Handling Asbestos Abatement in Hospitals
What to Expect During Removal of Asbestos
If a building was constructed between the 1920's through 1980, renovations or demolitions are more complicated. The building materials likely contain asbestos, making assessment and abatement necessary during projects.
Asbestos abatement is tricky enough for homeowners, but it’s even more difficult for hospitals that need to take care of vulnerable populations. In some cases, asbestos abatement can be so complex that some facilities may forgo renovations altogether.
The presence of asbestos materials doesn’t necessarily mean your building is dangerous. If the material is in good condition, maintained properly, and not disturbed, the risk of inhalation exposure is low. The problem comes with poorly maintained building materials and improper planning during demolition. Combined with unawareness, these may pose a significant health risk to hospital occupants, especially during a building renovation or major construction event.
Here's a short video to understand the essential measures for major renovation projects in hospitals.
How We See Asbestos and Clean Up Today
Although asbestos production and use in the U.S. has decreased dramatically over the years due to health concerns and regulations, historic asbestos-containing materials (ACMs) are still relevant in built environments today. About 125 million people in the world are exposed to asbestos at the workplace. Asbestos exposure is associated with:
Lung cancer
Asbestosis, which damages the lungs
Mesothelioma, a rare cancer of the chest and stomach lining
The U.S. Environmental Protection Agency created the National Emissions Standards for Hazardous Air Pollutants (NESHAP) to minimize the release of airborne asbestos during construction work.
The Clean Air Act requires work practices to minimize asbestos emissions from demolitions, renovations, and buildings (with the exception of residential buildings of four units or fewer). Any demolition or renovation of buildings containing asbestos must be inspected and the appropriate agency notified beforehand. Work practices such as wetting, sealing, and disposing of asbestos-containing building materials help prevent contamination of occupied spaces during and after the renovation.
People in the construction work area are at risk too, particularly during the removal of asbestos materials due to renovation, repairs, or demolition. It’s because of these risks that the Occupational Safety and Health Administration (OSHA) requires awareness, specialized work practices, and personal protective equipment.
The Difference Between Asbestos-Contaminated vs. Asbestos-Containing Materials
Asbestos-containing materials (ACMs) are composed of more than 1% asbestos by weight, according to the EPA’s definition. ACMs contain asbestos fibers, commonly found in:
Old insulation
Flooring
Roofing
Wallboard
Joint compound
Popcorn ceiling
If these materials are in good condition and remain undisturbed, they generally do not pose an immediate inhalation hazard.
But a renovation or demolition can release these asbestos fibers into the air. The EPA doesn’t regulate materials that contain less than 1% asbestos content by weight. Still, these materials can pose a health hazard and are thus regulated by OSHA.
Another potential risk in a building, especially a hospital, is asbestos dust sitting atop non-ACMs. These building materials did not originally contain asbestos but have since been contaminated with asbestos fibers. This can happen when ACMs are disturbed or damaged, and asbestos fibers become airborne and settle on surrounding surfaces.
For example, renovation, demolition, or degradation over time can disturb asbestos-containing materials above the ceiling. The asbestos fibers can then settle on nearby surfaces such as atop a suspended ceiling grid system. This can create an inhalation hazard when someone removes an affected ceiling tile to assess or do work.
Whether an ACM or an asbestos-contaminated building material, it can pose a health hazard if disturbed or damaged. You must properly remove and dispose of asbestos in order to ensure the safety of workers and the public.
Managing Asbestos-Containing Materials
Asbestos was most commonly used in building materials, including hospitals, constructed in the 1920's through 1980. Asbestos-containing materials include:
Thermal systems insulation (vessels, duct, and pipe insulation)
Roofing and siding shingles
Vinyl floor tiles and rolled flooring
Plasters, cements, putties, mastics, and caulks
Joint compounds and spacklings
Ceiling tiles and spray-applied surfacing materials (fire proofing, coatings)
Gaskets and jointings
Heat-resistant textiles
Since asbestos is prevalent in older construction and building material types, it can be a daunting task to assess, manage, and abate all ACMs, especially while a hospital is occupied. Often times, there is hidden ACMs behind walls, under floors, in plenum spaces, and other hard-to-reach areas.
Some ACMs in good condition are relatively unlikely to result in hazards when left undisturbed. However, when older ACMs are in poor condition or are disturbed or damaged, fibers can be released into the air and become an inhalation hazard. Additionally, asbestos fibers may settle on surfaces and cause inhalation hazards when those surfaces are disturbed. Therefore, it is crucial to identify, assess, manage, and abate ACMs correctly to minimize exposure and protect health.
If your project will disturb ACMs, you should identify, assess, and abate them prior to hospital renovations. This will minimize or eliminate inhalation exposures for those working in the surrounding spaces. Failure to properly deal with ACMs could also lead to fines or other penalties from governmental authorities.
Understanding the risk exposure related to asbestos in your building, especially a hospital, can be challenging:
Asbestos is a microscopic mineral. The typical length of asbestos fibers is 0.1 to 10 micrometers, so an individual airborne asbestos fiber is not visible to the naked eye.
There is a latency period from the time of exposure before symptoms of illness present themselves.
Because of their size and durability, asbestos fibers can remain suspended in the air long after they are released, and if not removed from an occupied space properly, potentially result in subsequent exposure.
Three Challenges of Asbestos Abatement in Hospitals
Critical patient care and high risk of exposure: Hospitals provide patient care services that require uninterrupted operations. Asbestos abatement work may disrupt hospital operations, leading to potential safety concerns for patients and staff if not performed properly. Secondly, improperly done asbestos abatement work creates a risk of airborne asbestos fibers, presenting an inhalation hazard. Lastly, hospitals are populated by individuals who may be more vulnerable to exposure from construction dust in general, such as the elderly, children, and those with compromised immune systems.
Complex building structure with limited access: Hospitals are typically large and complex buildings with multiple levels, wings, and systems. Certain areas of a hospital may be restricted due to patient care, hospital critical function, or security reasons. This can make it challenging to conduct a thorough asbestos inspection to identify ACMs, as well as subsequent asbestos abatement.
Regulatory compliance: Hospitals must follow strict regulations governing hazardous materials and infection control. Asbestos abatement must comply with these regulations, which can add additional complexity to the project.
If you want to know more about asbestos abatement, check out how one medical center in the Midwest dealt with it.
How To Design Your Asbestos Inspection for Success
Your goal is to mitigate the risk by doing proactive research and assessment and figuring out how to clean up and dispose of asbestos.
A licensed asbestos inspector considers previous historic information concerning a built structure and conducts an assessment of the renovation project and surrounding areas, including bulk sampling. A thorough inspection and assessment includes:
Awareness of limited accessibility
Asbestos may be located in materials hidden behind walls and deep within buildings, often in areas that are difficult to access. It is up to the professionals to identify where these areas are and what precautions are necessary for testing or awareness of inaccessibility. Asbestos waste is not always properly discarded during previous ACM maintenance work and may still exist in wall cavities or ceilings. During previous renovation projects, materials may be abandoned in place or built over rather than put in a designated asbestos landfill.
A building’s history of renovations
Older buildings will typically have a history of previous renovations or demo work. Before starting renovation or demolition, it is up to the professionals to work with the building owners and facility managers to collect needed information. This includes previous assessments, inspections, and drawings showing locations, types, and quantities of asbestos in the building.
Hidden ACMs
Building owners may feel confident in hiring a regular “clean” demolition contractor if the results of a previous asbestos survey were negative. However, in some cases, there may still be ACMs or contaminated surfaces hidden that have not been fully assessed. It may be necessary to perform additional asbestos sampling should there be new, previously unidentified materials. For example, if old asbestos-containing fire proofing is encapsulated by a newer layer of non-asbestos fire proofing, or enclosed with the installation of a hard deck, the initial asbestos survey may not have considered this. That means a hospital could need a trained asbestos abatement contractor.
Clear communication
Notify all relevant stakeholders, hospital staff, patients, and visitors as needed. Protect them during asbestos assessment and abatement through proper procedures conducted by a certified professional. Asbestos abatement in hospitals is a complex process that must be conducted with extreme care to ensure everyone’s safety. These abatement work activities typically include negatively pressure enclosures/containments, HEPA filters, air monitoring, and personal protective equipment such as a respirator and coveralls.
“Projects don’t go sideways because of bad news. They go sideways because of surprises. If you bring in the right professionals to help you strategize and plan your project, you can mitigate the bad news of the presence of hazardous materials and avoid costly surprises once the project is underway.”
—Chuck Cummings, GHP, Partner, National Account Executive
Conclusion
Construction in hospitals is complicated. And when you add in hazardous materials and clean up, it's even more so. A successful asbestos inspection requires a certified professional who understands the importance of research, assessment, and communication with all relevant stakeholders. By proactively mitigating the risk of asbestos exposure, hospitals can ensure the safety of patients, staff, and visitors and avoid costly surprises during renovation or demolition projects.