**3. Materials and methods**

The design of the current study includes three zones within two medical surgical floors of a SLUHN Allentown hospital campus. The three geographic zones (**Figures 1**–**3**) include a control floor with air handling unit (CF-AHU) HEPA-filtration remediation, a zone with mixed AHU-HEPA and LifeAire remediation (MIXED) with recirculated air, and a zone with comprehensive LifeAire Systems Air Remediation (LSAR). Within each of these zones, two occupied and active patient rooms were selected for air quality testing. Each of the two rooms was comprehensively evaluated per zone. The patient rooms were chosen such that the effects of elevators/entrances/exits as well as zone barriers would be minimized. Rooms were further chosen to optimize direct comparisons of resulting data. **Table 1** illustrates the zones and rooms evaluated during the study.

During each testing event, one of the two rooms listed were chosen for the complete suite of particulate, biological, and volatile organic compound (VOC) testing. For this study, the two rooms in each zone were considered equivalent. For each specific testing event, room preference was for patient occupancy, followed by consistency within each room between measurements.

**Figure 1.** Schematic representing the CF-AHU on the control floor.

Each of the rooms underwent comprehensive evaluation for airborne and surface viable bacterial, fungal, and VOC loads. Three commonly touched patient surfaces and two commonly touched clinical surfaces were evaluated per testing assay (**Tables 2** and **3**). In addition, the final diffuser providing supply air to the patient room and the return vents were swabbed for viable bacteria and fungi (**Table 4**).

**Figure 2.** Schematic representing LSAR and MIXED zones, respectively.

chemicals from the air—to a level of effectiveness not previously commercially available. Because of its effectiveness toward *Bacillus anthracis*, the LifeAire Systems is able to remediate airborne pathogens such as *Clostridium difficile*, *Aspergillus*, *Streptococcus*, *Pseudomonas*, Staphylococcus (including methicillin-resistant variety), smallpox virus, *Mycobacterium tuberculosis*, influenza virus, etc., each representing a consistent threat to both the hospital environ-

The design of the current study includes three zones within two medical surgical floors of a SLUHN Allentown hospital campus. The three geographic zones (**Figures 1**–**3**) include a control floor with air handling unit (CF-AHU) HEPA-filtration remediation, a zone with mixed AHU-HEPA and LifeAire remediation (MIXED) with recirculated air, and a zone with comprehensive LifeAire Systems Air Remediation (LSAR). Within each of these zones, two occupied and active patient rooms were selected for air quality testing. Each of the two rooms was comprehensively evaluated per zone. The patient rooms were chosen such that the effects of elevators/entrances/exits as well as zone barriers would be minimized. Rooms were further chosen to optimize direct comparisons of resulting data. **Table 1** illustrates the zones and

During each testing event, one of the two rooms listed were chosen for the complete suite of particulate, biological, and volatile organic compound (VOC) testing. For this study, the two rooms in each zone were considered equivalent. For each specific testing event, room preference was for patient occupancy, followed by consistency within each room between measurements.

ment and rates of HAIs [unpublished data].

**3. Materials and methods**

140 Vignettes in Patient Safety - Volume 4

rooms evaluated during the study.

**Figure 1.** Schematic representing the CF-AHU on the control floor.

**Figure 3.** Schematic representation of HVAC layout of the MIXED and LSAR zones.

#### **3.1. Testing assay: viable bacteria by air**

Air testing was completed using the third-party laboratories, EMSL, and Galson Laboratories under their proprietary method MICRO-SOP-132 [30, 31]. Following the standard operating procedures (SOPs) provided by the third-party laboratories and using a Viable Andersen Cascade Impactor and calibrated pump, samples were gathered for 5 minutes at 28 liters per minute onto a soy agar plate. The five most concentrated species were then identified and quantified.

**3.3. Testing assay: viable fungi by air**

**3.4. Testing assay: viable fungi by swab**

patients, visitors, and clinical staff.

**4. Results**

**3.6. Testing assay: nonviable particulate testing**

identified and quantified.

Air testing was completed using a third-party laboratory under their proprietary method MICRO-SOP-202 [30]. Following the SOPs provided by the third-party laboratories and using a Viable Andersen Cascade Impactor and calibrated pump, samples were gathered for 5 minutes at 28 liters per minute onto a MEA agar plate. The five most concentrated species were

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

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

143

Surface testing was conducted following applicable SOPs of the third-party laboratories. Using a sterile swab, an area measuring 2-by-2 inches was sampled in each location with a smooth back-and-forth motion while rolling the swab for 10 seconds. The swab was then capped and sent to the third-party laboratory for testing under method MICRO-SOP-202 [30].

The measured VOC load of each room was determined using the methodology described in EPA TO-15 [32]. Using an evacuated container, air was captured for 15 minutes. The TO-15 assay determines VOCs in air collected using specially prepared stainless steel canisters and subsequently analyzed by gas chromatography/mass spectrometry (GC/MS). Due to the live hospital setting and available locations to place the testing cylinder, longer sampling times were considered but not employed due to the risk of sample tampering by unmonitored

Particulate testing was conducted using a modified NIOSH 0500 method [33]. Sampling was conducted for 5 minutes at each testing site. The environmental testing was completed each month with sampling beginning in the morning and progressing through early afternoon. Clinical, housekeeping, operational staff and patients were blinded to both the study and zone locations to minimize any biases associated with behaviors or perceptions. Cleaning SOPs, patient care operations, patient appointment schedules, visitation, patient dining, and all operations of the floor remained unchanged. Sampling occurred during normal visitations, staff consultations, and meals to allow data acquisition and flow to simulate full hospital operations.

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.

The five most prominent species of viable fungi were identified and quantified.

**3.5. Testing assay: volatile organic compounds (VOC) testing**

#### **3.2. Testing assay: viable bacteria by swab**

Surface testing was conducted following all SOPs of the third-party laboratories. Using a sterile swab, an area measuring 2-by-2 inch was sampled in each location with a smooth back-and-forth motion while rolling the swab for 10 seconds. The swab was then capped and sent to the third-party laboratory for testing under method MICRO-SOP-132 [30]. The most prominent five types of bacteria were identified and quantified.


**Table 1.** HVAC design by study zone.

Bedside table (directly in front of patient)

IV support pole/IV support pole

Patient remote control—number buttons

**Table 2.** Patient surface sampling sites.

IV control faceplate

Pressure cuff bulb

**Table 3.** Clinical surface sampling sites.

HVAC room diffuser

HVAC room return

**Table 4.** HVAC surface sampling sites.

#### **3.3. Testing assay: viable fungi by air**

**3.1. Testing assay: viable bacteria by air**

142 Vignettes in Patient Safety - Volume 4

**3.2. Testing assay: viable bacteria by swab**

Bedside table (directly in front of patient)

**Table 1.** HVAC design by study zone.

Patient remote control—number buttons

**Table 2.** Patient surface sampling sites.

**Table 3.** Clinical surface sampling sites.

**Table 4.** HVAC surface sampling sites.

IV support pole/IV support pole

IV control faceplate Pressure cuff bulb

HVAC room diffuser HVAC room return

**Zone HVAC design**

CF-AHU AHU-HEPA remediation

LSAR LifeAire systems air remediation

prominent five types of bacteria were identified and quantified.

MIXED AHU-HEPA and LifeAire systems remediation

Air testing was completed using the third-party laboratories, EMSL, and Galson Laboratories under their proprietary method MICRO-SOP-132 [30, 31]. Following the standard operating procedures (SOPs) provided by the third-party laboratories and using a Viable Andersen Cascade Impactor and calibrated pump, samples were gathered for 5 minutes at 28 liters per minute onto

Surface testing was conducted following all SOPs of the third-party laboratories. Using a sterile swab, an area measuring 2-by-2 inch was sampled in each location with a smooth back-and-forth motion while rolling the swab for 10 seconds. The swab was then capped and sent to the third-party laboratory for testing under method MICRO-SOP-132 [30]. The most

a soy agar plate. The five most concentrated species were then identified and quantified.

Air testing was completed using a third-party laboratory under their proprietary method MICRO-SOP-202 [30]. Following the SOPs provided by the third-party laboratories and using a Viable Andersen Cascade Impactor and calibrated pump, samples were gathered for 5 minutes at 28 liters per minute onto a MEA agar plate. The five most concentrated species were identified and quantified.

#### **3.4. Testing assay: viable fungi by swab**

Surface testing was conducted following applicable SOPs of the third-party laboratories. Using a sterile swab, an area measuring 2-by-2 inches was sampled in each location with a smooth back-and-forth motion while rolling the swab for 10 seconds. The swab was then capped and sent to the third-party laboratory for testing under method MICRO-SOP-202 [30]. The five most prominent species of viable fungi were identified and quantified.

#### **3.5. Testing assay: volatile organic compounds (VOC) testing**

The measured VOC load of each room was determined using the methodology described in EPA TO-15 [32]. Using an evacuated container, air was captured for 15 minutes. The TO-15 assay determines VOCs in air collected using specially prepared stainless steel canisters and subsequently analyzed by gas chromatography/mass spectrometry (GC/MS). Due to the live hospital setting and available locations to place the testing cylinder, longer sampling times were considered but not employed due to the risk of sample tampering by unmonitored patients, visitors, and clinical staff.

#### **3.6. Testing assay: nonviable particulate testing**

Particulate testing was conducted using a modified NIOSH 0500 method [33]. Sampling was conducted for 5 minutes at each testing site. The environmental testing was completed each month with sampling beginning in the morning and progressing through early afternoon. Clinical, housekeeping, operational staff and patients were blinded to both the study and zone locations to minimize any biases associated with behaviors or perceptions. Cleaning SOPs, patient care operations, patient appointment schedules, visitation, patient dining, and all operations of the floor remained unchanged. Sampling occurred during normal visitations, staff consultations, and meals to allow data acquisition and flow to simulate full hospital operations.
