Until recent pandemic headlines IAQ was by far the most often ignored of the three ways to transmit disease in health care facilities (the other two being surfaces and human contact).

What does IAQ stand for? Indoor air quality. Doctors, infection prevention nurses, government agencies, and maintenance & engineering department heads are quickly coming around to the importance of managing air quality along with surface disinfection and human contact contamination.

The answer to how to decrease infection rates in hospitals starts with recognizing the serious threat of airborne pathogens.

So many documents tell you what they are and what illnesses they cause, but few if any centralize all the crucial facts about health care-associated infection (HAI) control in one place.

We’ve done that for you here.

Pathogens in the air are spread on particles or droplets. The solid matter may come from human skin scales, while the droplets may be generated from:

• Upper and lower respiratory tract
• Mouth
• Nose
• Vomiting
• Diarrhea

Small respiratory droplets start to evaporate after release and then change their size, resulting in droplet nuclei that are sufficiently small to remain suspended in the air for long periods of time — and still be infectious.

Respiratory droplets can be spread by:

• Breathing
• Talking
• Sneezing
• Coughing
• Singing
• Toilet flushing
• Dripping water taps
• Hard to clean drainage areas

Artificial means of producing potentially infectious aerosols in hospitals include using respiratory assist equipment such as:

• Nebulizers
• Ventilators
• Oxygen masks

Survival of pathogens in the air depends on their amount of time in the air as well as ambient environmental factors, like temperature and humidity. The transport of airborne droplets is affected by:

• Local ventilation air flows
• Movement of people
• Thermal gradients produced by various electrical equipment

Another factor is receptors in human host cells. Differing patterns of receptor distribution between different individuals in the upper and lower respiratory tracts will affect the ease with which inhaled airborne viruses can cause infection and disease.

The nature of the infecting agent and human respiratory activity itself may cause a different variety of pathogen to be expelled, with differing effects on secondary cases.

Coughing brings up deep-seated pathogens from the lower respiratory tract in the chest. These can include species of:

• Influenza
• Measles
• Pseudomonas
• Chickenpox
• Smallpox
• Tuberculosis

If you haven’t been focusing on air disinfection at your health care facility, the above information may have you scrambling for a quick solution. It’s beneficial, though, to first talk about testing. Because one company’s claims may vary wildly from another’s in terms of perspective and testing methods.

Many air device efficacy claims are based on testing with:

• Small bioaerosol chambers: Testing happened in a non-EPA Guideline Testing Chamber Location/Laboratory.
• Excessively long contact times: Pathogen contact time took multiple hours for an efficacy report.
• Ineffective killing percentage rate: The air disinfection device claims an efficacy rate of 99%. This rate is simply not sufficient when hospital-grade disinfection is needed.

Indoor air quality continues to rise in importance as a public health issue in multiple industry sectors. Many of the regulations affecting indoor air quality are only recommended guidelines by federal and nonprofit regulatory groups. These guidelines are fragmented, incomplete and overlapping, but the federal government and states are working on drafting regulations.

The EPA has strict requirements regarding EPA registered chemicals, including Good Laboratory Practices for chemistry, toxicology, and efficacy of these chemicals.

Air management devices do not require EPA registration and therefore do not require strict formal testing of their efficacy claims. Air management devices are only “regulated “ by the EPA rather than registered. Regulated devices are not required to disclose their efficacy data or verify their efficacy claims in their marketing materials.

A NOTE ON OZONE

The FDA has dispelled effectiveness claims made by air disinfection devices that involve ozone production.

The Scientific Air S400 produces NO by-products, including ozone, as verified in the Underwriters Laboratory 867 test report.

FDA, Code of Federal Regulations, Title 21, Volume 8. April 1 2017

” (a) Ozone is a toxic gas with no known useful medical application in specific, adjunctive, or preventive therapy. In order for ozone to be effective as a germicide, it must be present in a concentration far greater than that which can be safely tolerated by man and animals.”

The EPA does have a website on residential air cleaners. At this site they dispel the effectiveness claims of certain technologies such as photocatalytic oxidation. It is up to the consumer of these devices to carry out their due diligence on investigating efficacy claims in regards to particulate reduction, pathogen killing, and odor removal.

Further the EPA website on residential air cleaners, dispels the effectiveness claims of certain technologies that produce ozone. It is strongly recommend to carry out investigations and due diligence prior to purchase.