Patients often evaluate the care they receive in hospitals based on their first-hand experiences with doctors and nurses. But very rarely are they aware of the efforts of a facility’s maintenance and engineering department to provide a safe, clean and healthy indoor environment.
“Quality care is all about caring,” says Dan Vallieu, Thomas Jefferson University Hospital’s director of facility services. Part of Vallieu’s definition of caring for occupants is providing superior indoor air quality (IAQ). This effort is critical in keeping contaminants from entering the building, handling contaminants in the building, and maintaining a comfortable environment.
Over the last five years, the Philadelphia hospital has been upgrading its entire air-filtration system. For its IAQ-improvement efforts, the hospital earned the 2003 Clean Air Award from the National Air Filtration Association. By incorporating new technology, the hospital has achieved both efficiency and financial benefits, including $1.6 million in annual savings from lower energy use. To date, the hospital has spent $600,000 on upgrading the systems.
The decision to upgrade was prompted by the age of the existing units and problems such as water leakage, says John Mahony, project manager with the hospital’s facility design group.
“Of course, we were already meeting the industry’s IAQ standards prior to the upgrades,” he says. “But much of the equipment was at the end of its serviceable life, and it was obvious we needed to do some upgrades and changes.”
“As a system ages, maintenance managers need to be aware of its condition so they can petition administration for funding a replacement before a catastrophic event happens,” says Mahony, who worked with the maintenance department in developing the project’s scope.
The project received funding after Vallieu explained to hospital executives how upgrading equipment would improve environmental control, enhance energy efficiency and save money. For example, Vallieu suggested upgrading from 30-percent pleated to 40-percent filters.
“Because of the filters’ improved design, we created better air flow and could make sure we’re supplying ample air changes on all floors,” he says, adding that the new filters extended the changeout time by 25 percent from 90 to 120 days, bringing savings in material and labor costs.
“Although these individual filters cost more, we’re able to save money because we have to change them less frequently,” he says.
After collecting product information on IAQ-related equipment from vendors and selecting a team of consultants and contractors, Vallieu and the project managers began plans for upgrading the building automation equipment and all of the temperature controls, and surveying all of the air filters in the hospital facilities. Project managers compared the hospital’s application of IAQ equipment to industry standards and looked for areas needing improvements.
The ultimate concern of health care facilities when it comes to IAQ is controlling airborne bacteria that threaten the health of building occupants, particularly patients who are especially susceptible to infection.
“We were in touch with our environmental health and safety group and also infection control department, who had some IAQ concerns prior to the upgrades,” Vallieu says. Because providing the optimum number of air changes can reduce the risk of sickness, Vallieu says he paid particularly close attention to air-balancing issues throughout the upgrade.
“The last thing I wanted to do was be part of the problem,” Vallieu says.
To enhance contamination control, the hospital installed a ceiling-mounted negative air purifier with a HEPA filter in the emergency department and HEPA filters in operating rooms and critical-care areas.
“Because HEPA filters are more delicate than fine china, the maintenance staff received special training on how to handle a HEPA filter,” says Bill Cawley, CAFS, a distributor who consulted on the project. “They are extremely fragile. If you touch the surface of a HEPA filter, you can render it useless. It’s important they know how to handle them without touching their face.
“To ensure the HEPA filters didn’t have any leaks, an outside company tested the filters after they were installed by scanning each surface of the filters in every ceiling,” Cawley says.
Air balancing also plays a major role in keeping indoor areas healthy.
“Providing the right quantities of air so there is proper air balancing is extremely important,” Vallieu says. “The air balancing gives you the proper amount of air changes per hour, which leads to a lot healthier environment. When working on the air handler, managers need to make sure the balancing air flows and pressure correlate.”
“We have a program to make sure we’re delivering the right amount of air to each space and have the right measure correlation between those areas. The monitored spaces, like the isolation rooms, are pretty easy to see because they’re tied into the building automation system. In other areas, we have to take the pressure differentials manually between the rooms.”
One problem the department addressed immediately was water leaks from the air-handling units. Sound attenuators located upstream from cooling coils caused the air-flow velocity to accelerate above recommended levels. The air was traveling too fast for the coils to collect the moisture and, as a result, water dripped into spaces below the units.
“We relocated the sound attenuators downstream in the ductwork and replaced the coils,” Mahony says. “This allowed us to bring the air flow to an acceptable velocity.”
Other moisture-control upgrades included replacing final filters with hard-frame filters, which contain more media and moisture resistance and, as a result, prevent problems associated with saturated filters.
“When the filters get wet, they’re resisting air flow, and you’re not getting the air flow across the filter and to the building occupants who need the air changes,” Vallieu says. “It’s like if you can imagine taking a handkerchief, putting it over your face and breathing through it. Now, if you wet that same handkerchief and put it over your face, suddenly, it’s a lot harder to breathe.”
Many odors in hospitals come from materials that are either strong acids or strong bases. For example, urine is highly alkaline, a strong base.
To better control such odors, the hospital converted to PH odor control air filters in many areas of the buildings. These filters are designed to bring acid- and base-odor molecules into a more neutral, PH-balanced, odor-free state. The media fibers of the filter are coated with sodium bicarbonate, an industrial version of baking soda.
Another odor concern was exhaust fumes produced by helicopters that land on one of the hospital’s rooftops.
“The helipad is adjacent to the air intake for the bone-marrow unit, so it was critical that we took care of any odor concerns,” Cawley says.
Adds Vallieu, “If the helicopters were arriving and departing quickly, there wasn't a problem. But when they’re sitting up there running for an extended length of time, there is a significant amount of jet fuel exhaust coming out of the back.”
Prior to the upgrade, the hospital used traditional carbon-charcoal trays in the helipad area. This method usually doesn’t pose a problem, but it is possible for carbon from the trays to migrate through the building’s ductwork, Cawley says. So the hospital chose to upgrade to a disposable carbon adsorber for the helipad area.
“We eliminated our charcoal filter trays and selected a prefilter with charcoal impregnated in the media itself,” Vallieu says. “These filters allowed us to improve the air quality. Now, when we do 120-day changeout, we’re not just doing the prefilter; we’re doing a charcoal filter.”
After installing the filters, the team tested its efficiency in the helipad area.
“We knew if it worked here, it was going to work anywhere else, Vallieu says. “The filter turned out to be very successful.”
“We have done a lot of work,” Vallieu says, adding that some upgrades still need to be made to the common areas of the buildings. The checklist of items replaced includes hundreds of filters, as well as cooling coils, heating coils, valves and moisture eliminators on the air handlers. The project also included upgrades to the building automation system and equipment such as drive systems, supply fans and return fans.
“We feel we’ve done what we needed to do, but who knows what changes will happen over the next few years,” Vallieu says, adding that he will continue to look for ways to improve IAQ.
The effort is enhanced in many ways by today’s building automation technology, which greatly improves the facility services department’s capabilities.
“It is so great today that you can sit there and read all the numbers and control them from that point,” he says. “Back in the old days you had to go up and do all the readings by hand. That is why we can do so much more now.”
