Airborne Contamination Control through Directed Airflow in the Exam Room: A Pilot Study Using a Membrane Diffuser

Pati, Debajyoti; Pietrzak, Michael P.; Duthu, David; Lei, Ting-Kwo George; Vincent, David; Franklin, Tom; Harvey, Thomas E.; Ransdell, Troy

doi:https://doi.org/10.1260/2040-2295.1.4.655

Journal of Healthcare Engineering

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Research Article | Open Access

Volume 1 | Article ID 165318 | https://doi.org/10.1260/2040-2295.1.4.655

Airborne Contamination Control through Directed Airflow in the Exam Room: A Pilot Study Using a Membrane Diffuser

Debajyoti Pati,¹Michael P. Pietrzak,¹David Duthu,²Ting-Kwo George Lei,³David Vincent,¹Tom Franklin,²Thomas E. Harvey,¹and Troy Ransdell¹

Abstract

Airborne infections have been documented as a major source of hospital acquired infection - one of the major concerns in healthcare delivery. An important factor contributing to airborne infection is cross contamination through air particulate dispersion as affected by the ventilation system design. Clean room technology (with membrane ceiling) has been successfully used in technology and pharmaceutical industries to control airborne contamination. This study examined the performance of membrane ceiling technology in controlling air particulate dispersion in a mock-up exam room. It included both performance tests in a mock-up room and a simulation study of six different ventilation system designs using Computational Fluid Dynamics (CFD) analysis. Findings suggest that a membrane diffuser directed airflow ventilation strategy occupying approximately 20% to 30% of the ceiling surface and placed over the patient in a contemporary sized exam room provides a less turbulent airflow pattern and less mixing of the air between the patient and others in the room.

References

Centers for Disease Control, Morbidity and Mortality Weekly Report (MMWR), vol. 49, no. 08, pp. 149–153, March 03, 2000.
G. D. McKendrick and R. T. Emond, “Investigation of cross-infection in isolation wards of different design,” Journal of Hygiene (Lond), vol. 76, no. 1, pp. 23–31, 1976.
View at: Google Scholar
S. M. Opal, A. A. Asp, P. B. Cannady Jr., P. L. Morse, L. J. Burton, and P. G. Hammer, “Efficacy of infection control measures during a nosocomial outbreak of disseminated aspergillosis associated with hospital construction,” Journal of Infectious Diseases, vol. 153, no. 3, pp. 634–637, 1986.
View at: Google Scholar
G. Arlet, E. Gluckman, F. Gerber, Y. Perol, and A. Hirsch, “Measurement of bacterial and fungal air counts in two bone marrow transplant units,” Journal of Hospital Infection, vol. 13, no. 1, pp. 63–69, 1989.
View at: Google Scholar
R. A. Barnes and T. R. Rogers, “Control of an outbreak of nosocomial aspergillosis by laminar airflow isolation,” Journal of Hospital Infection, vol. 14, no. 2, pp. 89–94, 1989.
View at: Google Scholar
C. C. Hopkins, D. J. Weber, and R. H. Rubin, “Invasive aspergillus infection: possible non-ward common source within the hospital environment,” Journal of Hospital Infection, vol. 13, no. 1, pp. 19–25, 1989.
View at: Google Scholar
G. Mehta, “Aspergillus endocarditis after open heart surgery: An epidemiological investigation,” Journal of Hospital Infection, vol. 15, no. 3, pp. 245–253, 1990.
View at: Google Scholar
P. C. Iwen, J. C. Davis, E. C. Reed, B. A. Winfield, and S. H. Hinrichs, “Airborne fungal spore monitoring in a protective environment during hospital construction, and correlation with an outbreak of invasive aspergillosis,” Infection Control and Hospital Epidemiology, vol. 15, no. 5, pp. 303–306, 1994.
View at: Google Scholar
J. R. Babb, P. Lynam, and G. A. Ayliffe, “Risk of airborne transmission in an operating theatre containing four ultraclean air units,” Journal of Hospital Infection, vol. 31, no. 3, pp. 159–168, 1995.
View at: Google Scholar
S. Cotterill, R. Evans, and A. P. Fraise, “An unusual source for an outbreak of methicillinresistant Staphylococcus aureus on an intensive therapy unit,” Journal of Hospital Infection, vol. 32, no. 3, pp. 207–216, 1996.
View at: Google Scholar
V. G. Loo, C. Bertrand, C. Dixon, D. Vitye, B. DeSalis, A. P. McLean et al., “Control of construction associated nosocomial aspergillosis in an antiquated hematology unit,” Infection Control and Hospital Epidemiology, vol. 17, no. 6, pp. 360–364, 1996.
View at: Google Scholar
D. N. Kumari, T. C. Haji, V. Keer, P. M. Hawkey, V. Duncanson, and E. Flower, “Ventilation grilles as a potential source of methicillin-resistant Staphylococcus aureus causing an outbreak in an orthopaedic ward at a district general hospital,” Journal of Hospital Infection, vol. 39, no. 2, pp. 127–133, 1998.
View at: Google Scholar
L. C. McDonald, M. Walker, L. Carson, M. Arduino, S. M. Aguero, P. Gomez et al., “Outbreak of Acinetobacter spp. bloodstream infections in a nursery associated with contaminated aerosols and air conditioners,” Pediatric Infectious Disease Journal, vol. 17, no. 8, pp. 716–722, 1998.
View at: Google Scholar
J. R. Passweg, P. A. Rowlings, K. A. Atkinson, A. J. Barrett, R. P. Gale, A. Gratwohl et al., “Influence of protective isolation on outcome of allogeneic bone marrow transplantation for leukemia,” Bone Marrow Transplant, vol. 21, no. 12, pp. 1231–1238, 1998.
View at: Google Scholar
B. Friberg, S. Friberg, and L. G. Burman, “Correlation between surface and air counts of particles carrying aerobic bacteria in operating rooms with turbulent ventilation: an experimental study,” Journal of Hospital Infection, vol. 42, no. 1, pp. 61–68, 1999.
View at: Google Scholar
L. M. Mahieu, J. J. De Dooy, F. A. Van Laer, H. Jansens, and M. M. Ieven, “A prospective study on factors influencing aspergillus spore load in the air during renovation works in a neonatal intensive care unit,” Journal of Hospital Infection, vol. 45, no. 3, pp. 191–197, 2000.
View at: Google Scholar
I. Oren, N. Haddad, R. Finkelstein, and J. M. Rowe, “Invasive pulmonary aspergillosis in neutropenic patients during hospital construction: Before and after chemoprophylaxis and institution of HEPA filters,” American Journal of Hematology, vol. 66, no. 4, pp. 257–262, 2001.
View at: Google Scholar
P. Panagopoulou, J. Filioti, G. Petrikkos, P. Giakouppi, M. Anatoliotaki, E. Farmaki et al., “Environmental surveillance of filamentous fungi in three tertiary care hospitals in Greece,” Journal of Hospital Infection, vol. 52, no. 3, pp. 185–191, 2002.
View at: Google Scholar
B. D. J. Lutz, J. Rinaldi, M. G. Wickes, B. L. Huycke, and M. Mark, “Outbreak of invasive Aspergillus infection in surgical patients, associated with a contaminated air handling system,” Clinical Infectious Diseases, vol. 37, no. 6, pp. 786–793, 2003.
View at: Google Scholar
G. Moran, F. McCabe, M. Morgan, and D. Talan, “Delayed Recognition and Infection Control for Tuberculosis Patients in the Emergency Department,” Annals of Emergency Medicine, vol. 26, no. 3, pp. 290–295, 1995.
View at: Google Scholar
J. Monmany, N. Rabella, N. Margall, P. Domingo, I. Gich, and G. Vázquez, “Unmasking Influenza Virus Infection in Patients Attended to in the Emergency Department,” Infection, vol. 32, no. 2, pp. 89–97, 2004.
View at: Google Scholar
L. Li and J. Gu, “SARS Infection Among Health Care Workers in Beijing, China,” JAMA, vol. 290, no. 20, pp. 2662–2663, 2003.
View at: Google Scholar
J. Huddy, “How pandemic risk influences emergency department design,” Healthcare Design, October 2009, http://www.healthcaredesignmagazine.com/ME2/dirmod.asp?sid=&nm=&type=Publishing&mod=Pu blications%3A%3AArticle&mid=8F3A7027421841978F18BE895F87F791&tier=4&id=8D2821C92 F6C45A49F0FDF9ACA618E67.
View at: Google Scholar
C. J. Moll and W. C. Anderson, Vertical Laminar-Flow Clean Room of Flexible Design, 1972, US Patient No. 3,638,404, http://www.freepatentsonline.com/3638404.html.
I. Lavedrine, P. Thomas, J. Tharp et al., “Innovative Design Solutions for Burn Intensive Care Units,” in Proceedings of the 9th International IBPSA Conference, Montreal, Canada, August 2005.
View at: Google Scholar
D. Hope and D. Milholl, “A three-dimensional ultrasonic anemometer to measure the performance of clean zone air delivery systems,” Journal of the IES, vol. 36, no. 6, pp. 32–40, 1993.
View at: Google Scholar
ASHRAE, “Space Air Diffusion,” in ASHRAE Handbook of Fundamentals, chapter 20, 2009, www.Ashrae.org.
View at: Google Scholar
AIA Academy of Architecture for Health, Guidelines for Design and Construction of Hospitals and Healthcare Facilities, The American Institute of Architects, Washington, DC, 2006.
JACHO, Planning, Design, and Construction of Health Care Facilities, Joint Commission Resources, Oak Brook, IL, Second edition, 2009.
ASHRAE, 200 Special Project 91, HVAC Design Manual for Hospitals and Clinics, ASHRAE, Atlanta, GA, 2003.
D. C. Milholl, Membrane Diffuser Evaluation, BIOCON, LUWA USA, 1988.
C. Chao, M. P. Wan, L. Morawska et al., “Characterization of expiration air jets and droplet size distributions immediately at the mouth opening,” Journal of Aerosol Science, vol. 40, no. 2, pp. 122–133, 2009.
View at: Google Scholar
R. S. Papineni and F. S. Rosenthal, “The size distribution of droplets in the exhaled breath of healthy human subjects,” Journal of Aerosol Medicine, vol. 10, no. 2, pp. 105–116, 1997.
View at: Google Scholar
ASHRAE, ASHRAE Handbook–HVAC Applications, chapter 7, 2007, www.Ashrae.org.

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Copyright © 2010 Hindawi Publishing Corporation. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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