Construction activities are a known risk contributing to the growth and spread of waterborne pathogens in building water systems. The purpose of the study is to integrate evidence for categorizing construction activity risk factors contributing to waterborne disease in community and healthcare settings, establish severity of such risk factors and identify knowledge gaps. Using a systematic review, the inclusion criteria were: (1) studies with disease cases suspected to be associated with construction activities and waterborne pathogens, and (2) active construction work described in a community or healthcare setting. Each construction activity risk factor was correlated across all studies with the number of disease cases and deaths to establish risk severity. The eligibility review and quantitative synthesis yielded 31 studies for inclusion (community, n = 7 and healthcare, n = 24). From 1965 to 2016, a total of 894 disease cases inclusive of 112 deaths were associated with nine construction activity risk factors and waterborne pathogens. The present study findings support the need for building owners, water management teams and public health professionals to address construction activity risk factors and the analysis of current knowledge deficiencies within the scope of an ongoing water management program. The impact of construction activities on waterborne disease is preventable and should no longer be considered incidental nor accidental.
BackgroundThe World Health Organization has identified obesity as one of the most visible and neglected public health problems worldwide. Meta-analytic studies suggest that insufficient sleep increases the risk of developing obesity and related serious medical conditions. Unfortunately, the nationwide average sleep duration has steadily declined over the last two decades with 25% of U.S. adults reporting insufficient sleep. Stress is also an important indirect factor in obesity, and chronic stress and laboratory-induced stress negatively impact sleep. Despite what we know from basic sciences about (a) stress and sleep and (b) sleep and obesity, we know very little about how these factors actually manifest in a natural environment. The Assessing Daily Activity Patterns Through Occupational Transitions (ADAPT) study tests whether sleep disruption plays a key role in the development of obesity for individuals exposed to involuntary job loss, a life event that is often stressful and disrupting to an individual’s daily routine.MethodsThis is an 18-month closed, cohort research design examining social rhythms, sleep, dietary intake, energy expenditure, waist circumference, and weight gain over 18 months in individuals who have sustained involuntary job loss. Approximately 332 participants who lost their job within the last 3 months are recruited from flyers within the Arizona Department of Economic Security (AZDES) Unemployment Insurance Administration application packets and other related postings. Multivariate growth curve modeling will be used to investigate the temporal precedence of changes in social rhythms, sleep, and weight gain.DiscussionIt is hypothesized that: (1) unemployed individuals with less consistent social rhythms and worse sleep will have steeper weight gain trajectories over 18 months than unemployed individuals with stable social rhythms and better sleep; (2) disrupted sleep will mediate the relationship between social rhythm disruption and weight gain; and (3) reemployment will be associated with a reversal in the negative trajectories outlined above. Positive findings will provide support for the development of obesity prevention campaigns targeting sleep and social rhythms in an accessible subgroup of vulnerable individuals.
Construction activities in healthcare settings potentially expose building occupants to waterborne pathogens including Legionella and have been associated with morbidity and mortality. A Water Management for Construction—Infection Control Risk Assessment (WMC-ICRA) tool was developed addressing gaps in building water management programs. This enables healthcare organizations to meet the requirements of ANSI/ASHRAE Standard 188 referenced in numerous guidelines and regulations. A WMC-ICRA was modeled after the ICRA required for prevention and control of airborne pathogens to reduce the risk of healthcare associated infections. The tool allows users to evaluate risk from waterborne pathogen exposure by analyzing construction activities by project category and building occupant risk group. The users then select an appropriate level of risk mitigation measures. Technical aspects (e.g., water age/stagnation, flushing, filtration, disinfection, validation testing), are presented to assist with implementation. An exemplar WMC-ICRA tool is presented as ready for implementation by infection prevention and allied professionals, addressing current gaps in water management, morbidity/mortality risk, and regulatory compliance. To reduce exposure to waterborne pathogens in healthcare settings and improve regulatory compliance, organizations should examine the WMC-ICRA tool, customize it for organization-specific needs, while formulating an organizational policy to implement during all construction activities.
During the COVID-19 pandemic, implementing catastrophic healthcare surge capacity required a network of facility infrastructure beyond the immediate hospital to triage the rapidly growing numbers of infected individuals and treat emerging disease cases. Providing regional continuity-of-care requires an assessment of buildings for alternative care sites (ACS) to extend healthcare operations into non-healthcare settings. The American Institute of Architects (AIA) appointed a COVID-19 ACS Task Force involving architects, engineers, public health, and healthcare professionals to conduct a charrette (i.e., intensive workshop) to establish guidance during the alert phase of the pandemic. The task force developed an ACS Preparedness Assessment Tool (PAT) for healthcare teams to assist with their rapid evaluation of building sites for establishing healthcare operations in non-healthcare settings. The tool was quickly updated (V2.0) and then translated into multiple languages. Subsequently, the authors of this manuscript reviewed the efficacy of the PAT V2.0 in the context of reported case studies from healthcare teams who developed a COVID-19 ACS in community settings. In summary, policy makers should re-examine the role of the built environment during emergency pandemic response and its impact on patients and health professionals. An updated ACS PAT tool should be established as part of the public health preparedness for implementing catastrophic healthcare surge capacity.
Fluctuating building occupancy during the COVID-19 pandemic contributed to poor water quality and safety conditions in building water distribution systems (BWDSs). Natural disasters, man-made events, or academic institutional calendars (i.e., semesters or holiday breaks) can disrupt building occupant water usage, which typically increases water age within a BWDS. High water age, in turn, is known to propagate poor water quality and safety conditions, which potentially exposes building occupants to waterborne pathogens (e.g., Legionella) associated with respiratory disease or hazardous chemicals (e.g., lead). Other influencing factors are green building design and municipal water supply changes. Regardless of the cause, an increasing number of water management policies require building owners to improve building water management practices. The present study developed a Water Quality and Safety Risk Assessment (WQSRA) tool to address gaps in building water management for academic institutions and school settings. The tool is intended to assist with future implementation of water management programs as the result of pending policies for the built environment. The WQSRA was modeled after water management practices created for controlling water contaminants in healthcare facilities. Yet, a novel WQSRA tool was adapted specifically for educational settings to allow building owners to evaluate risk from water hazards to determine an appropriate level of risk mitigation measures for implementation. An exemplar WQSRA tool is presented for safety, facility, industrial hygiene, and allied professionals to address current gaps in building water management programs. Academic institutions and school settings should examine the WQSRA tool and formulate an organization-specific policy to determine implementation before, during, and after building water-disruptive events associated with natural or man-made disasters.
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