Indoor Air Quality Management In Hospitals Helps Prevent Infections

Hospitals are a unique environment for the spread of infectious diseases. COVID-19 aside, each year in the United States, healthcare-associated infections (HAIs) kill over 100,000 people annually. These healthcare-associated infections are considered errors in patient care and occur when a patient enters medical care for an ailment and becomes infected by a disease or virus unrelated to their original health issue. A comprehensive study completed by the Hospital Microbiome Project at the University of Chicago, Illinois, determined that healthcare-associated infections are most significantly caused by poor indoor air quality (IAQ). 

The climate of Health care facilities has been changed forever due to the current COVID-19 pandemic. It is more important than ever for health care facility management to fully understand their buildings IAQ and the effects it will have on their occupants. The use of highly efficient particle filtration in centralized HVAC systems reduces the airborne load of infectious particles (Azimi and Stephens 2013). According to ASHRAE  various strategies have been found to be effective at controlling transmission, including optimized airflow patterns, directional airflow, zone pressurization, dilution ventilation, in-room air-cleaning systems, general exhaust ventilation, personalized ventilation, local exhaust ventilation at the source, central system filtration, UVGI, and controlling indoor temperature and relative humidity. 

Contact Sanitation is an Incomplete Pathogen Eradication Method

Healthcare-associated infections occur in what the study describes as an environment of biological extremes. An environment of biological extremes does not occur naturally. Counterintuitively, it can exist in areas of limited physical space where there is a heightened state of virulence from anti-microbial medications and housekeeping disinfectants attempting to eradicate pathogens. 

Anti-microbial medications, sanitation equipment, and housekeeping disinfectants have historically been the common practice of hospital disinfectant programs, but in extreme cases, they can lead to stronger and more resistant pathogens that rapidly reproduce and thrive in the interior environment. There are often vulnerable patients inside hospitals with decreased immune defenses who are extremely susceptible to these pathogens. 

Contact sanitation, which is the use of anti-microbial medications, sterilizers, and disinfectants, targets the transmission of pathogens through contact and short distance interruption of large droplets. This sanitation strategy, however, does not interrupt all the means that pathogens have to spread throughout an interior space. 

Pathogens Can Spread Through the Interior Air

Pathogens can exist in droplet nuclei, which are aerosolized molecules less than five micrometers in diameter. Droplet nuclei can travel for extended periods through the air and are easily inhaled by patients or staff in a hospital.

Studies have shown that approximately 10 to 33 percent of all healthcare-associated infections travel through the air at some point between their initial source, the reservoir, and the eventual patient that they infect. Sanitation plans preventing pathogens spread through the air in medical facilities have historically not been as robust as contact sanitation plans. 

Using Indoor Air Quality Management to Prevent Infections

The study conducted by the Hospital Microbiome Project at the University of Chicago suggests that hospitals could target infectious disease spread economically and effectively by actively managing their interior air quality. 

As a result of the study, it was concluded that indoor relative humidity was the most statistically significant, independent variable affecting microbial spread throughout medical facilities. There was also a strong correlation detected between the presence of microbial communities and higher temperatures in rooms. The correlations between indoor air quality management and infectious disease spread are seasonal, and so air quality management becomes even more important during the winter months of a region. 

Relative humidity was the key air quality determinant in the study. The relative humidity is the amount of water vapor present in air expressed as a percentage of the amount needed for saturation at the same temperature. Proper employment of heating, ventilation, and air conditioning systems in medical facilities is the essential way to manage indoor air quality and maintain proper relative humidity levels.

The study by the Hospital Microbiome Project at the University of Chicago determined that a relative humidity below 40 percent was associated with an increased prevalence of healthcare-associated infections. The study suggested that maintaining indoor relative humidity between 40-60 percent relative humidity may be an effective and cost-efficient method of decreasing the spread of pathogens inside facilities.

The Responsibility is on Hospital Engineers and Facility Managers

The study completed by the Hospital Microbiome Project at the University of Chicago provides hospital engineers and facility managers with better data to guide their building management. Facility managers should create comprehensive plans to both monitors and maintain the indoor air quality in patient’s rooms and hospital interior areas. 

Maintaining relative humidity levels economically requires accurate monitoring capabilities and efficient HVAC systems in place to manage the large interior space inside hospitals. Hospitals often must invest in robust HVAC systems to meet the stringent demands of their air quality management plans. The best method of protecting these investments in HVAC equipment is to emplace comprehensive maintenance plans for the equipment. 

Maintenance Opportunities To Reduce Risks

Keeping Cooling Towers Clean is an effective way to provide quality IAQ by reducing the risk that outdoor air isn’t infected. Cooling towers that supply water for central air-conditioning systems, in general, are a common culprit for outbreaks of disease. These cooling towers can add to risks by emitting infected water vapor, which can be brought inside through fresh air ventilation points, and general entrances like windows, doors, etc. The best maintenance practices to prevent both viral and bacterial contamination inside cooling towers are aggressive cleaning plans paired with personnel training, monitoring, and testing. Our CTV-1501 TowerVac® Cooling Tower Vacuum safely removes solids from boiling tower basins common areas for bacteria, like Legionella and other micro-organisms, to flourish.

Cleaning and decontaminating ductwork is also a effective method for maintaining a healthy building. When evidence of microbial growth in your HVAC system or ductwork is present consider chemical antimicrobial solutions specially designed for HVAC systems.

There are also experts available and willing to help facility managers review their current maintenance plans or to create new plans altogether. As demonstrated by the Hospital Microbiome Project, indoor air quality is one of the most important building conditions to manage the spread of healthcare-associated infections. Facility managers and hospital engineers owe it to their patients to take an active role in maintaining indoor air quality and provide the safest environment possible to their patients. 

 

Next Steps:
The AHSE has put together a guide with tips on how to achieve proper IAQ and lower infections.

Read our Complete Guide HVAC Maintenance Solutions

Check Your Basic Skills on Duct and Ventilation System Cleaning

Learn about Duct Cleaning in Health Care Facilities 

Your Facility is Covered in Germs: What Does This Mean for a Facility Manager

Facility managers have a vital job. They responsible for ensuring the safe and effective operation and maintenance of a facility and it’s infrastructure, including the heating, ventilating, and air-conditioning systems in the wake of any virus outbreak. Key organizations in the world health field like the Center for Disease Control and World Health Organization are continually trying to update the global understanding of how exactly the COVID-19 virus is transported from person to person. ASHRAE has released proactive guidance to address the COVID-19 outbreak from a facility management perspective, and it is important for facility managers across the country to be in tune with the messaging.

ASHRAE COVID-19 Preparedness

ASHRAE has recognized that healthy buildings are part of the solution to maintain safe and healthy internal environments for building occupants. ASHRAE published official COVID-19 Preparedness Resources which serve as guidance to building owners, operators, and engineers on best measures and plans for protecting occupants.

As an airborne infectious disease, COVID-19 poses a potential risk to HVAC facility equipment. While little is known for sure about the virus and its ability to travel via HVAC systems,  Facility managers need to vary the approaches they take for each different type of facility that they manage. Additionally, it may become a necessity to clean the entire system to mitigate any risk and to provide comfort to employees, guests, and visitors. Currently, health care facilities have criteria for ventilation design and operation in place to mitigate airborne transmission of infectious diseases. In health care facilities, ASHRAE measures and local airborne transmission prevention policies aim to reduce transmission by both direct and indirect contact between employees and facility infrastructure. However, outside of critical areas like operating rooms, or infectious disease areas, little is known.

Emergency Planning

For other types of facilities that may not be specifically designed for infectious airborne disease control, active measures can still be taken to strengthen HVAC equipment’s ability to maintain the safety of the internal environment and air quality. One of the best measures to prepare for the COVID-19 outbreak is to develop and enact emergency planning procedures that increase the resiliency of facilities.

Engineers and facility managers can significantly support the capacity and efforts of emergency planning by understanding the design, operations, and maintenance adequacy of buildings for which they are responsible. An understanding of the capabilities and shortfalls of the building systems is key in determining which areas to target in an emergency preparedness plan. A building management system may have the means to increase dilution ventilation, increase relative humidity, or quickly clean and sanitize and disinfect components (coils, plenums, condensate systems, ductwork, etc) in order to respond to a crisis or outbreak.[1]

In the case of an infection occurring in an enclosed space or area, it is critical for facility managers to act quickly and apply the emergency plans set in place to deal with the situation. In the case of an airborne respiratory infection such as COVID-19, there are four quick steps that ASHRAE has identified that facility managers can take to quickly address the situation.

Step 1: Supply clean air to other susceptible occupants in the facility. Susceptible occupants may be anyone in the immediate area or the same room as the infected person.

Step 2: Containing the contaminated air as best as possible and exhausting it to the outdoors. It is important that air from a space with a potential infection is not recycled throughout the rest of the facility.

Step 3: Diluting the air in a space with clean air from outdoors and by filtering any recirculated air.

Step 4: Cleaning and sanitizing the equipment, surfaces, and shared spaces within a room that was susceptible to a COVID-19 outbreak. During these times it is also important to clean and disinfect evaporator and air handler coils.

Proper ventilation ultimately is the best method that facility managers can take to protect the workers and personnel inside the buildings that they manage. Ventilation systems should be thoroughly checked to ensure that components are properly cleaned and that the right filtration units are in place to clean the airflow. During emergency maintenance consideration of using Merv Rate Filters 13 and above may be worth looking into.

Cleaning and Maintenance

The COVID-19 virus outbreak is an undeniable reason for facility managers to analyze, practice, and supplement the cleaning and maintenance plans of their facilities. Many industrial and commercial facilities are full of germs naturally, and standard maintenance plans should meet regular thresholds for cleanliness and regularity each time they are exercised.

Global pandemics like the COVID-19 virus outbreak present unique situations when facility managers need to double down on their maintenance and cleaning plans. Though the nature of transmission of the COVID-19 virus is still under study, there has already been a proven occurrence of community spreading of the virus. Community spreading means that people are often infected in the midst of their everyday lives and activities because they were in areas where another person was infected by the virus.

No matter what type of facility that you manage, Goodway has products, advice, and proven maintenance strategies that can ensure your building is in the best position to help prevent the spread of illness.

[1] https://www.ashrae.org/File%20Library/About/Position%20Documents/Airborne-Infectious-Diseases.pdf

Steam: Natures Disinfectant

We’ve discussed the power of steam frequently on our blog. Many segments of the market around the world have embraced steam cleaning and sanitation for it’s immediate, and powerful cleaning performance.

In this post, we’ll discuss some of the science behind steam, how high heat, when used properly it can reduce bacteria and viruses inactive in seconds.  Dry vapor steam cleaning is an economical, eco-friendly, and effective form of cleaning, and we’re finding that these cleaners are particularly useful to the healthcare, hospitality, and facility management markets.

Read full blog post »

Coronavirus’s Impacts In Your Health Care Facility: What You Need to Know

What is the Coronavirus?

The CDC has been responding to an outbreak of a virus known through the media as the coronavirus. Coronaviruses are a family of respiratory viruses that act similarly and cause those infected to exhibit similar systems. The specific virus that has triggered the World Health Organization to declare an outbreak and international public health emergency is “coronavirus disease 2019,” abbreviated COVID-19, which was first detected in China.[1]

FOR COMPLETE AND UPDATED INFORMATION ON COVID-19 PLEASE REFER TO THE CDC WEBSITE HERE.

The symptoms and severity of COVID-19 are still under study by the CDC, as there have been cases ranging in severity reported. The severities in illness for infected people range from very mild to severe flu-like symptoms, with some cases resulting in death. The most susceptible people death from the COVID-19 virus seems to be older people and people of all ages with severe underlying and pre-conditions such as heart disease, lung disease, and diabetes, which make them more vulnerable to the effect of the virus.[2]

How is it similar to other viruses?

The SARS-Cov-2 virus, which is the formal name for the COVID-19 virus, is a beta coronavirus. This means that the virus is similar to makeup as the Middle East Respiratory Syndrome, known as MERS and with the scientific name MERS-COV and the Severe Acute Respiratory Syndrome from 2003-04 known as SARS.[3]

What disinfectants are effective against COVID-19?

Generic washroom soap and water is currently the most effective for limiting the spread of Coronavirus, and the Center for Disease Control (CDC) recommended method for preventing the spread of any pathogens, specifically the COVID-19 virus. In any case, personnel who practice recommended and regular basic hygiene measures such as washing their hands frequently with soap and water for at a minimum twenty seconds and using hand sanitizer after coming into contact with another human are minimizing their risk at contracting the virus. Alcohol-based hand sanitizers should only be used in the case when soap and water are not available.

Some common disinfectants that are effective in sanitizing equipment and objects from the COVID-19 virus include A-456 II Disinfectant Cleaner, Neutral Disinfectant Cleaner, Oxycide Daily Disinfectant Cleaner, Quaternary Disinfectant Cleaner, TB Disinfectant Cleaner RTU, and Virasept cleaner.[4]

How has the COVID-19 virus impacted healthcare?

Healthcare facilities across the country will likely be the local concentration point for both COVID-19 infected people to travel for care and where future infections could occur. Because of the critical role that healthcare facilities will play in treating and preventing the spread of the COVID-19 virus, it is important that all healthcare facilities take important steps now to prepare for the outbreak.

Three steps to take to be prepared

In order to be prepared, administration officials at healthcare facilities need to remain informed about the local and regional COVID-19 situation. The COVID-19 has demonstrated its ability to travel through community spreading, meaning that the virus’s approach will not be obvious, but once a nearby area sees infections, it is even more likely for the virus to spread to neighboring areas.

Step One: The very first step healthcare officials should take is to be prepared. The CDC has set up a COVID-19 website to inform the public on the status of the virus and this is an excellent place for healthcare officials to turn first for information and preparation guides.

Step Two: Establish local lines of communication and communication plans to help stop the spread of the virus. It is important for officials to establish relationships with key healthcare and public health partners throughout their community and neighboring communities. From these relationships, healthcare facilities can create an emergency contact list and emergency communication plan to enact should there be an infection within one of their facilities.

Step Three: Take strong measures to protect the workers and patients at the facility. Developing and reviewing facility emergency plans is a key preparation that all healthcare facilities need to exercise before the virus reaches their area. Once an infection is found at a facility, staff need to know the plan to act quickly to contain the virus from spreading across the organization. Healthcare facilities should also responsibly stock up and utilize basic health equipment such as masks, hand sanitizers, and gloves to ensure that they always have the basic equipment to protect their staff.

How can Goodway help?

Goodway offers a variety of sanitation materials to healthcare facilities for years, including surface sanitation solutions, and dry steam cleaners.  Contact us today to discuss your specific cleaning and sanitation needs.

 

[1] https://www.cdc.gov/coronavirus/2019-nCoV/summary.html

[2] https://www.ecolab.com/pages/coronavirus

[3] https://www.ecolab.com/pages/coronavirus

[4] https://www.ecolab.com/articles/2020/01/a-novel-coronavirus

 

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