Hospital & Healthcare Facilities Our population is aging and people are live longer lives due in part to the techniques and practices used in hospitals and healthcare facilities. Most all procedures involve the use of air filtration to provide a safe and clean environment to prevent infection and to stop the spread of airborne diseases. Copyright National Air Filtration Association 2006 Rev. 2

Estimated Deaths – Hospital Acquired Infections 90,000 per year And Costs $4.5 Billion Per Year Source: Centers for Disease Control and Prevention Even with the best of modern techniques, the Centers for Disease Control and prevention estimate over 90,000 people die each year due to hospital-acquired diseases – 75,000 of which are preventable. We at NAFA believe many of these deaths attributable to upper respiratory infections could be prevented with best practice use of higher efficiency air filtration. Copyright National Air Filtration Association 2006 Rev. 2

Airborne Contaminants Found In Healthcare Facilities That are transmitted through the airborne infectious droplet route Let’s discuss some of the more common airborne contaminants found in the hospital environment Copyright National Air Filtration Association 2006 Rev. 2

Bacteria/Virus/Fungi Bacteria – one-cell organisms that multiple by cell division Virus – multiply by entering a host cell, using the cell’s DNA to manufacture clones of themselves Fungi – multiply through the formation of spores that separate from the parent Hospital borne infections are usually caused by viruses, bacteria or fungi. Copyright National Air Filtration Association 2006 Rev. 2

Sources of Contaminants in Healthcare Environment Where do contaminants come from? Most people think outdoor air is “fresh” which, in most places it is not. Air handling systems that have not been properly maintained along with building furnishings and fixtures provide a large number of particulate and gas-phase contaminants. In hospitals and healthcare setting, people and processes are the biggest polluters of the indoor environment. Copyright National Air Filtration Association 2006 Rev. 2

AIA Filtration For Hospitals* Area Designation No. Filter Bank Filter Bank filter beds #1 #2 All areas for inpatient care, 2 MERV 6 - 30% MERV 15 - 90% treatment and diagnosis, and those areas providing direct service or clean supplies such as sterile and clean processing, etc. Protective Environment rooms 2 MERV 6 - 30% 99.97% (MERV 17) Laboratories 1 MERV 14 - 80% - Adm, bulk storage, soiled holding 1 MERV 6 - 30% - Areas, food preparation areas and Laundries *Guideline for Design and Construction of Hospital and Healthcare Facilities – Table 7.3 The new American Institute of Architects Guidelines for Design and Construction of Hospital and Health Care Facilities provides the air filter efficiency numbers for critical areas of a hospital or healthcare facility. Emphasize no fiberglass throwaway filters..everything starts at MERV 6 and above. Copyright National Air Filtration Association 2006 Rev. 2

Mini-pleat V-Cell Copyright National Air Filtration Association 2006 Rev. 2

History of HEPA Filters High Efficiency Particulate Air filter How do we remove the smallest of contaminants and make the air indoor cleaner and healthier for patients and healthcare workers? High Efficiency air filters for general ventilation and HEPA filters for critical areas are the most popular way of removing contaminants from the air. Copyright National Air Filtration Association 2006 Rev. 2

To Be A HEPA Filter “Throwaway extended-medium dry-type filter in rigid frame having minimum particle-collection efficiency of 99.97% (that is a maximum particle penetration of of 0.03%) for 0.3 µm particles of thermally-generated DOP particles or specified alternative aerosol.” --IEST This is the definition – emphasize the 99.97% is a minimum Copyright National Air Filtration Association 2006 Rev. 2

Background on HEPA Filters HEPA filters were invented during the Manhattan Project when removing nuclear particles from air was a must in the laboratories. Copyright National Air Filtration Association 2006 Rev. 2

HEPA Filter Testing HEPA filters should be factory tested to assure the minimum efficiency 99.97% on 0.3 micrometer particles Personnel installing/replacing should be trained in proper installation – proper personal protection In-place challenging for integrity is highly recommended There are several differences types of HEPA filters – most hospitals use the “A” type of HEPA, either downstream of all mechanical devices in the system, or mounted on the ceiling as a terminal unit. In all cases, HEPA filters should be tested at the factory and have a minimum efficiency of 99.97% on 0.3 micrometers – using an appropriate challenge. Installers of HEPA filters should be trained on the correct procedure of HEPA installation. Most manufacturers will be provide this information – if not, contact NAFA. Finally, after the filters are in, we recommend in-place filter testing. Copyright National Air Filtration Association 2006 Rev. 2

2 Years in Service Copyright National Air Filtration Association 2006 Rev. 2

HEPA Filter Integrity Testing In-Place Integrity (full media scan) Also includes joints, frames, ceiling, gaskets and other seals Even though the filters are tested at the factory, they are usually shipped via the Gorilla Trucking Company, hauled over the smoothest of roads, then transferred at a station where one or two prongs of the folklift will be run into the pack. After that, they are given to a local trucking company who kicks them off the back of the truck and warehouse people toss them onto the floor. Usually the installing individuals have not been trained in the best practice way of installing HEPA filters. Having HEPA filters scanned in situ is one of the best things that you can do to assure integrity…not only of the media, but of joints, seals, gaskets and the conveyance system. In-place testing can usually be arranged through your local NAFA representative or through the NAFA national office. Copyright National Air Filtration Association 2006 Rev. 2

Biological Safety Cabinets Copyright National Air Filtration Association 2006 Rev. 2

Ultraviolet Germicidal Irradiation Copyright National Air Filtration Association 2006 Rev. 2

Chemicals and Other Ethylene Oxide Aldehydes Waste Anesthetic Gases Surgical Smoke Latex - Protein on Powdered Particulate Antineoplastic Drugs Hospitals need to be aware of chemicals used that can effect the health of all occupants. All of the above chemicals can cause problems in the indoor environment. Gas phase filters using activated carbon and/or potassium permanganate can safely and effectively capture chemical and gas odors to keep them out of the indoor environment. Copyright National Air Filtration Association 2006 Rev. 2

Gaseous Contaminant Removal Principle Methods Physical – Adsorption Activated carbons Chemical - Chemisorption Chemically treated activated carbons Potassium permanganate impregnated media As discussed in the Technology of Clean Air presentation, the type of media used to remove chemical contaminants will depend on that particular chemical…consult your NAFA representative for details. Copyright National Air Filtration Association 2006 Rev. 2

Proposed Standard ASHE/ASHRAE Standard 170P Copyright National Air Filtration Association 2006 Rev. 2

SUMMARY Good Predictive Maintenance Good Housekeeping Listening – Observing – Following ASHE/ASHRAE and AIA Guidelines Use of higher efficiency filters and Integrity Testing in-situ of HEPA Filters Using gas-phase filtration for chemicals & odors In summary, hospital and healthcare facilities can improve in their efforts to clean up the indoor environment by using higher levels of air filter efficiencies, (MERV) filters, using factory tested and in place testing of HEPA filters, and using gas-phase filtration to remove chemicals and odors from the air. Copyright National Air Filtration Association 2006 Rev. 2

Cleaner Air = Safer Environment Doing this, we can reduce the number of hospital acquired illnesses and assure that when we go to a healthcare facility we go to get well. Copyright National Air Filtration Association 2006 Rev. 2