The Vital Role of Indoor Air Quality in Healthcare Facilities
In this post:
- The importance of IAQ in health care facilities
- Tools to maximize IAQ
- Four key focus areas
The concept of IAQ is especially important in regard to health care facilities. Patients, staff, and guests are all directly impacted by the quality of air in the building. An optimal health care space is one that enhances patients’ comfort and healing, and it's no doubt that IAQ plays an important role in this. Studies conducted by the U.S. Environmental Protection Agency (EPA) and others show that indoor environments sometimes can have levels of pollutants that are actually higher than levels found outside. Many health care facilities are more vigilant in ensuring their facilities have better IAQ to create more comfortable conditions and reduce airborne infections.
Viruses, bacteria, fungi, yeasts, molds, pollens, gases, volatile organic compounds (VOCs), small particles, and chemicals are part of a larger list of airborne pathogens that can be found in a hospital environment.
Surgically Clean Air ONYXsca Air Purifier
IAQ Standards in Healthcare
ANSI/ASHRAE Standard 62.1 - 2019, “Ventilation for Acceptable Indoor Air Quality,” is a recognized industry engineering design standard that directly addresses IAQ. This standard is also referenced by LEED rating systems. The standard addresses the criteria for comfort, which include air temperature, relative humidity, contaminants, air distribution systems, and pressurization. It also includes requirements specifically identified for health care occupancies but refers to ASHRAE 170 for ventilation requirements.
What Tools Can Help Improve IAQ in Healthcare Facilities?
HVAC systems are designed to perform several tasks. They work hard to purify the air; cool, humidify, dehumidify, and pressurize the space; and exhaust air from your facility. If the outside air is not filtered correctly, excessive dust from the outdoors is drawn into the building, which may result in poor IAQ. If the supplied air to the healthcare spaces is not conditioned or heated correctly, patients, staff, and visitors will experience discomfort. Changing replacement HVAC air filters once a month can help improve the airflow as well as trap dust, smoke, and other pollutants, keeping HVAC systems running optimally.
Ultraviolet (UV) disinfection can be used as an additional air disinfectant method in hospitals and healthcare facilities for the prevention and spread of airborne illnesses such as tuberculosis. There are three primary methods used in the health care industry: duct radiation (HVAC UVC lights), upper room air radiation (UV mounted in ceilings and protected from the bottom to prevent human exposure), and stand-alone units (self-contained UV shielded units containing a variable number of bulbs).
Duct radiation units, or HVAC UVC lights: Proper air filtration is the first line of defense against the circulation of pathogens within your HVAC system, reducing bacteria, viruses, and mold that either grow or pass through the air handling systems. HVAC UVC lights reduce the risk of cold, flu, allergies, and other illness associated with air handling systems.
Upper Room UVGI panels and lights can also be installed near ceilings to irradiate upper room air in ORs; this method can also be an effective strategy to augment the performance of HVAC systems by increasing filter efficacy and efficiency by controlling the growth of biofilm on filters. Some evidence supports upper-room UVGI as an effective means for deactivating bacteria and viruses.
Standalone UVC units work in spaces like patient rooms, visiting and waiting rooms, and more. They take the HVAC filtered air and add an extra layer of air purification to the space. Look for units with HEPA 13 filters for the maximum purification of the air.
Left: Molekule Air Pro RX for medical spaces, Right: ThinkLite Air Icon Air Healer
Focus On These Key Spaces
Airborne infection isolation (AII) rooms: AII rooms protect patients and staff from any impact sick patients can have on their external environments. AII rooms are negative-pressure rooms used to contain airborne contaminants in a hospital. If AII rooms are not properly pressurized, this will pose a risk of airborne transmission of pathogenic bacteria and viruses. This room is designed to exhaust more air than is supplied. If these spaces are not designed and constructed properly, they will expose hospital occupants to airborne pathogens. Typically, about a 20% differential is necessary to ensure an external direction flow of air from the room.
These rooms are essential because they are the best rooms to perform intubation of COVID-19-infected patients before they are placed on ventilators. Having the procedure done in these rooms will ensure the airborne contaminants are exhausted to the outside through HEPA filters and will not affect the other occupants in the hospital.
Protected Environment (PE) rooms: PE rooms are designed to be positively pressurized with respect to the corridors and anterooms (if designed with one). Patients in these rooms have compromised immune systems and therefore need to be protected from the impact of the surrounding hospital environments. If PE rooms are not properly pressurized, they will pose a risk to the patients that are receiving treatment. Like AII rooms, these rooms are designed to supply more air than is exhausted; typically, about a 20% differential is necessary to ensure an external direction flow of air from the room.
Operating Rooms (ORs): In ORs, both the patients and the staff must be protected by the HVAC system. IAQ in operating rooms is of extreme importance because the environment should be sterile for surgical procedures. This room is particularly important because some procedures are invasive and will expose the inside of a patient’s body cavity to the surrounding environment of the surgery room. These rooms are designed to be positive pressure with respect on the adjacent corridor. Airborne pathogens can infiltrate the internal body cavity during surgery resulting in unwanted infections.
ORs are also designed to have lower space temperatures than other areas in the hospital and are required to operate between 20%-60% RH. ANSI/ASHRAE/ASHE Standard 170 - 2017, “Ventilation of Health Care Facilities,” recommends a temperature band of between 68°-75°F. The minimum air change rate stipulated by ASHRAE 170 for ORs is 20 air changes per hour (ACH). The higher the air change, the cleaner the space, and the better the IAQ.
IAQ is of the utmost importance in the design of a health care facility. The comfort of hospital patients, staff, and visitors is directly related to internal environmental conditions. IAQ is also linked to infection control because of the role it plays in minimizing airborne infection. A complex hospital environment requires special attention to ensure healthy IAQ to protect patients and healthcare workers against hospital-acquired infections and occupational diseases. Poor hospital IAQ may cause outbreaks of building-related illnesses such as headaches, fatigue, eye, and skin irritations, and other symptoms, along with the spread of additional infections and diseases.
We approach IAQ from a whole-facility perspective, with the goal of not only reducing contaminants in the air but also improving the comfort level of building occupants through air quality improvements.
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