There is Something
in the Air
By MART GERAERTS,
Senior Consultant, Indoor Air quality in Medical Facilities, Economis
Walsberghe nv – Europe
Tuberculosis,
Aspergillus, Chicken Pox, Measles, MRSA-containing particles, etc. are known to
be floating around in the indoor air of most hospitals as confirmed by numerous
publications on Hospital Hygiene. H5N1 might join them in the near future.
Airborne infection
transmission causes severe human, social and financial problems and the numbers
of these infections are increasing as reported by the World Health Organization
(WHO) on Tuberculosis and the H5N1 pandemic.
But this is not
the point. The point is: Can we do something about it? The answer is “yes, we
can clean the indoor air.” Is it that simple? Yes it is, but it requires an
open mind and commitment from various departments in health care organizations.
For starters the
(bld)hygiene department(endbld) should look further than the debate and the
discussion on the topic of which form of transmission is most important and
rather focus on all of the parameters e.g. “contact – droplet – airborne” that
result in the transmission of infections. Linking “contact – droplet –
airborne” preventative measures, shall result in the one supporting the other.
Consider for one minute; “what is not in the air, cannot drop and contaminate
the furniture or medical devices” and more importantly, “cannot be inhaled.”
The (bld)technical
department(endbld) should look further than the (theoretical) technical details
of the HVAC system and have an open mind with respect to new, innovative
solutions and options that can support their existing ventilation system,
options that contribute to a safer hospital environment.
The
(bld)management(endbld) should make a cost-benefit analysis based on all the
criteria, facts and figures and consequences no different than commercial
companies do on a daily basis. Consideration should be borne in mind for, “the
cost of an infection vis-à-vis the cost of a preventive measure” in light of
all the potential savings in financial, patient outcome and reputation.
Herewith some
known examples to consider.
(1) It was established that airborne MRSA-concentrations are always
present in the patients’ room ( ~ 6 cfu/M(3)) and that higher concentrations
occur during bed-making ( ~ 116 cfu/M3). This means that high concentrations of
MRSA ( ~ 100 cfu/M3) must have fallen on surfaces like on medical instruments,
furniture and on the floor. Consequently, the result of other preventative
measures like sterilization or hand-hygiene will be diminished. Additionally,
part of the MRSA particles remain airborn ( ~ 6 cfu/M3) and will be spread by
the indoor air to other hospital areas. MRSA – Journal of Hospital Infection
(2002) 50; 30-35. “Evaluation of bed-making related airborne and surface MRSA
contamination.”
(2)
The risk that HCW’s are infected with
Tuberculosis is higher in the general departments like First Air, I.C.U. and
Autopsy (non-isolation) than in equipped departments (isolation rooms). Source:
“Hospital Ventilation and Risk for Tuberculosis Infection in Canadian
Healthcare Workers.”
(3)
Mobile HEPA Pro Units completed eliminated
Invasive Aspergillosis infections in patients undergoing (allogeinic) Bone
Marrow Transplant. Source: Aspergillus – European Bone Marrow Transplant 29 (2)
2002 P850-853.
Airborne infection transmission has no limits
or boundaries and the majority develops inside the hospital facility.
What are the technical options available to
decrease the risk of airborne infection transmission? The options are (a) to
renew all inadequate HVAC-installation and/or (b) to instal HVAC-systems with
HEPA filters in all the potential risk areas.
These options are fine when either building a
new facility or when costs are not an issue, both are rather demanding as they
require building activities with all the associated consequences including
disturbances both to the department and patients.
A workable and feasible option is to install
specifically designed and developed highly efficient HEPA filter units
(preferably mobile units) that filter/clean the indoor air by eliminating
airborne infection transmission at the source. (Inclusive of MRS and/or TB and virtually all other infectious
airborne particles).
What are the considerations when trying to
establish which HEPA filter unit? Which questions have to be asked? Which
device to choose? The most important criteria are; is the unit really
effective, does it achieve the level of filtration required and is the
information from the manufacturer correct?
The only reliable answers come from
international health care providers faced with the dangers of airborne
infection transmission, as airborne infection transmission in hospitals is an
international issue. Secondly from proven scientific confirmations that are
established by esteemed scientific organizations typically Hygiene Institutes
from University Hospitals that have worked with and tested a specific mobile
HEPA unit for a long period of time, preferably months or even years.
Only a unit that has offered significant
results (a high decrease or even better the total elimination of airborne
infection transmission – CFUs) should be deemed to be reliable.
The technical demands for an efficient (mobile)
HEPA unit are:
- the air intake should be at an effective
horizontal (breathing) level as from one meter and over 360 degrees
(air-intake at floor level is useless, this is not where people breath).
- The air-outlet should be over 360 degrees
diagonally upwards to create an airflow in the room (air outlet at floor
level is dangerous, cfu’s on the floor are made airborne again).
- HEPA 14 filtration with leak-test (no risk can be
taken with infectious diseases).
- The casing should be shiny stainless steel (to
prevent contamination to stick).
- No or limited maintenance (the unit has to
function 24/24 hrs, all year through).
- The electronics have to meet
maximum safety standards.
- Little or no occupation of floor
space (floor space is limited in the hospital rooms).
- Key remote control (only hospital
staff can control the unit).
Let us avoid the
discussion on “what infection rate is a socially acceptable level.” Even one
infection that could have been prevented is too much so let’s look at some
financial figures on the costs in Europe of an infection.
- The cost of an MRSA infection is between
10.000 and 36.000 Euro.
- Tuberculosis (non-resistant) is
10.000 Euro.
- Treatment of Invasive
Aspergillosis costs around 35.000 Euro.
- Preventative medication against
I.A. for ALL patients at risk, costs around 30 Euro/per day per patient
amounting to around 600 Euro/day for a ward.
With these figures
in mind, the question must be “How do we guard against the potential of
infection as a result of airborne infectious particles and the crippling
associates costs?” and the answer is simple as the costs to implement an
effective (mobile) HEPA concept pales into significance when compared to the
cost of an airborne infection outbreak?
- An efficient mobile HEPA unit that
protects health care workers, patients and visitors all year through,
costs substantially less than 10.000 Euro and is a one time investment.
- The initial budget estimate, too
create an isolation or patient safe room with air-cleaning and pressure
difference (positive or negative) is approximately 10.000 Euro.
Apart from that, a
professional isolation room with negative pressure (for Tubercolosis / H5N1) or
positive pressure (for immuno-compromised) is installed in less than a day.
Finally, when you
decide to implement an effective and efficient (mobile) HEPA filter device/unit
in your organization, make sure that the unit has been checked, better double
checked, and confirmed by medical, clinical and laboratory studies that were
published by esteemed medical organizations.
Then and only
then, you can be sure that there is nothing “bad” in the air and breath easy.
Is the war on
airborne infections and the danger imposed by these invisible demons that
simple? YES, it is.
