HtfQuGuideline On Mould Control Remediation in Healthcare Facilities - October 2016 PDF

MINISTRY OF HEALTH MALAYSIA
GUIDELINE ON MOULD
CONTROL AND REMEDIATION
IN HEALTHCARE FACILITIES
ENGINEERING SERVICES DIVISION

MINISTRY OF HEALTH
OcTOBER 2016
GUIDELINE ON MOULD CONTROL AND
REMEDIATION IN HEALTHCARE FACILITIES
Engineering Services Division

Ministry Of Health
MOH/ESD/2016 - 01
TABLE OF CONTENTS
Message from Director General of Health i
Preface by Director of Engineering Services Division ii
Acknowledgements iii
Executive Summary iv
1.0 INTRODUCTION TO MOULD

1.1 Cases of Mould in MOH Healthcare Facilities 1
1.2 Background of Mould 2
1.3 Causes of Mould Growth 4
1.4 Health Effects Due to Mould 7
2.0 INVESTIGATING POTENTIAL MOULD CONTAMINATION

2.1 Mould Investigation 10
2.2 Hidden Mould 11
2.3 Assessing the Building 11
2.4 Visual Inspection 14
2.5 Instrument for Site Investigation 14
2.6 Sampling 15
2.7 Preservation and Transportation of Samples 17
2.8 Testing 17
3.0 INTERIM CONTROL MEASURES OF MOULD IN BUILDING

3.1 Control Measure During Remediation 19
3.2 Occupants Protection 19
3.3 Environmental Control 20
4.0 REMEDIATION PROCEDURES
4.1 Introduction 21
4.2 Remediation Plan 21
4.3 Remediation Procedures 23
4.4 Remediation of ACMV Systems 29
4.5 Effectiveness of Remediation 31
5.0 PREVENTION OF MOULD GROWTH RELATED TO ACMV SYSTEM

5.1 Prevention Of Mould Growth Related To ACMV System 35
5.2 Ventilation 37
5.3 Insulation/ Thermal Control 38
5.4 Mould Control Measure During Renovation Activities 40
5.5 Organization Roles and responsibilities of infection control team 44
APPENDICES
Appendix 1 - IAQ Guidelines for occupied buildings under construction 48

Appendix 2 - Maintenance Schedule for ACMV System 50
Appendix 3 - Guidance on Moisture Control Strategy 52
Appendix 4 - Procedures for Dust Control/Preventive Measures 55
Appendix 5 - Pre-Construction Checks 57
Appendix 6 – During Construction Checks 58
Appendix 7 – Post Construction Checks 60
Appendix 8 – 2008 ASHRAE Handbook-ACMV Applications 61
REFERENCES 65
ANNEX
ANNEX A PROPOSED INVESTIGATION PROTOCOL 67

Annex A1 Occupant / End User Interview Form 68
Annex A2 Stage 1 – Walk-through Inspection 73
Inspection Flowchart 75
Stage 1 – Inspection Checklist 76
Annex A3 Stage 2 – Invasive Inspection 81
Annex A4 Stage 3 – Destructive Inspection 89
Annex A5 Inspection of ACMV Equipment 97
ACMV Equipment Inspection Checklist 98
Annex A6 Inspection Equipment’s and Instruments Checklist 101
ANNEX B CHECKLIST FOR MOULD REMEDIATION 102

ANNEX C PSYCHROMETRICS 103
ANNEX D DESIGN CONSIDERATIONS 109
Abbreviations 112
GUIDELINE ON MOULD CONTROL AND REMEDIATION IN HEALTHCARE FACILITIES
MESSAGE FROM
THE DIRECTOR GENERAL OF HEALTH
Mould is present almost everywhere. In an indoor environment, moulds are able to grow
whenever there are moisture, oxygen and organic substrate. They can grow on buildings and other
materials such as brick walls, ceiling, wood products, clothes and fabrics. The growth of mould on
materials in a built environment can affect the human health, depending on the extent of growth,
the length of exposure and the health states of the exposed personnel. However, mould growth can
be controlled indoors by controlling the moisture indoors.
Ministry of Health facilities such as hospitals and clinics are also prone to mould
contamination. As such, this guideline has been developed to provide information to the Ministry of
Health officials, design professionals, maintenance teams, contractors and others concerned with
mould contamination and remediation in the healthcare facilities. I would like to congratulate the
Engineering Services Division, Ministry of Health, for the publication of the guideline on mould
control and remediation in Healthcare Facilities.
The information in this guideline is intended to establish the minimum requirements to be

considered when investigating, assessing mould problems and remediation procedures in
healthcare facilities and similar types of building. I hope this guideline will be an important tool for
the healthcare provider and utilized fully by the Ministry of Health officials in controlling mould
contamination and remediation in healthcare facilities.
Datuk Dr. Noor Hisham Bin Abdullah

Director-General of Health
i
PREFACE
BY
THE DIRECTOR OF ENGINEERING SERVICES DIVISION
Water accumulation in indoor environments can lead to mould growth, which has been
associated with human health effects. Since mould requires water to grow, it is important to
prevent moisture problems in buildings. Poor understanding of the engineering mechanism, poor
installation of the engineering system and construction and poor maintenance of healthcare
facilities are some of the factors that cause mould contamination.
This guideline is to provide an approach to observe mould growth and address mould
contamination on structure material in healthcare facilities and general buildings. This guideline
offers guidance on the investigation of mould contamination and remediation procedures to control
mould problems. Mould growth in critical care areas of the healthcare facilities such as intensive
care units, surgery suite and maternity ward may pose significant health concerns to patients.
Indoor mould growth can be prevented or minimised by actively monitoring, inspecting and
correcting buildings for moisture problems and managing water damage materials. It will help those
in charge of maintenance to evaluate an in-house remediation plan.
Finally, I would like to thank the people involved in developing this guideline and I believe
that this guideline will contribute in improving the health of people in healthcare facilities.
Haji Md. Jalal Bin Bongkik

Director of the Engineering Services Division, MOH
ii
ACKNOWLEDGEMENTS
This guideline was prepared by the Engineering Services Division, Ministry of Health Malaysia
(MOH) and assisted by Healthcare Facilities consultant, Sistem Hospital Awasan Taraf Sdn. Bhd.
(SIHAT), who was appointed by the Government of Malaysia.
Both MOH and SIHAT wish to thank and acknowledge the following distinguished individuals
who contributed valuable comments towards the preparation of this guideline.
ADVISORS
1. YBhg. Datuk Dr. Noor Hisham Bin Abdullah
Director-General of Health
2. YBhg. Datuk Dr. Shahnaz Binti Murad

Deputy Director-General of Health (Research & Technical Support)
3. YBhg. Datuk Chin Goo Chai

Previous Director of Engineering Services Division
4. Tuan Haji Md. Jalal bin Bongkik

Director of Engineering Services Division
TECHNICAL COMMITTEE MEMBERS
Engineering Services Division
5. Tuan Haji Tauran Zaidi bin Ahmad Zaidi

6. Ir Khairul Azmy bin Kamaluddin
7. Encik Abdul Halim bin Abdul Hamid
8. Puan Jamilah binti Mahmood
9. Ir Rosmahadi bin Ali
10. Puan Wan Azura binti Wan Mohd Nasir
11. Ir. Mohd. Hisam bin Saat
12. Puan Nornadiah binti Ahmad
13. Encik Syed Masyhur Alfaqih bin Wan Mohd Yusop
Institut Medical Research
14. Dr Rafiza binti Shaharudin
Sistem Hospital Awasan Taraf Sdn. Bhd. (SIHAT)
15. Encik Khamsah bin Muhamed Som

16. Ir Fan Hong Poh
17. Ir Wong Wei Peng
18. Ir Chin Hooi Pung
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EXECUTIVE SUMMARY
Healthy indoor air is recognized as a basic right, as people spend a large part of their time each
day indoors. Besides homes, schools, a n d offices, healthcare facilities a r e where patients spend
almost 24 hours indoor, t h u s the indoor air quality can become more significant. The quality of
the air they breathe in those buildings is an important determinant of their health and well-being. The
inadequate control of air quality therefore creates a considerable health burden to the patients in the
healthcare facilities.
Poor indoor air quality due to the presence of many biological contaminants in the indoor
environment is caused by inadequate ventilation and moisture in the air and surfaces.
Excess moisture in almost all indoor materials leads to the growth of microbes, such as mould,
fungi and also bacterias, which are capable of emitting spores cells, fragments and other volatile
organic compounds into the indoor air. Also, moisture initiates chemical or biological degradation of
materials, which pollutes the indoor air. The health risks of biological contaminations of indoor air,
especially from mould, could thus be addressed by considering moisture as the risk indicator.
Chapter 1 summarizes the cases of mould in MOH Healthcare facilities, the background of mould,
causes of mould growth, health effects related to mould contaminations of indoor air and its exposure.
Chapter 2 clarifies the approaches related to mould investigation, hidden mould, assessing the
building and visual inspection. Moreover, the activities related to the instrumentation for site
investigation, sampling and testing are also discussed.
Chapter 3 discusses on the interim control measures of mould in the building approaches to
protect the occupants and control the environment.
Chapter 4 discusses on the remediation plan and procedures. Besides that, the remediation of
ACMV systems and effectiveness of remediation are also deliberated.
Chapter 5 discusses the causes and prevention of mould growth. These include the Mould
Control Measure during Construction / Renovation Activities. Organization Roles and responsibilities of
the infection control team are also covered.
Field inspection protocol for t h e investigation of mould in the healthcare facilities involved t h e
interviews of occupants, identification and correction of moisture sources causing the mould growth,
and determination of the extent and location of mould sites. There are three (3) levels of inspection.
The inspection procedures include the flow charts and the inspection forms. The level or degree of
investigation required for each project will vary. It may progress through one or more of these stages,
until the investigation goals are achieved and remediation can be taken. All of these inspection
checklists are in the Annexes.
InAnnex D, ‘Design Considerations’ offer guidance to the design professionals to provide for the
prevention of water intrusion and condensation build-up in the designs of building systems and
selection of building materials.
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1. INTRODUCTION TO MOULD
1.1 Cases of Mould in MOH Healthcare Facilities
Mould contamination has been an issue for the Ministry of Health, Malaysia
in recent times, particularly in healthcare facilities. This is attributed to many
factors which are caused by design shortcomings and oversight, poor
installation and construction of healthcare facilities, poor understanding of the
mechanisms of engineering that leads to mould contamination and
inappropriate mould remedial measures.
Moisture problems which had led to a mould infestation at a hospital in Johor

was the result of poor planning and layout of the various departments and
rooms with different air temperatures and Relative Humidity (RH)
requirements, inadequate insulation in walls and ceilings to cater for the
temperature gradients between rooms, t h e trapping of moisture and
contaminated air in the courtyard without ventilation and the infiltration of
contaminated warm moist air into the rooms and corridors.
In one of the MOH clinics at Melaka, the contamination was caused by the
following factors:
a) Condensation of water vapour from gross infiltration of hot a n d humid

outside air, t h e supply o f air temperature from the central air-
conditioning was very low, insufficient wall thermal/vapour barrier, and
the air volumetric flow rate was too high, resulting in rapid cooling in
some surfaces; and
b) Water leakage such as leakages in the roof, reinforced concrete gutters

and floor slab.
In one of the MOH clinics at Pahang, the infestation was attributed by the
inadequacy of the damp proof course in the walls, which allowed seepage
and capillary action of moisture into the building.
The infestation of mould in one of the MOH hospitals at Sabah was the result of
poor planning of the buildings. There was inadequate ventilation in the spaces
between blocks that resulted in the trapping of moist air, which then condensed
on the walls.
In one of the MOH hospitals in Sarawak, the mould problem that occurred was
due to the upgrading of the building from using a natural ventilation to the
installation of air conditioning system without the ceiling slab and wall
constructed with thermal insulation, infiltration of air and limited fresh air intake.
Mould infestation not only compromises the health of healthcare workers in the
occupied buildings, but could also pose a risk to the immunocompromised
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patients seeking treatments at the health facilities. It also affects the working
operations of the healthcare facilities and compromises the care of patients as
certain areas need to be closed off for remediation works. On top of all this, a
huge amount of resources need to be spent on investigating the mould
infestation and implementing remediation measures.
Therefore, a mould control and remediation guideline needs to be developed

for those involved in designing healthcare buildings, especially for those in the
architecture and engineering disciplines. This guideline will provide the
information required for mould rectification and also the design, construction,
maintenance and mould control in healthcare facilities.
1.2 Background of Mould
Moulds, also known as fungi, can be found both

indoors and outdoors. No one knows how many
species of fungi exist, but the estimates range from
tens of thousands to perhaps three hundred thousand
or more. Out of these, less than 500 mould species
have been described as human pathogens that can
cause infections. Moulds can multiply by producing
spores. Mould spores are very small and capable of
surviving a long time in dry conditions. As these spores
are very small (2 – 100 µm in diameter), it can easily
Aspergillus
float in air and transport very far.
Moulds cannot be eliminated from the indoor environment. However, they will
only grow in the presence of moisture and they do not need a lot of water to
grow. Even a little condensation can be enough. The other element needed to
grow is food, which can be any organic substance including dust. Moulds grow
best in warm, damp, and humid conditions. As mould grows, it digests
whatever it is growing on.
Moulds also need nutrients, which may include carbohydrates, proteins and
lipids. The sources are diverse and plentiful, ranging from plants and animals,
dust on surfaces and construction materials (such as wallpapers and textiles),
condensation or deposition of cooking oils, paint and glue, wood, stoned
products and other paper products. Nutrients are generally not the limiting
factor for indoor mould growth. Moulds are known to grow even on inert
materials such as ceramic tiles and can obtain sufficient nutrients from dust
particles and soluble components of water.
Moulds spread and reproduce by making spores, which are small and
lightweight, able to travel through air, capable of resisting dry, adverse
environmental conditions, and capable of surviving for a long time.
They may be transported into buildings on the surface of new materials or on

clothing. They may penetrate the building through active or passive ventilation.
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Mould spores are found in the dust and surfaces of every building, including
those with no dampness problem. Once moulds are indoor, mould growth can
occur only in the presence of moisture, and many moulds grow readily on any
surface that becomes wet or moist; that is, virtually all m o u l d s readily
germinate and grow on substrate in equilibrium with a relative humidity
below saturation (i.e. below 100%). Although mould can be found almost
anywhere, they not only need moisture but also nutrient to grow.
Mould species which grow on the substrate largely depend on the water
activity of the substrate. Water activity is the measure of water availability
and is defined as a ratio of the vapour pressure above a substrate relative to
the above pure water measured at the same temperature and pressure.
On the basis of their water requirements, indoor moulds can be divided into:
i) primary colonizers, which can grow at a water activity less than or equal
to 0.8;
ii) Secondary colonizers, which grow at a water activity level of 0.80 to 0.90;
and;
iii) tertiary colonizers, which require a water activity level greater than 0.90 to
germinate and start m o u l d growth.
Although high levels of humidity and some surfaces and interstitial

condensation may be sufficient for most primary and secondary colonizers,
tertiary colonizers generally require serious condensation problems. Common
causes that lead to condensation or moisture problems include:
i) Construction faults;
ii) Inadequate insulation i.e. between a cold and a warm environment, in
combination with poor ventilation;
iii) Water leaking from damaged pipes;
iv) Rainwater leaking through faulty gutters or a roof in disrepair;
v) Flooding and groundwater intrusion;
vi) Condensation at an interface (e.g windows or pipes); and
vii) Water t h a t can come from leaks in the plumbing or sewage system
inside the structure.
Mycotoxin mould
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1.3 Causes of Mould Growth
Most moulds produce spores which can be airborne, water-borne or insect-

borne and are highly adapted to grow and rapidly reproduce anywhere in the
buildings. They can strive on virtually all building materials and surfaces,
causing the degradation of materials as long as they are provided with
moisture, temperature (range of 8 – 49 ˚C) and nutrient.
1.3.1 Moisture
Of all the primary conditions or essential elements, moisture is the simplest and
the most universal requirement for triggering mould growth. Without moisture,
mould cannot access the nutrients in its food sources. On dry surfaces,
spores will remain dormant until adequate moisture appears. Most moulds
require the presence of considerable moisture (the amount of water) available
on or in the materials for growth.
The root causes of moisture problems in the buildings include but not limited to
the following:
i) Condensation;
The effects of temperature gradient due to improper humidity and

temperature control can lead to condensation. Condensation forms
whenever moist air contacts a surface at a temperature below the dew
point such as when concrete below flooring is much cooler than the room
temperature, uninsulated or misinsulated supply ducts and chilled water
pipes above t h e ceiling or inside unconditioned areas, uninsulated
surfaces of AHU, supply ducts, chillers, chilled water pipes, etc;
Condensation on the ceiling

ii) Air Infiltration;
Water vapour in the air moves in and out of building as part of t h e air
through little openings on the building envelope, and through large
openings such as doors and windows through the wind, and stack the effect
or driven by mechanical ventilation infiltrates or exfiltrates through the
opening in the building envelope;
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iii) Improper Mechanical Ventilation or Natural Ventilation;
Ventilation brings in humidity, and this humidity has to be removed through

condensation in the ACMV system (water vapor in ventilation air often
represents the single largest source of moisture in the healthcare facilities
building);
iv) Diffusion;
Water vapour diffuses into and out of the building through the building
envelope based on vapour pressure difference, surface area and material;
v) Roof Leakage;
vi) Drainage or plumbing problem such as leakage or burst pipes;
vii) Occupant – generated sources (occupants produce water vapour at

different rates, depending upon their activity level via respiration);
viii) Poor Condensate Drainage;
Improper draining of condensate from t h e air-conditioning system (from

cooling coil) which allows for the re-evaporation of moisture and
subsequent migration back into the conditioned spaces;
ix) Poor water proving materials installation below the floor slab may cause
ground water intrusion into the floors and walls;
x) The enclosure of wet materials in building assemblies during construction

by materials prone to moisture problems; and
xi) Flood
1.3.2 Nutrient or Food
Besides moisture, two others that support the conditions of mould growth are
temperature and nutrients, which are also inherent in the healthcare facilities
building. Healthcare facilities are maintained at the right temperature for mould
growth and built and furnished with suitable organic nutrients that can
encourage mould reproduction. While mould growth is possible on all
materials, appropriate material selection is nevertheless important to prevent
dirt accumulation and moisture penetration to control mould growth.
There are a host of materials in and around the healthcare facilities that are
under the conditions as mentioned that can become t h e breeding ground for
mould growth. In most cases, the substrate (organic or cellulosic materials)
that the mould is growing on provides the nutrients; however, in some
instances, the substrate (inorganic materials) is simply a foundation for the
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colony. In these cases, mould is feeding on microscopic organic matter that
is on the surface or trapped in tiny pores of the material.
Some common food sources of mould found in healthcare facilities include but
not limited t o :
i) Drywall;
Drywall is a paper- based product which is ideal for m o u l d growth, not

just on the surface but inside the material too;
ii) Dust and dirt;
Dust, dirt and lint in all fiberglass insulation provide an excellent source
of mould nutrient;
Insulation on the wall
iii) Concrete;
Concrete that has been painted or accumulated with dirt or dust may
cause mould reproduction. Leaks that occur behind concrete walls may find
mould growing profusely but not readily visible yet;
iv) Wood;
Wood is a great food source for mould. Mould spores will find their way
into the cellular structure of the wood, which is porous and cause rapid
deterioration;
v) Tiles;
Tiles are a very favourable place for mould to grow, where there is a high
humidity issue;and
6
vi) Carpet;
Carpets accumulate dirt; dust and mould spore coupled with the trapped
moisture become t h e ideal source of mould growth.
Mould Growth underneath the carpet
Due to the varied problems associated with mould growth, the approaches to
prevent and control it involve both engineering and mould remediation
strategies, which are interdependent.
1.4 Health Effects Due to Mould
M o u l d s are common in both indoor and outdoor environments. As a result,

all people have routine exposure to m o u l d , which may occur through
inhalation, ingestion, and touching mouldy surfaces. The main route of
exposure to mould for people living or working in mouldy indoor environment is
via inhalation or a direct contact with the airborne mould spores, fragments, or
metabolites.
Mould in indoor environments comprise of microscopic moulds, known as micro

fungi, while plaster and wood-rotting fungi are referred to as macro fungi
because they produce sporing bodies that are visible to the naked eye.
Adverse human health effects from the exposure to moulds may occur through
these 3 processes:
i) Allergy;
ii) Infection; and
iii) Toxicity.
Most moulds are generally not pathogenic to healthy humans. Only a few
moulds are pathogenic and infect non-immunocompromised individuals. They
include Blastomyces, Coccidioides, Cryptococcus and Histoplasma. However,
individuals with severely impaired immune function such as AIDS patients,
organ transplant patients as well as other patients on immunosuppressive
7
drugs, cancer patients on chemotherapy, etc are at a significant risk of
opportunistic mould infections.
In most of the non-contaminated buildings, the possible mould exposure would

not be expected to present a health hazard to very susceptible individuals. In a
contaminated situation, the risks from exposure to mould increases.
Reactions due to mould exposure vary and are complex, depending upon
many factors. Human factors include personnel susceptibility, route of
exposure, age and state of health. Mould factors include the amount and
length of time of exposure, viability of organism, and whether the effect is
infection, allergenic, toxigenic or some combination of these.
For the majority of adverse health outcomes relating to mould exposure, a high
level of exposure to living mould or a high concentration of allergens on
spores and mycelia can result in the likelihood of illnesses.
The effects of inhaling mould spores include allergies, infection or irritation.
i) Allergic and Hypersensitivity Effects
Some people are particularly sensitive to mould exposure. A significant

portion of asthmatics are allergic to mould, where exposure can bring on
attacks. The most common symptoms associated with allergic reactions
include a runny nose, sneezing, post-nasal drip with sore throat, eye
irritation, cough, wheeze, and other symptoms associated with the
aggravation of asthma. Immunological responses to mould include allergic
rhinitis, hypersensitivity pneumonitis, and asthma exacerbation. These
conditions require prior exposure for sensitization. These symptoms may
persist for some time after removal from the source.
ii) Irritant and Toxic Effects
Irritant Effects
Indoor growth of mould can lead to the production of Volatile Organic

Compounds (VOC), also referred to as Microbial VOCs (MVOCs), and the
presence of mould glucans. Glucans are components of many mould cell
walls. Prolong exposure and inhalation has been association with airway
irritation and inflammation and flu-like symptoms.
Toxic Effects
Some mould can produce toxin (mycotoxins) at varying levels that are
dependent on many complex environmental factors. Some symptoms and
maladies have been attributed to the toxic effects of fungi in the indoor
environments. The symptoms from exposure to mycotoxins indoors include
8
headaches, irritation, nausea, loss of appetite and skin problems.
Stachybotry’s is colloquially referred to as “black mould” or “toxic mould”.

Acute Idiopathic Pulmonary Hemorrhage (AIPH) in infants has been
described in many reports as associated with stachybotry’s.
iii) Infection Effects
In general, only a small number of mould have been associated with

infectious diseases. A person who is immune-suppressed is at a risk from
mould infection.
Several species of Aspergillus are known to cause aspergillosis, most

commonly A. fumigutus, A. flavus, and rarely, other species. Aspergillosis is
a disease that generally affects severely immunosuppressed persons.
An ingestion of high doses of aflatoxin (produced by a species of
Aspergillus flavus) in contaminated food causes aflatoxicosis and can result
in hepatic failure.
In general, young babies, asthmatics, and persons who have poor

immune systems (such as those undergoing cancer treatments and HIV
treatments) are at the higher risk if they are exposed to large amount of
mould.
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2. INVESTIGATING POTENTIAL MOULD CONTAMINATION
2.1 Moulds Investigation
In general, the levels and types of m o u l d found should be similar indoors in

non-contaminated buildings as compared to the outdoor air. Differences in the
levels or types of m o u l d found in air samples may indicate that t h e
moisture sources and resultant mould growth may be problematic. But if the air
handling system uses air filters, then, the number of organisms inside compared
to the outside will be lower, as we expect that the filter system will remove some
organisms. Any mould found in the inside air but not in the outside air must be
suspected as coming from an amplification site within the building. If the results
of air sampling confirmed the presence of m o u l d within the building,
remediation action should be taken immediately.
An investigation for mould contamination in the healthcare facilities normally can

be triggered by:
i) Observation of growing mould;
Mould may be observed on walls, ceilings, furniture, pipes, doors, floors,

window, ledges,books,files,documents,etc;
ii) Adverse health concerns of occupants;
A variety of symptoms or complaints from the building occupants, such as

allergic reactions (runny nose and red eyes, sore throat or irritated skin,
respiratory problems (more frequent exacerbation of asthma among
asthmatics) and other non-specific sick building syndrome symptoms such as
headaches, nausea, and fatigue, may trigger an investigation into a potential
mould contamination; and
iii) Unusual odours
Any unusual smell and musty odours may indicate a potential mould
contamination. Any moisture intrusion such as condensation, flooding, water
pipes leakage, sewerage pipes leakage, and roof leakage can have mould. If the
moisture is not addressed and become chronic or severe, this may lead to mould
contamination.
Condensation on the ceiling Water staining on the ceiling

could be due to condensation or
leaks from piping
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2.2 Hidden Mould
Indoor mould growth may be obvious in certain cases. As a special

consideration, mould may be growing on hidden surfaces, such as the back
side of a dry wall, wallpaper, or paneling, on top of ceiling tiles, the underside
of carpets and pads. Other possibilities of hidden mould locations are pipe
chases, walls behind the furniture, condensate drain pans inside t h e air
handling unit, porous thermal or acoustic liners inside duct works, or roof
materials above t h e ceiling tiles, could be due to roof leaks or insufficient
insulation. Some buildings’ finishes, such as dry wall with vinyl wallpaper over it
or wood paneling, may act as vapour barriers, trapping moisture underneath
their surfaces and thereby providing a moist environment where mould can
grow.
Investigating hidden mould problems may be difficult and will require caution
where the investigation involves disturbing potential sites of mould growth, thus
make sure to use t h e personal protection equipment (PPE).
Hidden mould underneath wallpaper Hidden mould above the ceiling

board
2.3 Assessing the Building
It is important to examine the building’s history. This involves looking at the

original design, its original intended use, construction (Workmanship, Materials
and Location), and any renovation or additions. These changes may lead to
potential opportunities for mould to grow.
The current use of a building may differ from its original intended use, due to
functional changes over time. F o r example, when office dividers and walls
are erected and then occupancy increases, the original air conditioning and
mechanical ventilation (ACMV) system may be inadequate. Condensation and
poor air circulation due to the increase in occupancy, created partitioned etc.
can lead to conditions suitable for mould growth.
Many of the healthcare facilities were built more than 20 years ago. As the
building structure ages, it may undergo deterioration. If the building envelope
11
breaks down and te proper maintenance is not carried out, the interior of the
building will become conducive for moisture intrusion. When this occurs,
mould infestation is likely to follow. It is important that the buildings of older
healthcare facilities with apparent deterioration are investigated by the qualified
technical personnel. Results of the investigation could reveal the source of
moisture intrusion that will lead to mould growth.
Maintenance team of the healthcare facilities should have qualified technical

personnel who will be responsible for inspecting and investigating mould
problems. Areas of inspection and investigation are as follows:
Building Exterior
i) Any peeling, blistering or damages that may allow water to penetrate at the
windows and doors, chiller plants and ACMV outdoor systems (fresh air
intake grill, exhaust grill etc).
ii) Roof damages that allow water to leak through.
iii) Any cracks, breaks or other damages of the exterior wall.
iv) Damaged or blocked drainage pipes or gutters that allow water to enter the
building.
Collection of sample
Building Interior
i) Basements should be examined for renovation that might trap

condensation.
ii) Evidence of water leak around pipes through the walls.
iii) Leakages through windows.
iv) Condensation around cold spots or chill water pipes.
v) Water leaks on plumbing pipes and sewages pipe.
vi) Leaks originating from the upper floor.
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vii) Temperature difference and High Relative Humidity (RH), leading to
condensation.
viii) Any leaks at the expansion joints of floor wall junctions.
ix) Any fault caused by improper building design (architecture, structural and
mechanical design).
Mould on ceiling tiles
There are various ages and designs of healthcare facilities in Malaysia.

Some are new and some are old, where the old ones have more damages and
cracks. The different conditions of the building’s environment of the
healthcare facilities can provide clues to potential mould contamination, which
are normally water or moisture related.
High relative humidity leading to condensation around the windows, walls,

ceilings or pipes, stained ceiling tiles, rotted wood, water stains around sinks at
kitchen, wash rooms, odours in the rooms are all indications of mould. Other
activity that might contribute to mould growth is the Air conditioning &
Mechanical Ventilation (ACMV) system that is not provided with the humidity
control mechanism.
As some of the healthcare facilities are undergoing upgrading work like

renovation and extension, these activities can provide opportunities for mould
movement and growth due to the movement of dust. Measures to control
dust during renovation work and to ensure the ACMV system is not impeded
need to be addressed through proper planning and monitoring at the
construction period.
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2.4 Visual Inspection
Visual inspection is an important preliminary step in identifying mould

contamination and in order to know the root cause. The extent of any water
damage and mould growth can be visually assessed.
Collecting of sample on
ceiling
The visual inspection should look at many areas e.g. leaking roof, leaking
pipes, ACMV system (leaking ducts and contaminated AHU), ceiling, tiles,
gypsum wallboard, walls, windows, carpets, bathrooms, showers, toilets and
basements.
ACMV system suspected to be contaminated with mould should not be in

operation, as to avoid the spreading of mould throughout the buildings.
2.5 Instrument for Site Investigation
Investigation can be carried out using simple instrumentations such as:
i) Sling Psychrometer can be used to determine accurately the percentage

of relative humidity without the need to refer to a complex schedule. This
device consists of a slide rule calculator which can convert temperature to
relative humidity quickly;
ii) Humidity meters can be used to determine indoor humidity and

temperature;
iii) Moisture meters provide qualitative moisture level in building materials and
might be helpful for measuring the moisture content in a variety of building
materials such as wallboard, carpet, wood, brick and concrete. Higher RH
levels with low temperature may indicate the potential for condensation,
leading to mould growth; and
14
iv) Borescope is a hand-held tool that allows users to see hidden mould
problem inside walls, ceiling plenums and other tight areas.
2.6 Sampling
Sampling for mould is normally not a part of the

routine building assessment. In most cases, if
visible mould growth is present, sampling is
unnecessary. Sampling may be conducted for
these reasons:
i) to determine the source of mould;

ii)there are health concerns;
iii)
for identification of the mould;
iv)to differentiate between mould and soot or
Testing of sample at the dust; and
site
v) involves litigation.
Sampling helps to guide mould remediation measures. If mould is being

removed, one needs to look into the extent of mould colonization and surface
bulk sampling in combination with moisture reading which might be useful.
Thus, they will be used to map the extent of the colonization.
Sampling for mould should be conducted by a qualified personnel with

specific experience in moulds sampling protocols, sampling methods, and
interpretation of results.
By testing the type of mould and mould concentrations indoor versus outdoors,
one can identify the source of mould contamination that might not be obvious
during visual inspection.
2.6.1 Type of Samples
There are primarily three forms of sampling commonly used in mould

investigations, which are surface or bulk sample, swab sample and air sample.
i) Bulk / Surface Samples
a) Surface sampling can be taken to determine the presence of mould

growth, if the presence of mould is uncertain for confirmation. The
spores and the species can be identified.
b) Bulk samples are usually collected from visible mouldy surfaces by

scraping or cutting the materials with a clean tool into a clean plastic
bag. Samples are then sent to an accredited analytical laboratory for
analysis.
15
ii) Swab Samples
a) This method is very similar to

surface sampling, and even allows
the sample to be taken in a wet
area.
b) Swab sample is simply done to

indicate the amount of viable spores
that are present on a surface. It is
also a non destructive form of
testing, and can be used on
substrates that are difficult to
Collecting sample of a wall
access or should not be damaged material
when sampling
iii) Air Samples
a) The air in a building can be sampled to evaluate the amount of spores

and mycelia fragments in the air. This method also involves the
collection of air sample outside the building, as well as the collection
of air sample from various locations within the buildings. Air sampling
for mould is necessary if the presence of mould is suspected due to
musty odours but cannot be identified by a visual inspection or bulk
sampling. This will determine the location and extent of
contamination. If it is found that if the ventilation system may be
contaminated, then air sampling is necessary to assess the extent of
contamination throughout the building. Personnel conducting t h e
sampling must be trained in a proper air sampling method for microbial
contaminants.Air sampling is done indoors in a space with intact walls,
roof and floors assemblies. Open windows, open entry doors, and
disassembled ceiling can affect the resulting data. Air sampling is
performed by collecting area samples. Ideally, samplers are placed in
the center of the room being sampled, or in a more open plan
environment and in a central location. This is to ensure that
representative samples are taken in all the appropriate areas of
interest.
b) Samples should be placed away from doorways, staircases, ventilation

supply duct and other openings. Placing the samplers on the floor is
not recommended because this might result in the re-suspension of
settled dusts.
c) Samplers can be used to measure microbiological parameters. Samplers

should be placed to the approximate breathing zone height or 1-1.5
meters above the floor to eliminate any potential bias in the results.
According to NIOSH method 0800 Bioaerosol Sampling (Indoor Air),
16
each site should be sampled for ten minutes. Before moving to the next
site, repeat twice to obtain triplicate consecutive samples.
d) As for the outdoor air samples which form the basis for comparison and
interpretation of t h e indoor air samples, the ideal location for
sampling t h e outdoor air is 10m above the ground upwind of the
structure.
e) For naturally ventilated buildings, o u t d o o r air samples should be

collected on balconies, as close to the edge of the buildings as possible.
For mechanically ventilated buildings, samples should be collected at
the air intake supplying all the areas of interest.
2.7 Preservation and transportation of samples
The samples of material suspected to contain mould are preserved and

transported properly so as not to contaminate the results. It is very important to
carefully follow the analytical laboratory’s prescribed procedures for sample
handling. If samples are damaged, this can lead to false negative results. The
samples should be kept dry and cool. It must reach at the laboratory within 24
hours of being obtained.
2.8 Testing
Testing is a requirement of sampling. Microscopic information of spores or

colonies requires expertise. Documented quality control in an accredited
laboratory used for the analysis of the samples is necessary. Evaluation of the
sampling data should be performed by an experienced professional. Air
samples should be evaluated by means of comparing the indoor and outdoor
air and by m o u l d type.
Culture plates after a few days’ growth
17
Acceptable Physical range for Parameters and Acceptable Limits for Indoor Air
Contaminants apply to all buildings served by the air conditioning mechanical
ventilation (ACMV) system, including the air-cooled split unit formulated by the
Department of Occupational Safety and Health, except for domestic buildings
and industrial buildings as stated in the Industry Code of Practice (ICOP) on
Indoor Air Quality 2010 (ICOP, IAQ 2010), which are listed in the table below: -
No Parameters Acceptable Range /

Limit
Physical Parameters
1. Air Temperature 23 – 26 ˚C
2. Relative humidity 40 – 70%
3. Air Movement 0.15 – 0.50 m/s
Indoor Air Contaminants
Chemical Contaminant
1. Carbon monoxide 10 ppm
2. Formaldehyde 0.1 ppm
3. Ozone 0.05 ppm
4. Respirable particulates 0.15 mg/m3
5. Total volatile organic compounds 3 ppm
(TVOC)
Biological contaminants
1. Total bacterial counts 500 cfu/m3
2. Total fungal counts 1000 cfu/m3
Ventilation Performance Indicator
1. Carbon dioxide C1000 ppm
Note:
1) The above parameters may not apply in specific rooms in the healthcare
facilities where parameters for the specific rooms have been specified by
other standards or building designer.
2) The above parameters do not apply for domestic buildings and industrial
purposes.
18
3. INTERIM CONTROL MEASURES OF MOULD IN THE BUILDING
3.1 Control Measure During Remediation
Mould contamination problems in a healthcare facility such as in the buildings

may worsen while the mould problems situation is under investigation and plans
are being made to find remediation solutions.
In these situations, an interim or proactive control

measures can be implemented to minimize
further damage, to limit exposure and stabilize the
situation. This will allow a more complete
evaluation of the problems and implement the
best corrective action. Interim control measures
should be carried out through the occupants’
protection and environmental protection.
The challenge in mould control and remediation

is to establish conditions that will not allow the
recurrence of mould through products and
reasonable techniques and measures.
Containment used during the
investigating procedure
3.2 Occupants Protection
If the building is found to be contaminated by mould, the major hazard faced by

the occupants is the possibility that they will inhale the mould spores or come
into contact with their skin.
When implementing any interim control measures in the buildings, the goal is
to protect the occupants. The occupants must always be the first concern and
when taking any action, their health and wellbeing should always be bored in
mind.
S o m e effective protections of building occupants are temporary evacuation,

site sanitation and containment.
3.2.1 Temporary Evacuation
Before temporary evacuation starts, the location/areas with active growth of

mould should be identified first. However, relocation priority should be given to
the occupants who are sensitive or with weak immunes.
3.2.2 Site Sanitation and Containment
When implementing site sanitation and containment in the building, face mask for
occupants should be provided in order to protect them. Moreover, air pathways
19
and pressure in different parts of the buildings must be controlled during the site
sanitation and containment.
Removal of the mould contamination is preferred to prevent the spore’s

dispersion. But before the removal is to be carried out, the first step is finding
a way to isolate the active growth.
Such isolation can include building a temporary barrier around the growth,
covering the growth with a material that will contain it, relocating the building
occupants, or a combination of the above. Where sensitive occupants or
immunes-compromised occupants are involved, they are best protected by
relocation.
After the growth has been isolated, measures to reduce the ability of spores and
mycotoxins to travel into the other occupied area must be effected. That may
require the control of the air pathways and air pressure in different parts of the
buildings.
Controlling pathways involves limiting the ability of spores and hyphen

elements to travel from the amplification sites and come into contact with the
building’s occupants by air circulation. Creating draft to blow spores and
hyphen element away might not be an ideal solution, as these might cause for
more dispersing of particulate. Lowering the air pressure in the growth area
should be done, so that it is less than that of the surrounding areas. The air from
this negative pressure area could then be discharged from the building
effectively, along with the spores and hyphen element it contains. The fresh air
can then be drawn towards the dirty area due to negative pressure. If active
growths occur in multiple locations, full understanding of the ventilation system
of the buildings is important.
3.3 Environment Control
Another interim measure is the control of moisture condensation and intrusion

into the buildings.
To reduce moisture in the buildings, this may involve the use of a

dehumidification equipment to lower the relative humidity to reduce the potential
of condensations. The Building Automation System (BAS) can be utilised to
monitor temperature, humidity and air flow with the objective of air humidity
control.
Interim control measures need to be monitored to determine its effectiveness.

Checking the air pressure in different parts of the buildings, monitoring
temperature and relative humidity to check the effectiveness of dehumidification
are necessary steps for mould prevention and recurrence which could be
automatically carried out by the BAS.
20
4. REMEDIATION PROCEDURES
4.1 Introduction
Mould remediation is the process of removal

and/or cleaning up of mould from an indoor
environment. In all situations, the underlying
cause of water accumulation must be rectified,
or mo ul d growth will recur. Any initial water
infiltration should be halted and cleaned
immediately. An immediate response (within
24 to 48 hours) and thorough clean up, drying,
removal of water damaged materials will
prevent or limit mould growth. If the source of
water elevates humidity, the relative humidity
should be maintained at a level below 60% in Material removal on the wall
air conditioned areas to inhibit mould growth.
Emphasis should be put on ensuring proper
repairs of the building infrastructure, so that
water and moisture damages in the building
do not recur.
4.2 Remediation Plan
Once there is an understanding of the

scope of mould contamination situation,
the health issues related to mould and
the implication of the project, a plan of
action must then be developed. This
remediation plan must address all
aspects of the problem and provide
complete directions of implementation.
The remediation plan can be carried by:
i) Defining the cause of the mould

contamination; and Removal of debris at the ceiling
ii) Defining the scope of remediation work.
21
4.2.1 Defining the Cause of the Mould Contamination
It is important that the mould contamination issue be fully understood, with clear
and accurate identification of the causes. Once it is done, the cleaning up of
mould contamination and correcting its cause can be planned properly and
carried out smoothly. Some of the causes of mould contamination are shown
as follows:
i) Design or installation errors in the buildings shell (external wall), which allow
water and moisture to intrude, leading to a condition that allow
condensation to develop.
ii) Building envelope and building materials used poorly insulated walls, which
lead to wall surface condensation. Improper water proofing on concrete flat
roof or improper roof drainage and poor ventilation of the building.
iii) Air conditioning and mechanical ventilation (ACMV) equipment, design and
installation issues such as below:
a) Improper settings of the environmental parameters;
b) Inappropriate or faulty designs such as the intake of air facing the

cooling tower, car park and kitchen exhaust;
c) The use of faulty equipment such as filters with poor performance, dirty
& unmaintained filter with inadequate filtration;
d) Improper installation such as ducting which is not properly jointed, filter

which does not fit the frame and wrong location selection for exhaust
air;and
e) Improper control of the ACMV System related to temperature and

humidity.
iv) Operation and maintenance issues such as below:
a) The natural deterioration of materials and equipment that require

maintenance such as roof leaking and damaged water pipes;
b) Inadequate hygiene maintenance of the building and plant rooms;
c) Inadequate hygiene maintenance of the ACMV equipment such as

improper cleaning of air conditioners’ filters and diffusers;
d) Inadequate maintenance of ACMV equipment which allow the

performance to deteriorate and not working within the specified
requirements;
22
e) Improper control or operation of the ACMV System which may cause
excessive moisture and humidity;
f) Unforeseen incidents such as water pipe breaks, sanitary pipe

leakages, etc.; and
g) Windows and doors kept open in an air conditioning room by

occupants.
4.2.2 Defining the Scope of Remediation Work
After identifying the causes of the contamination, the next step is to define
the scope of work required to fix the causes of the problem i n o r d e r to
clean up and repair the damage. It is important to ensure that every aspect
is considered, as often multiple causes exist, which might complicate the
solution. An action plan is necessary to resolve all the issues.
The remediation plan of action shall include:
i) Establish the extent of the damaged area and of the materials due to mould
contamination;
ii) Identify what needs to be removed. With the clear action plan, the extent of
the scope of works for remediation can be planned;
iii) Correct the situations that have allowed mould growth to amplify in the
building;
iv) Carefully address all hazards to minimize risk on health;
v) Establish site-specific infection control protocols for specialized areas such

as isolation wards and operation theaters;
vi) Develop contingency plans for emergencies during remediation works that
will be carried out;
vii) Carry out the remediation work;and
viii) Provide a follow-up evaluation designed to review the effectiveness of the

remediation works and corrections made.
23
4.3 Remediation Procedures
In the absence of a health based limit, there are several accepted ways to
determine the scope of mould remediation.
The area of visible mould as a remediation decision criterion is the most

commonly used decision method. As such, the size of the area impacted by
mould contamination as well as professional judgment and practical
consideration are used to help define t h e remedial procedures.
During the remediation process, the level of contamination dictates the level
of protection for the remediation workers. The three levels related to the size of
mould contaminations area are described below and each level has specific
requirements for worker safety.
Level 1: Small Isolated Area (0 - 4m2)
a) Remediation can be conducted by the regular building maintenance staff.

Such persons should receive training on the proper clean up method,
personal protection, and potential health hazards associated with mould
exposure.
b) Respiratory protection is recommended. Gloves and eye protection should

be worn.
c) The work area should be unoccupied. Vacating people from spaces

adjacent to work area is not necessary. But infants, patient recovering from
surgery, immune suppressed people, or people with chronic inflammatory
lung disease should vacate from the spaces near the work area
d) Containment of the work area is not necessary. However, efforts should be

made to reduce dust generation. Dust suppression methods, particularly
during any cutting or resurfacing of materials, are recommended. Methods
to consider include cleaning or gently misting the surface with a dilute soap
or detergent solution prior to removal, use High Efficiency Particulate Air
(HEPA) vacuum- shrouded tools or use a vacuum equipped with HEPA
filter at the point of dust generation. Work practices that create excessive
dust should be avoided.
Mould supported by a leak in the wall
24
e) Contaminated material that can be cleaned should be cleaned using a soap
or detergent solution. Materials that cannot be cleaned should be removed
from the buildings in a sealed plastics bag. Plastic sheeting should be
discarded after use.
f) If t h e work may impact a difficulty to clean t h e surface or items such

as carpeting, electronic equipment’s floor of the work area, egress
pathway should be covered with plastic sheeting and sealed with tape
before remediation.
g) The work area and areas used by remedial workers for egress should be
cleaned with damp cloths and mopped with a detergent solution. If
necessary, the work area and surrounding area should be HEPA
vacuumed and cleaned up with a damp cloth and detergent solution.
h) All areas should be left dry and visibly free from mould, dust and debris.
i) The rectification surfaces should be re-painted.
Mould found near the window
25
Level 2: Large Isolated Area (4m² - 10m²)
a) Remediation can be conducted by a trained building maintenance staff.
b) Respiratory protection is recommended. Gloves and eye protection should

be worn.
c) The work areas and areas directly adjacent should be covered with a
plastic sheet and taped before remediation, to contain dust and debris.
d) The work area and areas directly adjacent should be unoccupied.
e) Seal ventilation duct/grill in the work area, and areas directly adjacent with
plastic sheets. The ACMV System servicing this area may need to b e
shut down to properly seal the vents.
f) Dust suppression methods such as misting surface prior to remediation are

recommended.
g) Contaminated materials that can be cleaned should be cleaned using a

soap or detergent solution. Materials that cannot be cleaned should be
removed from the building in sealed plastic bags.
h) The work area and areas used by workers for egress should be HEPA
vacuumed and cleaned with a damp cloth or mopped with a soap or
detergent solution.
i) All areas should be left dry and visibly free from contamination and debris.
Heavy growth at the lower wall area
26
Level 3: Extensive Contamination (Larger than 10m² in a contiguous
area)
Properly trained and equipped mould remediation workers should conduct the
remediation. Besides that, a trained building or environment health professional
to provide a n oversight during remediation may be helpful to ensure quality
work and compliance with the work plan.
The following procedures are recommended:
a) Personnel trained in the handling of mould damaged material is equipped

with: -
i) Full face respirators with High Efficiency Particulate Air (HEPA)

cartridges;
ii) Full body overalls with head and foot coverings; and
iii) Gloves and eye protection to be worn.
b) Containment of the affected area:
i) Isolation of work area using plastic sheeting sealed with duct tape.
Furnishings should be removed from the area. Ventilation ducts/grills, any
other openings, and remaining fixtures should be covered with p l a s t i c
sheeting sealed with duct tape;
ii) The ACMV System servicing this area

should be shut down during remediation;
iii) Use an exhaust fan with a HEPA filter to

generate negative pressurization;
iv) Use air locks and clean changing room;
v) Egress pathways should also be covered

if a clean changing room is not used;
vi) The work area should be unoccupied; and Extensive mould growth
all over the room
vii) Contaminated materials that cannot be cleaned should be removed from
the building in sealed plastic bags. The outside of the bags should be
cleaned with a damp cloth and a soap or detergent solution or HEPA
vacuumed in the work area prior to their transport to an unaffected area
of the buildings.
27
c) Efforts should be made to reduce dust generation. Dust suppression
methods, particularly during cutting or resurfacing of materials are highly
recommended. Methods to consider include cleaning or gently misting the
surface with diluted soap or detergent solution prior to removal, using HEPA
vacuum shrouded tools or using a vacuum equipped with a HEPA filter at
the point of dust generation. Work practices that create excessive dust
should be avoided.
d) Before leaving the isolated areas, workers should remove the disposable
clothing to prevent the tracking of mould containing dust outside of the work
area.
e) The work area and egress should be HEPA vacuumed and cleaned with
damp cloth and mopped with a soap or detergent solution and be visibly
clean prior to the removal of isolation barriers. Plastic sheeting should be
f) All areas should be left dry and visibly free from mould, dust and debris.
28
4.4 Remediation of ACMV Systems
Mould growth in air conditioning and mechanical ventilation system (ACMV) can
pose building- wide problems. Obtaining professional help should be
considered, even for small amount of mould growth or moisture problems within
the ACMV system.
There are two types of remediation for t h e air- conditioned mechanical

ventilation system (ACMV). The remediation in the ACMV System is as follows:
Type 1 : Small Isolated Area of Contamination (< 1m²)
a) Remediation can be conducted by trained maintenance staffs that are familiar

with the design and function of the impacted ACMV System. Such persons
should receive training on the proper cleaning methods, personal protection,
and potential health hazards.
b) Respiratory protection is recommended.

Gloves and eye protection should be worn.
c) The ACMV System should be shut down prior

to any remedial activities.
d) Effort should be made to reduce dust

generation. Dust suppression methods,
particularly during any cutting or resurfacing
of materials, are highly recommended.
Cleaning or gently misting surfaces with a
diluted soap or detergent solution prior to
removal should be done. The use of High
Efficiency Particulate Air (HEPA) vacuum
shrouded tools or using a vacuum equipment Worker checking the air
with a HEPA filter at the points of dust conditioning grill
generation should be considered. Work
practices that create excessive dust should be
avoided.
e) The use of plastic sheeting to isolate other sections of system should be

considered.
f) Contaminated material should be cleaned using a soap or detergent

solution. Growth supporting materials that are contaminated, such as the
insulation of interior lined duct, flexible ducts and filters, should be removed
and sealed in plastic bags.
g) The work area and areas used for egress should be HEPA vacuumed and
cleaned with a damp cloth and mopped and a soap or detergent solution.
Any plastic sheeting should be discarded after use.
29
h) All areas should be left dry and visibly free from mould, dust and debris.
Type 2: Large Area of Contamination ( >1m² ) in the ACMV System
Properly trained and equipped mould remediation workers with specific training
and experience in the ACMV System should conduct the remediation. Trained
personnel during remediation can be helpful to ensure quality work and
compliance with the work plan.
The following procedures are recommended:
a) Personnel trained in the handling of mould damaged material is equipped

with:
i) Respiratory protection;
ii) Full body coveralls with head and

foot coverings; and
iii) Gloves and eye protection.
b) The ACMV System should be shut down prior to

any remedial activities.
Before and after cleaning the
c) Containment of the affected area: air duct
i) Complete isolation of work area from the other areas of the ACMV
System using plastic sheeting sealed with duct tape;
ii) The use of an exhaust fan equipped with a HEPA filter to generate
pressurization should be considered;
a. Consider using air locks and a clean changing room ;and
b. Egress pathways should also be covered if a clean champing room

is not used.
d) Efforts should be made to reduce dust generation. Dust suppression

methods, particularly during any cutting or resurfacing of materials, are
highly recommended. Methods to consider include: cleaning or gently
misting surface with a diluted soap or detergent solution prior to removal,
use of high efficiency particulate air (HEPA) vacuum shrouded tools, or
use a vacuum equipped with a HEPA filter at the point of dust generation.
30
e) Mould materials that can be cleaned should be
cleaned using a soap or detergent solution.
Growth supporting materials that are mouldy,
such as the insulation of interior lined duct,
flexible ducts, and filters, should be removed
in sealed plastic bags. The outside of the
bags should be cleaned with a damp cloth
and a soap or detergent solution or HEPA
vacuumed prior to their removal from the
isolated work area.
Mould growth inside air duct
f) Before leaving the isolated area, workers should remove disposable

clothing to prevent the tracking of mould containing dust outside of the work
area.
g) The work area and egress pathways should be HEPA vacuumed and
cleaned with a damp cloth or mopped with a soap or detergent solution
prior to the removal of isolation barriers. Plastic sheeting should be
h) All areas should be left dry and visibly free of mould, dust and debris.
In conclusion, after the moisture source has been eliminated and the mould
growth removed, the healthcare facilities premises should be re-visited and
then re-evaluated to ensure that the mould growth and remediation process
was successful. The premises should be free of any moulds.
4.5 Effectiveness of Remediation
4.5.1 Performance Criteria
Physical inspection to identify moisture and/or visible mould growth is an

essential step in determining the scope of remediation. One essential
performance criteria in judging the effectiveness of remediation is
documentation for all areas identified were appropriately remediated. For this
task, it is typical that 100% of the areas affected by mould growth are
physically re-inspected, the justification being the ease and speed of visual
inspection.
The primary quality control for remediation is verifying that the work practices of
the contractor are in accordance with t h e recommended and specified
cleanup method. But this may involve verification of training for the person
conducting the cleaning and verification for the consistent use of proper
technique among the workers.
31
4.5.2 White Glove Test
White Glove Test
One of the verification technique used for non- porous and semi-porous
surface is the “White Glove” test. The white glove is wiped across a smooth
surface and, if the dust is visible on the glove, the area is marked for re-
cleaning. This test has a number of limitations, including problem with rough or
porous surfaces and its inherent non- quantitative nature. Also, this test only
applies to a small percentage of the total area cleaned that would be tested in
this manner.
4.5.3 Measurement of Settle Dust
One of the criteria is the quantitative measurement of residual dust left on the
surface after cleaning. The quantitative measurement of residual dust is an
objective way to determine whether the material’s surfaces after remediation
have been returned to a satisfactory condition.
Based on the guideline developed by the American Industrial Hygiene

Association (AIHA), the reduction of residual dust on material surface to a
level ≤100mg/m² is the “key quality assurance (QA) performance indicator”
of a successful mould remediation. This test can be used for large or small
areas. A single test might be suffice in very small work areas. For larger areas,
more than one test is typically used, and statistical testing may be conducted
on the results to increase the reliability of the method. This gravimetric
measurement does provide information on the sufficiency of the cleaning
process in reducing dust loading and return of material surface to a satisfactory
condition.
If most of the dust is removed from the surface such that the remaining dust is
less than 100mg/m², it is then logical to assume that most accompanied spore
have been removed as well. In addition, the use of the 100mg/m² number as
a verification of cleaning has a number of advantages, including speed and
ease of understanding.
32
4.5.4 Sampling after Remediation
Besides depending on verification through inspection of the visible mould

growth, associated debris and dust were appropriately removed, where the
method of after testing and determining the kind/types of airborne mould in the
indoor air should be similar to those found in the outdoor air.
Air sampling is suggested to be conducted 1 or 2 weeks after completion of

remediation work and when the building and its ACMV system have equilibrated
with the outdoor environment.
4.5.5 Microbial Sampling of Surface
Tape lift sampling is recommended as a part of the final clearance inspection

process to verify that the spores were removed. The technique is straightforward
and not readily subject to misinterpretation. When used in final clearance, t h e
tape lift sample i s often collected from a nonrandom area where it is difficult to
determine visually if mould growth was removed. If moulds are found, the
suspected area is re-cleaned.
Tap lift sampling
4.5.6 Microbial Air Sampling
Air sampling for mould can be a useful additional method in determining whether
the indoor environment has been returned to a satisfactory condition.
The difficulties associated with the use of air sampling as the primary means of
final clearance are:
a. absence of numerical guideline for airborne mould and for bioaerosals in

general;
b. the necessity to collect many indoor and outdoor samples;
c. interpretation difficulties associated with varying kinds and concentrations of

mould found indoors and outdoors.
33
However, air sampling for mould propagules can be very necessary and a n
important component of final clearance in some buildings in which the initial
assessment did not identify all areas of hidden mould growth. S ome areas of
hidden mould could surface after the remediation work was done, and can be
detected by air sampling.
34
5. MOULD PREVENTION
5.1 Prevention of Mould Growth related to the ACMV System
Well-designed, constructed and maintained

building envelopes are critical to the prevention and
control of excess moisture and mould growth by
avoiding thermal bridges and prevent intrusion by
liquid or vapor-phase water.
Management of moisture requires proper control of

temperatures and ventilation to avoid high
humidity, condensation on surfaces and excess
moisture in materials. Ventilation should be
distributed effectively in spaces, and stagnant air
zones should be avoided. Well maintain air duct
Proper design, construction and operation of ACMV system should be taken into
consideration with the following requirements:
i. The need to restrict air movement in and between the various departments
through pressure differential to prevent t h e spread of airborne contaminants
including mould spore;
ii. The specific requirements for ventilation and filtration to dilute and reduce
contamination in the form of airborne microorganisms which include: mould,
bacteria, and hazardous chemical and radioactive substances. Ventilation
effectiveness is very important to maintain an appropriate indoor air quality.
Filtration is the primary mean of cleaning air, physical removal of particulates 2
filter (with efficiencies 20-40% and > 90 % respectively) for the effective removal
of particles with 1-5 um diameter (2nd filter –high efficiency filter). Special care
areas of the hospital –HEPA filter (at least 99.97% efficient for removing
particles > 0.3um diameter) to filter aspergillus spores with 2.5-3.0um diameter.
Peak efficiency for particle removal in the air space occurs between 12-15 air
change rate (ACH) and varies among different patient-care areas;
iii. The different temperature and humidity requirement for various areas and the
accurate control of environmental conditions. Design, operation and
maintenance of the ACMV system should focus on the humidity ratio or the
dew point temperature, as they represent “absolute “amounts of water or the
total mass of water vapor in the air and therefore allows for the definition of work
that must be done to change the moisture condition of the air. It should be used
in a contract document to avoid potential confusion caused by specifying the
RH alone;
iv. The design sophistication of ACMV should minimize the risk of transmission of
airborne pathogens such as mould spores and preserve a sterile and healing
35
environment for the patients and staff;
v. Installation of vapour sealant to prevent moisture infiltration;
vi. Installation of fire retardant insulation materials on walls, ceiling, floor slabs to
reduce the temperature difference and ensuring the surface temperature
remains above the dew point;
vii. Wrapping of ductwork and pipes with the appropriate insulation materials; and
viii. Application of UV light technology in air conditioning ducting for non-critical

areas could minimize microorganisms/bacteria’s coming into the user area.
These requirements demand very high quantities of outdoor air along with t h e
significant treatment of ventilation air, including cooling, dehumidifying, reheating,
humidifying and filtration.
One main function of t h e ACMV system is to remove moisture from the air
before the air is distributed throughout the healthcare facilities buildings. On the
contrary, an ACMV system that is part of an identified moisture problem may also
be a site of mould growth and serve to transport mould spores or other micro-
organism from the locus of contamination to the vicinity of the occupants. Improper
design, construction, operation and maintenance of ACMV system has the potential
to spread mould throughout the healthcare facilities building. Over-sizing ACMV
system can contribute to poor air distribution and insufficient dehumidification,
creating an environment that promotes mould growth.
Recommendations for engineering controls to contain or prevent the spread of

mould spore and other airborne contaminants should center on:
i. Adequate ventilation;
ii. Appropriate air cleaning (primary and secondary filtration); and
iii. Source control through adequate local exhaust ventilation
Proper maintenance of ACMV system should take the following into consideration:
i. Efficient design of ACMV system and proper ducting insulation techniques

during installation;
ii. Properly maintained ACMV components and proper FCU drain pan to eliminate
moisture source. FCU pan should be insulated and have the proper
gradient ; and
iii. The maintenance of the ACMV components should be done outside of user
areas with different access routes and carried out by a competent person.
36
The setting of percentages of fresh air depends on the requirements such as 100%
for operation theater room with ventilation.
5.2 Ventilation
Controlling contaminants such as mould spore through ventilation requires

simultaneous control of the following conditions:
i. Air change rates;
It is an important measure to control indoor air quality and is expressed

as room air exchanges per hour (ACH). Design of air changes should be
using a dynamic design that can change according to the air flow;
ii. Pressure gradient;
This is to control the air flow direction so as to prevent the dispersion of

mould spore and other pathogen-laden aerosols, dust, etc;
iii. Appropriate air distribution in the compartments being air-conditioned

to ensure effective distribution and avoid a stagnant air zone;
iv. High quality air filtration to ensure the effective removal of airborne
particles and mould spores; and
v. Precise temperature and humidity control.
Operation Theater
For operation theaters and other areas with ultraclean room requirements, 3
levels of filtration i.e. pre filter, primary & secondary filter and finally HEPA filter
should be provided for maintaining the indoor air quality, which is an effective
approach of air flow with HEPA-filter blown into a room in a unidirectional pattern
with the appropriate air change.
37
Healthcare facilities without specific ventilation standards should follow
ANSI/ASHRAE Standard 62, Ventilation for the acceptable indoor air quality. JKR
Technical Directive for The Prevention of Moulds and Fungi in Health-Care
Buildings provides directives that focus on the primary issue of addressing
condensation or high humidity due to air-conditioning that could be referred for
design consideration.
A high level of containment and control to prevent the spread of mould

contamination may be required during maintenance activities due to patient care
concerns. ACMV modifications will likely be necessary when a space is
remodeled where walls are moved or added and where laboratory hoods are
added or removed.
Appendix 1 provides the recommendation of Sheet Metal and Air Conditioning

Contractors National Association (SMACNA) IAQ Guideline for occupied building
under construction.
Appendix 2 gives maintenance schedule for the ACMV system.
5.3 Insulation/ Thermal Control
Many healthcare facilities have air-conditioning in areas that are side-by-side

with non-air-conditioned areas. Where the separation walls are not suitably
insulated, and unless the ingress of outside air is carefully controlled,
condensation tend to occur, especially when there is overcooling to the walls and
ceilings with a high temperature gradient.
To minimize or eliminate
condensation problems, vapor
barriers or insulation should be
incorporated in the designs of walls
and ceilings, including concrete slabs
of ceilings and floors of the hospital
buildings. These vapor barriers and
insulation with the right thickness
should be located and installed
properly or the building may have
moisture problems. Indoor relative
humidity should be kept below 60% -
ideally between 30% and 50%.
Likewise, to prevent condensation,
ducts, casing, piping and equipment
Worker applying insulation
with outside surface temperature
below the dew-point temperature of
the air, the surrounding should be well-sealed and insulated. The general intent
is to provide a sealed insulation which will not permit condensation on the
building assembly or sweating of the pipes or ducts and its support and will
38
not retain moisture to the detriment of its insulating capability.
Using the right product of insulation in the right place is critical for t h e
prevention of condensation that may lead to mould growth. A building requires
various barriers or insulation to water intrusion, and proper control of
condensation to prevent the trapping of moisture within the building assembly. It
is also important to specify the substrates for areas regularly exposed to
moisture.
Cellulose insulation has been recognized as useful in combating the Sick

Building Syndrome because it contains boric acid (treated with borax-based
additives) as a fire retardant and inhibits mould growth. Cellulose-insulated
building will provide a major inhibitor to mould growth because it significantly
reduces air leakage and results in a more airtight building, thus, preventing
moisture which is needed for mould growth.
Fire retardant Polyurethane foam or sprayed foam is a multi-purpose foam used

for a wide range of building insulations and may be used for the insulation of
walls and ceilings. It has the additional benefit of adhering to the surface to
prevent potential condensation from forming.
Insulation is also required to keep the cold air supply duct, chilled water pipes,
drain pipes, valves and fittings from direct contact with the warm, humid outside
air. This is to avoid condensation and to prevent heat gains to the duct and the
cooled supply air. Insulation is only effective when it is drying. In order to be
effective, there must be no holes or tears in it.
Sprayed foam used at the wall
Simply adding insulation without air sealing first will only give marginal
improvement results. Ductwork must be well-sealed, appropriately insulated with
the right amount of insulation, installed and balanced to ensure efficient cooling
and dehumidification.
Polyethylene insulation is impervious to mould and bacteria and is also tear-
39
resistant. It is also CFC-free and ozone friendly. Polyethylene insulation is
suitable for air-conditioned ductworks which supply conditioned air to the
operation theater and areas requiring a lower temperature.
Armaflex insulation which is a flexible elastomeric thermal insulation helps to

reduce or eliminate conditions that lead to biological contamination and bio-
aerosols, as it prevents moisture from wicking and is an efficient insulation. It is
manufactured without the use of CFC’s, HFC’s or HCFC’s. It is also
formaldehyde-free, low VOCs, fiber-free, dust-free and resist mould growth. It
can be used in air handlers, VAV units, ducts and other system components
requiring condensation control and moisture. It meets the requirements of NFPA
90A, NFPA 90B for duct coverings and linings and UL 181.
Polystyrene foam insulation is best tolerated by persons with multiple chemical

sensitivities.
Fiberglass contains no fungicidal additives. So, it soon becomes a very

hospitable environment for mould growth because of air infiltration which may
lead to moisture migration. Dust in all fiberglass insulation is an excellent
source of mould nutrients. To date, the serious reported cases of mould growth
in insulation have all involved fiberglass.
Nevertheless, the most effective way of keeping mould from growing in air ducts
is to control moisture. Steps to control moisture in the ductwork include:
i) Promptly and properly repairing any leaks or water damage;
ii) Removing standing water under the cooling coils of air handlers by making
sure the drain pans slope toward the drain and the drain is flowing freely;
iii) Making sure ducts are properly sealed and insulated in all non-air-
conditioned spaces, therefore, moisture due to condensation does not enter
the system and the system works as intended. To prevent condensation,
the heating and cooling system must be properly insulated; and
iv) Operating and maintaining any in-duct humidification equipment strictly

according to the manufacturer's recommendations.
5.4 Mould Control Measure during Renovation Activities
Biological contamination like mould can grow during each phase of

construction. During execution of the construction project, mould can settle on
building materials in the form of spores.
The following are some reasons and causes for mould growth during a
construction project:
i) Design problem;
40
ii) Uncontrolled moisture;
iii) Condensation;
iv) High relative humidity;
v) Damp building materials;
vi) The presence of spores, ideal temperature and sufficient nutrients;
vii) Site issues such as no proper quality control on civil works during
construction;
viii) Poor site drainage; and
ix) Inadequate building protection, stored building materials that get wet when
water stands in the basements and crawlspaces.
Mould spore may be released into the air during construction/renovation

activities, ranging from demolition and renovation, to construction. Moisture
control and management are keys to preventing mould growth and water-
damage to materials in healthcare facilities buildings, both during and after
construction; whilst dust and dirt raised during construction, demolition or
renovation projects within or adjacent to the health care facility provide nutrients
for mould spore to flourish. Small pieces of dirt or dust in the air are the main
ways that mould spores travel and cause infection in healthcare facilities. As
such, it is extremely important to employ the effective control and prevention
measures for effective moisture and dust control during construction and
renovation.
41
5.4.1 Dust Containment
The objectives of dust containment measures are to minimize the dust

generated during construction activity and second, to prevent dust infiltration
into adjacent patient care areas. The environmental control measures
implemented will depend on the type of construction/renovation being
undertaken in the hospital and the proximity of the at-risk patients to this site.
This will be based on the results of the environmental risk assessment.
Containment used during construction
Measures to reduce dust emission and prevent dust accumulation and

infiltration should include but not limited to the following:
i) The construction area should be sealed fully during the construction

period. A dust barrier should be created from the floor to the slab (true
ceiling) and edges sealed;
For short-term minor projects, this may use plastic sheeting. However,
for more long term projects, this should be a solid sealed barrier. It may
be necessary to create a lobby (anteroom) if the barrier is the
entrance/egress for construction workers;
ii) All windows, doors, vents, plumbing penetrations, electrical outlets and
any other sources of potential air leak should be sealed in the
construction zone;
iii) Air pressure in the construction zone should be negative compared with
t h e adjacent areas. An extract fan may be used for this purpose. Air
from the construction zone should be exhausted directly to the outside and
this is the most appropriate option. If this is not possible, then the air
42
should be filtered through HEPA filters (that have been properly fitted and
strictly monitored) before being re-circulated to the hospital;
iv) Dust reduction techniques should be used for cutting and hole-boring;
v) Debris should be removed from the construction area at the end of each
working day. Debris should be removed in covered containers, preferably
through window openings. A chute may be necessary if the construction is
above the ground floor level.
Containment used to isolate construction area
In addition, a normal good housekeeping procedure should prevail during the

operation in particular, and holding skips and other containers should be kept
moistened and/or covered. The construction area should be vacuumed on
a daily basis or more frequently if required, to prevent dust accumulation on
surfaces, ceilings and air duct grilles. As the quantity of dust generated will
vary depending on the type of building activity, the increased cleaning
regimes need to be adjusted accordingly to minimize dust accumulation.
Damp dusting and not dry cleaning is recommended. Air filtration systems
must be regularly checked. Where vacuum cleaners are used, in areas where
high-risk and very high-risk patients are cared for and in adjacent areas,
these should be equipped with HEPA filters and appropriately maintained to
minimize dust dispersal. Filters in the air filtration systems and the vacuum
cleaners need to be changed regularly and a record/log should be kept of
these changes;
vi) A mat with a sticky surface or moist carpet should be placed inside the exit
from the construction zone to trap dust. This should be
vacuumed/changed daily or more frequently when visibly soiled;
vii) Construction workers should wear protective clothing, which should be

removed before leaving the construction zone;
viii) Traffic control;
43
ix) If the diffuser is too close to the wall, it should be diverted in order to allow a
sufficient distance from the wall; and
x) Establish daily monitoring and documenting of all relevant activities within the
construction zone or renovation area.
Pedestrian: Pedestrian traffic from the construction area should be directed away
from patient areas, with workmen having a separate entrance to the
construction site. When possible, patients and visitors should avoid entering
the hospital adjacent to major construction/demolition sites, where debris or
dust is being removed from the work area.
Supplies: Alternative routes, which avoid the construction site, through which
inanimate items are transported throughout the hospital, may need to be
identified during construction. Clean or sterile supplies or equipment should be
transported to storage areas by a route that minimizes contamination risks from
the construction site.
In some critical areas and in some instances where it may not be possible to
alter traffic patterns, consideration will have to be given to schedule construction
to off-hour periods.
Appendix 4 describes the procedures for dust control / preventive measures.
Appendix 5, 6 & 7 provides a checklist of pre-construction task, during

construction checks and post construction action.
5.5 Organization Roles and Responsibilities of the Infection Control Team
Nowadays, occupants, patients, and visitors are more concerned about health
and more aware of allergic conditions and also more familiar with and aware of
the effects of mould in the hospital.
Mould abatement/control should involve the cooperation of many departments,

with each department having specific responsibilities other than technical issues
surrounding mere mould abatement/cleaning. These responsibilities begin with
the design of a building and end when the building is razed. Each department
must have an understanding of and commitment to the process and plan.
As such, t h e Hospital Infection control committee should draw up a hospital

policy for prevention or controlling the potential of mould growth.
The committee should ensure a multidisciplinary team comprising of the Head Of

Department/Unit, Engineers, Science Officer, Public Health Unit, Infection Control
Unit, Hospital Support Services staff/concessionaires and relevant medical staff
and clinician in high risk areas.
44
The committee should be established and policies and/or procedures to
coordinate demolition, construction and renovation project and proactive
preventive measures at the inception are put in place to minimize the risk of
mould- related problems. The responsibilities of all personnel involved should be
clearly outlined.
i) Hospital Director / Hospital Administrator
The Hospital Director / hospital administrator has the overall responsibility for
t h e health and safety of patients, staff, occupants and visitors. Hospital
Director / hospital administrator should ensure policies and/or procedures
are put in place that clearly outline the responsibilities of all personnel
involved in the prevention of mould growth, either on a routine basis or in
the course of a minor or major maintenance and construction work. In
general, the Hospital Director/hospital administrator should ensure that the
policies and/or procedures to preventi mould problem be developed and
implemented.
ii) Hospital Engineer / Liaison Officer
Communication and awareness of the risk factors associated with mould

growth is the key to reducing the risk to patients, staff and other occupants.
Hospital engineer / Liaison officers should ensure that a policy and/or
procedures are in place, outlining the necessary action for the prevention of
m o u l d growth, both on a routine basis and in the course of minor or major
maintenance or construction/renovation activities. He should ensure a
mechanism be established so that the construction project can be stopped,
should there be a significant breach in the preventive measures. The hospital
engineer/Liaison officers should ensure that the current knowledge of the best
practices in the control of mould growth and all policies and or procedures is
kept up-to-date.
iii) Hospital Support Services Staff
Facility manager of hospital support services and staff should be aware of the
risks posed by minor or major maintenance or construction activities to at-risk
patients and should consult with the infection control team in advance of such
activities. The facility manager should ensure that the best practice for
operation and maintenance for all activities and the schedule are strictly
adhered to. I n the event that major maintenance or construction activities
are planned in the hospital providing for at-risk patients, the facility manager
should identify the preventive measures in advance during the initial risk
assessment and provide a technical advice apart from including in the
tender documents to ensure all necessary precautionary measures are taken.
He should consult with the infection control staff in advance of such
activities. He should also ensure his staff monitor implementation of
preventive practices and maintain the records relating to a fixed plant
45
precaution and maintenance of all system and equipment.
The facility manager should ensure that the hospital support services staff
respond to water intrusion problems with quick (less than 24 hours) drying
and / or removal of water- damaged materials to prevent or limit mould
growth, apart from coordinating and managing the various levels of
remediation activities to ensure proper moisture management and mould
remediation. They should provide industrial hygiene expertise and techniques
for remediation activities including mould investigation, training, protecting
patients in adjacent areas and other tasks associated with their expertise.
Hospital support services staff with the hospital administration staff should
also provide knowledge and awareness to the staff and patients about the
need to close the doors and windows. For 24 hour rooms that are air-
conditioned, control over these rooms should be held. In addition, the
temperature requirements should be identified in non-critical areas such as
placing the temperature/humidity reader, for example, the hydrometer and
etc. to avoid condensation from occurring.
iv) Infection Control personnel
It is crucial that the infection control personnel play a major role in planning
the construction or renovation of major maintenance activities. Hospital
support services staff should ensure that the details of all works and
maintenance activities are communicated to the infection control team, who
in turn will liaise with the medical and nursing staff to identify the patients at
risk or other susceptible occupants and also to monitor the effectiveness of
the preventive measures taken throughout the activities. The infection
control team should also assure that the patients’ health and employees’
health are not impacted as a result of moisture intrusion or mould growth and
remediation by reviewing the Infection Control Risk Assessment (IRA) and
assist with the training.
v) Medical and Nursing Staff
Medical and nursing staff should be aware of the patient populations at risk,
of potential hazards that the construction/renovation or major maintenance
activities in dispersion of mould spores and other airborne contaminants
posed to patients and the preventive measure required.
vi) Other Roles of the Hospital Infection Control Committee
Apart from the above, the Hospital Infection Control Committee should ensure
that the risk assessment and hazard surveillance round be conducted
regularly by users and hospital support services staff. The data compiled
should be tabulated and evaluated by the Committee to identify strengths and
deficiencies in order to minimize or eliminate hazards and improve
performance. Any related illnesses and discomfort induced by mould data
46
should be collected and reviewed.
The specific responsibilities of the Hospital Infection Control Committee should

also include but not limited to the following:
i. Review quarterly report regarding the proper operation and malfunctions of

utilities system; recommend and ensure the completion of corrective actions
as needed;
ii. Review quarterly reports regarding hazardous materials management,

housekeeping, pest control, maintenance activities and ensure improvements
of all related activities to ensure all these activities minimise or eliminate
mould growth, especially in dust management and moisture management;
iii. Conduct quarterly surveillance rounds, review the data to identify trends,
recommend and ensure completion of corrective actions as needed; and
iv. Facilitate user and hospital support services staff orientation and training
programmes.
47
Appendix 1
IAQ Guidelines for occupied buildings under construction
1. ACMV Protection
Seal return registers during construction operations
Provide temporary exhaust during construction
operations
To the greatest extent possible, isolate and/or shut down the return side
of the ACMV system during construction. When ventilation must be
operational during construction activities, provide temporary filters.
2. Source Control
Use materials and products with low pollutant emissions including adhesives,
sealants, paints, carpet systems, and furnishings. Provide low and zero VOC
materials as specified
3. Pathway Interruption
Isolate areas of work as necessary to prevent contamination of clean or

occupied spaces. Provide pressure differentials and/or physical barriers to
protect clean or occupied spaces
4. Housekeeping
During construction, maintain project and building products and system to

prevent contamination of building spaces.
48
Appendix 1
5. Temporary Ventilation
Provide minimum 48-hour pre-ventilation of packaged dry products prior to

installation. Remove from packaging and ventilate in a secure, dry, well-
ventilated space free from strong contaminant sources and residues.
Provide a temperature range of 60◦ F (15.6 ◦C) minimum to 90◦F (32.2◦C)
maximum continuously during the ventilation period.
Provide adequate ventilation during and after installation of interior wet

products and interior final finishes
Provide filtration media with a Minimum Efficiency Reporting Value (MERV)

of 8 as determined by ASHRAE 52.2 during construction (and during owner
occupancy).
Note: Materials / products that generally require temporary ventilation for off
gassing include: adhesives, wood preservatives, composite wood products,
plastics, waterproofing, insulation, fireproofing, sealants/caulking, acoustical
ceilings, resilient floorings, carpet, paintings, sealers/coatings, wall coverings,
manufactured casework, and furniture.
6. Scheduling
Schedule construction operations involving wet products prior to packaged

dry products to the greatest extent possible.
7. Flush-out
After construction ends, prior to occupancy and with all interior finishes
installed, perform a building flush-out by supplying a total air volume of 14,000
cu.ft. of outdoor air per square ft of floor area while maintaining an internal
temperature of at least 60◦F and RH no higher than 60% (Higher RH level
may indicate potential for mould growth).
49
Appendix 2
Maintenance Schedule for ACMV System
Description Activities Frequency Remarks
Fill out daily log Check all set points such as pressure and Daily
temperature for proper setting and
function.
Overall Inspect the unit to ensure it is operating Daily

inspection in a “normal” condition for vibration, noise,
and odors. Verify gauges and
thermometers are reading within range.
Inspect for leakage due to access doors
not being properly closed. Verify that any
internal lighting is off. Verify all safety
guards are in place.
Inspect pulleys Inspect belt tension and alignment. Look Weekly

and belts for rubber shavings under the pulleys.
Grease fan and Inspect visible grease for metal shavings, Semi-
motor bearings indicating a possible falling bearing. Wipe
annually
away all excess grease after greasing.
Inspect grease tubing if installed for
integrity to make sure grease is getting to
the bearings. Check bearings for excess
heat, noise, or vibration.
Fan casing Check for cleanliness and proper tightness Semi-
at all anchorage points. Inspect isolators if annually
installed for installed for free movement.
Inspect flexible gasketing between the fan
and casing or duct for integrity issues such
as misalignment or leakage.
Condensate
Clean drain pan, flush with biocide and Semi-
drains
eliminate pockets of standing water. annually
50
Appendix 2
Maintenance Schedule for ACMV System (Cont’d)
Dampers Inspect damper actuator and linkage for Annually

proper operation by cycling fully opened to
fully close. Inspect blade gasketing if
present for integrity and flexibility. Replace
if damaged.
Filters Inspect filter rack for integrity. Inspect Annually

condition of local pressure differential
gauge, tubing, and pitot tubes.
Coils Inspect coil fins for physical damage, and As required

comb out any bent fins. Clean coils if
significant dirt is present and hampering
coil performance.
Electrical Tighten any loose terminal connections. Annually

connections
Outdoor grilles Inspect and clean grilles at all exterior Annually

building penetrations
Sensors Clean and calibrate sensors Annually
Ductwork Inspect for leakage and cleanliness As required
Cooling tower Check for cleanliness and damage Monthly
Chiller Check the condition of the compressor, chill Monthly

water supply and etc. replace if damaged.
51
Appendix 3
Guidance on Moisture Control Strategy (For Existing Building)
1) Moisture control strategy should include:
A. Housekeeping
 Keep material dry. Protect stored on-site and installed absorptive

materials from moisture damage. (Appoint Person in Charged (PIC)
for every store)
 Verify that installed materials and products are dry prior to sealing and
weatherproofing the building envelope.
 Install interior absorptive materials only after building envelope is sealed

and weatherproofed.
B. Inspection
Document and report results of inspections; state whether or not inspections

indicate satisfactory conditions.
i. Examine materials for dampness as they arrive such as materials that need to
examine and PIC to examine the materials.
ii. Examine materials for mould as they arrive and reject materials that arrive
contaminated with mould (PIC to examine)
iii. Inspect stored and installed absorptive materials regularly for dampness and
mould growth (frequency and PIC of inspection)
iv. Verify site drainage to ensure proper drainage of surface water and ground
water away from the building (frequency and PIC of inspection)
v. Weather proofing: Inspect moisture control materials as they are being restored
which includes: -
52
Appendix 3
Guidance on Moisture Control Strategy (Cont’d)
 Verify air barrier is installed and sealed completely (PIC)
 Verify correct shingling of the flashing for roof, walls, windows, doors,
and other penetrations (PIC)
 Verify insulation is installed without voids(PIC)
 Verify roofing is in accordance with ASTM D7 186 Standard Practice for

quality Assurance Observation of roof construction and repair (PIC)
vi. Plumbing: -
 Verify satisfactory pressure test of pipes and drains is performed properly

before closing in and insulating lines (Specification of the pressure and
PIC to check the pressure)
vii. Inspect ACMV system to verify: - (Please refer to Appendix 2)
 Condensate drain pans are sloped and plumbed correctly
 Access panels are installed to allow for inspection and cleaning of coils
and ductwork downstream of coils;
 Ductwork and return plenums are air sealed:
 Duct insulation is installed and sealed; and
 Chilled water line and refrigerant line insulation are installed and sealed.
C. Scheduling
 Schedule work such that absorptive materials, including but not

limited to porous insulations, paper-faced gypsum board, ceiling tiles,
and finish flooring are not installed until they can be protected from rain
and construction- related water.
 Weather-proof as quickly as possible. Schedule installation of moisture

controlled materials including but not limited to air barrier, flashings,
exterior sealants and roofing at the earliest possible time.
D. User Training
 Training given to users to make sure they know how to use the
equipment such as Air Conditioner properly
53
Appendix 3
E. Strategies to Control Moisture accumulation should include: -
 Minimizing moisture entry into the building envelope

 Control liquid moisture accumulation (condensation)
F. Procedures for moisture control during construction involves but not limited to
the followings:
i. Identify porous materials and absorptive materials used
ii. Identify schedule for inspection of stored and installed absorptive materials
iii. Review materials selected and specified for use in the building (Require
submittal of MSDS) to ensure that appropriate materials are used in areas
subject to elevated moisture.
iv. Addressing moisture and/or mould impacted building materials.
 Protect absorptive products from moisture damage before, during, and

after installation.
 Moisture sensitive materials that get wet during construction must be

dried thoroughly prior to installation. Immediately remove products
exhibiting stains, mold, mildew, or other evidence of water or moisture
damage to be immediately removed from site.
v. Identify storage areas: -
 Designate secure storage area to facilitate protection of stored

absorptive products.
 Clearly identify storage area. Keep products dry, clean, and orderly to
prevent contamination.
 Monitor storage areas for contamination; correct problems and

implement preventative measures.
54
Appendix 4
Procedures for Dust Control / Preventive Measures Dust Control
 Erect an impermeable dust barrier
 Ensure windows and doors are sealed
 A separate entrance away from patient traffic should be created for use by
construction workers
 Protective clothing should be worn by construction workers and removed

when leaving the construction site
 Dust barrier should not be removed until the project is complete
Ventilation of Construction Area
 Seal windows
 Maintain negative pressure within construction zone by using a portable

extract fan
 Ensure air is exhausted directly to the outside and away from intake vents or
filtered through a HEPA filter before being re-circulated
 Ensure ventilation system is functioning properly and is cleaned if

contaminated by soil or dust after construction or renovation project
Debris Removal and

Cleaning
 Contain debris in covered containers or cover with either an impermeable or

moistened sheet before transporting for disposal
 Remove debris at end of the work day
55
Appendix 4
Procedures for Dust Control / Preventive Measures (Cont’d)
 An external chute will need to be erected if the construction is not taking

place at ground level
 Vacuum work area with HEPA filtered vacuums daily or more frequently if
required.
Patient Risk Reduction
 Move all patients from the construction area
 If possible, move at-risk patients who are adjacent or near to the construction
area
 Ensure that patients do not go near construction area
 All windows, doors, air intake and exhaust vents should be sealed in areas
of the hospital containing patients who are classified as high-risk, if the
construction or demolition work is considered likely to result in mould -
contaminated air entering these areas
 Very high-risk patients should be treated in HEPA-filtered, positive pressure

rooms
Traffic Control
 Designate a traffic pattern for construction workers that avoids patient care
areas and a traffic pattern for clean or sterile supplies, equipment, patients,
staff and visitors that avoids the construction area
 A traffic path should be designated for the removal of rubble from the
construction site which preferably is separate to and away from all hospital
related traffic
56
Appendix 5
Pre-Construction Checks
 Building materials should dry before, during and after installation
 Inform project manager any water damage, leaks or intrusion on job site
 Dry out any wet material immediately
 Follow designs and specifications to avoid any misconduct of work that

would lead to water and other damage
 If any water intrusion or moisture accumulation occur before construction, let

architects know the design flaw
 During the design phase, carefully review the details with specific attention to
ensuring an impermeable envelope
 Take third party opinion with envelope engineer on water tightness of the
envelope for geometrically complex building
 Survey the existing building or renovation area for pre existing mould
exposure in the building or construction site
 Establish a partnering program with the owner and promote a peer review
for the mechanical system and the building envelope designs
 Consult manufacturers of moisture critical products to confirm the product’s

application and recommend standard details, and provide preferred installers
 Schedule Delivery of interior materials so they will arrive after exterior of

building has been sealed
 Provide dry area for materials storage and minimize storage time
 Cover materials with plastic sheeting or tarps to secure
 Pre arrangement for drying equipment (fans, dehumidifier, Vacuums, etc)
57
Appendix 6
During Construction Checks
 All materials should be inspected when deliver on site for pre existing mould
contamination
 Indoor building materials should be installed in dry condition as per

manufacturers’ specifications
 All water services and waste lines should be checked for proper installation,
Connections and for leakage
 Water lines (hot and cold water) properly insulated
 Inspection should be made for filling or hydro test of sprinklers
 All building penetrations should (doors, windows, balconies and decks, roof,
ventilation and exhaust ducts) install properly and checked for leakage
 All tears, openings or punctures in vapor barriers have been repaired
 All roof drains should be drained away from the foundation
 Roof drains properly supported and braced for large volume storms
 All moisture-generating equipment vented outdoors
 Provide proper ventilation to attics, crawl spaces or other enclosed areas
 Perform interim inspections; inclusive of representative from various discipline

such as Architect, Envelop Engineer, Mechanical Engineer, manufacturer’s
representatives to inspect for mould related issues.
 ACMV System
- To be installed by a competent specialist contractor

- Correct filters properly installed as per specification, no filters missing or
misaligned
- Drip pan for cooling cool drains properly
- All duct joints sealed properly
- The system is cleaned and commissioned
58
Appendix 6
During Construction Checks (Cont’d)
 The buildings finishes that might accumulate moisture, such as concrete

walls and floors, gypsum walls, wooden structural component, be allowed to
dry out completely before covered or hidden.
59
Appendix 7
Post-Construction Checks
 Ask manufacturers to inspect installations for warrantee purposes
 Brief the facility owner on their responsibilities to prevent mould growth
 Fix leaky plumbing hot and cold lines and leaks in the building envelope as
soon as possible
 Make observation for condensation and wet areas. Fix source of moisture
problem as soon as possible
 Prevent moisture due to condensation by increasing surface temperature or

reducing the relative humidity. To increase surface temperature, insulate or
increase air circulation. To reduce the relative humidity in air, repair leaks,
increase ventilation, or dehumidify
 Keep heating, ventilation and air conditioning (ACMV) drip pans clean
 Maintain indoor humidity; keep relative humidity within the range of 30-60%,
High relative humidity (above 70%) may indicate potential to mould growth.
 Perform regular building/ACMV inspections and maintenance and make

corrective actions if necessary
 Install and maintain proper air filters
 Clean and dry wet or damp areas or material within 24 to 48 hours
 Ensure new building penetrations are properly sealed
 Landscape watering system does not spray building foundation
 Conduct final visual inspection of pipe chases, utility tunnels and areas above
drop ceilings that are exposed to water or waste lines or that are directly
below roof
60
Appendix 8
2008 ASHRAE Handbook-HVAC Applications
61
Appendix 8
2008 ASHRAE Handbook-HVAC Applications (Continue)
62
Appendix 8
2008 ASHRAE Handbook-HVAC Applications (Continue)
63
Appendix 8
64
REFERENCES
1. Environment Protection Agency United State of America: “Mold Remediation in

School and Commercial Building”
2. American Industrial Hygiene Association (AIHA): “Recognition, Evaluation, and

Control of Indoor Mould”
3. Fungal Contamination: “A Manual for Investigation, Remediation and Control”

Hollace S. Bailey, P.E, CIAQP, CIE, CMR
4. New York City Department of Health and Mental Hygiene: “Guidelines on

Assessment and Remediation of Fungi in Indoor Environment”
5. Health Canada: “Fungal Contamination in Public Building: Health Effects and

Investigation Method”
6. National Air Duct Cleaners Association, Washington DC: “Assessment, Cleaning,

and Restoration of ACMV System ACR 2002”
7. American society of Heating, Refrigerating and Air-Conditioning Engineers

(ASHRAE): “Heating, Ventilating and Air Conditioning Applications”
8. American society of Heating, Refrigerating and Air-Conditioning Engineers

(ASHRAE): “Humidity Control Design Guide for Commercial and Industrial
Buildings”
9. The Facility Guidelines Institute (FGI): “Guidelines for Design and Construction
of Health Care Facilities”
10. Storey E, Dangmam KH, Schenck Petal: “Guidance for Clinicians on the
Recognition and Management of Health Effects related to Mold Exposure and
Moisture Indoor”
11. Centers for Disease Control and Prevention (CDC): “Prevention and Remediation
Strategies for Control and Removal of Fungal Growth”
12. “Industry Code of Practice on Indoor Air Quality 2010” Department of

Occupational safety and Health, Ministry of Human Resource, Malaysia
13. “Indoor Air Quality Guide”: American Society of Heating Refrigerating and Air-
Conditioning Engineers (ASHRAE)
14. “The ASHRAE Guide for Buildings in Hot & Humid Climates”: American Society
of Heating Refrigerating and Air-Conditioning Engineers (ASHRAE)
15. JKR’s Technical Directive for The Prevention of Molds and Fungi in Health-Care
Buildings
16. MOH- Panduan Teknik Bagi Penggunaan dan Pengawalan Suhu

Sistem/Peralatan Penghawa Dingin di Bilik Bukan Hospital.
65
17. Brandt ME, Warnock DW. Laboratory aspects of medical mycology. In: Dismukes
WE, Pappas PG, Sobel JD, eds. Clinical Mycology. New York, NY: Oxford
University Press; 2003:1--22.
18. “Bioaerosol Sampling (Indoor Air) NIOSH Method 0800”. Issue 1 : 15 January
1998. http://www.cdc.gov/niosh/docs/2003-154/pdfs/0800.pdf
66
ANNEX A
PROPOSED INVESTIGATION PROTOCOL
Protocols and guidelines for building evaluation include a visual inspection of the
property. The important goals of every mould investigation include notification of persons
with particular health risks, identification and correction of moisture sources causing
mould growth, and a determination of the extent and location of mould amplification site.
The level and degree of investigation required for each project will vary, but investigation
levels might be broadly categorized into Three (3) Stages depend on the situation. One
or more level inspection may be required, until the source of moisture problem has been
identified and extend and location of problems can be established and remediation can
be undertaken.
The Three (3) Stages are described below, and flowcharts are provided as a simplified
outlined of some of the decision processes at each stage.
67
Annex A1
OCCUPANT / END USER INTERVIEW FORM
Hospital Name: __________________________________________________________
Name of End Users: _______________________________________________________
Interviewer Name: _______________________________________________________
Date & Time of Interview: Date ___________________ Time __________________
1. Building History
a) Approximate age of building: __________ years
b) Aware of any renovations or changes in use? Yes No

Approximate year and nature of renovation.
i) Year ________ Change: ________________________________________
ii) Year ________ Change: ________________________________________
iii) Year ________ Change: ________________________________________
c) Area drawing available for the building: Yes No
d) Building is Air Conditioned Natural Ventilated
Type of ACMV System: ______________________________________________
e) Type of Building Wooden Concrete
f) Is building often too Hot? yes No
Too Cool Yes No
Description: ______________________________________________________
g) Thermostat Setting: Constant Changed at Night
Off after Office Hours
68
h) Spaces are: Maintained at same Temperature
Some are kept Cooler (List)
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
69
2. Observed Moisture and Mould Problems
a) Have you ever observed any leaks or moisture problems? Yes No
If yes, describe exact location: ________________________________________
__________________________________________________________________
b) Have you ever observed any mould in the building? Yes No
If yes, describe exact location: ________________________________________
__________________________________________________________________
c) Are they any unpleasant odours in the building? Yes No
Musty Earthy Smoky Dusty
Rotten Chemical Petroleum
Others: _________________________________________________________
Location: ________________________________________________________
When Last Notice: ________________________________________________
70
OCCUPANT’S / END USER’S MOISTURE EVENT REPORT
Consider all Locations
Detailed Occupant Description:
Where was it wet? ________________________________________________

(Exact Location and
Area Affected) ________________________________________________
________________________________________________
Was Mould Observed? ________________________________________________

(Exact Location and
Area Affected) ________________________________________________
________________________________________________
Amount of Water: damp Dripping Standing Water
Probable Source of Moisture: -
Leaks through Walls, Decks, Roofing, Windows
Sewage Backflow
Condensation on Building Surface
Condensation on Pipes, Ducts
Leaking Bath, Shower, Plumbing
Improperly Drainage
Underground Water Table
Others: ____________________________________________________________
Frequency of Wetting: -
Almost all the time, regardless of weather
71
Frequently, for example on most raining days
Occasionally, for example only after heavy rain
Rarely or not at all
Don’t know
For how many days was it wet / damp in the past twelve (12) months?
0~2 days 3~7 days 8~30 days
More than 30 days Don’t know
If currently wet, for how many days has moisture been present?
0~2 days 3~7 days 8~30 days
More than 30 days Don’t know
Signature: ___________________________________
Name of Inspector: ___________________________________
Date & Time: ___________________________________
72
Annex A2
STAGE 1 - WALK THROUGH INSPECTION
Stage 1 involves a visual, non-destructive inspection, to identify if there is reason to

suspect mould coloniza
tion or a need to perform a more detailed inspection. An interview of building occupants

should be conducted before inspection, to notify persons who may have particular health
risks and to collect information useful to the inspection.
Procedure for Stage 1 Inspection:
Environmental conditions on the day of inspection should be recorded, along with

evaluation of the type and condition of exterior building envelope components and a
quick walk-through of interior spaces to identify interior odours before becoming odour
adapted.
Interview a knowledgeable representative of the building occupants to collect information

regarding building history, and the history of any know moisture problems, and locations
of any persistent odours should be recorded.
Each reported “moisture event” (leak, flood, seepage condensation etc) should be
documented as a potential clue, and to direct the focus of more careful inspection.
The location of the musty odours or moisture reported by occupants must be also
carefully investigated.
A systematic visual inspection of each interior space included in the scope of the
inspection assignment must be conducted to help ensure that other problem areas are
not overlooked.
Noted types of building materials and finishes present any observed damage,
distinguishing between materials that area porous and non-porous. Also observed
damage for clues on the source of water or moisture problems.
A careful walk-through inspection will include close observation of accessible interior

surfaces using common inspection tools, notes and photographs. Investigate any
noticeable odours or visible evidence of mould growth, and any blisters, stains,
corrosion, deterioration, or discoloration that might indicate water intrusion or
condensation problem.
73
A flowchart and proposed checklist for Stage 1 inspection are appended
Report and Remediation:
The inspection report for a Stage 1 inspection might consist of a copy of the inspection
checklist with recommendation for recommendation, or include a narrative, or a plan
view drawing keyed to observation notes and photograph. The report should include a
record of the types of finishes present, and any observed mould growth or evidence of
moisture damage.
If the extent and location of mould contamination can be quantified and moisture sources
identified, the project can proceed to development of a remediation plan and organizing it
execution. Otherwise, a more detailed and invasive inspection protocol may be
warranted.
74
STAGE 1 INSPECTION FLOWCHART
Problem Stage 1 – Walk-through Inspection:

Report A preliminary inspection to assess severity of problem and identify obvious sources.
Evidence of extensive or concealed problems, or special health concerns may be indicate a
Site visit. more detailed (Stage 2) investigation.
Complete moisture
survey sheets and
occupant interview
Prepare inspection
report
Stage 1
Inspection Checklist
No
Is there occupant Is concealed

reported, or visible contamination
No
moisture or mould probable?
damage?
Yes
Health Evaluation by Testing

risk? Yes No
health care professional required
Removal recommended
Yes
Remove at-risk Testing

individuals protocol
Cause and
extent of mould No Proceed to
identified? Stage 2
Inspection
Yes
Preparation remediation Proceed to

specifications Remediation protocol
75
STAGE 1 – INSPECTION CHECKLIST (Visual Walk-through Inspection)
Hospital Name: __________________________________________________________
Inspector’s Name: ________________________________________________________
Date & Time of Inspection: Date __________________ Time ____________________
Weather Conditions: Clear Overcast Rain Drizzle
Outdoor Temperature: ______________ °C
Outdoor Relative Humidity: ______________ %
Building Exterior
Surroundings: Urban Suburb
Building Type: Wooden Concrete
Building Age: ________ Years
Stories: 1 2 >2
Roofing: Flat Pitched Roof
Type(s) __________________________________________________
Site Slope toward Building: Flat Sloping
Windows - Apparent Condition: Good Poor Visible Damage
Type(s) _____________________________________
76
INTERIOR PASS-THROUGH INSPECTION
(Check for Odors before becoming Acclimated)
Noted Odors: Yes No
1. Location: ______________________ Description: _________________________
2. Location: ______________________ Description: _________________________
Systematic Interior Walk-through
Notes on Separate Sheet: Yes No
Proceed in repetition through each room on each floor, in sequence from ground floor, to top
floor or to the rooms requested by owner / user. Extend and location of any noted moisture
strains or mould contamination should be included in the filed notes.
Repeat for each Room / Space
Moisture Event History: Yes No
Room Name: ___________________________ Use: ___________________________
Location: _______________________________________________________________
Finish Floor: Wood Carpet Vinyl
Stone Ceramic Tile Other: _____________
Wall: Gyp. Wood Plaster Masonry
Paint Vinyl Paper Tile
Fabric Other: __________________
77
Ceiling: Gyp. Bd Acoustical Tile Plaster
Wood Other: __________________
Inspect: Floor Edges Carpet Strip Window Sills & Jambs
Wall Base Door Sills Ceiling / Wall Joint
Ceiling Air Diffusers Behind Furniture
Seam in Vinyl Wall Coverings
Observe Damage: Yes No (Skip to next room / space)
Surface: Stains Mould Peeling / Blisters
Moisture: Dry Damp Wet
Description: _____________________________________________________________
________________________________________________________________________
________________________________________________________________________
Location: _______________________________________________________________
Surface area of Observed Mould Growth: ______________ m²
Sampling: No Yes Type: _________________________________
ID Labels: _______________________________________________________________
Photos: No Yes Photos Nos: ____________________________
Kitchens Range hood, Vented to Outdoors: Yes No
Bathrooms: Nature Ventilation Continuous Fan Fan on Demand
Indoor Plants: None Potted Indoor Garden
Mechanical System: None Yes (see ACMV Inspection Checklist)
Prepare Inspection Report and Recommendation: -
Concealed Damage: Probable Not Likely Cannot Determine
Inspector’s estimate of extend of mould growth in each affect room or zone.
78
Location Area (m²)
1. _______________________________ _______________ Cannot Estimate
2. ________________________________ _______________ Cannot Estimate
3. ________________________________ ______________ Cannot Estimate
Recommend: Proceed with Remediation
Additional Testing
Invasive Inspection
Recommended Additional Investigation: ______________________________________
________________________________________________________________________
________________________________________________________________________
Probable Cause of Damage: ________________________________________________
________________________________________________________________________
________________________________________________________________________
Recommendation for Prevention: ___________________________________________
________________________________________________________________________
________________________________________________________________________
Recommendation for Remediation: __________________________________________
________________________________________________________________________
________________________________________________________________________
79
Recommended Quality Assurance: ___________________________________________
________________________________________________________________________
________________________________________________________________________
Signature: ___________________________________
Date & Time: ___________________________________
Annex A3
80
STAGE 2 – INVASIVE INSPECTION AND INVESTIGATION
An invasive, slightly destructive inspection should be performed when mould

contamination is suspected but concealed, when the source of moisture is not apparent,
when health problems have been associated with mould. Air and dust sampling may be
needed to document occupant exposure if health risks are of concern.
Available building plans should be reviewed in advance to identify building assemblies

and location of insulation, vapour barrier, flashing details, plumbing locations type and
distribution of ACMV system, and all building envelope penetrations.
The process is similar to the Stage 1 walk-through inspection, but attention must be
focus on area of interest generated by occupant interview and Stage 1 inspection. The
inspection may also include sampling protocol requiring collection of samples before and
during inspection, if sampling is required.
Locations for invasive inspection are chosen where mould colonization is most likely,
based on visual evaluation of exposed surfaces, experience with similar construction,
and review of building plans. Other locations should be selected to view representative
conditions where mould is not expected, to confirm its absence or identify the
unexpected. Care should be taken to avoid cutting into plumbing and electrical wiring. A
large hole saw of 100mm, with snail inspection mirror and flashlights is useful for
removal of building materials and inspection at selected locations. Larger openings can
be cut where improvement visibility is desirable.
Cutting larger openings allows removal of material layer by layer, inspection between two
layers of material, and a better view into wall openings to identify the limits of visible
contamination.
If wall cavities are found to be clean, repair of the inspection opening can be performed
immediately after inspection.
Care must be taken when opening wall cavities to control dust and minimize the potential
for release of biological particulates into occupied spaces. Inspection openings should be
patched or sealed after inspection. Where contamination is observed, inspection should
continue in adjacent cavities and spaces until it limits can be identified and documented.
Visual inspection of concealed spaces can also be performed with a boroscope when
space limitations make access for cutting openings difficult, or to minimize disturbance
and damage to surfaces while allowing limited observation of concealed conditions.
Sampling might help identify where to look, but no sampling method can be relied on the
exclusion of visual inspection.
81
A proposed Checklist for Stage 2 Inspection is provided
Report and Remediation:
The Stage 2 inspection report may be similar to or supplement the Stage 1 (non-
destructive) report, with additional notes for observation of concealed spaces.
Documentation should be include specific reference to the extend, location and cause of
observed mould growth. Photograph and videotape are possible with an adapter for the
borescope, or using mirrors and light through cut openings.
Bulk samples may be collected during inspection to aid in documenting the nature of
contamination. If the moisture source cannot be identify and eliminated, leak testing or
additional destructive examination is warranted.
If the extent and location of mould contamination can be estimated with reasonable
assurance, the project can proceed to remediation.
82
Start from Stage 2 - Invasive Inspection and Investigation:

Stage 1 If special health concerns arise or contamination is suspected but concealed, additional
information may be needed and a more detailed inspection conducted. The investigation may
result in remediation if contamination is limited. Where problems are confirmed to be extensive
Review available and wide-spread, or if detailed documentation is required, a more destructive (Stage 3)
information investigation may be indicated.
Identify useful
Sampling Establish sampling Interpret sampling
participants Yes
warranted? protocol results
Stage 2
No Formulate
(Invasive
hypotheses and
Inspection)
inspection plan
checklist
Visible moisture Concealed Is litigation or

or mould No contamination No health claim
damage? probable? likely?
Yes Yes
Proceed to
Can cause and
Stage 3 No
extent be No Yes
inspection
determined?
Yes
Estimate extent, prepare Prepare report

remediation specifications
Proceed to Remediation
Protocols
83
STAGE 2 – INSPECTION CHECKLIST (Invasive Inspection)
Hospital Name: __________________________________________________________
Inspector’s Name: ________________________________________________________
Date & Time of Inspection: Date _________________ Time _________________
THIS level of inspection involves visual evaluation of concealed wall cavities and building
envelope components by borescope or cutting inspection openings. Proceed in locations of
observed surface staining or mould contamination identified in Stage 1 inspection, or where
mould contaminations is suspected but unconfirmed, or where contamination may be likely,
based on sampling results. Evaluate all exterior of any noted moisture stains or mould
contamination should be included in the field notes.
Occupant Interview Form completed? Yes No
Stage 1 Inspection completed? Yes No
Sample Analytical Report available? Yes No
Location of Interest: ______________________________________________________
Sampling required before Inspection? Yes No
Building Plan available? Yes No Reviewed? Yes No
Roof Assembly
_____________________________________________
(List material from exterior
surface to interior)
_____________________________________________
_____________________________________________
_____________________________________________
_____________________________________________
84
Exterior Wall Assembly
(List material from exterior _____________________________________________
surface to interior)
_____________________________________________
_____________________________________________
_____________________________________________
_____________________________________________
ACMV Equipment? Yes No
Cross Contamination Possible? Yes No
ACMV Checklist completed? Yes No
85
Field Notes
Label and sketch plan view of space on left, note observation and sample designation on right.
Room / Space name ______________ Notes:
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
Can cause and extent be identified? Yes No
86
Prepare inspection report and recommendations: -
Additional concealed damage: Probable Not likely Can’t determine
Inspector’s estimate of extent of mould growth in each affected room or zone:
Location Area (m²)
1. ________________________________ _____________ Cannot Estimate
2. ________________________________ _____________ Cannot Estimate
3. ________________________________ _____________ Cannot Estimate
4. ________________________________ _____________ Cannot Estimate
5. ________________________________ _____________ Cannot Estimate
Recommend: Proceed with Remediation
Additional Testing
Invasive Inspection
________________________________________________________________________
________________________________________________________________________
Recommendation for Prevention: ___________________________________________
________________________________________________________________________
________________________________________________________________________
87
Recommendation for Remediation: __________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
Signature: ___________________________________
Date & Time: ___________________________________
88
Annex A4
STAGE 3 - DESTRUCTIVE INSPECTION
A complete and systematic inspection is fairy destructive, and involves opening

representative building cavities and / or ACMV component so that the extent, location,
and nature of concealed mould can be observed and documented with reasonably
accuracy. This inspection level might be warranted if:-
1) Concealed contamination is probable but can not be identified using less

destructive inspection method,
2) The need for remediation is confirmed but location and extent cannot otherwise be
determined,
3) Moisture sources cannot be identified by less destructive observation or testing.
Careful documentation requires an orderly opening and removal process and preparation
of drawings showing the locations and allow estimation of area of contamination. It may
also be useful to record the appearance of the colonization as well as the extent, both in
photograph and field notes. A team of participants is required for large scale
investigation involving any significant portion of an occupied building.
Occupants should be interviewed to collect building history information.
A review of available building plan should be conducted to identify wall assemblies,

plumbing locations, roof or floor penetration which might provide path for moisture
migration. Review of mechanical drawings to identify ACMV system operation and
locations of ducts and registers.
All soft materials such as carpets, fabrics should be removed from the space in advance
of inspection if possible, or covered by fire rated poly ethylene sheet plastic during the
inspection .ACMV diffusers and registers should be sealed. If adjacent spaces are
occupied, determine if containment and negative pressurization will be required. Air in
containment area can be cleaned by air-washers, and / or exhausted through HEPA filter
equipped fan.
Care must be taken during any destructive inspection so as not to expose occupants to
mould uncovered during the evaluation.
This stage of inspections might be performed in conjunction with remediation.
89
Report:
The inspection report should include a copy of the remediation plan, completed
checklists, a compilation of field observation, laboratory analysis of any collected
samples with interpretation of results by qualified professionals, results of any quality
assurance testing, and recommendation for any additional required investigation or
remediation of moisture problems identified during the inspection.
90
Start from Stage 3 – Destructive Inspection and Remediation:

Stage 2 Extensive removal of building materials and thorough inspection of concealed conditions
may be needed to investigate pervasive problems or identify moisture sources, or to allow
detailed and accurate documentation of the location and extent of contamination. The level
Prepare drawings for of destructive work is normally disruptive to the building use, and may be best performed in
documentation conjunction with remediation.
Coordinate work with

building owner,
consultants and
abatement contractor
participants
Review notes on
preparation for Stage 3
inspection, perform Yes
inspection, complete
checklist
Proceed to
Follow-up Prepare inspection
Remediation
inspection or No report
Protocols
leak testing
Cause and
extent of mould No
indentified?
Evaluate Quality
Assurance sampling
test results
91
STAGE 3 – INSPECTION CHECKLIST (Destructive Inspection)
Hospital Name: __________________________________________________________
Inspector’s Name: ________________________________________________________
Date & Time of Inspection: Date __________________ Time ____________________
This level of inspection may be warranted if significant mould growth is confirmed by testing but
its cause or location cannot be identified by less destructive means, or if potential legal or health
claims require detailed documentation, or if investigation is performed as part of an extensive
remediation effort.
Completed occupant interview form Yes No
Stage 1 or 2 Inspection: Yes No
Consultants Industrial hygienist Mycologist Mechanical Engineer
ACMV Contractor Remediation Contractor Building Envelope Specialist
Health Care Specialist Other: ___________________________________
Establish Protocols for Sampling Before During After
Establish Detail of required Project Documentation
Inspection involves Entire Building Part of Occupied Building
Will remediation be performed during the inspection? Yes No
A preparation checklist for Stage 3 Inspections is provided.
92
Owner Contact: ___________________________ Phone: _____________________
Contractor Contact: ________________________ Phone: _____________________
Occupants notified of the purpose and schedule for investigation
Establish requirements for containment and levels of personal protection
Negative pressurization Required Not Required
½ mask respirators Full face positive air pressure respirators (PAPR)
Plan entry &egress Plan ventilation & exhaust filtration
Plan decontamination Plan barriers
Seal ACMV registers Evaluate impact of opening wall cavities
Distribute Health Notification Form for remediation personnel
Prepare separate blank drawing sheets for field notes Plans Elevations
Walk through with contractor to review work requirements and check work
preparation
Mark all locations for cutting and inspection
Establish critical barriers for containment
Check pressure differential in containment area
Open wall cavities for inspection –initial phase
Remove vinyl wall coverings from air – conditioned spaces
Document locations of moisture or mould contamination & bulk sample locations
Mark surfaces for additional removal or inspection
At locations where inspection suggests additional growth
To 2 feet (.6m) beyond limits of visible growth
Remove contaminated materials and open additional areas for inspection
Repeat opening, inspection ,documentation, and marking until visible growth is

removed
93
Identify probable cause of damage
Prepare Inspection Report and Recommendations:
Estimated total extent of mould growth: _____________ sf/m²
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
Recommendations for Problem Prevention: ___________________________________
________________________________________________________________________
________________________________________________________________________
Recommendation for Remediation (if not part of inspection): _____________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
94
Notes on Preparing for a Stage 3 Inspection
Inspector’s Preparation Checklist:
Identify list of inspection spaces
Review building plans, if available
Coordinate inspection / remediation goals with other consultants
Get room, air, car reservations if needed
Prepare blank survey drawing sheets in advance, if possible
Minimum: floor plans for each space
Preferred: interior elevations showing one side of each wall
Provide contractor with health notification from regarding health risks
Check supplies for sampling
(1) ½ mask HEPA filtered respirator (cutting samples)
(1) Eye protection (cutting samples)
(5) Disposable gloves (handling drywall)
(1) Utility knife or drywall saw (cut samples)
(125) Ziplock sandwich bags (bag samples)
(125) Index cards (to label samples)
(3) Felt marking pens (to mark labels)
(2) #2 lead pencils or lumber crayons (to mark drywall)
(1) Sample bag (carry samples)
Check supplies for inspection & documentation (supplies for 1 day)
(?) Blank survey sheets, min 2 copies for ea. condition
95
(1) Mech. pencil w/ soft lead & eraser (notes)
(1) Camera & spare batteries
(5) Film rolls or additional digital memory cards
(1) Flashlight spare batteries
(1) Small inspection mirror w/ handle
(1) Large inspection mirror
(1) Extension cord &drill
(1) HEPA filter equipped vacuum cleaner
(1) Sheet plastic and tape
(1) Borescope
(1) Borescope bulb (spare)
(1) Video camera w/light & spare battery (if video required)
(4) Blank video cassettes (unwrapped / sequence labeled on tape)
(1) Video Battery charger
Signature: ___________________________________
Date & Time: ___________________________________
96
Annex A5
INSPECTION OF ACMV EQUIPMENT
a) ACMV - One of potential source of contamination in a building
b) Inspection - To monitor performance of the system
- To ensure functional requirements are met
c) Items to be inspected - Environmental parameters in building
- Monitoring parameters for major components
- Record keeping and documentations
ACMV in healthcare are designed to provide several functions that affect

environmental conditions, infection and hazard control, and building life safety. There are
also potential of contamination in the building due to their role in mitigating the spread of
airborne.
Contaminations that could cause infectious.
Therefore, it is essential to have appropriate performance monitoring of these

system as to ensure they are functioning at optimum level. A structured program of
inspection on every major components of the system and any potential contributors to
the mold problem i.e. leaking shall be established and monitored.
The proper recording of critical environmental parameters as well as the

performance of equipment shall be kept for rectification and maintenance for further
reviewed to facilitate any proposal upgrading of the system in the future.
97
ACMV EQUIPMENT INSPECTION CHECKLIST
Hospital Name: __________________________________________________________
Inspector’s Name: ________________________________________________________
Date & Time of Inspection: Date ___________________ Time ___________________
Indoor Temperature: ______________ °C
Indoor Relative Humidity: ______________ %
Types of System: Heating Cooling Heating & Cooling
Other: ___________________________________________
Located: Plans (attached with form)
Please indicate: ___________________________________
_________________________________________________
Inspected: Cooling Coils Coil Temperature ________ °C
Outdoor Air Intake Humidifiers Condensate Pans
Outdoor Air Dampers Drains Filters
Condition / Comment: __________________________________
______________________________________________________
______________________________________________________
Control: Thermostat Humidistat Both
Ducts: Vigid Flexible Lined (inside) Insulated (outside)
98
Outdoor Air Ventilation Rate: __________ CF / Min / Person
__________ L / S / Person
__________ Air change / Hour
Method: Fan C O² Tr acer Gas
Temperature Not Determine
99
Observations: ____________________________________________________________
________________________________________________________________________
________________________________________________________________________
Recommendation: ________________________________________________________
________________________________________________________________________
________________________________________________________________________
Signature: ___________________________________
Date & Time: ___________________________________
100
Annex A6
INSPECTION EQUIPMENTS AND INSTRUMENTS CHECKLIST
½ mask HEPA filtered respirator Borescope
Eye protection Blank survey sheets
Disposable gloves Pencil
Utility knife Sample bag
Camera Thermometers
Flashlight Humidity meters
Ladder Moisture meters
Mirror with handle Pressurization meters
Signature: ___________________________________
Date & Time: ___________________________________
101
ANNEX B
CHECKLIST FOR MOULD REMEDIATION
Investigate and Evaluate Moisture and Mould Problems

 Assess size of moldy area (m²).
 Consider the possibility of hidden mould.
 Clean up small mould problems and fix moisture problem before they become large
problems.
 Select a remediation team leader for medium or large size mould problem.
 Investigate areas associated with occupant complaints.
 Identify sources or cause of water or moisture problem.
 Note type of water damaged material (wallboard, carpet, etc).
 Check inside air ducts and air handling unit.
 Throughout process, consult qualified professional if necessary or desired.
Communicate with Building Occupants at all Stages of Process.

 Designate contact person for questions and comments about medium or large
scale remediation as needed.
Plan Remediation
 Adapt or modify remediation guidelines to fit the situation; use professional
judgment.
 Plan to dry wet, non moldy materials within 48 hours to prevent mould growth.
 Select cleanup methods for moldy items.
 Select Personnel Protective Equipment.
 Select Containment Equipment – Protect Building Occupants
 Select remediation personnel who have the experience and training needed to
implement the remediation plan.
Remediate Moisture and Mould Problems :
102
 Fix moisture problem, implement repair plan and/or maintenance plan.
 Dry wet, non-moldy materials within 48 hours to prevent mould growth.
 Clean and dry mould materials.
 Discard moldy porous items that cannot be cleaned.
103
ANNEX C
PSYCHROMETRICS
Psychrometrics is the science of studying the thermodynamic properties of moist air. The
amount of moisture vapour in the air varies quite significantly under different conditions.
When the air is hot, it can contain a large amount of moisture vapour, sometimes as
much as 5% by volume. When it is cold, its capacity to hold the moisture is reduced.
When the temperature of warm air begins to fall, the vapour also cools and, if cooling
continues, it will condense into tiny moisture droplets. In the atmosphere this results in
the formation of clouds and eventually rain.
Definitions of Air
Moist air - is a mixture of dry air and water vapor.
Psychrometric Chart
The Psychrometric Chart provides a graphic relationship of the state or condition of the
air at any particular time. It displays the properties of air: dry bulb temperature (vertical
lines), wet bulb temperature (lines sloping gently downward to the right), dew point
temperature (horizontal lines), and relative humidity (the curves on the chart).
104
Dew Point & Condensation
1. Dew point temperature indicates the temperature at which water will begin to
condense out of moist air.
2. When air is cooled, the relative humidity increases until saturation is reached and
condensation occurs.
3. Condensation occurs on surfaces which are at or below the dew point temperature.
4. Dew point is represented along the 100% relative humidity line on the
psychrometric chart.
5. Dew point temperature is determined by moving from a state point horizontally to

the left along lines of constant humidity ratio until the upper, curved, saturation
temperature boundary is reached.
6. At dew point, dry bulb temperature and wet bulb temperature are exactly the same.
Cooling and Dehumidifying
Cooling and dehumidifying is the process of lowering both the dry-bulb temperature and
the humidity ratio of the moist air. If moist air comes in contact with a surface that is
below the dew-point temperature of the air, moisture will condense on the surface and
the air will be dehumidified i.e. becomes saturated (RH – 100%). This process is used in
air-conditioning systems operating in hot, humid climates. It is accomplished by using a
cooling coil with a surface temperature below the dew-point temperature of water vapor
in air. Typical cooling coils in air conditioning systems operate at approximately 40° -
50°F, below the dew-point temperature of typical indoor air conditions. The calculations
are identical to those for heating and humidifying the only difference being that the initial
state (state 1) is the warmer more humid state. As before, the total heat change (Q or q)
in going from the initial to the final condition can be broken into a sensible and latent heat
portion.
105
On psychrometric chart, this process is represented as line sloping downward and to the
left. This process is assumed to occur as simple cooling first and then condensation.
While the moisture is condensing the air is assumed to remain saturated.
Example
Consider a hot humid day 90°F and 90% RH. We want to condition the air to 70°F at
about 50% RH. We do this by chilling the air far enough to condense out enough
moisture to dehumidify it: the goal is to have air with absolute humidity not exceeding
0.008 lbs of moisture per pound of air (~50 to 55 grains per pound of dry air). Show the
processes on the psychrometric chart.
Solution
Plot 90° and 90% RH on the chart.
Read the absolute humidity at this point to 0.029 lbs moisture per lb of dry air or (195
grains of moisture per pound of air).
Check the final condition of 0.008 lbs moisture per lb of dry air and run the horizontal line
to saturation curve. Read the temperature as 50°F.
Cool the air from 90°F @ 90% RH to 50°F – Now there are 0.008 lbs moisture per lb of
dry air and 100% RH. 0.021 lbs of moisture per lb of dry air (142 grains of moisture) have
condensed out – the air is now dehumidified.
The air is dehumidified, but cold (50°F) and is at 100% RH; however, it only has 53
grains of moisture.
Warm Back Up to 70°F (sensible heating), the RH raises to ~50%
106
We had hot humid air
- Chilled it to condense the moisture out (state point 2).
- Warmed it back up to reach our target humidity (state point 3).
- Table below gives the temp, RH and specific humidity at each step.
Temperature RH Specific Humidity
90°F (32.2°C) 90% 0.029 lbs of moisture per lb d.a
Observable characteristics of a cooling and dehumidifying process are:
1. Dry bulb temperature decreases
2. Humidity ratio decreases
3. Vapor pressure decreases
4. Dew point temperature decreases
5. Wet bulb temperature decreases
6. Enthalpy decreases (there is a decrease in the energy level and with the loss of
energy, condensation occurs)
7. Relative humidity increases
107
This process is used in air-conditioning systems operating in hot, humid climates. Typical
cooling and dehumidifying process include chilled water and refrigerant cooling coils
which condition re-circulated room air or mixtures of re-circulated air and outdoor air
which is introduced for ventilation. The cooling coil shall have a surface temperature
below the dew-point temperature of water vapor in air for effective condensation.
108
ANNEX D
DESIGN CONSIDERATIONS
A typical construction team consist the following:-
- the design professional, either an architects, medical planners and engineers;

- the main contractors and sub-contractors working on specific aspects of the
building; and
- the building owner.
Each of these individuals has specific responsibilities for the minimization of water
intrusion, good indoor air quality and prevents mould growth in the new building.
The design professional is responsible for the design, or redesign for renovation, of the
building’s exterior envelope and the ACMV system, as well as the building’s other
building system, such as water piping and sprinkler system. The design professional
specifies building systems and materials that will minimize water intrusion and retard
mould growth in the event of water intrusion.
The main contractors and sub-contractors are responsible for the implementation of
architectural and engineering design. They are responsible for the proper handling and
storage of building materials on site to minimize water and weather damage.
The main contractor is responsible for the work practices of the construction workers on
site, including their sub-contractors, to ensure that engineering specifications are met.
In the design of a new building or the renovation of an existing building, it is necessary

that the design professional provide for the prevention of water intrusion and
condensation buildup in the proper building in the engineering specification, in the design
or redesign, of the building system, and in the selection of the new building materials.
Overall Design of the Building

There should also be sufficient ventilation channels provided to avoid trapping of
contaminated air with mould spores. Air wells must not be a depository of trapped
contaminated air but with openings to allow free movement of air. Basements should be
adequately ventilated as well to prevent mould formation.
109
Insulation
To prevent condensation on the ceiling and walls, the operation temperature of each
individual room in the hospital need to be known, in order to minimize or eliminate
condensation problem by introducing insulation. For design consideration on the
insulation the JKR’s document, Technical Directive for The Prevention of Molds and
Fungi in Health-Care Buildings can be referred.
Material Selection
The design professional will also be responsible for the selection of all new building
material. There are antimicrobial paints to apply to wall and ductwork, moisture resistant
gypsum board, and mould inhibitors in ceiling tiles. The design professional must
understand the conditions necessary for mould growth to suggest appropriate alternative
materials to be used. Those materials generally are inorganic or non-cellulose material
which can reduce risk over the life cycle of the building.
Building Systems
The design of air-conditioning, ventilation and exhaust system beside provide comfort
condition also required to reduce the risk of airborne cross infection by control of air
movement within certain department. Remove particulate or gaseous contamination and
airborne microorganisms by ventilation and filtration.
Also the ACMV engineer should have knowledge to prevent the ACMV system from
contributing to excessive moisture and mould growth in a building.
The guideline to be referred to is the ASHRAE documents. The ASHRAE Guide for
Buildings in Hot and Humid Climates, 2nd Edition, and Humidity Control Design Guide for
Commercial and Institutional Buildings.
As for others building systems containing water, such as the plumbing and sprinkler
system, it is important that the design professional detail the means by which the
contractor is to install these systems and when to activate them to prevent leakage and
breakage that would result in water intrusion.
Air conditioning sizing is an important aspect of maintaining a desirable environment in

Health-Care Buildings. Wrong sizing may cause insufficient cooling, overcooling or
insufficient moisture removal.
110
Cooling system design loads for purpose of sizing system and equipment should be
determined in accordance with the procedures as described in the latest edition of the
ASHRAE Handbook or equivalent publication consistent with available equipment
capacity.
All heat load calculations are required to be furnished as evidence of thorough, precise
and complete. Heat load calculation using “Rule of Thumb” or “BTU/hr per square ft”
method is not acceptable (Refer to JKR Technical Directive For The Prevention Of Molds
& Fungi In Health-Care Buildings)
ACMV designer should specify that ductwork including supply duct and return duct be
sealed along all transverse and longitudinal joints on ducts operating at less than 4” WC
pressure difference (995 Pascal) also sealing all duct wall penetration on system
operating at higher pressure. Sealed duct system should be specified with a leakage rate
of less than 3%.
ACMV designer should specify that outdoor air to be pretreated prior to enter the intake
of air handling equipment. Designer should quantify the ventilation load at design dew
point condition.
111
Abbreviations
ASHRAE American society of Heating, Refrigerating and Air-Conditioning
Engineers
AIHA American Industrial Hygiene Association
IAQA Indoor Air Quality Association
CDC Centre for Disease Control and Prevention
NYCDOH New York City Department of Health
EPA Environmental Protection Agency
HVAC Heating, Ventilation and Air- Conditioning
HEPA High-Efficiency Particulate Air
PPE Personal Protective Equipment
VOC Volatile Organic Compounds
UV Ultra Violet
cfm cubic feet per minute
RH Relative Humidity
JKR Jabatan Kerja Raya, Ministry of Works Malaysia
112
G U I D E L I N E O N M O U L D C O N T R O L A N D R E M E D I AT I O N I N H E A LT H C A R E FA C I L I T I E S
Engineering
Engineering Services
Services Division
Division
Ministry of Health
Ministry of Health
Level 3-7, Block E3, Parcel E, Precint 1
Level 3-7, Block E3, Parcel E, Precint 1
Federal Government Administrative Centre
Federal Government Administrative Centre
62590 Putrajaya, Malaysia
62590 Putrajaya, Malaysia
MOH/ESD/2016– 01
MOH/ESD/2016– 01

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MINISTRY OF HEALTH MALAYSIA

ENGINEERING SERVICES DIVISION

Engineering Services Division

Preface by Director of Engineering Services Division ii

1.0 INTRODUCTION TO MOULD

2.0 INVESTIGATING POTENTIAL MOULD CONTAMINATION

3.0 INTERIM CONTROL MEASURES OF MOULD IN BUILDING

5.0 PREVENTION OF MOULD GROWTH RELATED TO ACMV SYSTEM

Appendix 1 - IAQ Guidelines for occupied buildings under construction 48

ANNEX A PROPOSED INVESTIGATION PROTOCOL 67

ANNEX B CHECKLIST FOR MOULD REMEDIATION 102

The information in this guideline is intended to establish the minimum requirements to be

Datuk Dr. Noor Hisham Bin Abdullah

Haji Md. Jalal Bin Bongkik

2. YBhg. Datuk Dr. Shahnaz Binti Murad

3. YBhg. Datuk Chin Goo Chai

4. Tuan Haji Md. Jalal bin Bongkik

TECHNICAL COMMITTEE MEMBERS

Engineering Services Division

5. Tuan Haji Tauran Zaidi bin Ahmad Zaidi

Institut Medical Research

14. Dr Rafiza binti Shaharudin

Sistem Hospital Awasan Taraf Sdn. Bhd. (SIHAT)

15. Encik Khamsah bin Muhamed Som

1.1 Cases of Mould in MOH Healthcare Facilities

Moisture problems which had led to a mould infestation at a hospital in Johor

a) Condensation of water vapour from gross infiltration of hot a n d humid

b) Water leakage such as leakages in the roof, reinforced concrete gutters

Therefore, a mould control and remediation guideline needs to be developed

1.2 Background of Mould

Moulds, also known as fungi, can be found both

They may be transported into buildings on the surface of new materials or on

Although high levels of humidity and some surfaces and interstitial

Most moulds produce spores which can be airborne, water-borne or insect-

The effects of temperature gradient due to improper humidity and

Condensation on the ceiling

Ventilation brings in humidity, and this humidity has to be removed through

vi) Drainage or plumbing problem such as leakage or burst pipes;

vii) Occupant – generated sources (occupants produce water vapour at

viii) Poor Condensate Drainage;

Improper draining of condensate from t h e air-conditioning system (from

x) The enclosure of wet materials in building assemblies during construction

1.3.2 Nutrient or Food

Drywall is a paper- based product which is ideal for m o u l d growth, not

ii) Dust and dirt;

Insulation on the wall

Mould Growth underneath the carpet

1.4 Health Effects Due to Mould

M o u l d s are common in both indoor and outdoor environments. As a result,

Mould in indoor environments comprise of microscopic moulds, known as micro

In most of the non-contaminated buildings, the possible mould exposure would

The effects of inhaling mould spores include allergies, infection or irritation.

i) Allergic and Hypersensitivity Effects

Some people are particularly sensitive to mould exposure. A significant

ii) Irritant and Toxic Effects

Indoor growth of mould can lead to the production of Volatile Organic

Stachybotry’s is colloquially referred to as “black mould” or “toxic mould”.

iii) Infection Effects

In general, only a small number of mould have been associated with

Several species of Aspergillus are known to cause aspergillosis, most

In general, young babies, asthmatics, and persons who have poor

2.1 Moulds Investigation