John Pierson is manager of product development for Fiberlock Technologies, and shared with ICT the ins and outs of improving indoor air quality in healthcare settings.
Q: In an outbreak/pandemic scenario, what practices should automatically change to keep transmission of airborne infectious particles as low as possible?
A: The use of HEPA-filtered negative air machines, negative pressure anterooms and temporary containment units can greatly enhance a facilities ability to isolate potentially infectious patients. By giving a facility the flexibility to turn any standard room into a temporary isolation room, a hospital dramatically increases its ability to minimize airborne infections. The important thing to remember here is that pandemics, outbreaks and bio-terror events do not happen on a schedule and thus, a facility should have the ability to implement these countermeasures at a moment’s notice.
In the CDC Interim Guidelines on Smallpox, the CDC suggests that a facility or portion of a facility be set up to accommodate three segments of the populous: all contagious or probable infectious individuals, febrile patients without rash or other indicative symptoms and asymptomatic or vaccinated patients. In this guideline, isolation is defined as separation of a person or group of people to prevent the spread of infection. While most facilities have at least some level of fixed airborne infection isolation rooms, the chances are slim that they would have enough isolation rooms to facilitate the potential surge of a sudden outbreak and be able to accommodate these three potential segments safely.
Perhaps one of the biggest challenges a facility faces is the sudden influx of potentially infectious and critical patients. This surge of patients can prove to be an overwhelming force that can cripple any ER or outpatient clinic.
This is why the HRSA National Bio-Terrorism Hospital Preparedness Program states that all participating hospitals must have the ability to maintain, in negative pressure isolation, at least one suspected case of a highly infectious disease. It continues on to state that at least one facility in the region must have the ability to quickly isolate 10 patients within three hours post event (HRSA critical benchmark 2-2). Temporary containment units are an excellent way to meet these requirements and augment a facility’s ability to accommodate a sudden influx of patients.
Q: There are many ways that inside air can be protected from airborne pathogen transmission. What are some aspects that healthcare professionals can check right now to see if their systems are safe?
A: Most people in healthcare facilities are familiar with HEPA filtration as it relates to their building HVAC system, but at times less attention is paid to the portable negative pressure machines that are frequently used on a daily basis in the facility. These portable HEPA-filtered negative pressure machines are often used to control airflow and pressure differentials in rooms to create negative or positive pressure environments. They are also used with the portable containment units that most facilities are using now for dust control during maintenance.
In addition to adequate filtration devices like negative air machines, healthcare professionals should assess their physical inventories of critical equipment and supplies needed in the event of a pandemic like portable anterooms, disinfectants, masks, PPE and medication.
Q: Are there any errors you see time and again in hospitals that make patients and employees vulnerable to dangerous microbes?
A: The most common errors aren’t directly related to pandemics or outbreaks, but the common daily practices that have a far-reaching impact. The most glaring error is the lack of adequate dust containment and filtration during maintenance applications. Beyond the fact that dust is on its own a very dangerous airborne particulate, it also acts as an easy mode of transmission for other airborne pathogens. The dynamics that make dust good at staying airborne can also enable pathogens like Aspergillus, TB and SARS to further their range of impact. Pathogenic organisms can use this dust as a vehicle to remain airborne for far longer than they would be able to on their own. Hospitals can greatly reduce the impact of dust and the pathogens it carries by implementing the use of portable containment units with filtration into the ICRA process.
