Deciding how and where to best care for senior citizens as they get older can be an emotionally fraught experience. There are also several practical considerations that go into the decision to ensure their needs are met. Whether families decide to move their elderly parents in with them or to keep seniors in their own homes, a top priority is facilitating both a safe and healthy environment.
The National Institute on Aging advises people aging in place to install grab bars, ramps, and non-slip adhesives in their homes. Access to nutritious meals and following strict medication regimens are also advised. Experts recommend regular handwashing to prevent infections, and the CDC strongly urges senior citizens to get vaccinated against both COVID-19 and influenza.
But there is even more that can be done to ensure high-quality air and infection control in a private residential setting. Here is what you need to know:
What Residential HVAC Systems Were Designed To Do
Residential HVAC systems are designed to ventilate and filter air to maintain adequate air quality and control temperature. Ventilation and filtration remove odors and trap dust, smoke, and pollen. However, residential HVAC systems are not designed to capture toxic microorganisms.
HEPA filters capture pathogens which include bacteria, viruses, and even mold spores. Unlike hospital-grade HVAC systems, most residential units do not generate powerful enough airflow to overcome resistance caused by HEPA filters. Therefore, adding one to a home HVAC system is not a viable means of containing contaminants.
One way to reap the benefits of HEPA filtration in homes is through air purifiers equipped with HEPA filters. Since they reduce the number of particles that carry viruses by approximately 95%, they are considered medical grade.
Humidity Control Matters, Too
According to the International Journal of Environmental Research and Public Health relative humidity (RH) levels between 40-60% are optimal in homes for two reasons. First, mucous membranes are most resistant to infection around moderate humidity levels. Second, viruses living in aerosol particles survive for less time at 50% RH than in drier or very humid conditions.
Humidity control is not standard in residential HVAC systems, but it can be added retroactively. However, humidity control functionality that is incorporated into furnaces or central air conditioning only works when the system is running. Similarly, controlling humidity levels is not available through forced-water heating that uses boilers. If moisture control is not available through a household HVAC system, a stand-alone humidifier that monitors room levels will get the job done.
Volatile Organic Compounds
Exposure to volatile organic compounds (VOCs) can have short- and long-term adverse health implications. VOCs are gases emitted from various household products including new carpets, aerosol sprays, paint, PVC plastics, and air fresheners. VOCs originate indoors, and exposure to moderate levels of VOCs over time or high levels of VOCs in a short period of time can cause minor eye, nose, and throat irritation. Over time, higher concentrations of VOCs can cause liver, kidney, and central nervous system damage.
Air Purifiers Have Their Limits
According to Consumer Reports, air purifiers can remove contaminants only when they are floating in the air. Mites, mold, pollen, and VOCs are too heavy for most air purifiers. Units with HEPA filtration can capture aerosol droplets on which the coronavirus travels, but not all purifiers draw in enough air to actually reduce the volume of particles.
The Bottom Line
Avoiding harmful contaminants and facilitating quality indoor air is achievable, even in a private setting. Fortunately, a highly effective solution can be as simple and unobtrusive as a window AC unit.
Air Innovations brought over 25 years of experience designing and manufacturing customized solutions for temperature, humidity, and filtration control to its HEPAiRx® window-mount ventilating air purifier. The HEPAiRx system is a plug-and-play air filtration device comparable in size to a standard AC unit. The system quickly and thoroughly purifies a room of airborne particles and contaminants because each unit features medical-grade HEPA filtration and ventilation to exhaust air for a standard-sized room every 30 minutes.
The HEPAiRx unit brings in a high enough quantity of fresh air to naturally dilute VOCs without requiring a window to be open. It also uses upstream UV-C to kill viruses trapped on the intake side of the HEPA filter to give seniors an extra buffer against life-threatening elements. Lastly, the system has onboard heating, cooling, and humidity control features to keep residents comfortable.
The HEPAiRx system is currently the only solution on the market that can do the following:
- Brings dedicated fresh air into a room to naturally dilute potentially harmful aerosol particles, VOCs, and gases.
- Uses optional upstream UV-C to kill viruses trapped on the intake side of the HEPA filter – the only effective way to kill viruses on the HEPA filter.
- Integrates the HVAC to isolate the space from the existing systems. HVAC ductwork is a source of cross-contamination between spaces. The HEPAiRx system seals off the current system to separate it from adjacent rooms creating an actual isolation space.
Air Innovations’ HEPAirX system empowers adult children to take a proactive approach to keep beloved older family members safe and healthy. Or, the unit enables senior citizens to take charge of their own contamination control.
The global pandemic exposed a need to elevate the standard of care for the elderly. In particular, senior citizens living and spending time in group settings such as nursing homes, residential care facilities, and senior centers were at exceptionally high risk for contracting and dying of COVID-19.
As of April 2021, the U.S. Department of Energy reported that residents in long-term care facilities accounted for only 3% of the total 21 million confirmed COVID-19 cases in the U.S., yet made up one-third of the 350,000 deaths. Nursing home residents are particularly susceptible to COVID, and other infections, due to their naturally lowered immune functions and being prone to pre-existing conditions. Additionally, nursing homes lack the systems engineered to control the spread of potentially life-threatening contagious diseases, like COVID.
Various tactics are needed to prevent the spread of infections where older adults live and congregate. Fortunately, armed with some vital information, facilities can take steps to protect their communities better.
The Role of Ventilation And Filtration
Similar to other contagious pathogens, it became evident that COVID spreads primarily indoors. Beyond physical distancing and masking, the best way to reduce the spread is by implementing air ventilation and filtration systems.
According to the Journal of the American Medical Association (JAMA), “The weight of evidence indicates ventilation plays a key role in infectious disease transmission, (…) showing low ventilation associated with transmission of measles, tuberculosis, rhinovirus, influenza, and SARS-CoV-1.”
Elevate Ventilation Standards
Yet, JAMA also reports that most indoor spaces (except for hospitals) ventilate and filter air at minimum levels.
The American Society of Heating, Refrigeration, and Air Conditioning Engineers (ASHRAE) sets ventilation standards for most indoor spaces. However, these standards are intended to remove odors and ensure an adequate level of air quality. They don’t support an infection control strategy.
Better Filtration Plays A Key Role
Air filters and purifiers have several efficiency standards, including clean air delivery rate (CADR) and minimum efficiency reporting value (MERV). Established by ASHRAE, the MERV rating measures the quality of air filters used in central ventilation systems. For reference, MERV-8 is a typical low-grade filter that captures only 15% of small particles. MERV-13 filters are able to capture nearly 70% of small air particles and are an integral part of a larger infection control program. Standards for nursing home resident rooms require only MERV-7 filters.
HEPA filters are used in any application that requires contamination control. Air purifiers equipped with HEPA filters can capture even smaller microns than MERV filters. Since they reduce the number of particles that carry viruses by approximately 95%, they are considered medical grade.
Upgrading filters to capture a higher percentage of particles of all sizes is a reasonably simple way to protect the elderly living in long-term care facilities.
Incorporate Fresh Air
Researchers have found that fresh air delivered through AC or ventilation systems plays an important role in diluting the volume of viral aerosol particles in a room. Monitoring carbon dioxide (CO₂) levels is a simple way to ensure enough fresh air is in a room, as high CO₂ levels indicate that there is a lot of exhaled air in the room. A sick person has a greater chance of distributing viral particles to a healthy person.
Relative Humidity Matters, Too
In addition to regular ventilation and air filtration, the International Journal of Environmental Research and Public Health recommends maintaining relative humidity (RH) levels between 40-60% for two reasons. First, mucous membranes are most resistant to infection in moderate humidity levels. Second, aerosol particles potentially containing contagious diseases can live for less time at 50% RH than in drier or very humid conditions.
Facilities and residences for older people can monitor humidity and utilize humidifiers as needed at a low cost.
The Bottom Line
A multi-pronged approach is the best way to protect older citizens from low-quality air and infectious diseases. Fortunately, a highly effective solution can be as simple and unobtrusive as a window AC unit.
Air Innovations brought over 25 years of experience designing and manufacturing customized solutions for temperature, humidity, and filtration control to its HEPAiRx® ventilating and filtrating system. HEPAiRx systems are air filtration devices that are comparable in size to a standard AC unit. They combine multiple strategies for maintaining optimal health in a variety of applications. HEPAiRx units quickly and thoroughly purify a room of airborne particles and contaminants. Each plug-and-play unit features a MERV-17 medical-grade HEPA filter and ventilation to exhaust air for a standard-sized room every 30 minutes.
HEPAiRx systems are an ideal solution for use in nursing homes. Since each unit is entirely self-contained and compact, facilities don’t have to overhaul their existing HVAC systems. HEPAirX units empower facility administrators to take a proactive approach to keep our beloved older family members and staff safe and healthy.
The HEPAiRx system is currently the only solution on the market that can do the following:
- Bring dedicated fresh air into a room to naturally dilute potentially harmful aerosol particles, VOCs, and gases.
- Create either a negative or positive pressure environment.
- Use optional upstream UV-C to kill viruses trapped on the intake side of the HEPA filter – the only effective way to kill viruses on the HEPA filter.
- Integrate the HVAC to isolate the space from the existing systems. HVAC ductwork is a source of cross-contamination between operatories. When using the HEPAiRx system, you can seal off the existing system to separate it from adjacent rooms, creating an actual isolation space.
COVID-19 has put healthcare facilities under extraordinary pressure to accomplish more with less. Nurses and doctors had to care for waves of sick patients with limited resources. Medical personnel simply didn’t have the equipment or facilities needed to keep up with patient demand, and they struggled to contain the virus with makeshift solutions.
The most obvious way to protect patients and staff from those infected with COVID-19, or any other infectious disease, is to isolate them. Proper isolation rooms have dedicated HVAC and HEPA filtration capabilities. These rooms are constructed according to stringent guidelines from the CDC and other professional associations. Isolation rooms don’t share air or controls with the rest of the medical facility to prevent the risk of cross-contamination. However, at the height of the pandemic, even the most advanced, well-funded institutions could not isolate their contagious patients.
Protecting Patients and Staff
The most common type of isolation room utilizes negative pressure. These spaces have lower pressure inside the room than in the surrounding environment. As a result, contaminants can’t sneak out of the room and spread to the rest of the hospital. A negative pressure environment is maintained by using a dedicated HVAC system that continuously pumps clean air into the room near the floor and filters and sucks it back out through a grill near the ceiling. Other patients and medical staff are protected from the sick person.
Positive pressure rooms maintain higher pressure inside a space than the surrounding environment. These rooms are connected to a hospital HVAC system, which pumps clean, filtered air into the room. When the door to the space is opened, the high pressure forces out clean air and prevents any contaminants from entering the area. Positive pressure rooms are valuable for compromised patients—burn victims, surgery patients, birthing women, and injured emergency room patients—highly susceptible to infection or pathogens.
Perhaps now more than ever, building isolation spaces dedicated to protecting and treating vulnerable patients is a prohibitively expensive option for most hospitals.
Between forced facilities shutdowns and increased costs surrounding COVID-19 preparedness, U.S. hospitals lost an estimated $323 billion in 2020. Moreover, hospitals and health systems are projected to lose between $53 to $122 billion more in 2021. Beyond shrinking budgets, administrators can be slow to adopt change due to protracted stakeholder approval processes. The path of least resistance is often to maintain the status quo.
Versatility for Enhanced Level of Patient Care
Air Innovations strives to truly understand the challenges our customers and potential clients grapple with beyond controlling temperature and humidity. Adopting a holistic approach enables us to engineer lasting solutions that are adaptable to meet their evolving needs.
We designed the IsolationAir® system so that hospitals and medical facilities could continue delivering high-quality care to their most vulnerable patients without taking on a renovation project. Our systems convert standard-sized patient rooms into positive or negative pressure spaces depending on demand. Since the unit is portable, it limits the need for stakeholder approval often required for renovation projects. IsolationAir contamination control units are considered devices and not intrinsic parts of a hospital.
HEPA Filtration & UV Light
The portable unit includes medical-grade HEPA filtration to remove potentially harmful particles from a negative pressure space or into a positive pressure patient room. The unit also has UV-C light to sterilize contaminants that stick to the back of the unit and can be ingested by sick patients.
Designed for Patient Comfort
IsolationAir systems have onboard heating and cooling to keep patients comfortable when they are cut off from the hospital HVAC system. The AC functionality also serves to dehumidify exam and patient rooms.
Each unit comes equipped with flexible ductwork, and there are two ways to implement them.
To boost readiness to respond to increased patient volumes, hospitals can pre-facilitate inpatient or exam rooms by having a universal grill adapter connected to the return grill in the ceiling. At that time, maintenance staff can check for other air exhausts or leaks in the room and seal them up. When it becomes necessary to expand surge capacity for any reason, hospital staff can rapidly deploy an IsolationAir unit by simply plugging the unit into an emergency outlet and connecting the flexible ductwork to the available adapter.
Alternatively, medical facilities can simply wheel an IsolationAir unit into a particular exam or treatment room and install a return grill adapter to which the flexible ductwork on the unit will connect. Maintenance teams can seal up visible air leaks around windows and doors. Once on-site, the process takes less than an hour and doesn’t require specialty HVAC professionals. Installing a return grill adapter as needed before connecting the unit’s ductwork is a viable option when hospitals can foresee a rise in patient demand, as we did with COVID-19.
When Flexibility Matters Most
Anytime a room is used to “open up” patients, they are immediately susceptible to potentially life-threatening pathogens. Dedicated surgical theaters are typically designed as positive pressure rooms. However, there have been instances where hospitals have opted to permanently convert surgical spaces from positive rooms to negative rooms, a transition that requires planning and time.
Trauma patients and burn victims have the best chance of survival when treated in positive pressure rooms. Issues arise when a crisis happens, and hospitals don’t have enough positive pressure rooms to treat victims. The flexibility to transform an unpressurized room into a positive pressure space quickly enables a medical establishment to treat and save more patients.
Surprisingly enough, most labor and delivery floors and emergency units don’t have contamination control even though these patients are vulnerable to infections. Often, it is impossible to anticipate whether rooms should be positive or negative pressured spaces. Hospitals, extended care facilities, and emergency preparedness centers need the flexibility to determine—sometimes on the fly—whether patients need positive or negative pressure to save their lives or to prevent catastrophe.
The Final Verdict
Despite the enormous challenges and constraints facing hospitals today, administrators have solutions available to help them respond with agility to varying patient needs. We are proud our IsolationAir system can help medical professionals do their jobs easier and enable them to save more lives. When it comes to creating spaces to care for our most vulnerable patients, versatility is the name of the game.
IsolationAir® Systems meet the following industry guidelines:
- 12 air changes per hour via HEPA filters
- Each IsolationAir unit conditions rooms up to 375 sq ft with an 8’ ceiling
- A pressure differential of 0.01” minimum between a room and adjoining spaces
(May require additional seals around doors or other significant leak points in large rooms with poorly sealed doors).
- Continuous operation when plugged into an emergency generator outlet
- Provides stable temperature control for patient comfort
- Originally designed to meet the U.S. Department of Health and Human Services’ critical benchmarks:
- Critical Benchmark #2-2: Surge Capacity: Isolation Capacity
- Critical Benchmark #2-9: Surge Capacity: Trauma and Burn Care
- Cross-cutting Critical Benchmark #6: Preparedness for Pandemic Influenza
For additional information, see these websites:
- Centers for Disease Control and Prevention (CDC) – Guidelines for infectious disease control in health care facilities
- The American Institute of Architects (AIA) – Guidelines for design and construction of hospitals, including heating and cooling control to 75°F.
- American Society of Heating, Refrigerating and Air-Conditioning Engineers (ASHRAE) – Chapter 7 in Applications Handbook regarding health care facilities.