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 

Indoor Air Quality (IAQ): A Key Factor

 

Indoor Air Quality (IAQ) is a key factor in indoor environmental health. According to the Environmental Protection Agency (EPA), the average American spends 93% of their life indoors. This time could be at work, at home, or anywhere in between. With that much time indoors people are susceptible to the effects of indoor air pollution. This is a wide definition that can run from airborne dust and allergens to bacterial problems, to VOC’s or chemicals in the air. Groups that typically are most in danger of poor IAQ are the young, the elderly, and the chronically ill suffering from respiratory or heart disease, but with that much stuff in the air, are any of us safe?. To improve indoor air, most HVAC  systems, when properly sized and maintained, are set up to avert illness by eliminating airborne microbial contaminants, mostly through effective filtering. When there is inadequate ventilation, improper humidity, and exposure to contaminant sources in a building, the health of the IAQ is compromised. As a business and facility building owner or manager, working to achieve a healthy building for occupants is essential.

As it relates to the current pandemic crisis, many are questioning what role HVAC systems and good IAQ have in our overall health. We can only look to the scientific community for answers. 

Epidemiological studies have shown that buildings previously occupied by individuals infected or colonized with MRSA, VRE, or Acinetobacter baumannii are at a significant risk of acquiring these organisms from previously contaminated environmental sites. (Dancer et al. 2006, Boyce et al. 1997, Huang et al. 2006, Denton et al. 2005)

Building factors or pollution in buildings that are most frequently associated with respiratory health effects include:

  • Presence of moisture, water damage, and microbiological pollutants.
  • Animal and other biological allergens
  • Combustion byproducts such as nitrogen dioxide.
  • Moisture or dirt in HVAC systems.
  • Low ventilation rates.
  • Formaldehyde.
  • Chemicals in cleaning products.
  • Outdoor pollutants or vehicle exhaust.

IAQ in your building

According to OSHA, when you have poor indoor air quality inside your home it can cause headaches, fatigue, concentration problems, skin rashes, and eye, nose, throat, lung irritation, and chronic health problems such as asthma. EPA states that your indoor air is likely 2 to 5 times more polluted than the air outside. To keep indoor air quality inside a building in top shape, is it important to control the building’s humidity. The EPA recommends a range of 30-50% humidity in your space. Bacteria and viruses thrive and circulate through poorly maintained building ventilation systems, as with Legionnaires’ disease. Damp, humid air can increase the survival rate of viruses indoors. While keeping humidity down helps slow the process of mold, proper ventilation helps keep the air floor uncontaminated. Using a system with filters can help remove biological contaminants. When air is stagnant air disease is more likely to spread.  The EPA has created a Building Air Quality Guide: A Guide for Building Owners and Facility Managers

With all the uncertainty of the current climate, it is important to take care of the things you can control, like your indoor air quality. Clean, maintained HVAC systems will help prevent the spread of many environmental health issues. To keep HVAC Systems healthy regular maintenance is essential. 

A good place to start to achieve a healthy environment at work and home is ASHRAE’s article on Good IAQ Practices. 

 

Next Steps:

Check your basic skills on duct and ventilation system cleaning

Read: Better HVAC IAQ with Copper?

Get some tips and tricks to cleaning ducts and ventilation systems

 

 

 

 

The Dangers In Your Cooling Tower

Foul Play? Cooling Tower Cleanliness Key to Plant Efficiency

What’s the Scoop on Viruses in Cooling Towers?

The current COVID19 pandemic has increased public visibility on infectious diseases throughout the world. Viruses like the novel coronavirus (aka COVID-19) that is currently impacting multiple nations worldwide comes with thousands of different characteristics that dictate their spread, survival rate, and degree of infection. With this particular virus, much is still unknown. 

Numerous viruses throughout history have shown the capability to survive in the water in cooling towers if untreated. The main factors that influence a virus’s survival in water include temperature, organic material in the water, and the presence of aerobic microorganisms. Of these factors, the most critical influence on any virus’s survival is temperature. Every virus has its survivable range, but generally, a virus’s survival rate decreases with increasing temperature. High heat (above 100C) causes the fast inactivation of most viruses. The survival potential of a virus decreases even further with the presence of predatory microorganisms, such as protozoa which increase the inactivation rate of viruses in water.

Currently, it is thought that the novel coronavirus causing outbreaks of COVID19 worldwide is a not significant risk of contaminating industrial cooling towers. But little e research has been completed to date. 

It may be worth noting, however, that when tested, the data has shown that most coronaviruses die off very rapidly in sewage wastewater, up to a 99.9% reduction of viral activity in water after two or three days of exposure. Viruses, however, adapt quickly to their environments as they spread across the world, and so facility managers need to continually update their maintenance plans to react to known global threats. 

Protecting and Maintaining Cooling Towers

A building may not be occupied at the moment, but regular maintenance must remain essential. Facility managers have a significant responsibility to mitigate and prevent the contamination of cooling towers from diseases. Although not much is know yet on the current COVID-19 virus threat to cooling towers, bacterial contamination poses an even more severe risk to cooling tower maintenance, Legionnaires disease. Legionnaires disease is a notable bacterial infection that can thrive in aquatic systems such as cooling towers used in industrial cooling systems, evaporative coolers, nebulizers, and hot water systems. Similar to viruses, bacteria like the legionella pneumophila can infect the lungs of people inhabiting and visiting buildings and facilities. 

Cooling towers that supply water for central air-conditioning systems, in general, are a common culprit for outbreaks of disease. These cooling towers spread recycled and fresh air throughout the interior climate of a building. 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. 

The frequency and intensity of cooling tower cleaning should reflect the most recent government agency guidelines and the current local reports of contaminating risk levels. Frequent and lengthy scheduled cleaning of cooling towers will turn off critical building and operation equipment and will likely cause halts to facility operation. The risks to business operations need to be balanced with the current maintenance needs for facilities to ensure that business can continue while providing adequate maintenance for disease control. 

Facility managers can take numerous steps to mitigate the effects that increased cleaning plans and equipment downtime have on facility operations. These steps include tiered maintenance plans, where the facility shuts down only portions of cooling towers and related equipment at a time to maintain some level of operation while maintenance is cycled. Facility managers can also invest in the effectiveness and speed of their cleaning equipment. Smart investments in cleaning equipment can decrease the total downtime of equipment during cleaning. Goodway has numerous cleaning and maintenance solutions that facility managers can implement to reduce cleaning times while increasing effectiveness. Goodway’s cleaning solutions provide an economical and proven solution to preventing viral and bacterial build-up in cooling towers. 

The Dangers Of Ignoring Maintenance

Not correctly maintaining facility equipment, including cooling towers and water heating systems, can cost your thousands of dollars in repair and loss of efficient energy. But a danger much greater can be the fallout of a Legionella breakout. Take the mishandling of a Legionella breakout at an Illinois Veterans Home. After a year-long investigation of the break out that killed more than a dozen residents, Illinois paid nearly $6.4 Million to the families of the Veterans who lost their life to Legionella. General Frank Maution’s audit revealed the discharge of gallons of stagnant water when a hot-water heat was improperly returned to service that was previously offline. The leap that can be taken from a poorly maintained water tank to a cooling tower is not far apart. When water is left stagnant, a breeding ground for bacteria is created. Many buildings are unoccupied with non-essentials workers at home but make no mistake that regular maintenance is essential to keep buildings healthy for the return of occupancy.

Next Steps:

Research the complete line of Goodway’s Cooling Tower Cleaning Solutions to find the right solution for you.

Watch our webinar Preventative Maintenance for Cooling Tower Systems

Check out our 9 Tips To Controlling Legionella in Your Cooling Towers

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

Keeping Your University Safe From COVID-19

Preventing the Spread

University health and administration officials have a responsibility to their students, faculty, and staff to prepare and protect them against the COVID-19 outbreak in the United States. One of the most important steps that a University can take amidst the COVID-19 outbreak or any future outbreaks, is to prepare both formal University policies and practices as well as prepare the University population. Preparation builds resiliency in the wake of the COVID-19 outbreak and is the best prevention method for preventing the spread of the virus amongst students, staff, and faculty.

The COVID-19 virus, formerly identified as 2019-nCoV, was identified as a novel coronavirus not previously seen by public health officials. Despite the commonality of coronaviruses throughout the world and its tendency to cause mild to moderate illness, the World Health Organization has declared the outbreak of COVID-19 as a public health emergency and international concern.[1]

How does the virus spread?

The Covid-19 virus is spread primarily from person-to-person and travels through respiratory droplets that are produced from the mouth or nose when a person coughs or sneezes. The dwell time of these infected respiratory molecules is short, but when they reach the mouth, nose, or eyes of another person they commonly transmit the virus.

Not all viruses spread as quickly as easily as others, for example, the Measles is a virus that spreads extremely easily. The virus that causes COVID-19 is currently able to spread easily and consistently throughout the community, in a spreading method called community spread. Community spread means that people are often infected by the virus seemingly just because they are in an area where another person is infected by the virus.[2]

Community spread often results in people getting infected by the virus without being completely sure how or why they were infected. The ability of the COVID-19 virus to spread through community spread makes the virus a significant risk to people when they are carrying on about their everyday lives and moving between different crowded areas and groups. Universities are particularly at risk of community spread due to the classroom and lecture hall nature of the community of students and faculty.

Who to pay attention to?

The Integrating the Healthcare Enterprise International (IHE) is a global health care initiative lead by healthcare professionals and provides guidance on improving the information sharing of healthcare systems.

IHE, working together with local health departments, has an important role in slowing the spread of diseases like the COVID-19 virus. IHE’s efforts will help ensure students, staff, and faculty have safe and healthy environments in which to learn and work. These efforts and communications from IHE are important for University Health and Administration officials to reference and pay attention to when deciding how to react to a global health crisis like the COVID-19 outbreak.

Plan and Prepare: Take steps now to help stop or slow the spread of respiratory infectious diseases, including COVID-19

As the COVID-19 outbreak spreads across the United States, it is important for Universities to plan, prepare, and take preventative action now to reduce the potential for spread across the community.

The following are five steps that a University can take now to both prepare their community for the outbreak and even to slow or stop its spreading.

  • Step 1: Review, update and implement emergency operations plans (EOPs). Emergency operations plans are the standardized fallbacks and drills that Universities plan to enact in the occurrence of significant risk to the University or its personnel. These emergency operations plans can be either a strict policy or a flexible emergency template for a University to use to react. Ether way, EOPs are an essential, emergency fall back that should be verified and even enacted in the face of growing COVID-19 virus risk
  • Step 2: Monitor and plan for the absenteeism of staff and students. Infected personnel showing up at work or class is the quickest and most likely way for the COVID-19 virus to spread amongst a population. Universities need to both monitor and prepare plans of action for personnel who exhibit any flu-like symptoms at a minimum self-quarantine. Be prepared to evacuate the staff and students. Set up previsions for online learning.
  • Step 3: Establish procedures for students, staff, and faculty who are sick (with any illness) on campus. Procedures for students and staff will be different, and essential personnel should be identified, but in the case of any person experiencing flu-like symptoms, there needs to be a method to get them into self-isolation or quarantine.
  • Step 4: Perform routine environmental cleaning. Environmental cleaning measures should already be in place at the university and in response to the COVID-19 outbreak, it may be necessary to increase the frequency and intensity of the maintenance and cleaning plan.
  • Step 5: Create plans to communicate accurate and timely information to the IHE community. Information and the honest reporting of health statistics is the key to fighting the spreading of the virus and to keeping experts informed. University health officials should reach out to organizations like the IHE and establish a line of communication before the COVID-19 outbreak reach their communities.

 

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

[2] https://www.cdc.gov/coronavirus/2019-ncov/about/transmission.html

© Goodway Technologies, 2020. All rights reserved. Just Venting is powered by Backbone Media, Inc.