The Importance of Airflow and Ventilation in Aged Care

As I sit writing this post the wind is blustering against my office windows. It's great for getting the washing dry, but not so good for those of us who suffer from hayfever! However, I did take the precaution of taking an antihistamine first thing this morning in an attempt to ward off the sneezing attack that generally accompanies this situation.

And while the windy conditions might wreak havoc on my sinuses, I can also recognise the blessing that this breezy weather brings to us here in the southern hemisphere where many of us are experiencing our first really massive COVID outbreak.

Yes, I know that those living in some of the southern states have not been exempt from outbreaks over the past couple of years, but for us up here in the north, this really is our first proper encounter. It has come at a time when, thankfully, we have high vaccination rates and beautiful summer weather that encourages us to spend more time in the great outdoors and with our doors and windows wide open.

Why is this beneficial?

Because good airflow and ventilation is one of the key ways that contributes to decreasing the spread of the virus. But what is ‘good’ ventilation and how can you support this in an aged care setting?

We know that the COVID virus spreads via aerosol transmission (fine droplets suspended in the air). This means if the virus is present e.g. someone is infectious, then the risk of the virus spreading is higher in crowded, poorly ventilated indoor enclosed spaces compared to outdoor areas.

Fine aerosols tend to settle slowly and the droplets can remain suspended in the air for hours. They are able to be picked up in air currents and move around an area, infecting people who come in contact with the infected droplets.

So what is ventilation and how does it help to minimise the risk of infection? 

The first is natural ventilation which is often passive – air entering through open doors and windows or air vents; what we refer to as ‘fresh air.'

Then there are heating, ventilation and air conditioning (HVAC) systems which generally dilute contaminated indoor air through the introduction of fresh air from the outside as well as maintaining indoor air quality and thermal comfort.

Of course, both natural and HVAC systems can spread the infection. After all, they move air around. However, there are ways to minimise the risk.

If you are outside in the outdoors, the breezes are likely to dissipate the viral droplets faster and therefore decrease the viral load in a specific location, making it less likely that someone will come in contact with enough of the virus to infect them.

If you are indoors, the HVAC system can be supported by the installation of an air cleaner, a portable air circulation unit that draws air through a series of filters to remove aerosolised particles, including viral particles, and releasing purified air. Using a well-designed, positioned and maintained HVAC system can prevent aerosol transmission by:

• supplying clean air to areas where susceptible occupants are located
• containing contaminated air and/or exhausting it to the outdoor environment
• diluting the air in a space with cleaner air from outdoors and/or by filtering the air (Department of Health COVID-19 HVAC Systems in Healthcare Settings Policy | June 2021)

What are some of the practical ways that you can apply this knowledge?

Residential Care Setting

Standard Five of the aged care quality standards focuses on ensuring organisations provide an appropriate and safe service environment. For residential care services, this means you need to consider ways to support a safe living environment within the context of living with COVID and other infectious diseases that are circulating in the environment.

Here are some suggested responses:

• Set up buffer zones (e.g. a neutral area situated between cohorts of infected and non-infected residents) so that air is not circulated through the building and moving contaminated air from one area to another.
• Be aware of aerosol generating behaviours such as yelling, singing and coughing that can spread viral particles wider than the normal 1.5m range and can stay in the atmosphere longer. Continue to wear a mask whenever possible.
• Nebulisers can contribute to the spread of COVID if the person is infectious, instead change to puffers with spacers if possible. (Nebulisation and COVID-19 Australian Commission on Safety and Quality)
• Ensure air conditioning units are serviced and cleaned regularly and use these over open windows and doors to support consistent airflow.
• Fans can be used in single occupancy rooms regardless of the resident’s infection status (doors should be closed). Where the resident has a suspected or confirmed respiratory illness however, fans should be turned off when staff enter the room. (COVID-19 air and wind moving devices FAQ 2021)
• Use air cleaning units with a HEPA filter in areas where there is likely to be more people and / or the air circulation is lower.
• Consider the use of portable air cleaners / air scrubbers with HEPA filters in rooms that are under-ventilated and are used by residents who have or are suspected of having COVID.
• Run exhaust fans in bathrooms and toilets continuously to remove aerosolised viral particles from steamy showers and flushing of toilets.
• Take care not to overcrowd rooms especially where there is a lack of ventilation, instead space out residents so that air conditioners and air purifiers can do their job better.
• Resident’s should occupy a single room with the door always closed and the window open (where possible) if negative pressure is required to support airbourne precautions. (IPC Practice Handbook January 2020)

While you are looking at implementing many of these short-term responses, you should also take the time to review the overall physical facility; the way it is laid out, how people move around the area and interact with one another, access points to gardens and outdoor spaces.

Managers and Boards should consider long term plans to improve the facility. While you may not be able to do anything immediately, every facility should have written plans in place to continually improve or maintain facilities to an acceptable and safe standard for residents, that way you are well placed to respond quickly when grant funding rounds and other opportunities arise.

Home Care Setting

There can be additional challenges for staff working in a community care setting as they are supporting people who live in their own homes and there are a number of variables they cannot change. However, there are still things that you can do to minimise the risk of infection and improve ventilation.

• Where appropriate, ask clients to sit outside on verandahs or patios while you are working in the home.
• Open doors and windows if this improves airflow inside the home.
• Alternatively, ask the client to turn on air conditioners before you arrive and to continue to run for at least an hour after you leave, explaining to them how this will help minimise the risk of infection through aerosolised viral particles.
• Turn on ceiling fans where present to improve airflow in individual rooms, however be aware that fans can increase the risk of transmission when working with clients who are COVID positive and take additional precautions to protect yourself, including wearing a face shield as well as a mask.

Air purifiers

While not a perfect solution, in the right circumstances, a good air purifier can remove most viral particles from the air in a room. However, an air purifier can only filter the air in the room where it is situated. This means air in other parts of the home will remain untreated.

Additionally, viral-laden droplets (or other contaminants such as pet dander, dust, pollen or cigarette ash) that settle onto surfaces won't end up going through the air purifier.

HEPA (high efficiency particulate air) filters claim to capture particles down to 0.3 microns. While the COVID virus is around 0.1 micron, in practice HEPA filters have been found to be good at trapping the virus, although they don’t kill the virus so handle used filters with care, wearing PPE if changing filters.

• If your client has an air purifier with a HEPA filter, ask them to turn this on prior to your visit and to continue to run after you have left.
• Monitor the HEPA filter or other filters in air purifiers and remind clients if it appears these need cleaning or replacing to ensure effectiveness.
• Air purifiers are considered a health product and may be considered as an acceptable use of Home Care Package funds for those clients who wish to purchase one through their package where they have sufficient funds and it is an assessed need.

And don’t forget to continue to use PPE, including face masks and shields, that will protect both yourself and others from aerosolised droplets and follow the usual precautions to protect yourself and the residents or clients you care for.

Now, after all that, I'm reminded to go and clean the filters on my office air conditioner!

If you can think of someone else who might benefit from this article, send them a link. We’d appreciate it! And if you’re looking for more helpful resources, why not check out our Total Quality Package resource hub? We have culturally appropriate, tailored resources that are designed to make your job simpler and help you provide quality care to your clients. Click here to find out more.