Ventilation: What Schools Can Learn from Hospitals

As part of infection prevention against COVID-19, schools spent millions of federal dollars trying to upgrade ventilation systems. That money has been ill-spent, warn some experts.

APOLOGY: In an earlier version of this article, Infection Control Today® cited a report that has since been retracted. The report relied upon a source who is a former employee of a competitor of Global Plasma Solutions and who is now an advisor to that same competitor. A GPS spokesperson says that the article “contain[ed] false and defamatory statements about GPS and its proprietary ionization technology.” ICT® did reach out to GPS for a comment, but the company says that ICT® did not give it enough time to respond. ICT® has excised all mention of GPS from the article and apologizes to the company.

When COVID-19 shut down the world, of particular interest among many health care professionals who struggled to beat back SARS-CoV-2 and recreate normal involved the viability of ventilation—not only in hospitals, but also in schools. In fact, school ventilation should be considered almost as important as ventilation at health care facilities, as Infection Control Today® (ICT®) reported.

Infection preventionists (IPs) were encouraged to get more involved in monitoring hospital ventilation. Stephanie Taylor, MD, an expert on ventilation in hospitals told ICT® in June 2020: “In general, airflow has been managed by the engineers, by the architects, by the facility managers, and not so much by the clinicians. There is a lot you can do in indoor air management to decrease transmission of infections.”

Meanwhile, schools went to work, spending millions of dollars of federal money to upgrade their ventilation systems. It has not been money well spent, according to the school spending tracking website Burbio. According to Burbio, about 40% of the school districts in the nation spent federal tax dollars updating their heating, ventilation, and air conditioning (HVAC) systems, which have long been considered outdated when compared to high efficiency particulate air (HEPA) systems.

In fact, there is a roadmap that school districts can use when it comes to upgrading ventilation systems, says Paula J. Olsiewski, PhD, a contributing scholar at the Johns Hopkins Center for Health Security. Olsiewski cites a report published by the Center in May that “recommends using only proven technologies (increased ventilation, increased filtration including HEPA units, and UVGI) and not using unproven technologies,” she wrote in an email to ICT®. (UVGI—ultraviolet germicidal irradiation.)

When ICT® interviewed Olsiewski in December 2020, she said that hospitals were generally well-prepared for COVID-19—or as well prepared in terms of ventilation as they could be for an unknown pathogen—a point she reiterates today. “Many places in hospitals have up to 12 air changes per hour,” Olsiewski writes in her email.

She told us in last year’s interview that a big part of the problem was that it “took the [Centers for Disease Control and Prevention and the World Health Organization] a long time to recognize that this virus lingers in the air as an airborne virus.”

Olsiewski points out that hospitals follow ventilation guidelines set forth by the American Society of Heating, Refrigerating and Air-Conditioning Engineers (ASHRAE). The organization’s latest recommendations for how health care facilities should deal with COVID-19 were updated October 21.

ASHRAE’s updated recommendations note that “it is usually not feasible to retrofit existing HVAC systems with HEPA filters due to high pressure drops and the likelihood that systems will need new filter racks to allow sufficient sealing to prevent filter bypass. Adding HEPA filters to systems that are not designed for them may cause significant damage.”

In addition, according to ASHRAE:

  • To function properly, HEPA filters must be sealed properly in filter racks.
  • HEPA filters are often delicate and require careful handling to prevent damage and preserve performance.

In our interview last December, Olsiewski indicated that maintaining proper ventilation isn’t just a matter of having the right equipment. “These are highly regulated spaces,” she said. “But the problem becomes if they’re not maintained. If they’re not operated properly and not maintained properly.” In addition, some hospitals that need to cut spending will cut spending on ventilation maintenance and upgrades.

Last year, Olsiewski said: “One question you might ask: Were the emergency rooms designed to take in large numbers of sick people who are exhaling virus in every breath? That may have been a scenario that was difficult to manage.”

She also noted that while hospitals in general are well designed when it comes to ventilation, other health care facilities—such as individual doctor offices—might not be.

As ICT® reported during one of the surges, because emergency rooms were overflowing with patients hospitals had to learn how to build negative pressure rooms quickly.

In her email to ICT® today, Olsiewski said that she doesn’t have “any specific knowledge about nursing homes.”

ICT® ran articles about possible fixes for nursing homes including, again, how to build negative pressure wards, how nursing homes can create cost-effective infection prevention programs, and the need to staff nursing homes with fulltime IPs. And still nursing homes are far from being fixed.

Are schools far from being fixed? Yes, if they keep spending money on products that don’t work.