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Thursday, February 2, 2012

Airborne Virus

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Airborne Virus Control in


Hospitals


There are many examples of infectious aerosols affecting occupants of health


care facilities. It is expected, patients are often the main source of infectious


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cases, and their presence is a potential hazard to other patients and to


employee. Certain infectious such as tuberculosis, chicken pox, measles, and


Germen measles can be spread easily in air.


Employees and visitors can also be the reason of airborne infection on





patients. Airborne droplets often carry bacteria such as S. aureus, S


epidermides, and gram-negative rods, which are common causes of


postoperative wound infections.


Cases of infection with Apergillus have been reported in


immunocompromised patients. So the activity as building construction and


renovation that may be removed from the patient care area has been shown


to increase the airborne concentration of fungus spores and the incidence of


aspergillosis in immunocompromised patients.


Bacterial Infection


Examples of bacteria that are highly infectious and are airborne and also


travel threw water are Mycobacterium, tuberculosis, and Legionella


(Legionnaire’s disease). Wells (14) showed that droplets or in agents of


5 mm or less in size can remain airborne indefinitely. This is because bacteria


are typically present in colony forming units that are larger than 1 mm.


Some authorities recommend the use of high efficiency particulate air


(HEPA) filters having test filtering efficiencies of .7% in certain areas.








Viral Infection


Examples of viruses that are airborne are chicken pox, Rubella, and measles.


Epidemiological evidence and other studies indicate that many of the


airborne that transmit infection are submicron in size. There is no know


method to effectively eliminate 100% of the viable particles. Ultra low


penetration (UPLA) filters provide the greatest efficiency available.


Attempts to deactivate viruses with ultraviolet light and chemical sprays


have not proven effective enough to be recommended by most codes as a


primary infection measure. Isolation rooms are used to prevent the spread of


airborne viruses in the health care environment.


Molds


Evidence indicates that some molds such as Aspergillis be fatal to advanced


leukemia, bone marrow transplant, and other immunocompromised patients.


Prevent the entering and escaping of infectious aerosols


The most fundamental principle for airborne infection control is the


prevention of contaminated air to enter to or escape from a room.


This can be done by these two methods.


Seal the room. Differential air pressure can be maintained only in an entirely


sealed room. It is important to obtain a reasonable close fit of all doors and


seal all wall and floor penetrations between pressurized areas. The opening


of a door between two areas reduces any existing pressure differential


between them to such a degree that its effectiveness is nullified.


Pressurize the room to prevent infiltrated contaminant. This pressure


differential causes air to flow out the room through various leakage areas.


The outward air prevents the contaminated air to enter the room. The


negative pressure difference is obtained by supplying less air to the area than


is exhausted from it.


The room should have a permanently installed visual mechanism to


constantly monitor the pressure status of the room when occupied.


Remove infectious aerosols from air


Sources of infectious aerosols are both from outside and inside of the room.


The microbial level in operating room air is proportional to the number of


people moving about in the room.


Recirculation air shall be filtered by high efficiency air filter as recommended


in table with the total air change rate as recommended in table .


Outdoor air, before introduces to the room, shall also be recirculation air.

















Dilute the contaminated room air


General ventilation maintains air quality by two processes removal


and dilution of airborne contaminants. Uncontaminated supply air mixes


with contaminated air, which is subsequently removed from the room by the


exhaust system. These processes removes the concentration of droplet nuclei


in the room air. The outdoor air should be supplied as recommended in the


table and should be filtrated by air filter recommended in table 1.


Prevent micro-organism growth in the room


To control micro-organism aerosols, it is important to always keep room


relative humidity below 60%. Besides the air, the surface of the room must


not wet or damp to prevent micro-organism growth on the


surface.


The wall, floor, ceiling, door, window should be made of smooth surface,


easy t clean material. Air duct and pipe should not pass the room without


ceiling. Lighting fixture should have scaled cover.


Disinfect the air


Ultraviolet Germicidal Irradiation, was extensively studied in the 10s.


UV radiation is defined as the portion of the electromagnetic spectrum


Described by wavelengths from 100 to 400 nm. For convenience of


classification , the UV spectrum has been separated into three different


wavelength bands. Commercially available UV lamps used for germicidal


purposes are low-pressure mercury vapor lamps that emit radiant energy in


the UV-C range, predominantly at a wavelength of 5.7nm.


In duct irradiation systems, UV lamps are inside ducts that remove air from


rooms to disinfect the air before it is circulated. When UVGI duct systems


are properly designed, installed, and maintained, high levels of UV radiation


may be produced in duct work. The only potential for human exposure to this


occurs during maintenance operations.


Operating Room


Studies or the operating room air distribution devices and observation of


installations in industrial clean room indicate that delivery of the airborne


of the air from the ceiling, with a downward movement to several exhaust


inlets located on the opposite walls, is probably the most effective air


movement pattern for maintaining the concentration of contamination at an


acceptable level.


Operating room suites are typically in use no more than 8 to 1 hr’s per day.


For energy conservation, the air-condition system should allow a reduction


in the air supplied to some or all of the operating rooms when possible.


Positive space pressure must be maintained at reduced air volumes to ensure


sterile conditions.


Intensive Care Unit


These units serve ill patients, from postoperative to coronary patients.


Air pressure should be maintained positive with respect to any adjoining


by supplying 15% excess air. A variable range temperature capability of 4


to 7c, a relative humidity of 0% minimum and 60% maximum. Filter


efficiencies should be in accordance with table 1.


Conclusion


Hospitals are risk environments for airborne infection, because infection


sources and immunocompromised people are at the same place. Currently,


hospital’s are under programs to obtain certification for hospital quality


system, which is called Hospital Accreditation or HA. Accordingly, hospitals


are encouraged to promote safe and healthy environment fro patients,


relatives, visitors, and employee. However, most hospitals lack knowledge of


guidelines to effectively implement the airborne infection control measures.


This paper included basic knowledge of airborne infection, science of airborne


infection control, and the measures to effectively control infection and the


specific design criteria for several functions in hospitals.

















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