Reopening After A Hurricane: Steps for Healthcare Facilities to Ensure Safety and Compliance

Following the aftermath of Hurricane Helene, and any other disaster, one of the many challenges that medical and dental facilities will face is reopening. This article’s purpose is to provide some guidance for all facilities to open safely and to ensure a sanitary environment for both employees and patients.

There are several concerns that will need to be addressed when reopening following a prolonged shutdown. One of the top concerns is water safety-ensuring the water is safe for drinking, running equipment, and hand hygiene. Mold buildup, sanitary sewer systems operating correctly, surfaces being free of microorganisms, equipment being cleaned/disinfected/sterilized properly, and supplies being free of damage are just a few other issues to look out for. These concerns are just the “tip of the iceberg”, each facility will face different obstacles and challenges.

Dental and medical facilities will need to ensure several items are working in a safe and sanitary manner prior to bringing patients back. The following are a few infection control items that are to be assessed and ensure they are operating correctly for a facility to reopen. This list is not all inclusive, there may be other challenges as well.

• Determine if water is deemed safe to use and there is a sufficient supply of water. Water is needed for hand hygiene (sanitizers can be used in some cases), for dental equipment (such as compressors, instrument washers/ultrasonics, etc. to run properly), and for dental unit waterlines. Distilled water is needed for autoclaves and in some self-contained dental unit waterlines. Medical facilities need water for equipment such as ultrasonics, instrument/washers and autoclaves. OSHA would expect hand-washing facilities for employees.

EPA has a checklist on restoring water quality and can be found on this website: https://www.epa.gov/sites/default/files/2020-05/documents/final_checklist_for_maintaining_building_water_quality_5-6-2020.pdf

• The facility must be assessed for mold. Mold is a common problem after hurricanes due to high humidity and moisture levels. Mold can begin to grow within 24-48 hours of water exposure. Mold can be a serious health issue for people with allergies and respiratory illness.
• Sanitary sewer systems should be in working order. This is necessary to dispose of suctioned materials and toilets will need to be available for employee use. OSHA would expect adequate restrooms for employees. See OSHA standard: https://www.osha.gov/laws-regs/regulations/standardnumber/1915/1915.88#:~:text=The%20employer%20shall%20provide%20portable,a%20short%20duration%20of%20time.

• Environmental surfaces need to be cleaned and disinfected before patient care is delivered. Clean and disinfect surfaces with an EPA registered hospital level disinfectant.
• Supplies and equipment need to be inspected for any water damage. Expired supplies should be discarded and any that are damaged should be discarded according to manufacturer’s instructions for use. Sterilized instruments that have become compromised should be cleaned, repackaged and sterilized again.
• Maintenance should be performed on any equipment before using in the delivery of patient care, this includes autoclaves, suction lines, ultrasounds, radiology equipment, etc. Perform spore testing on autoclaves prior to use.
• For dental facilities only: Dental Unit Waterlines should be shocked then tested before use. If the testing reveals failing water quality, shock and test again. If testing continues to fail, troubleshoot and contact manufacturer as needed.

OSHA would expect a safe, sanitary workplace for employees. Employee safety should be at the frontline of concerns. Below are some items to consider when re-opening. Again, this list is not all inclusive, there will be other issues that will arise and may be present.

• The building should be safe to enter: structural changes, electrical lines down, traffic changes, and road construction need to be assessed.
• Hazardous materials, chemicals, and fumes need not be present.
• Other hazards need to be considered- flooding, sewage, fallen electrical lines, compressed gas cylinders that may have moved or been tipped over during the disaster.
• Is PPE (personal protective equipment) readily available and appropriate for any existing job hazards? Do you have adequate respiratory protection if needed?
• Fire hazards may be present- is the fire alarm system working? Exits need to be clear of debris, furniture, etc.
• Are there any slips, trip, or fall hazards now present?

HIPAA can also be a challenge during this time. There are many concerns in accessing and protecting health information during a disaster. Some things to consider:

• Ensure any damaged physical records or equipment are stored and protected:

1. 1. Make sure all physical records have been accounted for.
   2. If records have been damaged, create a plan for recovery or destruction in compliance with HIPAA standards.

• Ensure electronic Protected Health Information (PHI) is protected from unauthorized access.
• Implement temporary access restrictions if needed for employees working remotely.
• Verify firewalls, antivirus software, and any other security measures in place are up to date on all devices.
• Reiterate to staff their responsibility to report potential breaches or security incidents for proper and swift response.
• If using Telehealth services during recovery, ensure the platform is compliant for PHI protection during virtual visits.

For releasing information during a public health emergency this link contains a decision tool on when PHI can be disclosed: https://www.hhs.gov/sites/default/files/ocr/privacy/hipaa/understanding/special/emergency/emergencyprepdisclose.pdf

Once the decision has been made to return to work, the work begins in assessing the building and contents. Remember- Safety First for all! Keep in mind that persons involved in the clean up need to be protected from infectious diseases, chemical exposures, radiation, electrical shock, and potential fire hazards.

There are resources available for you to use. The resources used for this article were from the CDC, OSHA, EPA, and The Association for Dental Safety. We also have our own resource guide and a checklist for download.

TMC is here to help and guide. Your TMC Consultant and our Client Services support is here for you. Our thoughts are with all of those impacted by this disaster. Reach out to us with your questions and concerns.