COVID-19: What our healthcare clients are doing, and what we recommend for infection control
By Mike Zorich
The COVID-19 pandemic has mobilized health systems everywhere to implement their emergency preparedness plans related to infectious disease outbreaks. IMEG has been in contact with several of its healthcare clients as they enact their plans, with several of them asking for insight into what other organizations are doing – and what, if any, additional recommendations IMEG may have.
In the interest of sharing information that may be beneficial to all, following is a summary of the conversations we have had with our clients, whose actions are currently focusing on two major areas: patient surge and visitor access.
To prepare for the potential surge in patients, clients are:
- Reviewing their current quantity of airborne infectious isolation (AII) rooms versus anticipated containment needs. Several clients are also discussing modification of med surge rooms and/or floors for temporary isolation wards, and some are working with local health clinics, hotels, and college dormitories as back–up options should the patient surge be greater than they anticipate.
- Purchasing temporary structures such as tents or modular buildings that allow either triage for patients before entering the emergency department or for a means of separation between patients suspected of carrying the coronavirus from those in other areas of the healthcare facility.
- Purchasing portable air scrubbers with HEPA filters that can be used for temporary isolation rooms. Several facilities and infection control personnel are not able to achieve the code–required 12 ACH (air change rates per hour) for isolation rooms, but they are focusing their efforts to ensure the negative air pressure relationship is maintained as a minimum. They are finding the need to add door sweeps/seals in some cases to hold pressure. For the portable air scrubbers, facilities are utilizing the CDC Table B.1 to determine the time required for airborne-containment removal by efficiency to aid in room change-over.
- Procuring additional personal protective equipment (PPE). Acquiring and stockpiling N95 respirators is a big concern among our clients.
In addressing access to the hospital, several health systems are developing screening processes and visitor restriction policies. Several we spoke with have not yet implemented this policy, but they anticipate all visitors on campus (family, patients, contractors, staff, etc.) soon will be required to be screened before they can enter their facilities.
Infection control strategies for a health system should always include a collaboration of several strategies and not simply rely on the HVAC system. It is important to state that IMEG is not an expert on infectious diseases such as coronavirus – our recommendations are based only upon our expertise in the standard of care for patient isolation related to building system design, and in this case specifically, the design of ventilation and filtration systems. IMEG concurs with ASHRAE’s recommendation for using HVAC strategies with the highest documented results for reducing the risk of airborne infectious disease: dilution via ventilation, proper filtration, and ultraviolet germicidal irradiation (UVGI).
The Centers for Disease Control (CDC) and Prevention has stated that COVID-19 – officially named SARS-CoV2 – is a respiratory virus that they believe does not stay airborne for long. As is common with other respiratory viruses such as the flu and whooping cough, it is understood the droplets of SARS-CoV2 fall to the ground within 6 feet. (The CDC does not believe SARS-CoV2 is similar to tuberculosis or measles, which can be airborne for 100 feet or more.) The CDC is not requiring SARS-CoV2 patients be placed in AII rooms, but this should be considered if such rooms are available. (NOTE: Due to shortages of existing AII rooms, the CDC is recommending these rooms be reserved for patients undergoing aerosol-generating procedures. For more interim infection prevention and control recommendations, visit the CDC website.)
Other than recommending that air from AII rooms be exhausted directly to the outside or be filtered through HEPA filters before recirculation, the CDC has not given guidance on additional filtration requirements for general healthcare spaces.
IMEG recommends that all healthcare facilities first consult with their infection control department and administration to determine if filtration above current codes is required. Other suggestions include:
- Evaluating all current AII rooms to ensure ACH and negative pressure are maintained and continuously monitored
- Evaluating all central air handling systems to ensure filters have been changed and pressure gauges have been accurately calibrated
- Considering the purchase of portable HEPA–filtered air scrubbers that can be continuously monitored for use in temporary isolation rooms or wards. Modifications of these rooms for temporary use should be overseen by the health system’s infection control department. If portable HEPA-filtered scrubbers are utilized, ensure that the negative air relationship of these machines does not adversely impact adjacent spaces. (A thorough evaluation of the HVAC system is recommended.)
- Evaluating UVGI lights within air handling systems. Not all UVGI lights in air handling systems are intended for air sterilization. The most common UVGI light in an air handling unit is for coil/drain pan sterilization to reduce microbial growth. This type of UVGI light is not intended nor can it be modified to sterilize moving air.
- Review the relative humidity (RH) of patient care areas. Studies have shown spaces with an RH between 40% and 60% can cut the airborne travel distance of viral droplets and reduce the risk of healthcare associated infections (HAIs). Not all facilities or locations will have the capacity to achieve these humidity levels at all conditions, but we recommend it be part of your evaluation process.
These recommendations are shared with the goal of offering some measure of help to healthcare organizations as they find themselves midstream in this unfolding crisis. If IMEG can be of any assistance in regard to questions about your infrastructure, consider us a resource.