How Hospitals can Partner with Schools to Evaluate the ... · Impact of Asthma on Schools • #1...
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How Hospitals can Partner with Schools to Evaluate the Health of their Spaces (and what we’ve seen) Thursday, October 26 th 2017
Transcript of How Hospitals can Partner with Schools to Evaluate the ... · Impact of Asthma on Schools • #1...
How Hospitals can Partner with Schools
to Evaluate the Health of their Spaces
(and what we’ve seen)
Thursday, October 26th 2017
Learning Objectives
• Provide information on how to reach out to schools, get administrative buy-in, and communicate with various stakeholders in district
• Help identify key stakeholders in the district involved in decision-making and approaches for various target audiences
• What issues are routinely identified in schools
• Offer suggestions/solutions for addressing and resolving common issues in schools
1995 U.S GAO Identified Unsatisfactory & Very
Unsatisfactory School Environmental Conditions
Condition % of Schools
# of Schools
# of Students
Lighting
Heating Ventilation Indoor Air Quality
Noise Control Physical Security
15.6
18.9 27.1 19.2
28.1 24.2
12,200
15,000 21,100 15,000
21,900 18,900
6,682,000
7,888,000 11,559,000 8,353,000
11,044,000 10,638,000
School Facilities: Condition of America’s Schools. U.S. General Accounting Office, Washington, DC, 1995. GAO/HEHS 95-61
US Department of Education
Reports:
• In 2000, U.S. Dept of Ed. Report –
– 25% of U.S. schools need extensive repair or replacement of one or more buildings, and ~40% of schools report at least one environmental problem.
• 2004 U.S. Dept of Ed. Report
–Virtually nothing had changed.
Mendell and Heath (2006), “more
than enough evidence of poor
school indoor environmental health
to justify”:
• Immediate actions to assess and improve
IEQ in schools
• Focused research to guide IEQ
improvements in schools
Mendell, M. J. and G. A. Heath, “Do indoor pollutants and
thermal conditions in schools influence student performance?
A critical review of the literature”, Indoor Air, 15(27–52), 2005.
% of
Schools
with
Specific
Practices
% of Schools Providing Training on:
Results of the School Health Policy & Practices Study 2014, Div. of Adolescent and School Health, 2015 CDC, US HHS.
Schools Face
Inherent &
Unique Challenges
• Most densely occupied buildings
• Constantly fluctuating educational needs
• Budget dollars for regular maintenance and
renovation of school buildings have been forced
to a low priority
In other words…deferred maintenance
Research clearly shows a distinct
relationship between indoor
environmental quality and:
• Student and staff health
• Attendance
• Academic performance
• General cognitive ability
Turunen, et.al. International Journal of Hygiene and Environmental Health, 2014 217(7)
Gaihre, S et.al. Journal of School Health, 2014 84(9).
Mohai, et.al. Health Affairs, 30(5)
Cartieaux E, and MA Rzepka, Arch. Pediatrics, 2011 18(7)
Mendell and Heath Indoor Air, 2005 15(1)
Mendell, Mark and Heath, Garvin, U.S. Department of Education, April 2004, LBNL-2004-06
• Temperature
• Ventilation adequacy
• Relative humidity
• Carbon dioxide levels
• Amount of daylight
• Presence of noise
• Indoor pollutants and contaminants
Student success in the classroom
shown to be influenced by:
US EPA 402-K-03-006, August 2003, Indoor
Air Quality & Student Performance
• Improved Health
• Increased attendance =
more state funding($)
• Improved Academic Performance
• General cognitive abilities should
improve in a safer and healthier
learning environment.
What are the Benefits?
Mohai, et.al. Health Affairs, 30(5)
Cartieaux E, and MA Rzepka, Arch. Pediatrics, 2011 18(7)
Mendell and Heath Indoor Air, 2005 15(1)
Mendell, Mark and Heath, Garvin, U.S. Department of Education, April 2004, LBNL-2004-06
FAM
ILY
Hea
lth
care
Pro
v.
SCH
OO
L
Student with
Chronic Disease
Impact of Asthma on Schools
• #1 chronic illness among children and adolescents in the US (CDC, 2014)
• Significant rise in asthma in children- 49% increase since 1982 and is the #1 cause of school absences attributed to a chronic illness/condition. (CDC, 2012)
• As of 2009, 7.1 million (14%) children <18 have been diagnosed with asthma (ALA, 2012)
• In 2011, 4.1 million of children under 18 years of age had an asthma attack. (ALA, 2012)
One district’s asthma clinic visits
Safe & Healthy Schools Program
Should Be Comprehensive
An Integrated approach that considers:
• People occupying the school
• Any potential health hazards
• How the facility is cleaned, maintained, and
operated
• How to reduce absenteeism and increase
student performance
• The facility structure itself
Healthy schools require integrated,
effective & sustainable management
Communication is Critical:• Create District-level and Building-level Teams to
discuss and address issues
• Share information
• Teams will need access to environmental expertise:– IEQ Professionals OR
– Staff trained in school indoor environmental health.
• Offer to assist- Schools always in need of “expert” guidance
• Put your best foot forward- Play to your strengths and show your
expertise
• Work to build trust over time
- It takes years to build trust and that trust can
be lost in an instant
How to get district buy-in
Safe & Healthy Schools Process includes:
• Administrative/management activities
• Evaluation of existing activities and structure
• Training of staff
• Facility Assessments w/ building-level team
• Tracking and Surveillance (document ROI)
• Publicize activities and results
Administrative/Management Activities:
• Identify high-level “champion” within the district
• Creation and integration of organizational structure (as part of other structures)
• Creation and integration of lines of communication and/or chain-of-command
• Establish district-level and building-level teams
Key Decision Makers
• Administration- Principal, Superintendent, School Board
• Facilities & Purchasing
- Director of Facilities, HVAC Manager,
Purchasing Manager
• Health Services- Health Aides, School Nurse, Director of Health
Services
Strategies for Success - Speak
their language• Administration
- ROI, reducing absenteeism, $, student successand achievement, public relations
• Facilities & Purchasing- Costs (short and long-term), maintenance,
effectiveness, minimize impacts on health
• Health Services- Reducing asthma clinic visit, reducing
absenteeism, improved health outcomes, provide health education
Begin by evaluating district’s policies and procedures:
• Assess health and wellness initiatives• Establish routine maintenance and custodial
activities and schedules• Evaluate pest control strategies and activities• Search for safer cleaning products and more
effective custodial techniques• Review waste management and recycling• Assess presence of idling vehicles• Evaluate Chemical Management, Safety, and
Chemical Disposal plans
Facilitate Policy Review
Provide training opportunities for:
• Asthma education and training for nurses, coaches, teachers and students
• Education and training for maintenance and custodial staff
• Staff education and training in regards to occupancy-related issues
• Basic education and training for district-level and building-level teams
Teaching Teams How Buildings Work
The Four Main Factors (the 4 “P’s”) That Affect School Indoor Environmental Health are:
• Contaminant sources (Pollutants)
• Contaminant pathways (Pathways)
• Ventilation (Pressure)
• The health and medical history of the occupants (People)
The Most Common Problems Leading to Poor IEQ we’ve observed:
• Poor occupancy practices.
• Poor maintenance & custodial practices.
• Inadequate design and/or maintenance of HVAC.– A shortage of fresh air.
– Lack of humidity control.
Issues routinely encountered during Building Assessments
HVAC Systems and Ventilation
HVAC Systems and Ventilation
Cleaning and Allergen Control
Cleaning and Allergen Control
Moisture Control / Mold Prevention
Moisture Control / Mold Prevention
Moisture Control / Mold Prevention
How significant is the problem? Is
it actually a problem at all?
What does that ceiling stain mean?
• may indicate an older or current, active issue
• Depending on cause and location, the issue can be
prioritized accordingly
• Regardless of appearance, many ceiling stains are just
that…stains
Source Control / Room Contents
Source Control / Room Contents
Source Control / Room Contents
Security, Safety, and Injury Prevention
Security, Safety, and Injury Prevention
Security, Safety, and Injury Prevention
The Learning Environment
47
I didn’t even know this is under
my classroom…
Condensation on tunnel walls… …a clogged drain in tunnel.
48
or that this was outside my classroom…
Allergens and pest harborageIdling vehicle exhaust brought
into the facility
Air Intakes
49
or that this is above my classroom!
A clogged roof drain may not seem like
a serious issue, but…
50If it leads to this…
51
or this, then there are problems!
52
It’s primarily about making
informed decisions…
• Endocrine
• Sports Medicine
• Healthy Kids University / Fit Kids
• Physicians serving as Medical Directors
Other ways Hospitals can work with
Schools
• The “Healthy Schools” movement is a holistic or comprehensive approach to promote occupant health through safer and healthier academic environments.
• There is a link between the environment in a school facility and the health of the occupants, attendance, and overall performance of students and staff
• Certain groups (children and other sensitive individuals) are at greater risk for adverse health effects.
• There is school health data and scientific research that supports the creation and maintenance of safe and healthy school environments.
• “at present, evaluation of good IEQ is based not on specific indoor exposure limits…but on good practices of design, maintenance and operation of buildings that are considered to provide conditions of acceptable IEQ”.
Key Messages
• School Facilities: Condition of America’s Schools. U.S. General Accounting Office, Washington, DC, 1995. GAO/HEHS 95-61
• Mendell, M. J. and G. A. Heath, “Do indoor pollutants and thermal conditions in schools influence student performance? A critical review of the literature”, Indoor Air, 15(27–52), 2005.
• Results of the School Health Policy & Practices Study 2014, Div. of Adolescent and School Health, 2015 CDC, US HHS.
• Turunen, et.al. International Journal of Hygiene and Environmental Health, 2014 217(7)
• Gaihre, S et.al. Journal of School Health, 2014 84(9).
• Mohai, et.al. Health Affairs, 30(5)
• Cartieaux E, and MA Rzepka, Arch. Pediatrics, 2011 18(7)
• Mendell, Mark and Heath, Garvin, U.S. Department of Education, April 2004, LBNL-2004-06
• US EPA 402-K-03-006, August 2003, Indoor Air Quality & Student Performance
• CDC School Health Index (SHI) 2014 Elementary School Guidance
• ELI, “School District Liability for Indoor Air Quality Conditions”, 2005
• U.S. EPA. 2007. Envisioning Excellence and the Framework for Effective School IAQ Management: Six Key Drivers. The 8th Annual IAQ TfS Symposium, Washington, DC
Bibliography
Luke Gard, CIEC, CMC, BOCChildren’s Mercy Hospital
Environmental Health [email protected]
816-960-8926
Any Questions?
