Newsletter - October 2013
Volume 2 | Spotlight: Healthcare
Can a Hospital Building Make Me Sick?
There is a common phrase that “A hospital is no place for a sick person”. What is meant by this, is that because many people in hospitals are ill, by entering a hospital, one could be exposed to the illnesses others are fighting. Healthcare Associated Infections (HAIs) are infections that patients develop during the course of receiving treatment for other conditions. They can be caused by a wide variety of common wand unusual bacteria, fungi and viruses. HAIs are the most common complication of hospital care, occurring in approximately one in every 20 patients1. While doctors and nurses help patients recover from illnesses, the
indoor environment can also play a key role. One important building system that helps prevent illnesses from spreading around a hospital is the heating, ventilating and air-conditioning (HVAC) system.
In with the Good and Out with the Bad
Hospitals are highly engineered environments. For some rooms, such as negative pressure rooms, the HVAC system is designed to pull more out of the room than push in fresh air. An example of this is an Airborne Infection Isolation Room. This type of room is used when a patient has an infectious disease that could be spread through the air, such as tuberculosis. Other rooms, such as positive pressure rooms have more fresh air supplied than exhausted. Examples of these rooms include most operating rooms. There are many other specialty environments in hospitals and the HVAC system plays a key role in managing the desired pressure differentials for these rooms.
However, creating pressure differentials is only one part of the equation. Another very important function of the HVAC system is supplying fresh air. Supplying fresh air is an important function in any building as this helps reduce levels of carbon dioxide which is exhaled by the people in the building. In hospitals the HVAC system can also help remove other exhaled particles including airborne microbes. The hospital measures the air exchanges in terms of air changes per hour (ACH). Using the combination of engineered pressure differentials and air exchanges allows the building to reduce the potential for one person with an illness to spread that illness to others. But how does the hospital know which rooms must be positive, which should be negative and how many air changes are needed?
Guidelines, Standards and Occupants
Industry News
How HVAC Systems Help Reduce
Infections in Hospitals
Industry News
In addition to national guidance documents and regulatory standards, individual states and local jurisdictions may have additional requirements regarding design and installation of HVAC systems3. Once these systems
are in place, they are tested to ensure each area meets the design requirements.
This process is sometimes called “Test and Balance”, and entails looking at each room and verifying the room pressure differential, amount of fresh air supplied and total air changes per hour meet the project design requirements. So, once the system is in place and it meets the design goals, can we just forget about it?
Unfortunately, the answer is no.
Changes in outdoor conditions can impact indoor conditions. For example, if the original test and balance process was done during hot summer weather, the conditions indoors may be different during mild or cold weather. Occupants are another factor, since individual comfort levels vary. Some might be perfectly comfortable while others complain of stuffiness. Increasing fresh air intake may result in changing the balance. In addition, the hospital HVAC system is a delicate balance.
For instance, if you have ever tried to adjust the spokes on a bicycle wheel you can begin to understand the challenges associated with balancing a hospital HVAC system. When you loosen one bicycle tire spoke, the tension on others can increase. For an HVAC system, when you start adding or restricting air supplied to, or exhausted from, a space it can impact other areas. Other factors that can result in changes to pressure differentials and ACH’s can include the HVAC components themselves. Filters can become clogged over time and debris build up in ductwork can restrict flow. Sometimes ducts can become separated, partially crushed or otherwise damaged when maintenance or construction staff members work around them.
With occupant concerns, seasonal impacts and system function variability can impact pressure relationships, air exchange rates or both. So, how can a hospital be sure that things are as good now as they were when the system was commissioned?
Certification Surveys, Audits and Casual Observations
The environment in hospitals is considered when auditing for accreditation. Accreditation audits can come every three years or, in some instances, sooner. Accreditation requirement processes call for the hospital to develop and implement management plans and to regularly show that the building continues to meet the requirements of these management plans. Therefore, the hospital may have annual test and balance inspections conducted. In addition to annual inspections, the hospital can also conduct periodic spot checks so that systems are functioning as designed.
Key staff members are also trained on the concepts of HVAC system performance and the importance of air changes and pressure differentials. This can include clinical staff, maintenance staff, contractors and vendors that may work on or install building systems. These roving and/or occasional occupants can gather information using instruments or somewhat less technical means. For example when planning to enter a negative pressure room, one might open the door slightly and check to see if air moves in past the crack in the door. This can be done using a small piece of lightweight ribbon or puffing a small cloud of visible non-toxic powder and watching to see if air movement draws the ribbon or particles into the room.
Hospital construction projects often have work areas under negative pressure so that construction-related dusts are not released into other areas of the hospital. When the project pulls air from one space and exhausts air outdoors or to another space, this impacts the delicate balance of the hospital’s HVAC system. For this reason, impacts that the project may have on the environment must be considered4. When conducting accreditation surveys of hospitals,
surveyors pay special attention to the performance of the HVAC systems. The potential for a construction project to have impact on the hospital environment is also considered by the surveyor. Since audits and surveys can come at anytime and are typically
unannounced, the hospital needs to maintain optimal HVAC system performance so that it consistently meets design requirements.
If hospitals are required to maintain their HVAC systems then why do HAI’s still occur?
Not all HAI’s result from airborne pathogen exposure. Infections can result from a number of exposures. Hand transmission is generally considered the most common mode of exposure to infectious agents. A contaminant can be present on the hands of the patient, a family member, the healthcare workers or others and can be transferred to surfaces such as bedrails, remote controls or door knobs. That contaminant can then be picked up by others and transported around the hospital to other surfaces, potentially resulting in an HAI. Medical equipment not properly disinfected between procedures can also result in HAI’s. In addition, a patient with a weakened immune system caused either by illness or medical treatments can be at much greater risk of HAI’s. Drug-resistant organisms or so called “super bugs” are becoming common and are often found in patients that received previous treatments. The presence of these organisms can play a role in HAI rates. Hospitals employ a combination of measures to control HAI rates. This “bundling” of methods can include managing the use of antibiotics prescribed to patients, staff hand hygiene training and monitoring, educational outreach to patients and their visitors and frequent and thorough cleaning of the indoor environment. In addition to these very important methods, maintaining the HVAC system’s performance is also very important part in helping the patients heal and reduce the risk of acquiring an infection while in a hospital.
1. California Department of Public Health, www.cdph.ca.gov, http://www.cdph.ca.gov/programs/hai/Pages/ HealthcareAssociatedInfections.aspx
2. HVAC Design Manual for Hospitals and Clinics, 2nd Edition, ASHRAE 2013; ANSI/ASHRAE/ASHE Standard 170, Ventilation of Health Care Facilities; Guidelines for the Design and Construction of Healthcare Facilities, 2010 3. California Office of Statewide Health Planning and Development, http://www.oshpd.ca.gov/
4. The Joint Commission, Environment of Care Standard Section 02.06.05 EP2
Additional Announcements
Flu Shots: 2013-2014
Be responsible to yourself and others! Do your part in promoting public health. The 2013-2014 flu shots are here.
Flu vaccines are designed to protect against the influenza viruses that experts predict will be the most common during flu season. Three kinds of influenza viruses commonly circulate among people: Influenza A (H1N1), influenza A (H3N2), and influenza B viruses. Each year, these viruses are used to produce a seasonal influenza vaccine.
Read up on information about the immunizations, how flu shots work, who should get one and where to get one.
Click here to read more.
Don’t Forget to Wash Your Hands!
20 Seconds. That’s all it takes. It’s never too late and there’s never a better time to practice (and teach!) good hand hygiene.
Keeping hands clean one of the most important steps to take to help avoid getting sick and spreading germs to others. If soap and water are unavailable, use an alcohol-based hand sanitizer that contains at least 60% alcohol to clean hands.
Read up on tips for when and how to wash hands in different environments such as healthcare settings, emergencies and while travelling.
Service Spotlight
HEALTHCARE SUPPORT
To Hospitals, Medical Offices, Surgery Centers, Outpatient Clinics and other Specialty Environments
ForensicAnalytical.com
SERVICE OFFERINGS
PROVIDING INTEGRATED
ENVIRONMENT OF CARE
SOLUTIONS
Forensic Analytical Consulting Services has extensive experience providing practical and science–based solutions to the healthcare industry. We understand the nature of the healthcare culture and its highly specialized indoor environments and we continuously apply industry regulations and guidelines to arrive at safe, cost-effective and timely solutions.
FACS has provided industrial hygiene consulting solutions to hospitals, medical offices, surgery centers, outpatient clinics and other specialty healthcare environments. Whether your need is for a routine inspection, emergency industrial hygiene survey or comprehensive program development, FACS has the team and experience that meet your needs.
• Construction project design and monitoring
• Designing/participating PCRA programs
• Epidemiological investigation support
• Asbestos, lead and mold management
• Staff exposure assessments
• IAQ investigations
• Respirator fit testing
• USP 797
• Environmental sampling (MRSA, C.diff, mold, legionella)
• Building inspections
• Staff training and town hall presentations
• O&M program development and support
• Environment of Care management plan reviews
• Statement of conditions audits
• Infection prevention plans during construction
CONTACT LOS ANGELESSAN DIEGO858.504.0033 310.668.5600 SAN FRANCISCOLAS VEGAS702.784.0040 510.266.4600 SACRAMENTOPORTLAND 503.595.1001 916.726.1303
Right People.
Right Perspective.
Right Now.
New Hires
Jason Gomez - Director of Business Development | Los Angeles
Jason has a wealth of experience in business development and has worked in the environmental health industry over the last several years. Jason has worked closely with hospitals such as Hoag, Memorial Healthcare, City of Hope, Kaiser Permanente, UCLA Medical Center, Childrens Hospital of Orange County, Good Samaritan and St. Mary’s to ensure proper emergency response and planning. He strives to provide and maintain quality emergency restoration services that are tailored and customized to the unique processes and protocols that hospitals require.
Jason is also active in affordable senior housing and assisted living centers. He is an active member in good standing with associations such as Aging Services of California, California Assisted Living Association and the American Healthcare Services Association. He is currently raising awareness about proper emergency planning in affordable senior housing communities, helping to minimize disruption and displacement during large-scale emergencies.
He is recognized by the Institute of Inspection, Cleaning and Restoration Certification as a Certified Water Restoration and Fire and Smoke professional and by the California Society of Healthcare Engineers in Hospital Sustainability. Jason is also trained in OSHA policies and compliance.
Jason holds a BA and MA from California State University Fullerton and California State University Long Beach.
Priscilla Yung - Technician | San Francisco
Priscilla is a Certified Site Surveillance Technician and California Department of Public Health Lead Inspector/Assessor with over a year of experience managing and performing environmental and industrial hygiene projects. Priscilla’s experience includes asbestos, lead and microbial surveys, inspections and assessments; air sampling and site observations as well as indoor air quality monitoring. Priscilla has performed these services in commercial buildings, K-12 and higher education facilities, government buildings and residential complexes. She has experience reviewing contractor submittals for conformance to project specification requirements, preparing field observation reports and preparing laboratory results and findings.
Priscilla holds a BS in Environmental Science from the University of California at Berkeley.
