For facility managers in healthcare facilities, working with an organization’s infection control staff to do everything possible to prevent HAIs — healthcare-associated infections — is of high priority, especially in light of the recent Ebola scare. Among the areas of primary concern to FMs in managing this problem is air pressure and airflow.
The fancy term for HAI is “nosocomial” — it means an infection a patient or visitor acquires at a healthcare facility. What’s frightening is that they’re amazingly common. According to the Centers for Disease Control and Prevention, 1 in 20 patients has a HAI on any given day, and there are about 1.7 million cases — leading to 99,000 deaths — of HAI in U.S. healthcare facilities each year.
Three main areas of an FM’s core competencies are directly related to infection control effectiveness: air filtration and room pressure relationships, cleaning and housekeeping, and waste management and disposal.
Pressure and Airflow
“The most important thing about infection control is air flow,” says Bert Gumeringer, assistant vice president for facility operations at Texas Children’s Hospital in Houston. “Do you have the right exchange rates? Is the pressure negative when it needs to be negative and positive when it needs to be positive?”
Isolation rooms for patients with very infectious diseases — like tuberculosis and Ebola — must be negatively pressured to prevent air (and airborne pathogens) from escaping and infecting others. Conversely, says Gumeringer, patients who are immune-compromised must be placed in rooms with positive pressure to keep contaminants away. Operating rooms must also be positively pressured, because “you don’t want dirty air to be sucked into a room,” says Alan Neuner, vice president of facility operations for Geisinger Health System.
Properly pressurizing these isolation rooms is standard operating procedure for any healthcare facility, but where things get more complicated in regards to airflow is when changes are made to building operating systems or when performing any level of facility work — from replacing ceiling tiles to full-scale renovations.
Making a change to the temperature in a patient’s room as a response to a hot/cold call can also change airflow rates and pressures. “The engineering staff is well-intended,” says Gumeringer. “They’re trying to meet the needs of the customer.” So identifying a way to monitor pressure and airflow in patient rooms is important.
For rooms where directional pressure and airflow can’t be compromised, Neuner says his facilities include devices that monitor pressure and flow, and alarms if something is amiss. For less critical areas, quarterly checks are performed to ensure airflow and pressures are within tolerance. At Texas Children’s, the largest pediatric hospital in the United States, Gumeringer says his staff performs spot checks, but also has contracted with a company to do monthly checks on airflow. Gumeringer says the cost of this contract more than pays for itself, citing CDC statistics that a single HAI can cost $20,000 to $40,000 to treat. As well, he says, more than 50 percent of hospitals in Texas have been cited for not having proper airflow. “We believe in this testing very strongly,” he says. “The duty we all have is not only to look at cost, but also to look at the impact to the patient and the family.
By Greg Zimmerman– January 2015 –