Air Quality-related Infection Prevention and Control

Standard heating, ventilation, and air conditioning (HVAC) systems in healthcare facilities are designed to maintain air temperature and humidity at comfortable levels for HCP and patients; to control odors; to remove contaminated air; to facilitate air-handling requirements to protect susceptible HCP and patients from airborne pathogens and allergens; and to minimize the risk of healthcare-related reactions to aerosolized allergens.1

Malfunction of any component of the HVAC systems (e.g., outside air intake; filters; dehumidifiers; heating and cooling equipment; fans; ductwork; air exhaust or out-takes; registers; and diffusers or grilles) can contribute to unacceptable indoor air quality and the spread of healthcare-associated airborne pathogens and aerosolized allergens. Recommendations to maintain acceptable indoor air quality in healthcare settings are summarized in Table 1.1,2

Table 1. Recommendations to Maintain Acceptable Indoor Air Quality in Healthcare Settings.

  1. Heating, ventilation, and air conditioning systems
    1. Follow the American Institute of Architects (AIA) guidelines as the minimum standards where state or local regulations are not in place for the design, construction, and renovation of healthcare facilities.
    2. Monitor HVAC systems in accordance with engineers’ and manufactures’ recommendations to ensure optimal performance for removal of particulates and eliminate excess moisture.
  2. Laser plumes and surgical smoke
    1. In settings where laser plumes or surgical smoke are generated, wear appropriate personal protective equipment, including N95 or N100 respirators, to minimize exposure.
    2. Use central wall suction units with in-line filters to evacuate minimal laser plumes.
    3. Use mechanical smoke evacuation system with a high-efficiency filter to manage the generation of large amounts of laser plume when ablating tissue infected with the human papilloma virus.
  3. Latex-related aerosol contamination
    1. Use low-protein latex gloves; or, preferably, latex free gloves.

Areas in healthcare settings that require special ventilation include: (1) operating rooms (ORs), (2) protective environment (PE) rooms, and (3) airborne infection isolation rooms (AIIRs).1 However, community-based oral healthcare facilities are not expected to maintain areas that require special ventilation (e.g., ORs, PE rooms, and AIIRs).2