Paradoxically one of the places most vulnerable to the transmission of viruses, infections and bacteria are hospitals. That is why it is so important to take special care in the treatment and quality of the air that circulates inside each enclosure.
By: María Cecilia Hernández
If there is something more important for health than breathing clean air at all times and places, it is to guarantee the good quality of the air that circulates inside such delicate and vulnerable spaces as hospitals and operating rooms.This quality is determined, according to experts in the field, by the sum of several factors; these include temperature, humidity, air velocity, microbial pollution, volatile organic compounds (VOCs), and particles found in the environment.
Regarding the indoor air quality of a hospital enclosure, the director of Air Care, Mexico, Marisa Jiménez de Segovia, emphasizes that "in a hospital the care of indoor air quality is focused on the reduction of airborne pollutants to prevent the spread of infections. Within hospitals there are diverse environments with challenges and challenges that make them unique so the role of air conditioning in a hospital goes far beyond merely providing thermal comfort to patients, visitors and staff."
Establishing in what quality conditions the air circulating in a building is possible. Jaime Jiménez, CEO of Trane, explains that "air samples are required, the control of human exposure to pollutants and samples from the surfaces of the building."
Maintenance ensures quality
The equipment used to ensure good air quality inside a hospital establishment are machines that have a useful life ranging from 2 to 5 years.
Yair Balderas, representative of the company TTQ and expert in the design of HVAC systems for hospitals, indicates that "ASHRAE recommends using the ice water system, for its effectiveness and practicality, since the handling of refrigerant gases within a hospital requires the application of a greater number of preventive standards".
For his part, the Brazilian consultant Samoel Vieira de Souza, indicates that a fundamental part of the equipment that helps the process of keeping indoor air in good condition, are filters and absolute filters for areas with greater restriction conditions.
In that sense, the general administrator of Eair de México, Cristina Lainés Alamina, considers that "there are several types of filter and unlike membrane filters, HEPA filters are prepared to retain contaminants and much smaller particles. These prevent the spread of bacteria and viruses through the air and are therefore very important to prevent infections. Medical HEPA filtering systems typically incorporate high-energy ultraviolet light to remove any live bacteria and viruses trapped by the physical filter."
All experts agree that the maintenance of the equipment that provides the air in a hospital enclosure should be done monthly. "I suggest following the installation manual and being very attentive to the replacement time of the filters, which can often be less than recommended by the manufacturers, since it could be exposed to unfavorable conditions of the context. For example, in the cases of hospitals near large avenues," advises Vieira.
Predictive maintenance helps improve energy efficiency and operating cost management, reduces the likelihood of system failure, which could have a devastating effect on hospital capacity. Although most hospitals already have high-capacity building automation systems, many will have to provide additional training to enable professional technicians in facilities to use the system optimally.
Diseases the order of the day
An HVAC system that is properly designed, installed, with proper operation and maintenance, is essential to provide a healthy environment. "On the contrary, the lack of maintenance can generate and disseminate contaminants causing possible nosocomial and postoperative infections," explains the director of Air Care Mexico.
Likewise, the director of Trane explains that poor indoor air quality affects the entire operation of a hospital and this causes the discomfort of people, which leads to inefficiency and dissatisfaction of the staff. In addition, infections are transferred from one patient to another more easily, it keeps patients in their beds longer than necessary, it creates higher levels of bacterial growth, among other inconveniences.
Jiménez assures that "high levels of poor air quality can cause immediate health problems such as: aggravating cardiovascular and respiratory diseases, producing more stress on the heart and lungs, damaging the cells of the respiratory system, accelerated aging of the lungs and loss of lung capacity as well as reduced lung function, development of diseases such as asthma, bronchitis, emphysema, possibly cancer and, finally, shortens the life of the human being."
Latin American hospitals
The point of view of experts on the state and implementation of this type of technology in hospitals and operating rooms in the region is very varied. Some believe that there is still a long way to go in this regard, but many of them agree that the trend points to technological renewal at a slow but sure pace.
According to Rubén Céspedes, International Director of the National Air Filtration Associaton (NAFA) "in Santiago de Chile there are at least 4 private clinics with high demand; two of them certified by Joint Commission International and two others working to become certified. Regarding the public area, there is a local standard with more emphasis on the patient, but with environmental requirements for operating rooms (all with HEPA) or for protection and isolation rooms. That indicates the national standard. But there are still several that do not comply. However, every day there are more who ask for these certifications"
For its part, in Mexico, according to Céspedes, as of March 2011 there were about 145 hospitals with current certification of the National System of Certification of Health Care Establishments, of which 30 were certified with the standards internationally approved with Joint Commission International.
Similarly, Samoel Vieira indicates that in Brazil there are good facilities and, most importantly, there is legislation that dictates various mandatory requirements ranging from the formulation phase of the project, to the process in use. One of the requirements is the design of a Maintenance, Operation and Control Plan, known as PMOC, which includes the cleaning procedure of the ducts, and of the equipment in general. "This plan is mandatory for the production areas in pharmaceutical laboratories and hospitals. Thus, all large hospitals use this methodology and every day more users are convinced that maintenance is very important even to save money, "insists the consultant.
Despite all the efforts and advances in the implementation of this necessary and vital technology, Cristina Lainés, from Eair Mexico, believes that "unfortunately, we have a lot to do since this control is not effective in all cities in Latin America, it may be because it is expensive to access this type of air control; I believe that we have a commitment both to society and to ourselves, not only in innovation and respect for the needs of the environment, but also in health care."
Select the filter well
Yair Balderas explains below the standards that must be followed to select the filters to be used in hospital establishments.
The selection of filters is made based on the Minimum Reported Efficiency Value (MERV) of ASHRAE Standard 52.2-2007. The MERV reports the minimum efficiency per particle size that a filter can remove.
The ASNI/ASHRAE/ASHE Standard 170-2008 (Standard for Ventilation of Health-Related Buildings) establishes the minimum filtration requirements to remove chemical, physical and biological contaminants that may affect the medical care of patients, convalescence and the health of patients, hospital workers and visitors. However, there are operating rooms in which high-risk operations such as organ transplant or spinal cord operations or orthopedic surgeries are performed, so the ASHRAE 2007 Handbook recommends using HEPA filters at the exit of the injection.
Poor air quality, human symptoms
Hospitals use a wide range of chemicals in medical and laboratory procedures, some of which can affect indoor air quality, such as:
• Carbon monoxide (CO);
• Nitrogen dioxide (NO2);
• Particulate matter (PM) and sulfur dioxide (SO2).
According to Jaime Jiménez, CEO of Trane "the symptoms of poor indoor air quality are very broad and depend on the pollutant. They are reflected in humans and can easily be confused with symptoms of other diseases such as allergies, stress, colds and flu. The most common manifestations are: cough, sneezing, watery eyes, fatigue, dizziness, headaches, congestion of the upper airways, etc. If symptom relief is observed soon after leaving a particular room, or construction, your symptoms may be caused by indoor air pollutants."
Even for healthy people, poor air quality can lead to irritation or breathing difficulties during work. The actual risk depends on the current health status, the type and concentration of the pollutant, and the time of exposure to polluted air.
