Warding off air quality problems
Clean air is probably more important for the facilities users of hospitals and care homes than in any other sector. In the light of recent reports of infection being spread through ventilation ductwork, Gary Nicholls, MD of duct cleaning experts Swiftclean, explains the importance of complying with TR/19 guidelines.
There was a time when clean air was prescribed by doctors as a health cure for patients with respiratory ailments, and it has long been recognised as beneficial for everyone. In the past, much of the concern over indoor air quality centred around preventing condensation by providing a plentiful air flow for the occupants of a building. However, the recent incidence of infection being spread through uncleaned ductwork at Queen Elizabeth University Hospital in Glasgow has highlighted the importance of removing from ventilation ductwork, following inspection on a regular basis, the inevitable accumulated dust, dirt and lint that can harbour bacteria and mould spores.
All ventilation ductwork should be inspected and tested at regular intervals and cleaned where dust levels exceed the benchmark limits in compliance with TR/19, the leading guidance document for ventilation hygiene, issued by BESA. The second edition of TR/19 introduced a requirement for all newly installed ventilation systems to be handed over for use in cleaned, TR/19 compliant condition. This was an important advance because, prior to this, ventilation ductwork was all too often found to contain dirt and debris from the construction process. There still may be some systems which have never been cleaned and which pre-date the second edition of TR/19, so it is vital for good air quality that these are tested and where necessary cleaned to TR/19 guidelines as soon as possible.
Unfortunately, as it is largely hidden, it is too easy for the ventilation system to be out of mind as well as out of sight. Although news reports of infection being spread are alarming, we should take them as an impetus to spur us to inspect, test and where necessary clean ventilation systems regularly. This benefits everyone. Care staff who work in poor air quality will suffer a cumulative long-term effect leading to increased sickness and absence levels, which is not good news for patients or managers. Additional costs will be incurred for replacing staff on sick leave, putting additional pressure on hospital budgets. Patients with compromised health or immune systems will be more immediately vulnerable to the ill effects of poor air quality, particularly hazards such as airborne spores or bacteria. Just as handwashing is now a major emphasis in hospitals, clean air should also be a high priority.
In every commercial building, it is important to classify the ductwork of the ventilation system as low, medium or high in terms of cleaning requirements. In a hospital, there will be different classifications according to the area and function of each sector of the building. The manager responsible for maintenance, perhaps in consultation with infection control, will need to define the classifications of each ventilation system serving the healthcare facility. Operating theatres, not surprisingly, will typically have a high classification. Wards, although not quite as critical, must have a good indoor air quality in order to promote speedy recovery and good health, so these will likely be given a medium classification. All public areas, as well as administrative offices should also be given a classification, typically medium. Less well occupied areas such as boiler rooms can be probably be given a low classification, however, steps must still be taken to ensure that these premises are as clean as possible, to prevent bacteria, such as the pigeon-related infection which affected Queen Elizabeth University Hospital, from entering the ventilation system.
The actual cleaning process in all these classification areas is the same, it requires the effective removal of any dust, dirt, lint or construction debris, leaving the ductwork completely clean and capable of meeting the TR/19 post clean verification test. The practical difference between the different classifications is in the thickness or weight of deposit which indicates cleaning being required. TR/19 sets out helpful tables which indicate how frequently the various areas in a building should be tested according to their cleanliness classification. Some parts of a hospital will require particular treatment; for example, laundry extracts must be regularly cleaned to remove dust and lint particles which can cause fires. Another potential fire hazard is the build up of grease in a kitchen extract system. Again, TR/19 explains how often these should be cleaned according to the rate of grease accumulation.
In order to comply with TR/19, it is essential that we have access to the entire ventilation system, so particular attention should be given in every new system, to providing adequate access to achieve TR/19 compliance throughout. In older systems, we can retrofit additional access doors, but where solid ceilings and false walls are added after installation, this may not be possible without major renovation works. It is far better, therefore, to design and install new ventilation systems with future TR/19 compliance in mind. In settings where we care for the sick or infirm, maintaining good indoor air quality, and therefore the ability to access all the areas of the ventilation system, is always essential for everyone.