**4. Results**

The overall study results are presented in **Figure 4** and in **Tables 5–7**. All data were provided by independent third-party laboratories after sampling the air and designated surfaces in each patient room associated with the specific study zone, as outlined in the methodology section. A comprehensive environmental assessment of viable bacterial, fungal, and VOC pathogens was conducted each month and repeated a total of 4 times between March and July of 2018.

**Zone VFBA VFBS VBBA VBBS**

*Cladosporium* Associated with infections to skin, sinuses, and lungs; significant

diseases; spores produce toxic VOCs

*Staphylococcus capitis* Natural skin flora often associated with infections caused by

*Micrococcus luteus* Source is typically patient-oriented, mouth, mucosae, oropharynx,

*Bacillus clausii* Associated with respiratory infections and GI disorders, produces

*Dermabacter hominis* Associated with wound infections, abscesses, and positive blood

*difficile*, and *Enterococcus faecium*

cultures

and upper respiratory tract, often associated with ill patients

antimicrobial substances active against *Staphylococcus aureus*, *C.* 

*Bacillus licheniformis* Associated with soil and bird plumage Circulating air in patient

catheters and aortic valves

and LSAR).

*Staphylococcus saprophyticus*

*Staphylococcus epidermidis*

*Staphylococcus haemolyticus*

LSAR Nil Nil Nil *Staphylococcus* spp.: capitis

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**Table 5.** Identification of viable bacteria and fungi by air and on surface within the three study zones (CF-AHU, MIXED,

**Pathogen Association with patient illness Location within clinical** 

*Aspergillus* Associated with pulmonary infections, infections to skin lesions Circulating air in patient

Associated with urinary tract infections Circulating air

Skin flora and low association with HAIs Circulating air in patient

Antibiotic resistant and associated with skin flora Circulating air in patient

allergens impacting asthmatics and patients with respiratory

(patient remote), epidermidis

145

*Corynebacterium* (patient

(faceplate)

http://dx.doi.org/10.5772/intechopen.84530

remote)

**space**

room

room

Patient remote HVAC Return

Patient Remote HVAC Return

in patient room

Patient Remote HVAC Return

Patient Remote HVAC Return

Return

room

room

room

room

room

room

room

Circulating air in patient

Circulating air in patient

Circulating air in patient

Circulating air in patient

Circulating air in patient

**Figure 4.** Results for viable airborne and surface bacteria and fungi and VOC load in each zone (CF-AHU, MIXED, and LSAR). Legend: AHU, air handling unit; VFBA, viable fungi by air (CFU/m<sup>3</sup> ); VFBS, viable fungi by swab (CFU/in<sup>2</sup> ); VBBA, viable bacteria by air (CFU/m<sup>3</sup> ); VBBS, viable bacteria by swab (CFU/in<sup>2</sup> ); VOCs, volatile organic compounds (ppb); PT, particulates (mg/m3 ).


Comprehensive and Live Air Purification as a Key Environmental, Clinical, and Patient Safety Factor… http://dx.doi.org/10.5772/intechopen.84530 145


**Table 5.** Identification of viable bacteria and fungi by air and on surface within the three study zones (CF-AHU, MIXED, and LSAR).


**Figure 4.** Results for viable airborne and surface bacteria and fungi and VOC load in each zone (CF-AHU, MIXED, and

); VBBS, viable bacteria by swab (CFU/in<sup>2</sup>

*Staphylococcus* spp.: capitis, epidermidis, *haemolyticus*,

Gram-negative rod Gram-negative rod (return) *Bacillus spp.: clausii*, *licheniformis* Gram-positive cocci (remote,

return)

); VFBS, viable fungi by swab (CFU/in<sup>2</sup>

); VOCs, volatile organic compounds

Staphylococcus spp.: capitis, *haemolyticus* (remote, return), *hominis*, *saprophyticus* (return) );

LSAR). Legend: AHU, air handling unit; VFBA, viable fungi by air (CFU/m<sup>3</sup>

(remote, return)

(return)

**Zone VFBA VFBS VBBA VBBS**

CF-AHU *Aspergillus Aspergillus Micrococcus luteus Micrococcus lylae*

*saprophyticus*

*Dermabacter hominis Kocuria palustris*

*Bacillus licheniformis Dietzia cinnamea*

*Streptococcus anginosus*

*Staphylococcus haemolyticus* Nil

).

*Cladosporium Cladosporium*

VBBA, viable bacteria by air (CFU/m<sup>3</sup>

MIXED Yeast *Rhodotorula*

(ppb); PT, particulates (mg/m3

144 Vignettes in Patient Safety - Volume 4


There were 3100 ppb VOCs and <8.3 mg/cubic meter of nonviable particulates in CF-AHU

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147

There were no viable bacteria by swab, 2350 ppb VOCs, and <8.3 mg/cubic meter of nonviable

Finally, there were no viable bacteria by air, no viable bacteria by swab, no viable fungi by air, 1300 ppb VOCs, and < 8.3 mg/cubic meter of nonviable particulates in LSAR Zone (**Table 8**). The reduction in VOCs is due to the remediation of viable fungal spores and their concomitant production of fungal VOCs. As there was a HEPA filter in place on the serving air handling unit, all air was HEPA-filtered. This was confirmed by the nonviable particulate assessment

Often neglected, indoor air quality is an important component of ensuring healthy and safe environment across various healthcare facilities [34]. It is well established that there exists "strong and sufficient evidence" of the association between ventilation, air movements in buildings, and the transmission of bacterial, fungal, and viral infectious diseases [35]. Consequently, the need for high efficiency/reliable air filtration becomes a necessity, especially in critical environments such as acute care wards, critical care units, isolation units, and operating rooms [36–38]. The current project highlights the importance of an integrated system, such as the LAS-APS, in the modern healthcare environment. The subsequent discussion will synthesize our study's results in the context of acute care hospital

Perhaps most importantly, we noted a substantial decrease in air contaminants across all measurement categories. As the degree of air remediation increased from CF-AHU Zone or the control floor to comprehensive coverage in the patient rooms in LSAR Zone, a significant decrease in airborne bacterial, fungal, and VOC load was observed. The decrease in both bacterial and fungal loads within the air was concomitant with a significant decrease observed on commonly touched clinical and patient surfaces. Within the control zone, many of the pathogens identified in air samples from patient rooms were also found on commonly touched patient surfaces and on the return vents of the room. This data provides a significant contribution to our understanding of the airflow and path of aerosolized pathogens within the typical clinical space.

Previously published data show a strong relationship between the presence of airborne fungal spores and air quality in the hospital setting [39]. As part of the current study, viable fungi species of *Aspergillus* and *Cladosporium* were speciated and quantitated within the control zone patient rooms. Our results demonstrate a substantial decrease in fungal spore detection

The presence of bacteria, both in the air and on various surfaces, has been shown to be deleterious to healthcare outcomes [40, 41]. In addition to the fungal species, viable bacterial

rates when using LAS-APS technology, as compared to the other approaches.

Zone (**Table 6**).

**5. Discussion**

setting.

particulates in the MIXED Zone (**Table 7**).

of <8.3 mg/cubic meter in all study zones.

**Table 6.** Pathogen characteristics of zone CF-AHU (the control zone).


**Table 7.** Pathogen characteristics of MIXED zone-partial remediation (CF-AHU and 35% LSAR).


**Table 8.** Pathogen characteristics of LSAR zone patient rooms.

There were 3100 ppb VOCs and <8.3 mg/cubic meter of nonviable particulates in CF-AHU Zone (**Table 6**).

There were no viable bacteria by swab, 2350 ppb VOCs, and <8.3 mg/cubic meter of nonviable particulates in the MIXED Zone (**Table 7**).

Finally, there were no viable bacteria by air, no viable bacteria by swab, no viable fungi by air, 1300 ppb VOCs, and < 8.3 mg/cubic meter of nonviable particulates in LSAR Zone (**Table 8**). The reduction in VOCs is due to the remediation of viable fungal spores and their concomitant production of fungal VOCs. As there was a HEPA filter in place on the serving air handling unit, all air was HEPA-filtered. This was confirmed by the nonviable particulate assessment of <8.3 mg/cubic meter in all study zones.
