**5. Discussion**

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

*Kocuria palustris* Pathogen responsible for UTIs Circulating air in patient

the most common causes of hospital-acquired pneumonia, septicemia, folliculitis, and surgical site infections

*Staphylococcus hominis* Associated with infections in immunocompromised patients HVAC Return

*Rhodotorula* Common clinical contaminant associated with soil and water HVAC Return *Staphylococcus haemolyticus* Antibiotic resistant and associated with skin flora Circulating air in

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

associated infections in immunocompromised patients

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

*Staphylococcus epidermidis* Skin flora and low association with HAIs IV control faceplate

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

Gram-positive cocci *Staphylococcus aureus* and *Streptococcus pyogenes* are two of

*Micrococcus lylae* Associated with skin flora, opportunistic pathogen in immunocompromised patients

Yeast Associated with pulmonary infections and skin lesion

*Dietzia cinnamea* Associated with catheter and orthopedic prosthesis-

*Streptococcus anginosus* Common cause of abscesses, abdominal and thoracic

*Corynebacterium* Normal skin flora, low association with infections, prosthetic devices

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

*Staphylococcus capitis* Natural skin flora often associated with infections caused by catheters and aortic valves

infections, endocarditis, and bacteremia

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

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

infections

GI illness

146 Vignettes in Patient Safety - Volume 4

Gram-negative rods Associated with *E. coli*, *Salmonella*, *Shigella*, *Pseudomonas*, severe

**space**

room

room

Patient Remote HVAC Return

HVAC Return

HVAC Return

**space**

Circulating air in patient room

patient room

patient room

Circulating air in patient room

Circulating air in patient room

**space**

Patient Remote

Patient Remote

Circulating air in patient

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 setting.

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

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 species were also identified within the patient rooms of the control zone. *Staphylococcus saprophyticus*, *Staphylococcus epidermidis*, *Staphylococcus capitis*, *Micrococcus luteus*, *Staphylococcus haemolyticus*, *Bacillus clausii*, *Bacillus licheniformis*, *Dermabacter hominis*, *Kocuria palustris*, Gram-positive cocci, Gram-negative rods, *Micrococcus lylae*, and *Staphylococcus hominis* were found in both the recirculating air of the patient room and on the patient remote and HVAC return. Many of the aerosolized pathogens found within the recirculating air were found on the HVAC return vents. Presence of these pathogens on the return vents confirms their aerosolized nature and threat to the clinical spaces also served by the recirculated air. With the exception of *Bacillus licheniformis*, each of these pathogens is associated with patient illness and infections. The sources of the above airborne pathogens are most likely the patients, visitors, and healthcare workers [42, 43].

It is important to note that the current, preliminary study represents the first comprehensive evaluation of infectious and aerosolized pathogens and their speciation, location, and concentration within a typical hospital setting. The study provides important data regarding the complex relationship between airborne pathogens and air filtration methodologies in the context of the molecular and microbial epidemiology of illness and infections in the clinical setting. A greater understanding of the role of airborne pathogens in illness in the clinical setting will help facilitate the identification of proper and more optimal levels of remediation.

Comprehensive and Live Air Purification as a Key Environmental, Clinical, and Patient Safety Factor…

In the modern healthcare environment, organizations strive to provide optimal patient experience by improving the quality of patient care, enhancing clinical outcomes, while at the same time containing associated costs. Rarely is there an opportunity to utilize technology that positively impacts quality and cost of hospital care without a detrimental "trade off" or major changes in existing behaviors or protocols. We hypothesized that LAS-APS implementation within the SLUHN facility will lead to notable enhancements in air quality across areas serviced by this air filtration/purification system. The current study clearly demonstrates a significant reduction across all forms of air contamination following the installation of LAS-APS. These results represent an important milestone for further research in this critical and

, Lee Levicoff<sup>3</sup>

\*

1 Department of Research and Innovation, St. Luke's University Health Network,

2 Department of Health Information Technology, St. Luke's University Health Network,

3 Department of Planning and Construction Management, St. Luke's University Health

5 Department of Patient Care Services, St. Luke's University Health Network, Allentown,

4 Department of Integration, St. Luke's University Health Network, Allentown,

6 Epidemiology and Biostatistics, S.Eid Consulting, Macungie, Pennsylvania, USA

, Frank Ford<sup>4</sup>

, Beverly Snyder5

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

149

,

often neglected area of healthcare facility operations and maintenance.

, Chad Brisendine<sup>2</sup>

and Kathryn C. Worrilow7

\*Address all correspondence to: kcworrilow@lifeaire.com

**6. Summary**

**Author details**

Sherrine Eid6

Stanislaw P. Stawicki1

Allentown, Pennsylvania, USA

Allentown, Pennsylvania, USA

Pennsylvania, USA

Pennsylvania, USA

Network, Allentown, Pennsylvania, USA

7 LifeAire Systems, Allentown, Pennsylvania, USA

It is also important to note that patient rooms in the MIXED Zone received approximately 35% of their recirculated air from the rooms from the LSAR Zone and thus benefited from the installed LAS-APS filtration capacity. The zone also served as an "internal control" as it was located on same the floor as LSAR Zone. Viable yeast was found in the circulating air of the patient rooms in LSAR Zone, and viable *Rhodotorula* was found on the HVAC return vent. Although at a significantly reduced level from that observed in CF-AHU Zone, viable bacteria were identified within the air of the patient rooms of MIXED Zone. *Staphylococcus haemolyticus*, *Dietzia cinnamea*, and *Streptococcus anginosus*, each a potential source of patient illness and infection, were identified in the patient rooms of MIXED Zone. *Bacillus licheniformis* was also identified but is not associated as a source of patient illness or infection. Interestingly, there were no viable bacteria found on the surfaces swabbed in MIXED Zone. VOCs were reduced over that assessed in CF-AHU Zone. The reduction of viable fungi in MIXED Zone corresponded to the simultaneous reduction in fungal VOC sources.

The patient rooms in LSAR Zone received all of their supply and recirculated air from the LAS-APS installation. There were no viable fungi by air or swab detected in the patient rooms in LSAR Zone. Likewise, there were no viable bacteria by air detected in the patient rooms in LSAR Zone. Low levels of *Staphylococcus epidermidis* were found on the IV control faceplate, and *Corynebacterium* and *Staphylococcus capitis* were found on the patient remote. Because no viable bacteria were identified within the air of the patient rooms in LSAR Zone, the surface bacteria identified on the patient remote and IV control faceplate were most likely due to direct surface-to-surface contact. The lowest levels of VOCs were found in the patient rooms of LSAR Zone as these rooms demonstrated no viable fungi in the circulating air.

The vast majority of infectious surface fomites originate from the air and may be directed onto surfaces by air flow generated by in-room fans and air conditioning systems [44–46]. Consequently, a reduction in airborne bacterial and fungal pathogens should be associated with a reduction in surface fomites [44, 47]. Overall reduction of airborne and surface bacterial and fungal pathogens responsible for patient illness and infections should result in a reduction of associated illnesses, HAI rates, and improved metrics of patient care inclusive of, but not limited to, length of stay and readmission rates. Improvements in these outcome metrics should, by association, correlate to risk mitigation and cost avoidance.

It is important to note that the current, preliminary study represents the first comprehensive evaluation of infectious and aerosolized pathogens and their speciation, location, and concentration within a typical hospital setting. The study provides important data regarding the complex relationship between airborne pathogens and air filtration methodologies in the context of the molecular and microbial epidemiology of illness and infections in the clinical setting. A greater understanding of the role of airborne pathogens in illness in the clinical setting will help facilitate the identification of proper and more optimal levels of remediation.
