771 Air Quality Evaluation and Remediation of the University of Texas Medical Branch Following Hurricane Ike

Sunday, March 21, 2010
Grand Hall (Hyatt Regency Atlanta)
Angela Hewlett, MD , University of Nebraska Medical Center, Omaha, NE
Carmen Tichindelean, MD , Munsen Medical Center, Traverse City, MI
Pamela Falk, MPH , University of Texas Medical Branch, Galveston, TX
C. Glen Mayhall, MD , University of Texas Medical Branch, Galveston, TX
Background:   Hurricane Ike resulted in the evacuation and subsequent temporary closure of the University of Texas Medical Branch in September, 2008.  The hospital complex sustained significant damage as a result of the storm due to wind and flooding, which caused multiple mechanical malfunctions in the hospital’s ventilation system.  Concerns for the presence of airborne fungal organisms that may pose significant risk to compromised hosts were evident.  Investigations were initiated by the Department of Healthcare Epidemiology in order to prepare the facility to resume patient care.   
Objective:   To illustrate air quality problems encountered as a result of facility disruptions from a natural disaster using airborne fungal sampling, and to describe methods utilized for mitigation of these facilities.
Methods:    Air sampling began on October 11, 2008 using a Casella (HB3109-03) Airborne Bacteria Sampler and BBL inhibitory mold agar (Becton, Dickinson).  Multiple air samples were obtained from patient care areas, operating rooms, and entrance points to the hospital buildings.  The inhibitory mold agar plates were incubated at 30oC for 5 days, examined for growth, and total colony counts were documented.  Fungal organisms were identified using routine methods.
Results:   A total of 1819 air samples were obtained from our hospital complex from October 2008 until October 2009. Air sampling demonstrated high total colony counts of fungal organisms including pathogens like Aspergillus spp., Fusarium, and Zygomycetes in multiple patient care areas as compared with previous air samples obtained as a routine infection control practice.  Investigation into the hospital’s ventilation delivery system revealed malfunctioning air handlers, leakages, and intake filters loaded with debris.  Facilities mitigation attempts were initiated, including air duct cleaning, repairing malfunctioning air handlers, patching leaks, surface cleaning and replacing intake filters which resulted in a reduction in the total colony counts of fungal organisms.
Conclusions: Natural disasters have the potential to cause severe damage to hospitals, rendering facilities in need of repair and/or replacement.  These damages can result in poor air quality, including high numbers of fungal organisms in patient care areas that may pose a risk to the health of compromised patients.  Investigations should be initiated in an effort to remediate these facilities prior to resuming care of patients.