OPERATING ROOM
Maintaining air, steam, water quality simply elemental
by Kara Nadeau Photo credit: nikkytok |
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y air, steam or water, microbes and contaminants can spread throughout healthcare facilities, including those areas that play a key role in patient care and safety. This includes the Central Service/ Sterile Processing & Distribution (CS/SPD) department, where instruments are repro- cessed, and the operating room (OR) and other procedural areas where patient care is delivered. ecause it is often difficult if not impos- sible - to monitor effectively air circulating in a room and the water and steam used for cleaning and sterilizing instruments with the naked eye, the quality of these elements can sometimes be overlooked. Poor air, steam or water quality in a healthcare environment can endanger staff members and patients, and damage infrastructure, equipment and instruments.
Manufacturers of systems for air, steam and water quality management, mitigation and treatment in healthcare environments offer their insights into the challenges faced in this area, the impact of poor quality, and best practices for measuring and monitoring these critical elements.
Quality in the air
Air quality is quickly becoming the next frontier in infection prevention, explains Jim Dacek, Senior Product Manager, Surgical Solutions, STERIS.
“In recent years, healthcare has addressed room surfaces, hand hygiene, gowning, etc., in the OR, but there hasn’t been much emphasis placed on air as a primary source of contamination. Hospital staff members need to be aware of potential risks associated with air quality that is out of spec (tempera- ture, humidity, particle counts, differential pressure, etc.) per American Society of Heating, Refrigerating and Air-Conditioning Engineers (ASHRAE) Standard 170-2017, Ventilation of Health Care Facilities.” In the OR and other procedural areas, James Marsden, Ph.D., Executive Director of Science and Technology, RGF Environmental, notes how air-borne or particle-borne pathogens including bacteria, virus and mold, can result
The STERIS CLEANSUITE gapless laminar flow ceiling system
cracks in the buildings founda- tion, outdated or poorly function- ing HVAC systems, and windows that are not properly sealed (or conversely, left open for too long) can all carry air pollutants into an environment and make achieving sterilization difficult,” Birkenes explained.
“The goal of a hospital CS/SPD is to provide the right items to the user at the right time and under the right conditions,” Hoffmann added. “Providing a sterile item in the right condition to the end
in nosocomial infections and reinfection rates. He points to a recent case where a hospital’s failed efforts to contain Aspergillus mold led to a one-month-old baby’s heart infection fol- lowing open heart surgery, and the family’s subsequent lawsuit.1
“Poor air quality presents considerable
risk to patients and staff through nosocomial infections,” said Marsden. “Airborne viruses like SRS-Co- and inuena can cause patient and staff issues, as can air and surface born bacteria like MRSA, strep, C-diff, as well as mold and yeast issues in HVAC and air- conditioned spaces.”
Karen Hoffmann, RN, MS, CIC, FAPIC, FSHEA, an infection preventionist consultant for the Vidashield UV24 fromNuvo Surgical, echoes the risks.
“Contaminated air in CS/SPD has been a factor in surgical site infection outbreaks primarily involving mold and fungi (e.g., Curvularia),” said Hoffmann. “CS/SPD staff, who must work in close contact with disinfectants and sterilant products, can also suffer from breathing respiratory irritants for prolonged periods.” Specific to the CSSP, Oyvind irkenes, CEO of Airthings, points to how harmful contaminants, such as airborne pollut- ants, particulate matter, bacteria and more, can undermine sterilization efforts if they are not removed from the air in the department. “There’s a reason we refer to air qual- ity contaminants as ‘the invisible enemy’
12 December 2021 • HEALTHCARE PURCHASING NEWS •
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user’s area requires not only good work practices, but also good environmental condi- tions. The challenge for CS/SPD is to ensure that environmental monitoring systems are used routinely (according to the established standards) for proper quality assurance to ensure good environmental conditions.” As Birkenes indicates, the impacts of poor air quality can also have a major impact on health and well-being of CS/SPD staff mem- bers. He references the risks of “Sick Building Syndrome,” which the Environmental Protection gency (EP) defines as “A set of symptoms that affect some num- ber of building occupants during the time they spend in the building and diminish or go away during periods when they leave the building. Cannot be traced to specific pollut- ants or sources within the building.”2 “Poor air quality, caused by a broad range
of factors like CO2, airborne pollutants, particulate matter and more, can lead to a number of detrimental outcomes ranging from triggering asthma and allergies all the way to radon-induced lung cancer and the transmission of airborne viruses,” said Birkenes. “Mold or mildew spores can also irritate the respiratory system.” Birkenes says another contributing factor to
poor air quality in the hospital environment is the heavy use of chemical cleaners, coupled with “notoriously dry air” that increases the risk for chemical exposure and virus trans- mission due to lower-than-recommended humidity levels.
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