It is so important to stay aligned , to trust each other enough to be able to pick up the phone when something bad has happened , whether it ’ s a flood or an explosion or some other event , and to be able to work together effectively . Infection preventionists need key relationships beyond who they directly report to , such as people in the pharmacy , in the microbiology lab , in environmental services and their plant management or facilities management is right up there in importance .”
activities we are performing in the space , what kind of patient populations we are serving , the types of illnesses , conditions , or disease they might have , and what kinds of procedures and surgeries we are performing . Then , we can re-examine whether we need to make some changes to increase air changes or improve filtration or change the direction of the air , and what should that be ? Post-COVID is the time to reassess , which I don ’ t think is a bad thing .”
Dickey continues , “ When we were first were dealing with COVID , many people were saying that certain patient-care activities , all the way down to brushing a patient ’ s teeth , should be considered an aerosol-generating procedure . Fear can be tricky ; it can make people believe that a very minor activity fits into the category of high risk . When fear is low , we see swings to the opposite side of the spectrum , where healthcare personnel don ’ t want to wear an overabundance personal protective equipment ( PPE ); they say , “ I just want to wear what I and my patient need to be reasonably safe .’ But there ’ s a sizable grey space between being reasonably safe and having a work space with absolutely no safety risk . You can require the use of a significant amount of PPE to try to achieve a risk factor of absolute zero , but there is a certain level of tolerance among healthcare personnel to don or doff PPE . The goal is comfortable and effective PPE that provides a reliably safe environment , but no work environment is going to be totally without risks at all times .”
Dickey agrees that IPs should befriend their facilities director . “ I was fortunate that my facilities director and I were not only personal friends , but the closest of professional colleagues , and I think it ’ s one of the most critical relationships you can have , for both parties ,” she says . “ It is so important to stay aligned , to trust each other enough to be able to pick up the phone when something bad has happened , whether it ’ s a flood or an explosion or some other event , and to be able to work together effectively . Infection preventionists need key relationships beyond who they directly report to , such as people in the pharmacy , in the microbiology lab , in environmental services and their plant management or facilities management is right up there in importance .”
One of the reasons for the existence of that key relationship is that environment of care-related guidance can be intricate , and facilities directors can be very helpful in translating recommendations into practice that supports infection prevention .
For example , let ’ s review the myriad recommendations issued by societies governing healthcare air-related imperatives .
In January 2021 the American Society of Heating , Refrigerating and Air-Conditioning Engineers ( ASHRAE )’ s Epidemic Task Force released new guidance to address control of airborne infectious aerosol exposure . ASHRAE ’ s Core Recommendations for Reducing Airborne Infectious Aerosol Exposure are based on the concept that ventilation , filtration and air cleaners can be combined flexibly to achieve exposure reduction goals subject to constraints that may include comfort , energy use and costs .
“ This guidance outlines a clear approach for lessening the risk of infectious aerosol exposure for building occupants that can be applied in a wide range of applications , from homes to offices to mobile environments such as vehicles and ships ,” said William Bahnfleth , PhD , PE , chair of the ASHRAE Epidemic Task Force , in a statement . “ ASHRAE ’ s Core Recommendations are based on an equivalent clean air supply approach that allows the effects of filters , air cleaners , and other removal mechanisms to be added together to achieve an exposure reduction target .”
In early April 2021 ASHRAE ’ s Epidemic Task Force released an updated statement on the airborne transmission of SARS-CoV-2 in buildings : “ Airborne transmission of SARS-CoV-2 is significant and should be controlled . Changes to building operations , including the operation of heating , ventilating , and air-conditioning systems , can reduce airborne exposures .” It replaced the April 2020 statement that said airborne transmission was “ sufficiently likely ” that airborne precautions should be taken . At that time both the World Health Organization ( WHO ) and the Centers for Diseases Control ( CDC ), contended that transmission of SARS-CoV2 was by droplet and fomite modes , not airborne . Subsequently , both acknowledged the risk of airborne transmission indoors .
In early July this year , ASHRAE published ASHRAE Standard 241 , Control of Infectious Aerosols , its consensus-based , code-enforceable standard that was developed to reduce the risk of infectious aerosol transmission in buildings . At the time of the announcement by ASHRAE that it was working on a draft of a first-ever pathogen mitigation standard , 2022-23 ASHRAE president Farooq Mehboob , noted , “ The entire world was touched by the effects of the pandemic , and we learned that an effective way to protect ourselves from the spread of pathogens is to improve the indoor air quality and ventilation in the buildings that we occupy . Nowhere in the world do we have a standard that universally addresses the concept of mitigating pathogen spread and IAQ and ASHRAE is proud to lead in the development of the guidance .”
ASHRAE ’ s Standard 241 establishes minimum requirements to reduce the risk of airborne disease transmission , such as SARS-CoV-2 virus , the influenza virus , and other pathogens in buildings , including healthcare facilities . The standard applies to new and existing buildings and major renovations and provides requirements for many aspects of air system design , installation , operation , and maintenance .
“ Volunteers and staff dedicated their expertise and thousands of hours of their time to address this urgent industry and societal need ,” said ASHRAE ’ s Bahnfleth . “ The development of this standard shows not only ASHRAE ’ s ability to respond rapidly to a societal need , but also a steadfast commitment to
20 august 2023 • www . healthcarehygienemagazine . com