventing and reducing mold in hospitals and other healthcare facilities. However, a 2019 ABC News article linked 6 deaths in hospitals to mold. It is not for a lack of trying that healthcare facilities struggle with preventing and effectively reducing mold so why does it continue to be such a challenge?
First, it is important to establish the overwhelming incentives hospitals and healthcare facilities have to manage mold within their facility. Not only does mold cause structural damage to the facility costing them money and potential lost revenue, mold has been directly attributed to healthcare associated infections (also called hospital acquired infections or HAIs). A healthcare associated infection can cost a facility up to $60,000for treatment and management, which through the Affordable Care Act not only falls entirely on the facility to cover the costs, but also directly impacts Medicare reimbursements.
When the Affordable Care Act was developed two programs within the act included aspects related to HAIs and reimbursements. Medicare payments were reduced to healthcare facilities and were then redistributed to the facilities based on performance scores including HAIs. The two programs with an impact on HAIs and thereby on mold are; the Value-Based Purchasing program which incentivizes purchasing based on quality of care over quantity provided and the Hospital-Acquired Condition Reduction program which includes a penalty for facilities in the lowest-performing quartile of patients being impacted by HAIs or other health conditions attributed to the facility such as mold.
All this being said, it is clear that hospitals and other healthcare facilities are well incentivized to effectively manage the impact of HAIs and mold in their facilities. The question then becomes why so many facilities continue to struggle with mold today. There are factors present which make mold management more difficult in a hospital or healthcare facility.
One of the most prominent challenges has to do with the purpose of the facilities themselves. Hospitals and clinics by their very nature serve patients and residents that are at a heightened level of susceptibility. Healthy people are exposed to mold on a regular basis inside buildings and outside. This exposure typically has little or no effect and often goes unnoticed. This same level of exposure for a patient with an already compromised immune system or other health complications can be much more dangerous. Skin, for example, is one of the body’s best defenses again infection and the effects of mold. If a patient or resident has a cut or open wound of any sort the risk is increased greatly. Most individuals recognize this with general infection, but often overlook this aspect when it comes to the impacts of mold. In addition to this, certain treatments used in hospitals or healthcare facilities may increase the already heightened level of susceptibility for patients or residents being treated.
Another challenge healthcare facilities are faced with is the fact that conditions within the facility are prime for the introduction and growth of mold. Mold grows best in darkness and requires organic material to feed on such as drywall or dust. Healthcare facilities are extremely complex with large wall and ceiling cavities where mold can grow relatively undetected. Facilities typically have complex air handling systems to control temperature, humidity and any other factor required to maintain optimal conditions. These elaborate systems, however, can act like a highway for airborne mold spores allowing it to quickly spread to far reaching areas within the building. This often creates a highly complex scenario when evaluating potential mold growth. Another factor that both introduces mold into the facility and helps mold move within the facility is the high amount of traffic healthcare facilities experience. Hospitals, senior living facilities and many medical clinics are open around the clock with patients and residents constantly coming and going. Mold spores can settle on clothing only to be brought into a facility and then introduced into the environment when they become disturbed, dislodged and made airborne again.
Lastly, in order for mold to thrive it requires moisture. Healthcare facilities have a great deal of water and plumbing making them prime environments for mold growth. From the miles and miles of plumbing in hospital walls and ceilings to HVAC systems which may experience condensation and even laundry collection and processing areas where wet and damp clothing or linens provide excellent sources of moisture, hospitals and healthcare facilities are at an increased risk for water damage, excess moisture and resulting mold.
Understanding that hospitals and healthcare facilities are at an increased risk of mold, it is crucial that preventative measures be taken. Some of the most effective methods are also the most basic and that is to perform regular inspection and maintenance on all systems within the facility such as plumbing and HVAC. Look for standing moisture or materials that remain wet or damp. These are prime areas of concern when it comes to mold. Keep in mind these areas may be inside ductwork or within walls.
In a recent mold-related incident at a children’s hospital in Seattle, the cause was found to be the air handling system. As previously mentioned, this can be extremely difficult to manage once the mold has been introduced to multiple areas within the facility. Another occurrence on a maternity floor in Staten Island hospital was caused by water-borne mold behind a sink wall. In that case, 53 employees were sickened, and all the newborns had to be moved to a backup nursery. Other incidents range from a simple ice machine failing to drain to a mold affected surgical room. It is critical to inspect all areas and aspects, no matter how insignificant or mundane it may seem.
One area to pay particular attention to when inspecting a facility are the ceiling tiles. Look for discolored tiles and if any are found conduct a detailed inspection of the surrounding area to determine whether there may be excess moisture present. It is vital to thoroughly inspect the entire area because moisture will travel by “wicking” through materials such as drywall. The source of the water may be located a good distance away from the first signs of damage.
