What the Doctor Ordered

November 6, 2006
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Hospital air sometimes gets a very bad rap. Amid patient and staff complaints of it being too warm or too cold, too dry or too humid, are the realities of maintenance and budget - particularly budget - and an increased awareness of the need for infectious disease containment.

HVAC service and construction contractors need to be aware of these needs, plus a few others, in order to work effectively in the health care market.

According to Laura Rygielski, director of the health care market for Trane, "We have seen an increase in process specifications both for service and construction work driven by ASHE (the American Society for Healthcare Engineering). There is an increasing understanding of what kind of containment is required.

"Contractors particularly need an understanding of airflow distribution holistically," she said.

"Trying to isolate a piece of equipment is a challenge. We need to make sure we are looking at the whole system and what it is trying to achieve."

A NEED TO ISOLATE

"Before, I think people looked at containment from a construction debris standpoint," she said. This would mean keeping down dust that resulted from construction and renovation work, and keeping it away from ventilation systems.

Although this is still important, "Now hospitals are requiring anyone who works on their campus, service and maintenance staff as well as construction contractors, to be certified and aware of isolation- and infection-related isolation issues."

The spread of disease and risk of a global pandemic are fueling concerns in professional and nonprofessional circles. Just a few high-profile problems that have cropped up in the past few years are avian flu, drug-resistant tuberculosis (TB), and bioterrorism-related infectious diseases such as anthrax and smallpox.

"There are a lot of things to consider," Rygielski said. "Issues evolving in our society, like drug-resistant TB and potential flu pandemics, force us to consider how we are going to contain and isolate patients, and protect health care workers." Appropriate space pressurization is key, "tracking that from a documentation standpoint. You don't want to get hit with one of those issues and find out you're not prepared."

In cases of infectious disease, she said, negative pressurization is needed to contain the infection to a limited space.

However, isolation zones are not limited to infectious disease areas. Additional isolation zones include burn, cancer, and transplant centers, whose patient populations tend to have severely depleted (in some cases completely nonfunctional) immune systems. In cases where patients have a depleted immune response, positive pressurization is needed to push air, and infectious agents, outward from the space.

What should a health care contractor do? "Try to get educated and engaged in infection-control issues," she said. "Get up to speed on the Environment of Care standard of the Joint Commission on Accreditation of Healthcare Organization (JCAHO). ASHE offers its Healthcare Construction Certificate Program across the country, which is required by many healthcare organizations to do work on their property.

"The Joint Commission now does unscheduled visits and checks for this type of documentation," she added. "Be aware of what your customer needs to provide to show compliance.

"Hosptials need to track the appropriate data from isolation rooms," Rygielski said. "That will help when you do have somebody come in for an inspection.

SERVICE AND MAINTENANCE

Keeping accurate service and maintenance records for HVACR equipment can be vital for the hospital's compliance with standards.

"A growing number of hospitals and health systems are telling the contractors and operations-maintenance staff, you need to understand the issues when you are doing service," Rygielski said.

"Ceiling inspections, for instance, disturb potentially infectious dust in the plenum space. We are seeing that there is a lot more education needed for contractors and technicians."

Regarding their own safety, "I think contractors need to understand that most all hospitals have procedures for the protection of their workers," Rygielski said. "Make sure you are fully educated as to the safety procedures that hospital employees take."

"Reliability-centered maintenance" is a popular phrase in hospital administration circles.

"We're starting to see a lot more health care groups talk about reliability-centered maintenance," Rygielski said. In a survey of what is keeping administrative executives up at night, among the leading contenders were deferred-maintenance issues - higher energy expenditures and unscheduled repairs.

"Most execs understand that they may have put themselves in a position where they have not done appropriate service," she said.

"For that reason, there has been a lot of replacement hospitals built because earlier upgrades were not performed when they should have been. Now we're seeing an evolution in the other direction. Obviously, there are limited dollars for new buildings."

HUMIDITY UNBALANCED

In addition, "We have to look at how the mechanical system's performance impacts the patient and staff environment, and patient outcome," she said.

For instance, a room that is too dry might not be ideal for patients with upper-respiratory problems. Likewise, too humid of an environment can lead to mold growth and proliferation.

In surgical suites, "Doctors want to drive temperatures down lower," Rygielski said. "It helps reduce patient bleeding. But when you make it cooler, the relative humidity is driven up. If you get any kind of moisture droplets, you have a breech in sterilization."

Most standard air conditioners have a limited low temperature dehumidification capacity; the air dew point cannot be lower than the coil temperature. Specialized dehumidification products have been designed to lower humidity levels after the temperature is lowered.

For example, the Trane Cool, Dry, Quietâ„¢ (CDQ) system allows for the transfer of moisture from the supply air, lowering its dew point, to the return air (mixed air) for removal.

"The result is more than 200 percent additional water removed from the air," the company said, adding that "health care facility managers will notice lower energy costs." According to the company, the product can lower dew point temperatures 5° to 15°F, without lowering the chilled water temperature, and without subcooling and then reheating the air to achieve a low dew point.

Lower humidity in surgical suites help eliminate condensation on walls, ceilings, and surgical equipment; allowing lower temperatures. This, in turn, minimizes patient bleeding times and improves drying time for glues, allowing for proper settings in orthopedic procedures.

"Ultimately, in the area of temp-humidity control I think we will see increased regulations, with tighter monitoring like you now see for pharmaceutical companies," she said.

DO NO HARM

The most important thing for health care contractors to keep in mind, said Rygielski, is the same as the physician's Hippocratic oath: "First, do no harm."

Publication date: 11/06/2006

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