The Promise of Optimal IAQ amidst COVID-19
By Sharjeel Yunus
Poor indoor air quality can have devastating consequences on infection rates in a healthcare facility, making it more pertinent than ever to manage it effectively during this pandemic.
IAQ or Internal Air Quality is a key metric in ensuring hospitals work efficiently and effectively. Having high standards can greatly reduce the risk of SHS (Sick Hospital Syndrome) and HAI (Hospital Acquired Infections) among patients, staff and visitors, especially given the ongoing coronavirus pandemic. So let’s take a closer look at IAQ, its impact on staff and visitors, and explore additional steps hospitals can take to ensure they maintain quality air internally.
What is Internal Air Quality and where does it impact healthcare?
IAQ refers to the air quality within and around a structure/facility, and is an important component of healthy indoor environments. In hospitals, a healthy environment is necessary for patients to heal, and staff to work at optimum levels. In fact, patients can turn worse in an environment which has poor IAQ.
IAQ of a healthcare facility involves multiple factors such as thermal comfort (temperature and humidity), concentration of airborne particles, chemical contaminants, and outdoor air quality which affect the exposure and wellbeing of patients, staff and visitors. Which is why maintaining good IAQ is mandatory for any healthcare facility as it safeguards the patients, hospital staff and visitors from hospital acquired infections (HAI) and sick hospital syndrome (SHS).
The Current Setup - Is it the best?
Currently, hospitals are doing their best to ensure high IAQ. Mechanical ventilation systems are designed specifically for separate sections, depending on the density and purpose of each section. This is a specialised task which requires careful analysis and planning of all air paths and ventilation streams, right from the intake of fresh air to the expulsion of contaminated air.
When asked about the current setup, Satish Kamble, General Manager - MEP Design, Hosmac said, “For hospitals we follow the ASHRAE-170 (American Society of Heating, Refrigeration and Air-conditioning Engineers) set of norms and standards. These lay down the norms for the many departments in hospitals such as OPD, ICUs, general wards, indoor air patients, outdoor air patients etc. Take for instance clinical areas expect operation theatres (OTs): as per ASHRAE-170 we follow a 2-step filtration process. This two-step process brings the particle count down to 5 microns. For OTs and the positive environment department where bone marrow transplant and cancer patients are treated, we add a third HEPA filter which brings down particle count to 0.3 microns. This is done owing to the critical nature of these spaces and the presence of immuno-compromised patients.”
In addition to filtration and care - quality monitoring along with regular maintenance and upkeep of the ventilation system, air supply units and filters help considerably. Doing this accomplishes a lot in terms of reducing the risk on patients and staff. However, these steps aren’t enough when it comes to dealing with infectious diseases. For these, special setups need to be created. Satish says, “When it comes to individuals who have infectious diseases such as TB or COVID-19, we create isolation rooms with negative pressure as compared to the adjacent areas. This ensures that air from inside does not spread to the other areas.”
The COVID-19 Situation - Where Does Air Quality Factor In?
Given the current pandemic enveloping the planet, isolation wards and negative pressure spaces are critical in reducing the spread and effective containment of the virus. However, there are many challenges associated with these. The primary one being, the huge costs associated with creating new facilities. This means converting existing facilities/spaces, to meet the growing societal demand.
On this topic, Satish says, “Whenever an existing space is converted to a COVID-19 centre, it does not factor in all protective and preventive measures essential for COVID-19 patients such as negative pressurization, air recirculation etc. In fact, there are two factors we should look at closely for determining whether a space can be converted to a COVID-19 facility: processed filtration and volume circulation.”
Doing this, is easier said than done. For COVID-19 patients and facilities, air supply and circulation involves tremendous effort. The core challenge here is that air cannot be taken back or recirculated, and must be treated and filtered before it is disposed of in the atmosphere. As per existing norms, the air must be changed at 12 ACPH (air changes per hour). However, most converted spaces not existing healthcare centres, might not have a closed ventilation system which is capable of the same. Also, decontaminating this air requires HEPA filters and UltraViolet Germicidal Irradiation (UVGI) coils, which just adds to the cost and feasibility of running such a facility.
When it comes to hospitals, converting the wards or ICUs into COVID-19 zones doesn’t go a long way either. According to Satish, “If you’re converting an ICU area into a COVID-19 area, then you’re ignoring the fact that ICU areas have recirculating air units. However, you can get around this by adding a separate exhaust with a UVGI coil/lights. Doing this does ensure basic guidelines are met but this does compromise other factors such as air temperature.”
IAQ - A Bit of Planning Goes A Long Way
The effects of bad air quality management are as devastating as the infection rate of any disease the hospital has. If poorly designed, the air management system itself can create more harm than all the good the hospital does. A properly maintained and fitted ventilation system contributes significantly to the health and wellbeing of the patients, staff and visitors at the hospital.
“What hospitals can do to maintain air quality is at optimum levels is ensure that UVGI coils and HEPA filters are installed at the outlets of the exhaust fans. This way, even if there is an infection found within an area, the UVGI coils can destroy the germs and virus before they spread. Although research is being conducted on the efficacy of UVGI lights against the coronavirus, these precautionary steps can go a long way in reducing the spread and contamination of HAIs.” says Satish.
In an idealistic world, SHS and HAIs would not exist, but that is not the world we live in. Today, there are more cases than we’d like to admit which are either SHS or HAIs - not just among patients, but also hospital staff and visitors. Ignoring these facts and not accounting for air quality will only further the stress on the healthcare system. But by taking the right steps in improving the air quality, we can greatly boost the efficiency and timeliness with which healthcare is delivered.