Officer claims Yokosuka hospital officials ignored safety warnings
YOKOSUKA NAVAL BASE, Japan — Improper ventilation in some of the rooms at U.S. Navy Hospital Yokosuka could potentially expose patients and staff to airborne illnesses and infections, according to a hospital safety inspector who says his warnings to superiors about the dangers have been ignored.
Multiple utility rooms used to store biohazardous and soiled material prior to disposal are circulating air back into the intensive care unit and other parts of the hospital, alleges Lt. j.g. Matthew Clemens, one of the hospital’s industrial hygienists. In a worst-case scenario where waste material from a patient with a communicable disease is deposited in those rooms, the ventilation system could allow pathogens to flow back into the hospital’s rooms and corridors, Clemens said.
There is no evidence that any patient has fallen ill because of the ventilation problems.
But “if the disease is good enough to put someone in an ICU room, even a little chance of it getting out is too much,” Clemens said. “Tissues, dirty linens, clothes with germs on them can go into that room. If the bagging procedures aren’t done properly or someone drops something on the floor, it can create a problem.”
Even less dangerous germs in rooms that vent air back into the hospital can risk patient health, according to another hospital worker who seconded Clemens’ claims but requested anonymity for fear of repercussions.
“For a normal, healthy person it may not be a big deal,” the employee said. “But if you have a [wound], you don’t want germs, and the last thing you want are nosocomial [hospital-acquired] infections.”
Clemens said he reported his findings about the ventilation problems twice verbally in January and again in a Jan. 26 e-mail to his supervisor, industrial hygiene department head William Heath.
When no action was taken, Clemens said he e-mailed the hospital’s nursing director in February. Shortly afterward, Clemens said, Heath removed him from working on the hospital inspection assignment. He said he has suffered other retributions for speaking out, including being subjected to threatening comments and unreasonable work duties.
Navy Hospital officials deny all of Clemens’ allegations and counter that the facility is safe.
Heath told Stars and Stripes last week that facility workers had repaired the situation involving the intensive care unit and that another industrial hygienist had rechecked the room.
“A little bit of [air] is going out into the hallway,” Heath said. “In that room, the risk of airborne things being in there is very low.”
Heath said he removed Clemens from the 2009 industrial hygiene inspection report because he was getting too personally involved and because Clemens failed to communicate properly.
“He was going into areas where he shouldn’t in this report,” said Heath.
While working on the hospital’s annual inspection report earlier this year, Clemens said he consulted a 2008 report that cited multiple utility rooms with non-compliant ventilation systems. He said he retested the rooms and found that some were still failing safety tests a year later. In one case, Clemens said, air leakage and the lack of proper air exhaust meant the room didn’t comply with the military-accepted standards set by The American Society of Heating, Refrigerating and Air-Conditioning Engineers.
While most hospital-acquired infections occur through direct contact, illnesses such as tuberculosis and Legionnaires’ disease can be acquired through the air, experts say.
A study by the U.S. Centers for Disease Control and Prevention estimated that in 2002, U.S. hospital patients suffered 1.7 million hospital-acquired infections, 417,946 of which occurred in intensive care units.
Experts in industrial hygiene expressed concern about the situation described by Clemens.
If the Navy hospital’s industrial hygienists are finding that utility rooms are venting air into other rooms, it’s a significant health risk, said Kenneth Weinberg of Safdoc Systems, a Massachusetts-based environmental health consulting firm.
“The potential for spreading airborne pathogens is certainly great from that source,” Weinberg said. “You clearly want to contain those as much as possible … it should be addressed immediately.”
The risk is compounded by the hospital’s clientele, who may be subject to additional health risks by traveling in Asia and the Middle East, Weinberg added.
“There are things we haven’t necessarily as U.S. citizens or service people overseas been exposed to before and they have little immunity to any of these things, not withstanding shots they get,” Weinberg said.
The average U.S. hospital does routine “surveillance rounds” to check that rooms with soiled material have the correct air pressure and air changes per hour, said Weinberg, who is a former Department of Veterans Affairs hospital industrial hygienist and was also director of safety at Boston’s Massachusetts General Hospital for 12 years.
However, the risk also depends on the hospital’s other practices with soiled and hazardous materials, said Theodore Hogan, a Chicago-based certified industrial hygienist.
If hospital workers are, for example, properly bagging hazardous material and scrupulous about their own contact with germs, then the risk of spreading disease out of those rooms is low, Hogan said. Yet Hogan acknowledged that industry standards for hospitals say that air in utility rooms should be kept from circulating in the hospital.
“It’s not a best practice,” Hogan said. “It’s not something you shut down the hospital over, but yes, it’s something that should be addressed.”
Lt. Patricia Roldan, acting director of public health services at the Yokosuka hospital, said that all hospital workers are trained to work with biohazardous materials.
The materials typically kept in the intensive care unit biohazard room don’t suggest a threat of airborne pathogens, Roldan said.
Clemens said he found six rooms that didn’t meet official standards by allowing the air supply to fully ventilate outside of the hospital.
A family practice department utility room’s air was flowing back into the hospital when it should have been completely exhausted outside, according to a Feb. 6, 2008, inspection document obtained by Stars and Stripes. A recent recheck determined that the problem still existed, according to documents.
Once outside, ultraviolet rays and other environmental factors neutralize most germs, Clemens said. But the nightmare scenario would involve a deadly disease flowing back into the air supply and quickly infecting workers and patients inside, he added.
Heath, the head of the hospital’s industrial hygience department, said that 10 corrections have been made to the hospital’s ventilations systems since 2008.
“If it’s a real risk, I bring it up to the executive officer or commanding officer,” Heath said. “Otherwise, as a normal process, you make adjustments and recheck.”
Capt. Kevin Knoop, a doctor and the hospital’s executive officer, was made aware of the issues raised by Clemens in a recent Stars and Stripes interview.
He said that since arriving at the hospital this year, he has been impressed with the different departments that oversee health and safety after walking around the building with hospital officials.
“What I came away with is that the building is getting a good routine, regularly scheduled maintenance look,” Knoop said. “I’m very confident that these programs are running well.”