From the beginning of the pandemic, even before the coronavirus was discovered to be a greater airborne threat than a surface one, senior living communities turned their attention to air circulation.
The knowledge that air matters in infection prevention and control is basic to people in senior living, who take all steps possible to keep it clear and clean.
“The good news: There is a strong foundation for the importance of good indoor air quality,” says Marla Thalheimer, senior ESG program manager at RE Tech Advisors. “But COVID has catapulted this topic to the forefront.”
Two statistics to keep in mind:
- The EPA some years ago determined that most people spend 90 percent of their lives indoors. That’s a lot of breaths.
- Good indoor air quality can double cognitive performance scores, according to a joint study by Carrier, the Harvard T.H. Chan School of Public Health, SUNY Upstate Medical University, and Syracuse University.
To reap these benefits, steps range from simple and low-cost to using a highly effective new technology (which is becoming less expensive as it becomes more widely used).
Putting ions to work
While the technology of needlepoint bipolar ionization™ (NPBI) has been in use for about 10 years, interest in and use of this system has jumped during the pandemic.
“The link between COVID and air quality is becoming clearer,” says John Walter, executive vice president at Direct Supply.
“We have found skilled nursing facilities installing needlepoint bipolar ionization led to a measurable and reduced risk of COVID transmission compared to facilities that did not.”
How it works (the short version): A device in the air-handling system produces positive and negative ions. The ions work like bumper cars, crashing into particles of mold, bacteria, and viruses—and the encounter ionizes the cells out of commission. The ions also knock out volatile organic compounds (such as paint fumes) and odors.
And for the big finish, they cause the bacteria and virus particles to stick together in clusters. On their own, the tiny virus particles could get through an air filter. But in clusters, they’re too big, and the filter catches them.
There’s an important difference between needlepoint bipolar ionization and previous versions of bipolar ionization: “The difference is needlepoint bipolar ionization uses a smaller amount of electricity to generate the ion. When you use a larger amount of electricity that can create ozone, which is not good for an environment,” says Maria Pfeffer, PE, senior project manager at KFI Engineers, a firm in St. Paul, Minn. The systems are also self-cleaning and effectively no-maintenance.
“NPBI is a relatively new technology for senior living,” says Direct Supply’s Walter. “It is a key ingredient for improving air quality and fighting known issues like influenza, so prospective residents can have faith that our buildings are, in fact, the safest places for them to live.”
The caveat with unfamiliar technology is the need for experience in installation. “We are making sure the installation is done properly by our network of experienced senior living HVAC technicians, who are trained on best practices and confirm there is sufficient ion density after every installation,” says Walter.
Pros and cons
Communities are also using portable high efficiency particular air (HEPA) filtration units, either alone or in conjunction with NPBI. Pfeffer cautions that there currently is a long lead time to get the filters, because of rising demand.
Another technology uses UV light within the system. The pros are that it works well where there are wet surfaces, Pfeffer says, such as on the downstream side of a cooling coil, where trouble can grow. While it may be a good solution for some situations, it also requires careful and experienced installation, is costly, needs yearly bulb changes, and uses more energy than NPBI.
What’s important, says Pfeffer, is choosing what’s right for your buildings and community. Getting good indoor air quality is a balancing act of multiple factors: Are you in a warmer or colder climate, a dryer or more humid one? What are your energy-use goals? What do the building plans look like—and what are you expecting to change in years to come? What size are the spaces, and how many people do they usually host?
An improved filter, for instance, will likely mean more energy will need to be used to move the air. Bringing in more outdoor air, which can improve indoor air quality, will require more energy use. Installation costs as well as operational costs over time will come into play.
Hidden issues
Everything inside your community has some effect on the indoor air quality—and some are more obvious than others.
During the pandemic, cleaning solutions can sometimes be a culprit. “Throughout the pandemic, we have seen an increase in ‘homemade’ solutions, experimental application and the promotion of various broad application methods in an effort to cover more area in a shorter amount of time,” writes Amanda Bakken, lead chemist and disinfection expert at Ecolab.
“Practices that do not follow manufacturer’s instructions for use—such as mixing chemicals, using more cleaning agent than necessary or at the wrong concentration, or using chemicals for reasons other than their intended use or in a way other than its intended application—can have a negative impact on indoor air quality and safety,” she writes.
Look for EPA registration and follow the labels for use, how to apply, and time in contact with surfaces. “If people are in close proximity, consider applications that minimize aerosolization—such as wiping or flooding/immersion techniques—to ensure indoor air quality and the comfort of those in the space,” Bakken writes.
Disinfectants, for instance, are meant for hard surfaces—trying to spray them to disinfect the air won’t work but will badly affect indoor air quality.
And keep in touch with your vendors, Bakken says. The increased risks of infection, often-changing guidance, and staff turnover have combined to make consulting experts more frequently more important.
Don’t overlook these
“There are many things than can negatively impact air quality either from a health perspective—such as mold spores or biofilm—or from a resident perception perspective—such as odor challenges, writes Linda Homan, RN, BSN, CIC, senior manager of clinical affairs at Ecolab.
“Through some of our senior living audits we have uncovered potential risk in these often overlooked or infrequently used areas:
“Drains can be a vector for transmission of bacteria. There is evidence that sink, shower, and other wastewater drains in healthcare settings have been associated with outbreaks, particularly among the most vulnerable patient populations.
“Implementing a routine drain disinfection program with a product that kills bacteria in biofilm, can maintain proper contact time for the product to take effect, and can be easily applied on a routine schedule may provide sustained decolonization of the sink drain, thereby preventing transmission of potentially dangerous pathogens from sinks.
“Areas in which water is used, including laundry and kitchens, areas containing water features such as fountains or aquariums, or areas that are susceptible to moisture could provide an environment for mold. Additionally, stagnant, or standing, water can cause conditions that increase risk for Legionella.”
The VOC factor
“Have you ever walked into a room that’s just been painted and you get an instant headache?” asks Thalheimer. “That strong odor is from volatile organic compounds, or VOCs, released from the paint in the air.”
These come from products we use every day, she adds—even air fresheners. Flooring, rugs, upholstery, curtains, appliances—all can contribute to the effect. The EPA web page on the topic says “levels of several organics average 2 to 5 times higher indoors than outdoors. During and for several hours immediately after certain activities, such as paint stripping, levels may be 1,000 times background outdoor levels.”
Fortunately, many manufacturers have since the 1990s been offering low-VOC versions of products, with these alternatives costing the same or very little more.
A community effort
Finally, individual residents can make a difference:
- Offer furnishings, surfaces, and finishes that are low-VOC when residents are choosing room options or resident committees are looking into new carpets or flooring.
- Check out dry cleaning—are there strong chemical smells in the clothing after cleaning? This may mean too many chemicals are being used. This is one of the major causes of VOCs and indoor air pollution. A community could offer delivery or coupons from a “greener” dry cleaner.
- Cleaning products don’t need to smell overwhelmingly strong to work. Share information on using products correctly with residents who do their own cleaning.
Negative Pressure Rooms Can Help Keep Virus From Spreading
To help keep COVID-19 from spreading through circulating air, many communities are trying different setups to create negative pressure rooms.
The idea is to create an air flow in a space so that clean air flows in, but air that might carry aerosolized virus will flow out in only one direction and be exhausted from the building. This is not as complicated as it sounds, says Maria Pfeffer, PE, senior project manager at KFI Engineers—they plan them for schools so that children who are sick won’t spread an infection while waiting for someone to come pick them up.
An exhaust can be created with a fan—whatever will pull air out of the room and keep it from recirculating in the room or anywhere else in the community. Having a door that opens inward to the negative pressure space rather than outward to the positive space is necessary to maintain the airflow in the right direction. Some have created “foyer” areas with plastic sheeting outside rooms to make it possible to go in and out more easily.
The system can be monitored through the community’s IT system to ensure the pressure is working.
While many of today’s negative pressure systems are rigged with plastic sheeting, tubes, and plywood, negative pressure rooms or even wings are likely to be designed into new communities and put in during renovations—architects and designers say they’re being asked about them.
