FacilityCare September 2009 : Page 26

INDUSTRY EXPERTS ANSWER YOUR FACILITY MANAGEMENT QUESTIONS Document Recovery Is it possible to recover critical medical documents, such as patient records and X- rays, damaged by fire, flood or mold caused by excessive moisture? What steps are nec- essary to do so? K.S., Ann Arbor, Mich. Recovering and restoring documents is possible. The best results are linked to the speed at which appropriate action is taken. Depending on ambient conditions after a disaster, studies show that mold can begin to grow on water-damaged doc- uments within 72 hours of exposure. Electronic media; pictures, including sono- grams and angiograms; and X-rays have an even shorter “half-life.” Delay in stabilizing and addressing dam- aged documents also increases the cost of reclamation. More important, each day delayed is another day doctors, nurses and other medical staff lack access to critical information required to treat their patients and perform administrative services. Choosing a Document Restoration Vendor Many restoration companies do not pro- vide document reclamation services in- house. Choosing a vendor that provides in- house services or directly hiring a document reclamation company will strengthen com- munication lines and lessens the burden of the facilities personnel having to oversee the recovery effort. This also allows better busi- ness continuity and eliminates unnecessary subcontracting markup. Pricing structures vary greatly among the few large document reclamation firms, though basic services are often comparable in terms of total cost. The quote is not the only cost to consider. A hidden cost can be the business interruption caused while critical documents are inaccessible or in the process of reclamation. Consider the time frame for completion a significant, if not equal, component in evaluat- ing the cost of a contractor’s services. To ensure the best possible business continuity, it is important to secure written commitments to a project completion time frame and the serv- ices desired when the documents are returned. Do not feel pressured to wait in line for the return of documents, because competition exists among document recovery firms. 26 | FACILITYCARE facilitycare.com Request a committed completion date and provisions for document access during the reclamation process in the scope of work. Finally, before executing a contract, see what provisions there are for the return of documents. For example, will the staff require assistance reshelving documents or integrating document images into existing electronic content management? The scope of work should clearly state how the docu- ments will be returned and how the contrac- tor will satisfy staff needs. Document Inventory and Removal Documents should be inventoried, removed from the disaster zone and stabi- lized by qualified professionals. Prior to the release of documents, it is important to ensure HIPAA compliance. The legal department should be able to readily pro- duce a HIPAA partnership agreement for a principal officer of the document recovery firm to execute. Removing documents from a healthcare facility, especially when damage and location are widespread, requires collaboration with the document custodians, strict attention to detail and adequate labor to safely transport the documents out of the facility. Recording the location and order of documents ensures a proper chain of custody and enables an effi- cient reintegration of the documents once reclamation services are complete. Once removed, the inventoried boxes of documents should be loaded onto a moni- tored freezer trailer for temporary storage for mitigation of damage or expeditiously deliv- ered to a document reclamation center for immediate treatment. Although drying sys- tems can be mobilized to the affected medical facility, the cost of sending affected docu- ments to a document reclamation center for treatment is typically far less expensive. The Document Reclamation Process The two most common methods of docu- ment drying are vacuum freeze drying and desiccant drying. Vacuum freeze drying is an aesthetic solution, while desiccant drying is a functional solution. Vacuum freeze drying produces the best results with books. The documents are blast- frozen at -20º F and loaded into the drying chamber. This ensures that no additional damage occurs; microbial growth, warping of paper and file folders, and bleeding of ink are arrested. Vacuum freeze dry chambers, how- ever, are limited in size and production capa- bility. It is not uncommon during years with major catastrophes such as Hurricane Katrina for documents to remain in a blast-frozen backlog for months or more. Desiccant drying is not recommended for books but is an effective alternative to vacu- um freeze drying for medical documents if accurately employed. A qualified desiccant drying firm typically has a specialized racking system that allows a significant flow of super- dried air through the individual pages of the affected documents. Technicians manipulate the pages throughout the drying process to ensure equal distribution. This method results in moderate wrinkling of the paper but has two major advantages over vacuum freeze drying. First, it allows access to the documents during the drying process, giving medical professionals the option to request expedited patient charts via fax or PDF. Second, the desiccant method can accommodate tens of thousands of boxes of documents and records at one time. Depending on the nature of the damage, affected documents may require more treat- ment than simple drying. Gray water from a sprinkler discharge may expose the docu- ments to chemicals in the line, or sewer water may introduce biohazardous materials that are retained in paper fibers. These issues need to be addressed but can be evaluated during the drying process. Circumstances may also require that the documents be cleaned. This can include gamma irradiation to address biohazards and microbial growth. Technicians use standard cleaning methods, such as HEPA vacuuming and wiping with chemical sponges, to clean surface dirt, mold and debris. The cost for this service depends on the extent of damage. Documents such as active patient charts, human resource files and payroll records are sometimes selected for reproduction or imag- ing in lieu of cleaning, despite an increase in cost. If so, it is important to obtain a detailed scope of work from the contractor, specifying exactly how the documents will be duplicat- ed or indexed in digital form. The contractor should commit to quality of paper and man- ner of labeling and ensure that the originals will be retained for a sufficient period to enable the document custodians to audit SEPTEMBER 2009 ASK THE EXPERTS

Ask The Experts

K. S., Ann Arbor, Mich.

Recovering and restoring documents is possible. The best results are linked to the speed at which appropriate action is taken. Depending on ambient conditions after a disaster, studies show that mold can begin to grow on water-damaged documents within 72 hours of exposure. Electronic media; pictures, including sonograms and angiograms; and X-rays have an even shorter “half-life.” Delay in stabilizing and addressing damaged documents also increases the cost of reclamation. More important, each day delayed is another day doctors, nurses and other medical staff lack access to critical information required to treat their patients and perform administrative services. Choosing a Document Restoration Vendor Many restoration companies do not provide document reclamation services inhouse. Choosing a vendor that provides inhouse services or directly hiring a document reclamation company will strengthen communication lines and lessens the burden of the facilities personnel having to oversee the recovery effort. This also allows better business continuity and eliminates unnecessary subcontracting markup. Pricing structures vary greatly among the few large document reclamation firms, though basic services are often comparable in terms of total cost. The quote is not the only cost to consider. A hidden cost can be the business interruption caused while critical documents are inaccessible or in the process of reclamation. Consider the time frame for completion a significant, if not equal, component in evaluating the cost of a contractor’s services. To ensure the best possible business continuity, it is important to secure written commitments to a project completion time frame and the services desired when the documents are returned. Do not feel pressured to wait in line for the return of documents, because competition exists among document recovery firms. Request a committed completion date and provisions for document access during the reclamation process in the scope of work. Finally, before executing a contract, see what provisions there are for the return of documents. For example, will the staff require assistance reshelving documents or integrating document images into existing electronic content management? The scope of work should clearly state how the documents will be returned and how the contractor will satisfy staff needs. Document Inventory and Removal Documents should be inventoried, removed from the disaster zone and stabilized by qualified professionals. Prior to the release of documents, it is important to ensure HIPAA compliance. The legal department should be able to readily produce a HIPAA partnership agreement for a principal officer of the document recovery firm to execute. Removing documents from a healthcare facility, especially when damage and location are widespread, requires collaboration with the document custodians, strict attention to detail and adequate labor to safely transport the documents out of the facility. Recording the location and order of documents ensures a proper chain of custody and enables an efficient reintegration of the documents once reclamation services are complete. Once removed, the inventoried boxes of documents should be loaded onto a monitored freezer trailer for temporary storage for mitigation of damage or expeditiously delivered to a document reclamation center for immediate treatment. Although drying systems can be mobilized to the affected medical facility, the cost of sending affected documents to a document reclamation center for treatment is typically far less expensive. The Document Reclamation Process The two most common methods of document drying are vacuum freeze drying and desiccant drying. Vacuum freeze drying is an aesthetic solution, while desiccant drying is a functional solution. Vacuum freeze drying produces the best results with books. The documents are blastfrozen at -20º F and loaded into the drying chamber. This ensures that no additional damage occurs; microbial growth, warping of paper and file folders, and bleeding of ink are arrested. Vacuum freeze dry chambers, however, are limited in size and production capability. It is not uncommon during years with major catastrophes such as Hurricane Katrina for documents to remain in a blast-frozen backlog for months or more. Desiccant drying is not recommended for books but is an effective alternative to vacuum freeze drying for medical documents if accurately employed. A qualified desiccant drying firm typically has a specialized racking system that allows a significant flow of superdried air through the individual pages of the affected documents. Technicians manipulate the pages throughout the drying process to ensure equal distribution. This method results in moderate wrinkling of the paper but has two major advantages over vacuum freeze drying. First, it allows access to the documents during the drying process, giving medical professionals the option to request expedited patient charts via fax or PDF. Second, the desiccant method can accommodate tens of thousands of boxes of documents and records at one time. Depending on the nature of the damage, affected documents may require more treatment than simple drying. Gray water from a sprinkler discharge may expose the documents to chemicals in the line, or sewer water may introduce biohazardous materials that are retained in paper fibers. These issues need to be addressed but can be evaluated during the drying process. Circumstances may also require that the documents be cleaned. This can include gamma irradiation to address biohazards and microbial growth. Technicians use standard cleaning methods, such as HEPA vacuuming and wiping with chemical sponges, to clean surface dirt, mold and debris. The cost for this service depends on the extent of damage. Documents such as active patient charts, human resource files and payroll records are sometimes selected for reproduction or imaging in lieu of cleaning, despite an increase in cost. If so, it is important to obtain a detailed scope of work from the contractor, specifying exactly how the documents will be duplicated or indexed in digital form. The contractor should commit to quality of paper and manner of labeling and ensure that the originals will be retained for a sufficient period to enable the document custodians to audit them for correct order and clarity of the copy or image. Once the retention period expires, the contractor should provide the medical facility with a Certificate of Destruction. Conclusion X-rays, patient charts and personnel records are the veins through which the knowledge and vitality of a medical facility flows. Knowing in advance how to secure qualified professional assistance with document reclamation as part of the complete recovery effort will save time, money and perhaps lives. Health facility managers should ensure that document recovery is included in their emergency preparedness plans in order to avoid significant loss of business continuity and escalating costs. -Joe Perko Flooring We are considering installing a polished concrete floor for our facility, but we’re concerned about dust from any potential renovation. How can this be done without compromising air quality? -B.H.,Kansas City,Kan. Polished concrete flooring is a new trend taking hold in commercial facilities. It’s considered a “green” floor, and compared to tile floors, it’s more sanitary and more durable and it requires only a quarter of the maintenance. The process used to install the floor should include diamond polishing pads and a powerful vacuum system. Essentially, polished concrete is a multistep progressive grinding process that transforms a concrete floor surface into an entirely new floor. When considering polished concrete as an alternative floor in a facility, one issue to consider is how the installation of the floor will affect patients and staff as well as any equipment in place. That’s because the process actually grinds the top layer of concrete into particulate matter. However there are effective methods developed to virtually eliminate the dust during the flooring process. To remove particles while installing a polished concrete floor, it’s best if HEPA filters are used with exceedingly powerful vacuums that pull air to a high velocity. A high-efficiency particulate air (HEPA) filter is a type of super-efficient filter that should be used during the floor grinding process to maintain air quality. In that way, virtually no dust will be released into the building, preventing contamination of equipment and keeping the work environment healthy and dust free. Once a polished concrete floor is installed, the low maintenance cost to keep a consistent shine is the single greatest advantage. Polished concrete is inherently easy to clean. That’s because the polishing process reduces the surface area, or pores, that trap dirt. The floor has a flat, smooth surface texture, so the dirt stays on top. It even requires less soap. Common on commercial floors today is VCT tile. Typically the coat on top of VCT is burnished and buffed to maintain its shine. But periodically the coat builds up and requires that it be stripped off, and the process begins again. Not so with polished concrete. And not only does polished concrete require significantly less maintenance to stay shiny, but it can also take better advantage of new green-cleaning technologies. Many facilities prefer polished concrete because it’s more sanitary, whereas VCT can hold dirt and bacteria that hide in the joints between tiles. Particularly attractive is that a polished concrete floor is immediately accessible after cleaning so activities are not interrupted. There is no waiting time for materials to cure. The annual estimates for cleaning and maintaining a nice bright shine on polished concrete run as little as $0.09 to $0.25 cents per square foot, depending on what level of shine you want to maintain, compared with $0.60 cents to $1.05 for VCT. The payback for installation is recovered quickly because of the low maintenance cost. If properly installed, polished concrete is a stunning, low-cost green alternative to more traditional flooring. The install process is quick and painless in the right hands. And for those of us looking for eco-friendly floors, we now have a good option. -Seth Rose Going Green How do we filter marketing claims to select green products? -L.L.,Philadelphia, Pa. Choosing green products requires a holistic approach. Internally, an environmental policy that includes directives for green purchasing is a good starting point for reducing an organization’s environmental footprint. Establishing a green supply chain provides guidelines that meet the needs of a specific industry and/or regional climatic concerns. In the meantime, here are a few questions to ask. • What’s in the product? • How was the product made? • Does the manufacturer subscribe to sustainable practices? • Is the product certified against a sustainable product standard? • What is the off-gassing of the product? • Is the product durable? • How is the product maintained? • Is the product recyclable? • What happens to the product at the end of its useful life? Externally, some of the best tools available are independent standards that consider the entire enterprise of a particular product. These third-party certifications provide assurance that a product, process or service conforms to specified requirements. They also support decisions that balance economy, ecology and social equity in daily business decisions. Certifications for green products take the product life cycle into account and take that worry from the specifier. Single-attribute offgassing standards like GreenGuard and Green Label Plus address volatile organic compounds (VOCs). The Carpet and Rug Institute’s Green Label Plus program for carpet and adhesives sets scientifically based standards for indoor air quality (IAQ) to ensure that customers are purchasing lowemitting products. Multiattribute green standards often employ Life Cycle Assessment (LCA) in considering the life phases of a product. Examining the environmental impact categories of LCA can be instructive in appreciating its role in the product selection process. Two standards that serve as models for sustainable certification are NSF-140 and SmaRT. The ANSI/NSF 140-2007 Sustainable Carpet Assessment, or NSF-140, is intended for commercial, hospitality and similar carpets and serves as a universal industry standard. Reliable third-party verification from reputable auditors provides assurance that product expectations are met. California standards have been incorporated into the final ANSI/NSF 140-2007 standard at Platinum certification levels. Smart is a consensus national standard developed by The Institute for Market Transformation to Sustainability (MTS). Smart is approved as part of the LEED Green Building Rating System based on compliance with comprehensive sustainable product certification criteria. Green manufacturers make sustainable choices on all products and in all production decisions. They seek certification to ISO 14001 – the highest global standard for environmental responsibility and follow Design for the Environment (DfE) protocols. Applying Life Cycle Inventories and Life Cycle Analyses against the ISO 14040 standard allows these companies to evaluate components and their impact on the environment. Maintaining a green supply chain reduces waste and conserves resources. Today, it’s not just the product. Green companies look at ways to reduce packaging waste, which also saves energy and resources. End of life (EOL) alternatives now are considered at the point of purchase rather than at the end of use. Reclamation programs are important in reducing waste in landfills as well as costs by weight and regarding chemicals of concern. -Bill Gregory Signage How can our signage be an effective wayfinding tool while being incorporated it into the overall design concept of the hospital? -S.D.,Portland, Ore. Signage has come a long way over the last 30 years. Gone are the days of plastic plaques that came in a limited color palette and then were discarded when their messages were obsolete. Signs had only one purpose, and that was to communicate. Today, signs are available in infinite colors and materials that not only help visitors, patients and staff reach their destination but are valuable tools for branding and design. Hospital visitors and patients often have a lot on their minds. Navigating through your facility should not be one of them. Careful planning is paramount to creating the most functional, attractive, cost-effective and codecompliant signage installation possible. Working with a designer who specializes in wayfinding ensures a solution tailored to your specific style, budget and overall needs. Once needs are determined, a manufacturer that provides a turnkey solution is critical for the planning to be successfully executed. A quality signage system will provide sustainability and ease of maintenance, which are essential in the ever-changing environment of a hospital. A system approach is a collection of wayfinding interior and exterior signs that will convey your hospital’s unique identity consistently. For signs that require frequent changes, systems can provide specialty signs that specify paper for easy in-house applications along with providing blank graphic inserts for a facility’s sign shops. This adaptability provides the opportunity to incorporate interior design and brand identity elements. Turnkey providers also offer professional sign installation services that guarantee the proper execution of the planning, design and sign fabrication. This installation component protects your investment and saves additional time, money and frustration. It’s also important to consider a sign provider that offers innovative tools to support your ever-changing environment. Maintenance manuals of sign drawings with specifications combined with quick-ship programs make reordering easy and fast. A manufacturer that is dependable and products that are sustainable save dollars and frustrations down the road. It used to be that signage was only noticed when it failed to communicate to visitors to or occupants of a facility. Now signs not only are an effective tool for wayfinding but tell visitors who you are as an organization. A well-planned sign system is an integral part of your brand identity. An offering of signs for every purpose and location, all linked through aesthetic consistency, all crafted to exacting specifications and all peerless in accommodating change is today’s standard in the sign industry.

Previous Page Next Page

Publication List