The Importance of an Indoor Air Quality Strategy

A major concern in any hospital or clinical environment is the potential for acquiring a nosocomial infection. A nosocomial infection is defined as those for which there is no evidence that the infection was present or incubating at the time of hospital admission. 

These infections cause many adverse health effects to patients, and cost billions of dollars in treatment. The National Academy of Medicine (formerly known as the Institute of Medicine) reported that nosocomial infections caused approximately 88,000 deaths annually — one every six minutes — and cost an estimated $4.5 billion per year. 

Also, since the advent of the Affordable Care Act, hospitals have been held to higher accountability standards, and now are required to report the incidences of hospital-acquired infections (HAI) and are ranked by that score. This can affect not only the hospital’s reputation and marketability, but also Medicare reimbursements can be denied for HAI-related costs and extended stays.  

There are various ways these infections transmit, including direct contact; indirect contact, such as through contaminated instruments; and droplets caused by coughing, sneezing and hospital procedures. While droplets may only be able to propel a short distance, they can often become suspended on particles. Small particles in the particulate matter (PM) 2.5 range can stay suspended in air for long periods of time, are too small to be filtered by nasal cilia and are inhaled down into the lungs, allowing viruses to infect and spread. 

The recent outbreak of coronavirus (2019-nCoV) has also triggered more awareness of the transmission of air and surface viruses. Coronavirus, if deposited on a non-porous surface, stainless steel, etc., can be viable for hours to days. This means an infected person can cough or sneeze and expel droplets into the air that ultimately deposit on surfaces. Another person can contact that surface with their hands and touch their face and can become infected. COVID-19 can take up to 14 days to incubate, so an infected person will not be symptomatic immediately.

A strategy to address and improve indoor air quality (IAQ) is important to curtail the spread and impact of nosocomial infections. The U.S. Environmental Protection Agency has defined three parameters in controlling and improving IAQ: source control, ventilation and air cleaning. 

All health care workers involved in patient care should practice standard precautions to minimize the spread of pathogens as much as possible. Adequate ventilation, pressurization and air changes per hour are vital to ensure clean air enters into a less-clean space, and that air cleaning strategies can work to their designed values. 

Air cleaning is important. Filtration strategies must be designed to remove small-range particles from the air entering the space. Ultraviolet light (UV) bulbs can help to disinfect surfaces like air-conditioning coils, but care must be exercised when applying UV light as UV exposure can be dangerous to people, and particularly damaging to the eyes. 

Also, many good technologies, such as bipolar ionization, exist that can interact with contaminants within spaces and further reduce particle levels, and affect the reproductive ability of pathogens like coronavirus, norovirus, C. difficile, and staphylococcus. 

Bipolar ionization also provides an active component to air cleaning. Many air- and surface-cleaning strategies are passive and sometimes temporary. Wiping down surfaces sanitizes them at that point in time, but does not ensure continuous sanitization. Media filters, electronic filters, UV systems, or photocatalytic oxidation are passive technologies that will clean air that passes through the device. 

Bipolar ionization is an active technology: air ions are delivered to the occupied space through the air systems and saturate the space. Ions in the natural ecosystem will interact with air and surface contaminants and provide air cleaning and air and surface sanitization, a continuous disinfection effect. Also, regular IAQ monitoring of IAQ levels should be implemented to ensure performance. 

Awareness of IAQ and air-pollutant levels is increasing exponentially. Effective IAQ monitors use internet-of-things (IoT) capabilities to record and store data that can be accessed and used to proactively make adjustments to IAQ. Cutting-edge, air-purification systems also use real-time IAQ data to adjust air-purification output on a proactive and reactive basis. 

What you can’t see in the air can hurt you. However, by identifying areas for concern, developing a proactive strategy to address airborne transmission of contaminants, and measuring results at a hospital or other care facility can reduce exposure to nosocomial infections, and their adverse health effects and treatment costs. 

Tony Abate is vice president and chief technical officer at AtmosAir Solutions (www.atmosair.com ) in Fairfield, Conn., and a certified indoor environmentalist. AtmosAir Solutions provides clean indoor air technology for hospitals, medical offices and health care facilities.