easy is something most of us take for granted. Unfortunately, just because
we get the air we need to live does not mean that the air around us is
particularly healthful for us. Particulates and gases enter our nose and
lungs all the time, and we are usually unaware of it. Some of those
particulates are harmless; some can be deadly under the right circumstances.
Ironically, healthcare facilities have all the ingredients present for
unhealthful air; yet, patients expect to go there and get well again, and
often do recover from their illness or injury, with nary a thought to air
quality during their stay.
The National Institute for Occupational
Safety and Health says, "Indoor environmental quality (IEQ) ... is
determined by many factors, including lighting, air quality, and damp
conditions. ... Indoor environments are highly complex and building
occupants may be exposed to a variety of contaminants (in the form of gases
and particles) from office machines, cleaning products, construction
activities, carpets and furnishings, perfumes, cigarette smoke, water-
damaged building materials, microbial growth (fungal, mold, and bacterial),
insects, and outdoor pollutants. Other factors such as indoor temperatures,
relative humidity, and ventilation levels can also affect how individuals
respond to the indoor environment."
Nowhere is air quality more important than
in the healthcare setting. Some interesting solutions have been born from
the need for better quality air.
Kevin Maughan, CEO,
NOVAERUS, Tampa, FL, talked about
their solution, based on plasma sterilization. The NOVAERUS field emits
electrons that disrupt biofilms and cell walls of microorganisms, while
using less energy than a 40-watt light bulb. "Developed for use in
hospitals, nursing homes, and assisted-living facilities," said Maughan,
"the NOVAERUS airborne infection-control system provides significant health,
environmental, and cost benefits to patients, staff, and visitors. NOVAERUS
eradicates all airborne viruses, bacteria, pathogens, mold, allergens, and
odors using the company’s patented air plasma field technology. It is
effective against even the most harmful contaminants, including methicillin-resistant
Staphylococcus aureus (MRSA), Clostridium difficile, norovirus,
"The NOVAERUS field uses a multifaceted
plasma sterilization technique that is uniquely destructive to all
microorganisms," explained Maughan, "with viral kill rates near theoretical
perfection (99.9999999999%). The NOVAERUS system draws air into the unit and
through a plasma field, rendering microorganisms inert and immediately
destroying them at a cellular level. It also reduces microbial surface
counts by up to 68%."
Maughan highlighted the cost-effectiveness
of the NOVAERUS plasma sterilization method. "Facilities will realize
immediate financial benefits, including significant reductions in staff sick
days; readmission rates associated with infections in nursing homes; amount
of money facilities spend on antibiotics, isolation rooms, and chemicals to
mask odors; and flu and norovirus outbreaks, which reduce the risk of
closing admissions during critical times of the year. The yearly expense for
installing NOVAERUS facility-wide typically equates to the cost of treating
one healthcare-acquired infection."
Nothing spells success like positive
experiences. Maughan spoke of two facilities that have used NOVAERUS with
good results. "The West Gables Health Care Center, a skilled nursing
facility in Miami, and the Bay Oaks assisted-living facility, also in Miami,
are two of the first long-term−care facilities in the country to implement
infection-control programs that combine the NOVAERUS plasma technology with
their staffs’ proven expertise and traditional best practices. Both have all
but eliminated incidents of respiratory distress among residents and staff."
"Marco Carrasco, administrator of the West
Gables Health Care Center, reports that, during the first 2 months of 2013,
his facility had 115 total admissions, with only 3 patients that were
rehospitalized for pneumonia. This represents a significant reduction from
both the previous year and the national average (18.3%). Bay Oaks
administrator Kathryn Kassner has not had one resident visit a physician due
to a respiratory issue since January 2013."
One of the most prevalent trends in air
cleansing is use of ultraviolet C (UV-C) light waves. Absorption of UV-C
disrupts the DNA of microorganisms, rendering the cell unable to grow or
reproduce. The inability to reproduce inhibits its ability to infect, and of
course the cells die off.
before and after Steril-Aire UVC Emitter germicidal lamps installation.
Tim Leach, Healthcare Solutions Director,
Steril-Aire, Burbank, CA, talked about the virtues of their system. "Since
the building’s mechanical system is essentially the "respiratory system" of
the healthcare facility, its bioburden has an impact on literally every area
of the hospital for every patient, every visitor, every member of the
hospital staff, 24/7. Installed in existing or new heating, cooling, and
ventilating (HVAC) systems, Steril-Aire’s patented germicidal ultraviolet
irradiation (UVGI) system keeps coils and drain pans clean, eliminating a
major amplifier, reservoir, and disseminator of pathogens contributing to
"Many microorganisms that grow in
air-conditioning systems are those
commonly attributed to healthcare-acquired infections (HAIs). These include
Pseudomonas, Serratia, Enterobacter, Acinetobacter, Aspergillus, and
Staphylococcus. The proper use of UVGI/ UV-C is lethal to mold,
bacteria, and viruses. Studies demonstrated a greater than 5-log reduction
of the bioburden within the HVAC system and the patient-care environments.
These studies also demonstrated the improved HVAC and patient-environment
hygiene was directly correlated to reduced infections within critically ill
patient populations. Additionally there is no evidence microorganisms can
become resistant to the germicidal effects of UV-C."
Leach also talked about the financial
advantages of using UVGI. "Steril-Aire healthcare customers typically have
seen a return on investment in less than 2 years. One major tertiary-care
hospital reduced HAIs, saving the hospital over $850,000 annually in
nonreimbursable direct medical costs on a $50,000 investment.2
Reduced HAIs [have] an impact not only on the facility bottom line but also
in improving Hospital Consumer Assessment of Healthcare Providers and
Systems (HCAPHS) scores and community image."
"Because the UVGI eliminates the need to
chemically clean the HVAC systems cooling coils, it can be considered
green," said Leach. "No chemicals and no ozone also mean it is safe for
building occupants. By keeping HVAC components clean, Steril-Aire UV-C also
increases system heat-exchange efficiency, improving thermal comfort while
significantly reducing energy and maintenance costs."
Leach offered scientific evidence. "Steril-Aire’s
healthcare customers have realized reduced HAI rates, improved patient
outcomes with shorter stays, and a significant reduction in direct and
indirect medical costs."
"A peer-reviewed study2
performed at Women and Children’s Hospital of Buffalo (NY) demonstrated a
>5-log microbial-load reduction per square centimeter of HVAC coil in just 6
days," said Leach. "The study showed a 50% reduction in
ventilator-associated pneumonia, reduced antibiotic use in neonatal
intensive-care high-risk patients, as well as medical savings of more than
$850,000 in the first year." Leach added, "Rio Grande (TX) Hospital achieved
over $60,000 annual savings in energy costs, while reducing maintenance and
Richard Hayes, President,
Devices Inc., Valencia, CA, highlighted their extensive experience with UV-C
air cleansing. "UltraViolet Devices Inc. (UVDI), has been in the UV-C
airstream disinfection space for over 10 years. Our largest air-disinfection
vertical is healthcare where UV-C air-disinfection systems are installed in
HVAC equipment to disinfect air delivered to operating rooms, emergency
rooms, intensive care units (ICUs), and burn wards, as well as general
hospital air. These UV-C air-disinfection systems are on 24/7, to
continuously deliver disinfected air throughout the facility."
airstream disinfection systems are
installed in the facility's HVAC equipment.
"UVDI’s UV-C air-disinfection systems are
mounted permanently in the HVAC system and are easily installed by hospital
maintenance staff. Once installed, they clean the air 24/7 and deliver
disinfected air to the hospital areas the HVAC system services. UVDI’s
proprietary airstream disinfection modeling software, developed in
conjunction with the Pennsylvania State University, accurately determines
airstream microorganism kill performance based on UV-C system design, target
organisms, and HVAC system parameters. With our proprietary software, UVDI
has the ability to easily tailor UV-C system airstream design to achieve
desired disinfection results."
"UV-C is lethal to all single-cell
organisms. It has been used safely for over 100 years to disinfect drinking
water. UV-C has been used for tuberculosis management since the 1950s, but,
due to technology advancements, has recently gained strong interest in the
healthcare space to mitigate threats from air-transmissible pathogens such
as influenza, Legionella, and tuberculosis, as well as surface environmental
contamination threats such as MRSA and C difficile."
Hayes cited positive experiences from users
of their UV-C product. "Recently, Florida Hospital Group (FHG), Orlando, FL,
a 2,247-bed healthcare provider with 7 acute-care campuses, conducted an
extensive 18-month test of 4 UV-C manufacturers to determine who would be
the best UV-C system supplier for their facilities. At the conclusion of the
study, FHG selected UVDI as their UV-C system supplier due to efficacy but
also due to the lowest cost of ownership of the systems studied."
Meredith Jimenez, Corporate Communications
Director, American Green Technology, South Bend, IN, talked about a product
expected to be available from the Arcalux Corporation, Houston, TX, shortly
before this printing.
Arcalux Health Risk Management System
"The Arcalux Health Risk Management System
(HRMS) is suited for any healthcare facility where contracting HAIs is a
risk to the health of staff and patients," said Jimenez. "Employing Centers
for Disease Control and Prevention’s recommended hierarchy of controls, the
Arcalux HRMS eliminates pathogens at the source by using differential
pressure to create airflow through a UV-C radiation chamber. Then
filtration, purification, and dilution take place, resulting in continuously
purified air and a reduction of pathogens causing HAIs. The HRMS is the only
patented system using this technology."
"The advantages of the HRMS are numerous,"
said Jimenez. "First and foremost, it will help save lives. It is an energy
efficient "green" product that uses less than 100 watts of power. Not only
is this product simple to install but it doesn’t upset the current HVAC
system in place and it is easy to maintain with tool-less lamp, filter, and
Jimenez added, "According to the Report
on the Performance of the Arcalux Health Risk Management System, by
Wladyslaw J. Kowalski, Ph.D., PE, ‘The superior performance of the Arcalux
HRMS will enable high levels of air disinfection to be achieved as well as a
consequent reduction in the risk of airborne nosocomial infection in any
Peter Gordon, Senior Partner, Germgard
Lighting LLC, Greenwich, CT; Chair, IUVA Healthcare Working Group, talked
briefly about their UV-C product in development. "Germgard is developing a
point-of-surgery, point-of-care, point-of-use, mobile, UV-C, LED-based,
air-disinfection device. It utilizes an innovative patent pending adjustable
entrapment technique enabling very high efficacy against spores, bacteria,
and viruses in a very compact space. Its unique size and scalable features
allow it to be integrated into other infection-prevention disinfection
systems or as a low-cost, environmentally friendly, low power consumption,
stand-alone unit. It will provide a high level of air disinfection,
preventing infectious pathogens from settling on surgical sites during
procedures, on high-touch surfaces, on the patient during recovery in the
ICU, or on workers or victims in emergency or disaster situations."
Airborne particulates can present an
elevated risk during construction projects at healthcare facilities. Natural
and man-made disasters also may call for special measures. Fortunately,
there are companies that provide products designed specifically to contain
and isolate. Mintie Technologies Inc., Los Angeles, CA, is one of those
companies. Jim Bieritz, Director, US Sales, described some of their
containment products. "Mintie ECUs [environmental containment units] are
used for construction, renovation, and maintenance activities to provide
safe risk mitigation for projects requiring Infection Control Risk
Assessment containment levels 1 through 4 in occupied patient space. An ECU2
Bundle with the Corridor Flange solution provides for temporary surge
isolation. This scalable design provides contingency options for creating
larger isolation areas, such as a corridor or a wing of a facility, when
emergency plans escalate. Additionally, the ICORoom option is designed for
containing an OR suite when an infected patient needs to undergo a surgical
procedure, mitigating risk of spreading contamination from the positively
Mintie’s ECU2 generation of product is modular,
scalable, and multifunctional, with all four levels of containment to comply
"Mintie provides mobile containment to
facility engineers and contractors to contain particulate generated by their
work," continued Bieritz. "Whether access to plenum or sidewall space or
segregating HVAC service is required, Mintie products meet the challenge of
mitigating HAIs. Disposable envelope (DE) options for existing frames add a
superior option for work in critical-care areas. With proper use, Mintie
containment products are an effective means to protect against HAIs related
to facilities work activity, especially for patient populations that are
immunocompromised and for critical-care populations. Utilizing containment
mitigates the risk and costs associated with HAIs, lawsuits over wrongful
death, and fines for noncompliance by the Joint Commission."
Bieritz noted their products’ ease of use.
"Mintie’s frame design makes deployment simple and ready to use in minutes.
The collapsible frame makes the ECU product easy to store, and it is very
portable. The mobile platform allows for easy relocation without removing
ladders and tools. The attachable Tow Cart can carry a HEPA unit to provide
level 3, required negative pressure for
critical-care environments. The DE eliminates maintenance of the product."
1. National Institute for
Occupational Safety and Health. Indoor environmental quality.
Last accessed August 13, 2013.
2. Ryan RM, Wilding GE, Wynn
RJ, et al. 2011. Effect of enhanced ultraviolet germicidal irradiation in
the heating ventilation and air conditioning system on ventilator-associated
pneumonia in a neonatal intensive care unit. J Perinatol.
3. Olmsted RN. Pilot study of
directional airflow and containment of airborne particles in the size of
Mycobacterium tuberculosis in an operating room. Am J Infect Control.