Why air quality is critical for safe hospitals and doctor offices

When a person catches an illness in the hospital or other medical facility, it is called a healthcare-acquired infection (HAI), also known as a nosocomial infection or hospital-acquired infection. These infections take a toll on patients, healthcare workers, caretakers, and health systems at large.

TThis issue became especially critical in the context of the widespread COVID-19 pandemic that gripped medical facilities across the world, exposing millions to the deadly SARS-CoV-2 virus. And though the critical phase of the pandemic has passed, the virus and other viruses remain serious health concerns.

“Results from studies clearly indicate that, each year, hundreds of millions of patients are affected by healthcare-associated infections around the world.”

The World Health Organization (WHO) reports that most countries, including some regions in the United States, do not have systems to document HAIs. Many nations with HAI surveillance systems struggle to keep accurate data due to the complexity and lack of standardized criteria for diagnosing HAIs. While it is difficult to pinpoint an exact number, “results from studies clearly indicate that, each year, hundreds of millions of patients are affected by healthcare-associated infections around the world,” and COVID-19 was no exception (1).

HAIs happen far more often in developed nations than most would like to admit.

HAIs happen far more often in developed nations than most would like to admit. For example, about 1.7 million Americans (one in ten patients) are infected in U.S. hospitals every year, and millions were exposed to or contracted COVID-19 from the spread of the virus in uncontrolled medical environments. Almost 100,000 die from HAIs alone, and hundreds of thousands died from complications of COVID-19 (2).

In Canada, 220,000 HAIs occur (one in eight) every year and about 8,000 of those people die, although the COVID-19 impact was much lower in relation to HAIs (with just over 200,000 documented cases and around 10,000 deaths) (3).

It’s estimated that 2.6 million people in the European Union (EU) are affected by HAIs every year, resulting in at least 90,000 deaths in addition to 8 million COVID-19 cases and between 200-300,000 deaths (4).

There is limited public information for China (5).

What safety precautions can healthcare facilities take?

Addressing infection control in hospitals requires integrating HVAC and air-pressure-control with dedicated infection-control systems and minimizing unplanned airflows through building envelopes and interior spaces.

The combination of filtration equipment and airflow rates are often misunderstood or underappreciated for the effect they have on the concentration of infectious agents in any conditioned space. Along with source control, filtration should be considered one of healthcare’s key defenses against infectious agents, as it helps remove a large percentage of both airborne viruses and bacteria with every complete air change through an air handler. If the filter efficiency and/or air change rate is increased, a larger number of infectious agents would be removed per pass (6).

Filtration should be considered healthcare’s first line of defense against infectious agents.

IQAir air purifiers, including the HealthPro Plus room air purifier, have been shown to help cut hospital aspergillosis infections by more than 50% and remove up to 99.5% of aerosols as small as 0.003 microns – this includes the SARS-CoV-2 virus, which ranges in size from 0.08 to 0.15 microns in diameter.

Also, IQAir's Cleanroom H13 air cleaner has been shown to help reduce Methicillin-resistant Staphylococcus aureus (MRSA) contamination.

IQAir President Frank Hammes states that, “We feel the most relevant protocols should involve HEPA filtration. However, we also feel that negative pressure should be mandatory for known cases. This is because patients in the nearby hall (who are not wearing personal protective equipment) should also be protected from cross contamination. We ventilate contaminated air out of the building through negative pressure. Negative pressure is maintained by keep double doors closed at the entrance of the room.” (7)

IQAir stand-alone air cleaners have been shown to help cut hospital aspergillosis infections by more than 50%, and filter up to 99.5% of aerosols as small as 0.003 microns – including SARS-CoV-2.

IQAir also offers environmental control of chemical compounds and odors through:

  • filtration of ambient air
  • creation of pressure differentials (containment of chemical compounds and unpleasant odors through negative pressure areas)
  • source capture (capture and filtration of chemical compounds and unpleasant odors at their source).

To prevent transmission of pathogens that may be spread by both routes (varicella, disseminated herpes zoster, and SARS-CoV-2, for example), it may be necessary to use a combination of airborne and contact isolation precautions.

Airborne transmission isolation procedure specifications require:

  • A single-patient room with negative air pressure ventilation and outside exhaust
  • That the door to the room be kept closed except for entry and exit

An IQAir Cleanroom H13 air purifier can help significantly reduce MRSA contamination in patient isolation rooms, according to a study conducted by the Department of Biology at Nottingham City Hospital (UK) (8).

Drug-resistant “superbugs” and mutating viruses

A growing body of evidence suggests that drug-resistant superbugs, which some scientists are calling "nightmare bacteria," are spreading more quickly inside U.S. hospitals than previously thought (9).

This is also the case for many viruses, including the SARS-CoV-2 virus – a 2020 study of over 5,000 individual cases of COVID-19 found that SARS-CoV-2 has the ability to mutate into multiple strains with different pathologies due to natural changes in amino acids present in the virus’ protein spikes and, as a result, resist treatment that could previously treat the infection (10).

A growing body of evidence suggests that drug-resistant superbugs, which some scientists are calling "nightmare bacteria," are spreading more quickly inside U.S. hospitals than previously thought.

When they're not drug-resistant or subject to mutation, most bacterial infections can easily be treated with antibiotics, vaccines (if available), or simply rest at home. However, mutation and antibiotic resistance of strains within families of bacteria, or with especially deadly infections like COVID-19, is a concern. Other multidrug resistant (MDR) bacteria known to cause hospital acquired infections include:

  • Methicillin-resistant Staphylococcus aureus (MRSA): This bacteria is resistant to many antibiotics and can cause a range of health issues from skin infections to sepsis, pneumonia, and bloodstream infections (11).
  • Carbapenem-resistant Klebsiella pneumoniae (CRKP): Klebsiella pneumoniae (K. pneumoniae) is a bacteria commonly found in the human intestines. It does not cause health problems until a person is exposed to it outside of the intestinal tract. For infection to occur, K. pneumoniae must enter the respiratory tract to cause pneumonia or the blood to cause a bloodstream infection. Healthy people rarely get K. pneumoniae infections. Carbapenems are a class of antibiotics usually used as a last line of defense against certain bacterial infections (gram-negative) that are resistant to other antibiotics. This makes the development of CRKP especially concerning (12).
  • MDR Pseudomonas aeruginosa: This bacterium primarily infects patients with a severe lung disease. It most often causes infections in people with cystic fibrosis (CF). P. aeruginosa infections in non-CF patients are most common in those with chronic obstructive pulmonary disease (COPD) (13).
  • MDR tuberculosis (TB): MDR-TB is a TB infection by tuberculosis-causing bacteria that are resistant to treatment with at least isoniazid and rifampicin, two of the most powerful anti-TB drugs (14).
  • MDR Acinetobacter baumannii: A. baumannii has become a leading cause of HAIs in the U.S. and around the world. There are an increase of strains that are drug-resistant, particularly resistant to carbapenem antibiotics (15).
  • MDR Clostridium difficile: Hospital-acquired Clostridium difficile infections are a growing problem in hospitals in the U.S. and many other countries (16).

Other airborne pathogens causing HAIs

The increasing number of healthcare-associated infections has received significant attention in recent decades, especially opportunistic fungal infections. These include:

  • Varicella-Zoster Virus (VZV): Virus that causes chickenpox and shingles 17
  • Measles (rubeola): Caused by a single-stranded RNA virus 18
  • Smallpox: Caused by the variola virus (19)
  • Avian influenza (bird flu): Avian viruses occur naturally in bird aquatic birds around the world. They can infect poultry products and other animal species. Avian flu viruses have sporadically infected humans (20).
  • Severe Acute Respiratory Syndrome (SARS): Remember SARS? It was a flu virus causing panic in the early 2000s (21).  IQAir is proud to have helped slow the pandemic, having been chosen by the Hong Kong Hospital Authority (HHKA) as the only air cleaning technology capable of helping remove the SARS virus from the air.

How to protect yourself from HAIs

Choose the cleanest hospital

Do some research to choose the best hospital for you, whether you’re a medical provider or specialist yourself or a patient choosing a facility, especially for long-term stays. Learn what you can about a hospital's infection track record and choose the one that has the lowest infection rate. You may want to discuss this with your healthcare provider, your primary care physician, and your own patients, too.

Learn what you can about a hospital's infection track record and choose the one that has the lowest infection rate.

If your insurance allows it, or if you can afford it, ask for a private room. Having a room to yourself will reduce the chance you will be infected by another patient.

There are certain times of the year that are more dangerous than others, increasing the opportunities for patients to acquire infections, such as during the influenza season (22).

During the COVID-19 pandemic, single-patient rooms may be in short supply in many overburdened hospitals. But privacy and isolation can be the primary factor in stopping the spread from infected patients to those visiting for other medical reasons.

Choose a doctor with a low infection rate

Once you know which hospital is the cleanest, ask which doctors have the specialty you need. Do some background research to choose the right doctor for you.

Prior to your hospital admission, work with your doctor to set the stage for reducing your risk of infection.

Prior to your hospital admission, work with your doctor to set the stage for reducing your risk of infection. Recommendations may include:

  • Using chlorhexidine soap when you shower for a week before admission
  • Taking antibiotics a day or two prior to your surgery
  • Stop smoking, as there is a correlation between smoking and higher infection rates

Prepare your hospital stay

By understanding how infections spread, you can prepare ahead of time by packing some items that will help you fend off those germs. As a doctor or specialist, you should attempt to keep these items on hand at all times, including:

  • Antiseptic wipes and sprays will help you kill germs on surfaces.
  • Make a sign that says "PLEASE WASH YOUR HANDS before touching me." Hang it someplace in your hospital room so that it can’t be missed, such as above your head, so every caregiver will see it.
  • A germ-filtering mask to prevent breathing in infected particles and aerosols. Find masks at your local pharmacy. Be sure they are the germ-filtering kind, with at least N95 or KN95 ratings, and don't let someone else open the package if they haven't already washed their hands.
  • Wear a face mask to reduce your exposure to airborne bacteria and viruses. A pollution protection mask rated for KN95 and N95 protection, such as the IQAir Mask, is tested to remove many types of infectious bacteria, aerosols, and viral matter from the air you breathe.
  • Bring a high-performance air purifier that can create medical-grade air, such as the IQAir HealthPro Plus or an Atem personal air purifier. This will help remove particles of all sizes as well as mold spores, airborne bacteria, and airborne viruses from the indoor air.

Healthcare-acquired infections, including the highly contagious SARS-CoV-2 virus, are preventable, and seeking care should not be avoided out of fear. However, awareness empowers you to protect yourself and those you care about, and helps you protect your patients from the growing risk of airborne transmission of deadly, contagious infections like COVID-19.

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