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News - June 2019

It’s in the air

It’s in the air

Hospitals rely heavily on infection control to ensure the health of patients, staff and visitors.

And, as many contaminants are transferred though the respiratory system; air quality in hospitals is a key consideration when designing or upgrading facilities.

Paul Gallagher, air cleaner product manager at Camfil, told hdm: “Understandably, infection control measures tend to concentrate on hygiene, particularly handwashing, environmental cleaning, intravenous line care and antibiotic control.

“However, there is another, equally important, source of infection that can be overlooked or underplayed – the air we breathe.”

Risk factors

Hospital air quality and ventilation play a decisive role in affecting air concentrations of pathogens such as fungal spores (Aspergillus) and other hospital-acquired (nosocomial) infections, therefore they have a major impact on infection rates.

“Essentially, airborne pathogens are transmitted in one of three ways”, explains Gallagher.

“Fungal spores may be released into the air and make their way into the hospital environment.

“And micro-organisms can be transmitted directly from person to person in the form of droplets in the air produced by coughing or sneezing; while infectious diseases like tuberculosis are transmitted via lingering droplets that remain indefinitely suspended in the air and can be transported over long distances.”

Sources of airborne pathogens include construction and renovation activities, ventilation system contamination and breakdown and vector-borne transmission via, for example, pigeon droppings or insect or rodent droppings.

“Hospital patients are particularly susceptible to infection from airborne contamination because their immune systems are often compromised due to illness,” said Gallagher. “So, the importance of good indoor air quality in controlling and preventing airborne infections in healthcare facilities can’t be over stressed, and providing clean filtered air is key to maintaining good air quality.”

Filter it out

Air quality control and mitigation measures in healthcare facilities include mechanical ventilation, which involves changing the air in the space; and air cleaners, which does not. Both require effective filtration.

“By using certified high-efficiency particulate air (HEPA) filters, air purifiers can remove up to 99.97% of particles and airborne droplet nuclei from the air to support the ventilation system,” explains Gallagher.

While there are significant variations in composition and use between different HEPA filters, the filtration process itself is relatively simple, even if the filters themselves can be complex in their design and construction.

Gallagher said: “Most healthcare facilities have air handling units in place that incorporate coarse filters to take out pollutants such as dust and pollen and to clean the air coming into the building.

“Portable HEPA units are often used as a supporting system to the clean the air of harmful smaller particulates; PM2.5 and below in diameter.

“Air purifiers typically employ a system of internal fans to pull the air in a healthcare facility through a series of filters that remove harmful airborne particles such as dust, pollen, bacteria and viruses.

“The air purifier then circulates clean air back into the room. This process repeats several times an hour, keeping the environment clean and healthy.”

The installation of ventilation systems in hospitals is covered by a number of standards, including Health Technical Memorandum (HTM) 03-01, which sets out the minimum design criteria of the air handling unit (AHU) with regards to safe access for routine inspection and the control of bacteria that can be found in stagnant water.

Other standards include Health Building Note (HBN) 00-09, which highlights the major infection prevention and control issues and risks to address to achieve designed-in IPC, and Building Engineering Services Association (BESA) TR19 to ensure that particulate, bacteria and infection levels are kept below certain levels.

Take advice

Offering advice to specifiers, Gallagher said: “Every environment is different, so the type, specification and size of equipment required will depend on a number of factors including room configuration, potential risk; for example, whether it is a general population area or an area requiring exceptionally-clean air such as an operating theatre.

“It also depends on the situation. For example, if construction work is taking place and people are being moved around different wards, then portable equipment is most appropriate.

“My advice to specifiers is to consult with an expert before taking any steps to install filtration.”

Selection criteria should include reputation and how well established the business is.

But finding the right supplier also involves considering price, reliability, service quality, and depth and breadth of experience of the market.

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