This article presents ways to enhance indoor air quality (IAQ) at health care facilities and hospitals in Seattle, Washington, including information on effective, efficient air filtration solutions.
Article Chapters
- Introduction
- The Significance of Improving Indoor Air Quality in Health Care Facilities and Hospitals
- Solutions for Enhanced IAQ in Patient Rooms, Pharmacies, and Operating Rooms
- Longer Filter Lifecycle for Health Care Facilities and Hospitals
- Energy and Labor Savings for Health Care Facilities and Hospitals
- MERV vs. MERV-A
- Filters and Filtration for Health Care Facilities and Hospitals
- Waste Reduction: Sustainable Practices for Health Care Facilities and Hospitals
- Conclusion
Introduction
Safe indoor air quality (IAQ) in health care facilities and hospitals is essential to patient care and the well-being of personnel. Efficient ventilation and air filtration are necessary to reduce airborne exposure to contaminants like viruses, bacteria, chemicals and odors. The Washington State Department of Health notes that because facilities vary in design, age and HVAC systems, so does their ability to provide effective ventilation and air filtration. Therefore, the department recommends consulting with a professional engineer or HVAC specialist to ascertain the best way to improve the system’s ventilation and air filtration capabilities for each of the many rooms in the buildings.[1]
ACI Mechanical and HVAC Sales (ACI), headquartered in Seattle, Washington, has been working with engineers, facility operators and contractors across the Pacific Northwest since 1985 to deliver solutions that improve IAQ, maximize energy efficiency and building economics and help to ensure healthy air and comfort for building occupants.
“Indoor air quality is important to all commercial and residential buildings, but it is uniquely vital in health care facilities and hospitals,” says Keith Glasch, ACI’s President. “Because of our expertise and customer service, ACI’s air quality solutions are found in health services buildings throughout the region to help to ensure patient and employee safety and to meet regulatory standards.” Read more here.
The Significance of Improving IAQ in Health Care Facilities and Hospitals
IAQ affects both the comfort and health of patients, workers and visitors at health care facilities and hospitals. According to the U.S. Environmental Protection Agency (EPA), people can experience effects from indoor air pollutants soon after exposure or even years later. Symptoms that might arise shortly after exposure to a pollutant include throat, nose and eye irritation, headaches, fatigue and dizziness. Health effects that may show up after long or repeated periods of exposure can be debilitating or fatal and include heart and respiratory diseases and cancer.
Inefficient ventilation can increase indoor pollutant levels by not drawing in enough outdoor air to dilute emissions from pollution sources and by not carrying indoor air contaminants out of the area. High temperature and humidity levels can also elevate concentrations of some pollutants.[2] Air filtration complements ventilation by capturing airborne contaminants and cleans the air before it is returned to the indoor environment.
Ensuring proper ventilation and air filtration, hospitals can significantly reduce the concentration and transmission of airborne pathogens like bacteria and viruses, leading to lower infection rates among patients and staff. Controlling the airborne transmission of pathogens through optimal IAQ also can play a crucial role in preventing hospital-acquired infections, which often lead to longer hospital stays and even death in some cases. In addition, when patients are in an environment with good IAQ, their bodies can focus on healing and recovery rather than reacting to poor air conditions. This can lead to shorter hospital stays and quicker overall recovery times.
“Common types of contaminants in a hospital include mold such as Aspergillus, which results from moisture and creates spores that become airborne with the slightest disturbance. Studies have also shown the presence of airborne viruses and fungi that are created by moisture and water that can cling to ducts and vents and spread throughout a hospital when cool air or heat blows through the HVAC system. These contaminants can have a serious effect on patients who have suppressed or weakened immune systems and are much more susceptible to lower grade airborne bacteria and viruses that would not affect people with healthy immune systems,” says Marc Johnson, Camfil USA, Healthcare Segment Manager. Read the full story.
Solutions for Enhanced IAQ in Patient Rooms, Pharmacies and Operating Rooms
Maintaining good IAQ throughout hospitals and health care facilities is a challenge because of the many different functions within the various departments. Patient rooms, operating suites, isolation rooms, pharmacy, imaging rooms, common rooms, emergency rooms, laundry and maintenance rooms, to name a few, all need unique IAQ solutions. This diversity of functions, occupants and processes makes ventilation and air filtration strategies more complicated in hospitals and health care facilities than most other public utility buildings.[3]
“The constant movement of people and equipment is always present in a hospital. Housekeeping crews move rapidly from room to room using various chemicals and cleaning agents in each. Internal laundry services wash and dry tons of sheets and blankets daily. Food service prepares and delivers meals throughout the entire building. The process of removing supplies used in ORs, such as tubing or packaging from single use instruments, and prepping the room for the next procedure is a major undertaking. Of course, the patients themselves are an obvious source of contaminants through coughing or sneezing which can introduce pathogens into the airstream,” says Marc Johnson, Camfil USA, Healthcare Segment Manager. Read the full story.
Air filtration is an important part of an HVAC system that can be tailored to fit specific areas of a hospital or health care facility. American Society of Heating, Refrigerating and Air-Conditioning Engineers (ASHRAE) Standard 170 is a guideline for determining how to filter the air for different spaces within a hospital.
A Minimum Efficiency Reporting Value (MERV) rating is used to characterize how well an air filter removes particulates of various sizes. ASHRAE recommends a minimum filtration efficiency target of MERV 13.
Particulate air filters rated as a MERV 14/14A should remove 75% of all particles larger than 0.3 microns, while a MERV 16/16A-rated air filters should remove 95% of particles larger than 0.3 microns. Adding HEPA filters can capture the smallest particles—up to 99.99% of all particles greater than 0.3 microns. Gases and vapors introduced into the airstream from sources like vehicle fumes, cleaning agents and sterilizing chemicals can be controlled by using molecular filters (also known as activated carbon filters).
Air filter recommendations:
General Patient Rooms: MERV-9A and MERV-14A
Pharmacy: MERV-9A Prefilter, HEPA Terminal Filtration
Surgery/Operating Suites: MERV-9A Prefilter, MERV-16A Final, HEPA Terminal Filtration
Longer Filter Lifecycle for Health Care Facilities and Hospitals
Hospital and health care facility operators can improve IAQ and reduce airborne contaminants by using high-efficiency filters in the HVAC system. Premium air filters provide highly efficient contaminant removal, require less frequent replacement and reduce HVAC energy use. Higher-end filters can last two to three times longer than low-cost filters because they maintain their efficiency in capturing particles and enabling proper airflow.
“Low-cost filters typically clog faster, causing a rise in operating costs as the HVAC system is forced to consume more energy to push the same amount of air through the system. … In addition to lower energy consumption overall, this means fewer filter changes which translates to fewer filters, less labor and reduced waste. All of these factors reduce operating costs even further,” says Marc Johnson, Camfil USA, Healthcare Segment Manager. Read the full story.
Energy and Labor Savings for Health Care Facilities and Hospitals
The fan energy needed to move air through the HVAC system is the third-largest energy cost item in a hospital or health care environment. Air filtration greatly contributes to this energy cost because filters are designed to create resistance to airflow, which forces the air distribution fans to work harder and use more energy. However, it is possible to achieve optimal filtration in each area of the facility, maintain MERV-rated efficiency through the life of each filter and reduce energy costs. Premium filters are designed to reduce HVAC energy expenditures while maintaining a high level of contaminant removal and requiring fewer filter replacements.
Using the right air filters based on average lifetime resistance to airflow and the filters’ ability to maintain their MERV-rated efficiency can save a facility approximately half of its HVAC fan energy costs. Read more.
In addition, installing high-efficiency air filters in HVAC systems as part of an IAQ program can also lead to decreased labor costs and increased productivity because tasks involved with transporting, changing and disposing of filters are significantly reduced.
“The total cost of ownership of an HVAC system that is well maintained includes costs for energy consumption, installation, labor, and waste disposal. The right air filters can save companies in each of the categories significantly,” says Marc Johnson, Camfil USA, Healthcare Segment Manager. Read the full story.
MERV vs. MERV-A
Although ASHRAE recommends a minimum filtration efficiency target of MERV 13, there is more to the MERV story that must be considered. First, air filters can be manufactured with an electrostatic charge that temporarily increases the particle capture efficiency. This results in the filter being assigned a higher MERV rating than its actual value. Then, as the filter starts to load with airborne contaminants, the charge loses its ability to attract particles, and the MERV value drops.
For example, within a short period of time the partical capture efficiency of a MERV-13 air filter can drop to that of a MERV-8 filter, putting IAQ at risk. To address this issue, ASHRAE specifies an alternative testing method to determine air filter efficiency without electrostatic charge. The values characterized by this test are called MERV-A values.
“An easy way to remember the distinction between MERV and MERV-A is to think of the ‘A’ as standing for ‘actual,’ so a filter’s MERV-A rating represents its ‘actual’ efficiency,” says Marc Johnson, Camfil USA, Healthcare Segment Manager. Read the full story.
Hospitals and health care facilities should use MERV-A-rated air filters to ensure optimal lifetime performance. Note that the HVAC system’s air filter capacity may make it unfeasible to incorporate MERV-13A-rated filters. If this is the case, use the highest MERV-A-rated filter that the HVAC system can handle.
Filters and Filtration for Health Care Facilities and Hospitals
Airborne transmission of contaminants can occur by the spreading of small-particle residue of evaporated droplets. These droplets contain microorganisms that are 5 microns or less in size and remain suspended in the air for long periods of time. Dust particles containing an infectious agent are another source of airborne contaminants. Air currents disperse contagious microorganisms throughout a hospital or health care facility, where patients, personnel and visitors inhale them.
Examples of airborne contaminants and recommended filtration:
The SARS-CoV-2 particle size has a range from .06 microns to .14 microns. However, the virus attaches itself to aerosol droplets generated by breathing, talking and coughing that are generally around 1 micron in size. If airborne at that size, at least 90% of these particles would be captured by a MERV-14A filter.
Staphylococcus aureus has a diameter of 0.8 micron to 1.0 micron. An air filter with a MERV-14A rating under ASHRAE Standard 52.2, will remove more than 90% of the contaminant.
Tuberculosis has a diameter of 0.2 micron to 0.5 micron and a rod length of 1.0 micron to 4.0 microns. Although an ASHRAE MERV-14A filter likely would remove at least 90% of the contaminant, additional HEPA filtration is recommended to ensure the highest percent of contaminant capture.
Aspergillus is easily removed by MERV-14A-level filtration.
“Special air handling and ventilation are required to prevent airborne transmission. Room air cleanliness is always a function of filter efficiency and the number of air changes. … Viruses and other sub-micron contaminants cluster and often adhere to larger items that easily become airborne such as skin flakes. Many are removed from the airstream when the larger particles are captured by the filter,” explains Marc Johnson, Camfil USA, Healthcare Segment Manager. Read more.
Waste Reduction: Sustainable Practices for Health Care Facilities and Hospitals
Waste management in hospitals and health care centers is crucial for protecting the environment and public health. Implementing environmentally friendly approaches can reduce the impact of health care waste on the ecosystem and contribute to sustainability. Environmentally friendly practices for waste management in health care settings include waste segregation, recycling and reuse, waste-to-energy technologies, safe disposal of pharmaceuticals, using biodegradable products and waste reduction.
Using high-performance air filters in HVAC systems contributes sustainable practices because they not only significantly improve IAQ throughout all of the specialized areas of the facility, but they also lower energy consumption, which reduces the center’s carbon footprint. Premium air filters also reduce waste sent to landfills because they require less frequent replacements, so fewer filters are used. These longer-lasting, high-performance air filters also use fewer materials and generate less greenhouse gas (GHG) emissions during production and transportation.
“Camfil’s product line has been expanded to include a range of filters that maintain their efficiency over their life and use less energy to move air through the filter. These include the company’s 30/30 filters and Durafil ES – green air filtration products that also reduce a customer’s carbon footprint, helping to tackle climate change,” notes Marc Johnson, Camfil USA, Healthcare Segment Manager. Read the full story.
Conclusion
Clearly, IAQ is vital to human health, especially in hospitals and health care facilities where many patients are immune-compromised and more susceptible to the health risks posed by airborne contaminants. Likewise, personnel and visitors need effective HVAC and air filtration systems to reduce their exposure to biological contaminants. Improving IAQ can also help to reduce hospital-acquired infections, boost energy savings and contribute to sustainable operations and waste management.
“In order to comply with the intent of ASHRAE 170 minimum requirements and to ensure safety in health care environments, Camfil recommends that facility directors insist on MERV-A values and request that a corresponding test report be supplied with every quotation,” adds Marc Johnson, Camfil USA, Healthcare Segment Manager. Read more.
Because IAQ solutions for hospitals and health care facilities are complex, consulting with HVAC specialists and professional engineers, like Seattle, Washington-based, ACI Mechanical and HVAC Sales, is necessary to determine the best ways to achieve regulatory compliance and improve the HVAC system’s ventilation and air filtration functions for each specific area of the facility.
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[1] Indoor Air Quality, Washington State Department of Health, https://doh.wa.gov/community-and-environment/air-quality/indoor-air
[2] Introduction to Indoor Air Quality, U.S. Environmental Protection Agency, https://www.epa.gov/indoor-air-quality-iaq/introduction-indoor-air-quality
[3] Ibrahim F, Samsudin EZ, Ishak AR, Sathasivam J. Hospital indoor air quality and its relationships with building design, building operation, and occupant-related factors: A mini-review. Front Public Health. 2022 Nov 8;10:1067764. doi: 10.3389/fpubh.2022.1067764. PMID: 36424957; PMCID: PMC9679624. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9679624/
Headquartered in Seattle, Washington, ACI Mechanical and HVAC Sales is the Pacific Northwest’s vendor of choice for commercial HVAC applications. Since 1985, ACI has been partnering with consulting engineers, contractors and their customers to help buildings thrive. Solutions include applications for education, data centers commercial office buildings, healthcare, and industrial facilities. ACI’s team includes 35 degreed sales engineers and project professionals working with over 50 equipment manufacturers.
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