Advertisement

HVAC System Design in Healthcare Facilities and Control of Aerosol Contaminants: Issues, Tools, and Experiments

  • Cesare Maria JoppoloEmail author
  • Francesco Romano
Chapter
Part of the SpringerBriefs in Public Health book series (BRIEFSPUBLIC)

Abstract

Ventilation design greatly affects disease transmission by aerosols in healthcare buildings and is necessary to protect patients and healthcare workers against Hospital Acquired Infections (HAI). The rising concerns for antibiotic resistance and the strong push to save energy are motivating an assessment of current situation and are supporting a multidisciplinary effort to use novel approaches and tools. The paper is suggesting a shift to performance-based concepts, made possible by a wider use of IAQ sensors and of CFD simulation tools. The paper highlights the key role of particles and Microbe-Carrying Particles, how they are generated and spread by people and can be controlled by dilution and filtration. The viable and non-viable particle measurement techniques are described and OPC emerge as a widely usable tool to quantitatively assess, monitor and control hospital ventilation. Being people the most relevant indoor particle source, it is shown how aerosol dispersion from people can be reduced using occlusive clothing and how different garments are performing in Test Chamber and in OT. The simulation and experimental study of a high-performance OT ventilation system is used in order to show potential benefits of OPC and CFD tools.

Keywords

Healthcare facilities Ventilation and air-cleaning Air cleaners and air filters Air sampling Indoor air quality 

References

  1. ASHRAE. ASHRAE position document on airborne infectious diseases. Atlanta: ASHRAE; 2014.Google Scholar
  2. Azimi P, Stephens B. HVAC filtration for controlling infectious airborne disease transmission in indoor environments: predicting risk reductions and operational costs. Build Environ. 2013;70:150–160.Google Scholar
  3. CDC (Centers for Disease Control). Guidelines for environmental infection control in healthcare facilities. Recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee (HICPAC). Atlanta: U.S. Department of Health and Human Services (HHS) for CDC; 2003. p. 52(No. RR-10).Google Scholar
  4. Charnley J, Eftekhar N. Postoperative infection in total prosthetic replacement arthroplasty of the hip-joint with special reference to the bacterial content of the operating room. Br J Surg. 1969;56:641–9.CrossRefPubMedGoogle Scholar
  5. DIN 1946-4. Ventilation and air conditioning—part 4: ventilation in buildings and rooms of health care. DIN; 2008.Google Scholar
  6. FGI (Facility Guidelines Institute). Guidelines for design and construction of health care facilities. FGI 2014 Chicago: American Society of Healthcare Engineering of the American Hospital Association. http://www.fgiguidelines.org.
  7. Kujundzic E, Matalkah F, Howard DJ, Hernandez M, Miller SL. Air cleaners and upper-room air UV germicidal irradiation for controlling airborne bacteria and fungal spores. J Occup Environ Hyg. 2006;3(10):536–46. doi: 10.1080/15459620600909799.CrossRefPubMedGoogle Scholar
  8. Lidwell OM, Lowbury EJL, White W, Blowers R, Stanley SJ, Lowe D. Airborne contamination of wounds in joint replacement operations: the relationship to sepsis rates. J Hosp Infect. 1983;4:111–31.CrossRefPubMedGoogle Scholar
  9. Ljungqvist B, Reinmüller B. People dressed as a contamination source: some calculations. Eur J Parenter Pharm Sci. 2004;9:83.Google Scholar
  10. Ljungqvist B, Reinmüller B, Gustén J, Nordenadler J. Performance of clothing systems in the context of operating rooms. Eur J Parenter Pharm Sci. 2014;19(3):95–101.Google Scholar
  11. Ljungqvist B, Reinmüller B, Gustén J, Nordenadler J. Clothing systems in operating rooms. A comparative study. J IEST. 2015;58(Suppl 1):20–3. doi: 10.17764/1098-4321.58.1.20.CrossRefGoogle Scholar
  12. Miller-Leiden S, Lobascio C, Macher JM, Nazaroff WW. Effectiveness of in room air filtration for tuberculosis control in healthcare settings. J Air Waste Manag Assoc. 1996;46:869–82.CrossRefGoogle Scholar
  13. Morawska L. Droplet fate in indoor environments, or can we prevent the spread of infection? Indoor Air. 2006;16(5):335–47. doi: 10.1111/j.1600-0668.2006.00432.x.CrossRefPubMedGoogle Scholar
  14. Romano F, Ljungqvist B, Reinmüller B, Gustén J, Joppolo CM. Dispersal chambers used for evaluation of cleanroom and surgical clothing systems. Examples of performed tests and results. In: Proceedings of 23rd symposium of ICCCS—International Confederation of Contamination Control Societies. 20–23 Sept 2016. São Paulo. Brazil.Google Scholar
  15. Romano F, Gustén J, Joppolo CM, Ljungqvist B, Reinmüller B. Some aspects on the sampling efficiency of microbial impaction air samplers. Particuology. 2015a;20:110–3. doi: 10.1016/j.partic.2014.11.008.CrossRefGoogle Scholar
  16. Romano F, Marocco L, Gustén J, Joppolo CM. Numerical and experimental analysis of airborne particles control in an operating theater. Build Environ. 2015b;89:369–79. doi: 10.1016/j.buildenv.2015.03.003.CrossRefGoogle Scholar
  17. Stacey A, Humphreys H, et al. A UK historical perspective in operating theatre ventilation. J Hosp Infect. 2002;52:77–80.CrossRefPubMedGoogle Scholar
  18. Tang JW, Liebner TJ, Craven BA, Settles GS. A Schlieren optical study of the human cough with and without wearing masks for aerosol infection control. J R Soc Interface. 2009;6(Suppl 6):S727–36. doi: 10.1098/rsif.2009.0295.focus.CrossRefPubMedPubMedCentralGoogle Scholar
  19. Tellier R. Aerosol transmission of influenza A virus: a review of new studies. J R Soc Interface. 2009;6(Suppl 6):S783–90. doi: 10.1098/rsif.2009.0302.focus.CrossRefPubMedPubMedCentralGoogle Scholar
  20. Whyte W, Hejab M. Particle and microbial airborne dispersion from people. Eur J Parenter Pharm Sci. 2007;12(Suppl 2):39–46.Google Scholar
  21. Whyte W, Hodgson R, Tinkler J. The importance of airborne bacterial contamination of wounds. J Hosp Infect. 1982;3:123–35.CrossRefPubMedGoogle Scholar
  22. World Health Organization (WHO). Natural ventilation for infection control in health-care settings. Atkinson J, Chartier Y, Pessoa-Silva CL, et al. (eds). Copenhagen: WHO; 2009. http://www.ncbi.nlm.nih.gov/books/NBK143284/.

Copyright information

© The Author(s) 2017

Authors and Affiliations

  1. 1.Department of EnergyPolitecnico di MilanoMilanItaly

Personalised recommendations